“Medicare Basics: 11 Things You Need to Know”

Suzanne FiscelIa, PA-C, BCPA / November 10, 2020

medicare confusion and costs

I found this wonderful article in “Medicare Basics: 11 Things You Need to Know”
by: Catherine Siskos
September 16, 2020

Medicare Mistakes to Avoid Making

Here’s the recap…

Catherine Siskos does an excellent job of covering all the information you need to know to protect your loved one’s health and your inheritance.
Remember, the average family spends $5000 a year on extra medical bills. So Medicare does not pay for everything.
If you are a caregiver who has your loved one going to doctor after doctor and it is never-ending, consider questioning every treatment plan. We get into more of this in the Patient Best® Medical History Book.

One extra important point…

I would add that you really should get a professional INDEPENDENT agent to go over this with you and your loved one. Some agents want to push the plan which gives them the biggest commission. Some agents sit in front of a grocery store and say they are professionals. Maybe they are, but I prefer a professional independent agent who will give you all the facts after knowing the true health of your loved one. Someone who does this year-round and not during the Medicare Enrollment season.
You can do all this over the phone. Just find at least 3 agents and call them.
Then pick the one you trust and have them take care of you and your loved one year after year.

In the meantime, here is an overview of Ms. Siskos’ article.

  1. The standard premium in 2020 is $144.60 per month and is projected to rise to $148.50 in 2021
  2. Plan F is the most popular policy because of its comprehensive coverage, but as of 2020, Plan F (along with Plan C) is unavailable for new enrollees. (If you are new, then look at Plan G.)
  3. Your choice of providers may be more limited with Medicare Advantage than with traditional Medicare, and recent research has found that sicker enrollees often dump Medicare Advantage in favor of original Medicare. (This is cheaper but if you live in another state during winter months, beware. This is like an HMO and limits your doctors to your network within your one state. Your out-of-network fees are outrageous. And yes, we do see many of you in our clinics every winter.)
  4. If you choose traditional Medicare and your income is above a certain threshold, you’ll pay more for Parts B and D. (hasn’t been announced yet). (How can we buy something if we don’t know a price?)
  5. If you are already taking Social Security benefits, you will be automatically enrolled in Parts A and B. For those who have not started Social Security, you will have to sign yourself up for Parts A and B. If you are still working and have health insurance through your employer (or if you’re covered by your working spouse’s employer coverage), you may be able to delay signing up for Medicare. (You need to read more in the article. Remember, it’s #5.)
  6. Open enrollment runs from Oct. 15 to Dec. 7 every year during which you can change Part D plans or Medicare Advantage plans for the following year, or switch between Medicare Advantage and original Medicare.
  7. For 2021, the coverage gap begins when the total amount your plan has paid for your drugs reaches $4,130 (up from $4,020 in 2020). At that point, you’re in the doughnut hole, where you’ll now receive a 75% discount on both brand-name and generic drugs. Prescription drug manufacturers pick up 70% of that tab and insurers 5%. You pay the remaining 25%. Catastrophic coverage, with the government picking up most costs, begins when a patient’s out-of-pocket costs reach $6,550, the maximum spending limit for beneficiaries in 2021, which is $200 higher than 2020’s cap.
  8. Medicare beneficiaries can receive a number of free preventive services. You get an annual free “wellness” visit to develop or update a personalized prevention plan. Beneficiaries also get a free cardiovascular screening every five years, annual mammograms, annual flu shots, and screenings for cervical, prostate, and colorectal cancers. (Note: no shingles shots – grrr)
  9. When the coronavirus pandemic hit, telehealth was expanded so that patients could use smartphones in their own homes to consult with a broader range of medical professionals, a feature that is expected to become permanent. But Medicare offers no discounts for telehealth, and in most cases, beneficiaries pay the same cost for virtual visits as those in an office—20% of the bill with the Medicare Part B deductible applying. (Caregivers really need to look into this service for their loved ones. As a physician assistant who has done telemedicine, it is SO easy!) Get my guide at: Telemedicine: Simple Tricks
  10. While Medicare covers your health care, it generally does not cover long-term care—an important distinction. Under certain conditions, particularly after a hospitalization to treat an acute-care episode, Medicare will pay for a medically necessary skilled nursing facility or home health care. But Medicare generally does not cover costs for “custodial care”—that is, care that helps you with activities of daily living, such as dressing and bathing. (Caregivers are so out-of-luck. It is so distressing that home care is not included as it leads to better health for the senior and caregiver and ultimately, less medical costs.)
  11. If you disagree with a coverage or payment decision made by Medicare or a Medicare health plan, you can file an appeal. The appeals process has five levels, and you can generally go up a level if your appeal is denied at a previous level. (Since 90% of all bills are wrong, it is beyond me why caregivers do not take over these bills and use a Medicare billing advocate to get these bills down.)

There are so many things that can go wrong with your loved one’s health insurance. Go ahead and get a professional person who understands how Medicare works and will always have your best interest in mind. Ask your friends and relatives who they go to when they need advice on Medicare.

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Suzanne FiscelIa, PA-C, BCPA

I know exactly what it's like to feel like you just can't keep up. Working a full-time job, raising 3 children as a single mom, and taking care of her aging mother. But after feeling lost, overwhelmed, and guilty for spreading herself too thin, I saw all her patients and their caregivers going through the same thing. I learned how to put simple systems in place to keep my life free from distractions, find free time to do the things I wanted, and enjoy my family along the way. These simple step-by-step solutions have been shared with my patients, friends, and family. They too have found organization, confidence, peace, and freedom. Now we all live the life we love while caregiving! Come join us!

Hi I'm Suzanne

And my mission is to find you practical easy-to-follow solutions for everyday caregiving. Find out more HERE.

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