It may be one of the
biggest misconceptions people have about Medicare — thinking that when
they’re eligible, they can enroll and then they’re set for life.
Nothing could be further
from the truth. “Set it and forget it “is what most beneficiaries do, and this
can lead to costly mistakes.
To maximize your Medicare
coverage in 2021, consider the following:
•Take advantage of
preventive care benefits. Preventive care utilization remains low among
Medicare beneficiaries despite an ever growing list of free preventive services
that Medicare will cover. Medicare beneficiaries can receive screening for
colon cancer and breast cancer – among other free tests – without paying any
coinsurance or deductibles.
If you’ve had Medicare
Part B for longer than 12 months, you should take advantage of the Annual
Wellness Visit (AWV). The AWV will help you stay up-to-date on your current
health and risk factors. Services covered in the AWV include: routine
measurements, review of medical and family history, and recommendations for
necessary preventative and treatment services.
These benefits are
especially important for those with chronic health issues like diabetes or
cardiovascular conditions. The AWV can now be conducted via telehealth.
•Pay attention to your
Medicare Advantage plan’s rules. In 2020, approximately 99 percent of all
Medicare Advantage enrollees were in plans that require prior authorization for
some or most services. Prior authorization simply means the plan requires prior
approval of certain services or tests. The plan will either approve or deny a
physician’s order and they can also add limits, such as specifying a number of
visits. It is your responsibility to know the plan’s requirements and to ensure
services are preauthorized before seeking treatment. Without preauthorization,
you will likely be responsible for the entire bill.
•Use preferred pharmacies
whenever possible. Medicare Part D plans offer you the choice between using
preferred and standard retail pharmacies. It is to your benefit to fill your
prescriptions at a preferred pharmacy, where cost-sharing can be dramatic. You
should also use your plan’s mail order pharmacy option, where you can receive a
90-day supply of medication at a lower cost than if you filled the same supply
at a retail pharmacy. Ask your doctor if there is a generic alternative to any
brand name drugs your taking.
•Check if you qualify for
any state or federal programs that can help pay your Medicare premiums and
expenses. There’s no shortage of Medicare beneficiaries who can’t afford their
drug and medical costs. The Medicare Savings Program and Extra Help Program can
substantially lower your out-of-pocket costs if you qualify. These programs are
often underutilized because they are not well publicized. Contact Social
Security for further information about the Extra Help Program. Your county
assistance office can provide additional information on Medicare Savings
Programs.
•Always appeal coverage
denials. As a Medicare beneficiary, you have the ability, and the right, to
appeal any Medicare coverage or payment decision. And, the odds are you’ll win.
A recent Department of Health and Human Services Inspector General’s report found
that Medicare Advantage plans deny claims at an alarmingly high rate. It’s easy
to see why. Advantage plans hope you won’t appeal because it’s more money in
their pocket. Appeals are always more successful when you enlist the help of
your physician. Persistence pays off.
•Enrolled in employer
insurance? Pay attention to how it works with Medicare.
This is especially
important if you’re still receiving coverage from your employer. Medicare can
be either primary or secondary to your employer insurance, but this depends
whether you are actively working, the size of the employer, among other
factors. If Medicare is the primary payer, it pays pay first. Your employer
coverage pays secondary for costs not covered by Medicare.
•Take action during the
Medicare Advantage Open Enrollment Period, Jan. 1 – March 31. For Medicare
Advantage enrollees who may have missed or not paid close attention to the
Medicare Open Enrollment Period, you have another chance to join, switch, or
drop your Medicare Advantage plan. Start by making some plan comparisons on the
Medicare Plan Finder and contact the plan directly if interested. Coverage will
start the first day of the month after you enroll.
•Guard your Medicare
card. Remember to treat your Medicare card number as if it were a credit card.
Only give it out your number to trusted professionals like your doctor or
pharmacist. Under no circumstances should you disclose private information to
“officials” over the phone.
•Take advantage of your
state’s Medicare counseling program. All 50 states offer free personalized
Medicare assistance and counseling. Your State Health Assistance Program
(SHIP), can help answer questions about coverage, appeals, enrollments, and
other Medicare complexities.
Further, SHIP counselors
can help you apply for financial assistance programs.
For more information, and
details about the SHIP program, visit: https://www.shiptacenter.org.
Joel Mekler is a
certified senior adviser. Send him your Medicare questions at mekbab2000@verizon.net.
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