MYM Podcast 38: 2016 Edition Released

The 2016 Edition of Maximize Your Medicare is available NOW. Is a new edition really necessary? Yep.

Subscribe to the Maximize Your Medicare Podcast click HERE.

MYM Podcast 29: Radio Interview, Annual Election Period Edition

Radio Interview, Annual Election Period
I have been doing a lot of radio interviews recently, New York, Los Angeles, Pittsburgh, et al. Art Lewis and I have spent over 6, 1-hour sessions together. Our latest was this past Saturday, and we discussed the Annual Election Period.

Listen to the podcast here.

Subscribe to the Maximize Your Medicare Podcast here: Click here to Subscribe

MYM Podcast 26: How to Get Started on Medicare

FREE Android App Available Now
If you don't know where to start, or are too embarrassed to ask, or want to help someone in your life, then start with this free Android app.

Simple as You Like....
You enter your date of birth, and answer some questions about your existing coverage (employee, retiree, married, etc). No personal information stored. Ever.

You get your personalized calendar and your questions answered (even if you didn't know what to ask)...
Your Medicare Open Enrollment Dates
Is it Annual Election Period?
Can I make changes now?
Personalized Report, based on your answers to simple questions

Who Can Use This? 
The obvious: those that are turning 65, those that don't know when Medicare begins, those that don't know when to enroll, those that don't know what their rights/options are, those that are married with full-time working spouses, those....get it? Pretty much anyone, anytime.
The not-so-obvious: those with senior parents who don't know how Medicare works, caregivers that need to have background information about Medicare for their patients/clients, those that have employer coverage changed or cancelled, those that pay many hundreds of dollars a month to continue with employer-based retiree plans, those...get it?

Why?
a. Many people aren't asking, when they should be....
b. Many people think they are "stuck," when they aren't....
c. Many people want to help their senior parent, but their senior parents can't / won't talk about getting older....
d. Many people think they cannot "afford it," when there are many options available...
e. Many people don't want to feel "dumb"...Medicare is confusing to almost everyone.
The app is free and you can use it as many times as you want, so that you are on the right path, so that you have an idea about what to consider, so that you can avoid unintended consequences resulting from uninformed choices.

Get it here:
A. Scan this QR code into your Android app (Google Play app):

B. Click here.

MYM Podcast 23: Just the FAQs

"I Don't Know Where to Start"
If you are turning 65 years old,

If you have a Medicare-eligible parent that you want to help,

If you face healthcare costs you don't understand under Medicare,

If you need information that you can use, in language that you can understand,

"I'm All Set": Probably Wrong

a. Employers change (or eliminate) retiree benefits
b. Medicare Advantage and Medicare Part D (Rx) change every year
c. PPACA means that pre-Medicare family members can get private insurance
This is just for starters...

Monday, June 16, 5PM EDT

I have conducted this program everywhere (libraries, senior centers, conferences, senior programming at colleges), with all types of audiences.

You can see a short list on other pages of this blog.

I will leave my phone number on during the broadcast, and you can bring me your questions. 

$2.99 PPV Webcast
Just click here to register.

I need to charge because the host charges me, and I want to keep the spammers out.

Listen to me speak about the webcast:

Subscribe to the Maximize Your Medicare Podcast here: Click here to Subscribe

MYM Podcast 18: Radio Interview WNPV with George Toth, CFP

Radio Interview, April 21, 2014
Every financial planner has his/her own perspectives. You can listen to my comments on Medicare here. The focus is on correct enrollment, and the penalties that can occur.

You can listen to this episode here.
You can subscribe to this podcast here.

MYM Podcast 4: Observation Status Correctly Explained

Outpatient Hospital Rules Have Changed

For some unknown reason, newspapers and local TV stations continue to report that this is a problem. Don't get me wrong, it remains to be the source of confusion. HOWEVER, the story should be that the rules have improved substantially, and that if you stay over two midnights, then you will be presumed to have "inpatient" status, thus avoiding much of the controversy. Click here to listen.

Medicare ABCs Webinar/Q&A Dec 2 7PM EST

Monday, December 2, 2013: 7PM EST

Register by clicking here.

If you don't have the time, you will be sent the recording anyways (I will send it out to all those that purchase the session). The drawback: you won't be able to send in your questions. I will also be answering questions via Skype during that time.

You May Already Understand Medicare, but....

I promise that someone you know very well doesn't, like a spouse (!), friend, relative, neighbor. This is not the typical social/financial issue. When your neighbor doesn't understand Medicare, doesn't protect him/herself, then YOU will be a payer at some point in time. One reason that healthcare costs challenge the nation: the financial risk to the system is made much worse when people cannot pay their medical bills. This is, in many cases, avoidable. Medicare is the single best value for the money for those that are eligible: the pricing of Obamacare-compliant plans is revealing that very fact. The point? 

Libraries, Colleges, Talk Radio, and More

Maximize Your Medicare is part of library systems throughout the country, but the fact is that some people won't read a book (sigh). To some degree, I can understand that a verbal explanation is superior. Then, the problem is that it is very difficult to know who to trust, and to know whether that person is motivated for other reasons, or to know if that person is qualified. 

Simple session, you can make your own determination about the information that I will provide, and the information that you can use. One more thing: I won't be recommending any particular carrier or plan. 

You can click here to see the many places that I have been, and will be, in the coming days and months. There are also links to comments that I have made on talk radio as well. 

Can't Be Free (Sorry)

There is however, a money-back guarantee. I am pretty certain that you will receive your $2.99's worth. The reason for the upfront fee: keep out spammers who will do nothing that send out peculiar messages, pictures, and slow down the connection. No one said anything about multiple viewers in the same room, however....

Happy Holidays to Everyone!

Observation Status Change: Imperfect, But Much Better

Fewer Chances for Error
It used to be that a patient would need to be specifically determined to have "inpatient" status in order to be covered by Medicare Part A. Observation stays are NOT covered. It is conceivable to have stayed in the hospital for a long period of time, and not be considered to be an "inpatient" stay. Thereafter, that same patient could have been admitted to a Skilled Nursing Care Facility, in which case the cost of that stay would also be uncovered under Medicare Part A. Long-term care insurance would also not be effective in this case, because claims are only good, after Medicare has paid. Since Medicare has not paid, then LTCi would also not pay to beneficiaries.

CMS Rule Change Begins October 1
If you stay at the hospital over 2 midnights, then you will be considered to be inpatient status. This will reduce the number of cases when there are extended stays in the hospital under observation status, followed by Skilled Nursing Facility stays, all uncovered by Medicare Part A.

Perfect? No.
There are still situations in which a patient could be uncovered by Medicare Part A. 2-day inpatient stays (as well as 1-day) are not covered by Medicare Part A. Observation stays for 1 day are not covered under Medicare Part A. Audits for stays longer than 2 days will no longer need to be audited, and subjected to change to observation status, since the presumption will be that it is an inpatient stay. That will greatly reduce the amount of unexpected charges resulting for observation stays.
.

Medicare ABCs LIVE Webinar

Monday, August 29th, 11:00AM (EST)
Some people would rather have a verbal explanation, because a book may create followup questions. Some people don't know where to begin to ask. I wrote Maximize Your Medicare to address this, and the audience is enormous: more than 9,000 will turn 65 everyday in the United States. This will continue for most of the next 2 decades.
You Can Ask Me Questions LIVE
I will go through Medicare and explain its components. I will explain how it differs from health insurance that many have been used to. I have done so at libraries, senior centers, and on talk radio shows. I have heard and seen the level of uncertainty on people's faces and in their voices. Adult-age children need to have this information: you get pulled into the situation, and usually (unfortunately), under unfavorable circumstances. Caregivers face questions continuously regarding what Medicare covers, and what it does not.
Money Back Guaranteed
At $3.99, it is inconceivable (to me, I am biased) that you will not get your money back. There will be information that is not widely known, until it may be too late. Frequently, this could have been avoided. In any case, if you join the Webinar, and find that it isn't worth the $3.99, then I will refund your money. Guaranteed.

$3.99 Medicare ABCs Live Video Webinar

 

 

More information can be found here.

Don't Qualify for Medicare Part A?

What Happens if You Don't Qualify For Part A
Some people have not worked, for some reason or another, for the required number of qualifying quarters that would make Medicare Part A free.  For those people, there are still some solutions.
First, you can pay by yourself.  Depending upon the number of quarters that you have worked, you can qualify by paying a monthly premium.  If you have worked for 30-39 quarters, that monthly premium is $243.  If you have worked for less than 30 quarters, then the amount $441.
Second, if you have very limited financial resources, then you may qualify for governmental assistance.  For example Qualified Medical Beneficiaries is one of multiple tiers of governmental assistance available via Medicaid.  If you are a QMB, then you may receive assistance in paying for this premium.

Observation Status Rule Change? Hopefully.

Quick Review of Observation Status
In order to be eligible for benefits under Medicare Part A, a patient must be admitted under inpatient status.  Observation Status, however, is different, and services that a patient receives under Observation Status are covered under Medicare Part B.  This is a real problem for Medicare beneficiaries: a blog post about this topic can be found here.

Observation Status and Medicare Part A

Medicare Part A Includes Hospitalization
If you are admitted inpatient into a hospital, then you are covered by Medicare Part A.  In 2013, this is subject to a $1184 deductible per benefit period.  In other words, you need to pay the first $1184, before receiving any Medicare benefits under Medicare Part A.   There's more, however.

Observation Status Doesn't Count
If you admitted to the hospital under "Observation" status, then this does NOT qualify for Medicare Part A benefits.  You will be charged the entire amount.  In addition, your Medicare Advantage and your Medigap policy will NOT cover you.  That is because Medicare must be the primary payer before you receive benefits under either of these.

You Need to Check
It is understandable that this is the furthest thing from your mind.  Nevertheless, you (or the person that is caring for you) need to be careful, or else you may be in for an unwelcome surprise.  

Unfortunately, It Gets Worse
There are two additional points to know.
First, your status can be changed after the fact.  The reason for this is that there is someone at the Medicare system reviewing your file before paying benefits.  You may have been originally under inpatient status, but then have your status changed to Observation status.
Second, the Affordable Care Act encourages hospitals to admit patients under Observation status.  The reason is, in an attempt to curb excessive hospitalization, that hospitals are fined if there are an excessive number of patients who are readmitted to the hospital for the same reason within 30 days.  However, those admitted under Observation Status do not count towards this number.  It is logical, then, that hospitals would want to admit someone under Observation Status, rather than inpatient, because that reduces the chance of paying this penalty to the federal government.

Maximize Your Medicare
Maximize Your Medicare is written to point out these subtle points.  Many people do not know these points, and don't become aware of them, until it is too late.  The objective of the book is to provide the information before the fact.  You are then in greater control of the risks that you are accepting.  We cannot predict the future, but you can consider your own situation and your own priorities, so that you can choose for yourself.

This Happens: Medicare Advantage Cost Sharing Worse Than Original Medicare

Medicare Advantage Plans Are Approved by the CMS

Every year, Medicare Advantage plans of all types are approved by the Center for Medicare and Medicaid Services (CMS).  Every plan must be at least as good as original Medicare, i.e. those plans which include prescription drug benefits needs to be at least as good as Medicare Part A, Part B and Part D.  

"At Least As Good" Means....

Here is the issue.  When the CMS approves plans, these plans must be at least as good as original Medicare, which is defined as the actuarial equivalent.  What does that mean?  It means that statistics are used to determine that the Medicare Advantage plan is at least as good as original Medicare, on average.  That does NOT mean that your Medicare Advantage plan is better than original Medicare for each particular benefit.  You can (rightfully) ask:  What in the world does THIS mean?

Example: Skilled Nursing Facility Care

I am not going to point out insurance companies; it is not the point of the blog, or the book Maximize Your Medicare, to point out specific companies or specific policies.  However, here is a real-world example.

Original Part A Skilled Nursing Facility Care:

0-20 days:  $0.  Medicare pays.

20-100 days:  You pay the first $148 per day in 2013, Medicare pays the remainder.

100+ days:  You pay 100%

Medicare Advantage Example:

0-20 days:  $50/day copay.

20-100 days:  $150/day copay.

This Happens

If you stay at a skilled nursing care facility for 100 days, it is entirely possible that you will pay $1160 more than under original Medicare.  

Get Maximize Your Medicare, Get Informed

These small details seem insignificant, right?  Tell that to the subscribers of this plan in 2013, who are admitted to a Skilled Nursing Facility. I cannot fix this, and neither can you, other than to become informed every year, to check every year, to protect yourself to the best of your ability.  

You want $9.99 of value?  There it is, free, and there are many, many more examples of this in Maximize Your Medicare.

Medicare 2013 Premiums Announced

Medicare 2013 Cost Sharing
The Center for Medicare and Medicaid Services (CMS) has released the cost sharing details for 2013.   The tables in this blog will be updated in very short run.  Here are the highlights.

Part A Deductible: The deductible will increase from $1156 to $1184.  This is the amount per benefit period.  A very important explanation and illustration of what this entails is included in the book, Maximize Your Medicare.

Part A Hospital Stay:  The copay for days 61-100 have increased to $296/day.
Part A Hospital Stay:  The copay for days 101-150 have increased to $592/day.
Part A Hospital Stay:  The copay for days 151+ remains at 100%.  Medicare pays $0.

Part A Skilled Nursing Facility:  The copay for days 20-100 have increased to $148/day.

Part B Premium:  The base rate will increase from $99.90 to $104.90.
Part B Annual Deductible: The annual deductible will increase from $140 to $147.

Note:  Your rate may be higher than this if you make over $85,000 per year.

The table of premiums, copays, and coinsurance can be found here.