Questions to ask your doctor.

My thoughts on some of the six excellent questions Elizabeth Rosenthal, author of “An American Sickness,” suggests you should ask at every doctor’s appointment to make sure your medical bills are what you expect.

Question #1. How much will this cost?  Your provider’s office staff will know the fee a procedure, or series of procedures are billed at. And they will be able to tell you if your health plan has negotiated a different fee schedule including your flat copay or co-insurance percentage. To be forewarned is forearmed.

Question #4: Are there cheaper alternatives that are equally good, or nearly so? One example I see is a medication that is a combination of two, or more, off-patent generics. Check your health plan’s drug formulary and compare the co-pays. If the new combination pill is high priced ask your prescribing doctor why the one pill is recommended over taking two; sometimes the only benefit is convenience.

Question #5. Where will this procedure take place and how does that selection affect my cost?  Your health plan may have a preferred pricing arrangement (called “in network”, “participating” or “contracted”) with other facilities. Ask your doctor about performing the procedure at one of those.

One more suggestion. Contact your health plan agent or member services representative when planning an appointment with a new provider or facility.  Your plan may have preferred providers, usage limitations and pre authorization requirements. 

http://www.pbs.org/newshour/making-sense/column-6-questions-to-ask-at-every-doctors-appointment/?utm_source=facebook&utm_medium=pbsofficial&utm_campaign=newshour

3 Questions and Answers About 2017 Medicare Part A

Medicare-Card

When you’re first eligible for Medicare, usually when you turn 65, you have an Initial Enrollment Period to sign up for Part A.   You usually don’t pay a monthly premium for Medicare Part A (Hospital Coverage) if you or your spouse paid Medicare taxes for 40 quarters, or ten years, while working. This is sometimes called “premium-free Part A.” Most people get premium-free Part A.

In general Medicare Part A covers

  • Hospital care
  • Skilled Nursing Facility Care
  • Hospice
  • Home Health Services
  • Nursing Home Care (as long as custodial long-term-care isn’t the only care.)

If you are admitted as an inpatient in a hospital or Skilled Nursing Facility Medicare Part A pays for your stay after a $1,316 deductible that must be met for each hospital benefit period.

Q1: So what’s a hospital benefit period?  

A: This period begins the day you’re admitted as an inpatient in a hospital or Skilled Nursing Facility (SNF) and ends when you haven’t received any inpatient hospital care (or skilled care in a SNF) for 60 consecutive days. For example, you were admitted and released from a hospital on days 1 and 4.  After 60 consecutive days of NOT being in the hospital, that would be day 64, the benefit period ended.  If you were admitted to the hospital of SNF on day 65 a new benefit period would start and, yes, a new $1,316 deductible would apply.

Q2: After the $1,316 deductible, is there a daily copay?

A: The $1,316 deductible covers the first 60 days of hospital confinement cost or 20 days of skilled nursing facility eligible expenses.  After these periods, in patient hospital and skilled nursing facility co-pays apply to hospital stay days 61-150 and skilled nursing facility stay days 21-100. (See below)

2017-A-Chart

Q3: Is there a health plan to help cover those hospital and skilled nursing deductible and daily co-pays?

A:  Yes. A Medicare Supplemental Insurance plan, often known as “MediGap,” can help with the Medicare Part A deductible and daily co-pay expenses.  As a reminder, Medigap policies generally don’t cover long-term care, vision vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

 In New York State, the Department of Financial Services posts the current monthly premiums for Medicare Supplement plans by zip code. Click here or call me at 518-346-2115 for assistance.

Switching Medicare Supplement (Medigap) policies

Reasons Why New Yorkers Switch Their Medigap Policies:

As a reminder, Medicare Supplement, also known as Medigap, are policies designed primarily to supplement (or fill the gap) Medicare benefits. You simply present your red, white and blue Medicare card to the provider or facility along with the Supplement / Medigap card to help with out-of-pocket costs; such as deductible and co-insurance amounts with Original Medicare Part A  and Part B.

Currently, there are 10 standardized Medigap plans, each represented by a letter (A, B, C, D, F, G, K, L, M, N; there’s also a high-deductible version of Plan F). These plans are available in most states.  While premiums will vary from state to state the standardized benefits of each lettered plan remain the same despite the insurance company or location. For example, Plan F benefits are the same in Florida as they are in New York.

Q: Is there an Annual / Open Enrollment Period?

Most people buy their Medicare Supplement / Medigap policy during the six month period after they first enroll in Medicare.   After that, in many states,  Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy.

Q: So How Do New York State Residents Have More Protection?

New York State laws and regulations continue this open enrollment period. A person enrolled in Medicare Parts A and B may purchase a Medigap policy at any time. Insurers may not consider an applicant’s health status, claims experience, or age.  Laws in New York also prohibit insurers from basing Medigap premiums on age and charging a higher premium as they grow older.  Also,

Q: But What About Pre-Existing Conditions; Are They Covered?

Medigap insurers may impose up to a six-month waiting period to be covered for any preexisting conditions a person may have. Federal law and New York State regulation define a preexisting condition as any condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.

Under New York State regulation, the waiting period may be either reduced or waived entirely, depending upon whether an individual has had previous health insurance coverage. Medigap insurers are required to reduce the preexisting condition waiting period by the number of days an individual was covered under some form of “creditable” coverage so long as there were no breaks in coverage of more than 63 calendar days.   Translation: If you are switching from a “creditable” plan that you have held consecutively for six months, New York regulation requires the new Medicare Supplement / Medigap plan to reduce or waive the six month pre-existing condition waiting period.

Questions about Switching a MediGap Policy?

Please call me at (518) 346-2115 or send a quick note with your contact information and question.

Please visit and follow via Facebook Page. Daniel G. Alcorn, a licensed and independent agent, represents licensed insurance companies in New York and other states.  Dan may receive compensation for individual enrollments in Medicare Advantage, Medicare Supplemental Insurance , Medicare Prescription Drug or Long Term Care plans.

Tips: Prepare For A Trip To The Doctor

doctor-visit

Sometimes face to face time with our doctor seems rushed.
So to get the most out of this short time, and perhaps even a healthier outcome, I have summarized below several tips that doctors recommend from an article I read in the Wall Street Journal titled Get The Most Out Of A Trip To The Doctor and written by Sumathi Reddy.

 

1. Ask Questions. Doctors suggest writing out a list of questions before your visit to ensure that you remember them. Write the questions in order of importance in case you can’t get to everything.

2. Mind the time. Stay focused on why you’re in the office. We all like a little chit-chat and doctors like to know what’s going on in our lives but if you only get 10 minutes then minimize the small talk. Call ahead if you’re running a few minutes late and minimize your waiting time by booking appointments first thing in the morning.

3. Bring your Meds. That includes herbal and over-the-counter medications, and prescriptions you might have got from another doctor. Bring the actual bottles with the original label so you can double-check the dosing and make sure there hasn’t been an error.

4. Take Notes. Writing down what the doctor says could help your memory, jog your memory later after the visit.

5. Tell the Truth. Even uncomfortable topics such as poor eating habits, or medication adherence, or risky practices might cause you to avoid or sugar-coat a subject, but don’t leave things out. If you’re not being truthful the doctor can’t do their best job in taking care of you.

6. Bring a Friend. Going to an appointment accompanied by a spouse, and adult child, or a friend is particularly important if you’re expecting important test results. You may have trouble understanding or remembering things, and having someone else there can help with that.

7. Be Realistic. Having a hard time getting more exercise like the doctor told you to, or having trouble changing your diet? Don’t feel embarrassed to ask a question if you don’t understand something, and keep the instructions realistic.

8. Bring Things Up First. When you’re having a health concern that provokes some anxiety, you may need to work up the nerve to ask about it, but don’t save it to the end of the visit. Then you’ll have the least time to discuss it. Having a prioritized list of what you want to discuss with the doctor can help with this.

Please visit and follow via Facebook Page. Daniel G. Alcorn, a licensed and independent agent, represents licensed insurance companies in New York and other states.  Dan may receive compensation for individual enrollments in Medicare Advantage, Medicare Supplemental Insurance , Medicare Prescription Drug or Long Term Care plans.

When what we do helps someone… February 2017

…. it’s great to hear results.    Read more of this post

Medicare Part A / B Savings Program

Medicare-Card

 

 

 

 

 

 

Most Medicare beneficiaries pay $0 for the Part A hospitalization benefits if they or their spouse paid Medicare taxes while they worked.

For Part B medical insurance, most people pay the standard $104.90 monthly premium.

helpFor New York State residents meeting certain conditions, a Medicare Savings Program may help pay the Medicare Part A and Medicare Part B premiums, deductibles, coinsurance and copayments.

 

Together with the EPIC Prescription Drug Program,  this New York State Medicare Assistance program can help seniors with the cost of healthcare.  I am available to assist with education and enrollment (518) 346-2115.

Important Links:

red_arrow Download 2014 NY State Medicare Part B assistance Form

red_arrow Visit New York State Department of Health

red_arrow Visit Medicare.gov