Medicare has announced their costs for 2013.
Medicare Part A (Hospital Insurance Costs)
Most people don’t pay a premium for Medicare Part A.
In 2013 you will pay
– $1,184 deductible per benefit period
– $296 per day for days 61-90 of each benefit period
– $592 per “lifetime reserve day” after day 90 of each beneft period (up to a maximum of 60 days over your lifetime)
Skilled Nursing Facility Stay
In 2013, you pay
– $0 for the first 20 days of each benefit period
– $148 per day for days 21-100 of each benefit period
– All costs for each day after day 100 of the benefitd period
Medicare Part B (Medical Insurance)
Medicare Part B Monthly Premium:
|If your monthly Income in 2011 was||You Pay|
|File Individual Tax Return||File Joint Tax Return|
|$85,000 or less||$170,000 or less||$104.90|
|Above $85,000 up to $107,000||Above $170,000 up to $214,000||$146.90|
|Above $107,000 up to $160,000||Above $214,000 up to $320,000||$209.80|
|Above $160,000 up to $214,000||Above $320,000 up to $428,000||$272.70|
|Above $214,000||Above $428,000||$335.70|
Part B Deductible – $147 per year
Medicare Part D began on January 1, 2006. That year people on Medicare had until May 15, to join a plan. If the beneficiary was eligible at that time, and they were not in their Initial Enrollment Period or a Special Enrollment Period then their penalty began June 1, 2006.
Let’s use this example
2006- 7 months penalty
2007- 12 months penalty
2008- 12 months penalty
2009- 12 months penalty
2010- 12 months penalty
2011- 12 months penalty
2012- 12 months penalty
—- 79 months total penalty —-
The penalty is not multiplied by the premium a person is paying; it is multiplied by the national average base premium. For 2013 that is $30.00 so we take 79 x .3= $23.70 in additional Part D premium per month for their Part D Plan.
Not everyone pays this amount though. Some people were not on Medicare in 2006 so their penalty starts at the end of their Initial Enrollment Period or their Special Enrollment Period.
Let’s use this example:
Mrs. Smith became eligible for Medicare on July 1, 2010. She was healthy and was not taking any medication and so she did not join a Medicare Part D plan. In 2012 she had a stroke and now takes several expensive medications. She wants to join a plan for 2013. What is her penalty?
Her Medicare began July 1, 2010, her Initial Enrollment Period ended October 31, 2010, so her penalty goes back to November 1, 2010.
2010- 2 months penalty
2011- 12 months penalty
2012- 12 months penalty
———— 26 months total penalty————
26 x.3= $7.80 in additional monthly premium
Sometimes an individual continues to work past the age of 65. In this case they may have a Special Enrollment Period for their Medicare Part D plan.
Mr. Jones works until he is 67. He retired on May 1, 2009. He had 63 days from when his employer coverage ended to choose a Medicare Part D plan. Since he did not join a plan by July 1, 2009 he will pay a penalty when he enrolls into a Part D Plan for 2013.
2009- 6 months total penalty
2010- 12 months total penalty
2011- 12 months total penalty
2012- 12 months total penalty
————– 42 months total penalty———–
42 x .3= $12.60
Medicare Open Enrollment begins on October 15 and ends December 7, 2012. The Open Enrollment Period is for individuals currently on Medicare, during this time they may change their Medicare Part D plan or their Medicare Advantage plan.
This year SHICK is hosting several events around the county. Each event is on Thursday and will run from 9 a.m. to 3 p.m. At these events Medicare beneficiaries will be able to sit down with a trained Medicare Counselor to learn about their Medicare Part D and Medicare Advantage Plan options.
If you would like to attend one of these events, please call 316-660-0100 to schedule your appointment. Bring your Medicare card and a current list of your medications to the appointment.
Today is like Christmas for me, it is the day that Medicare announces the Landscape of Plans for the next calendar year. Every year I look forward to this information with baited breath because it lets me know what the next three months have in store for the SHICK Program.
The most noticeable change for 2013 is that the AARP Medicare Advantage Plan, MedicareComplete is not renewing their coverage in Sedgwick County. This to me is actually great news. Not because the plan was bad, I honestly do not know that since I was never enrolled into the plan and never had to work with it. It is great news because it allows the beneficiaries who are currently enrolled in that plan, a Special Enrollment Period for a Medigap plan.
The Kansas Supplemental Insurance Shopper’s Guide gives guidance on how this works:
When a beneficiary is enrolled in a Medicare Advantage Plan and that plan is leaving Medicare or stops giving care in the area, or the beneficiary moves out of the service area.
Beneficiary has the right to by:
The beneficiary may purchase any Medicare supplement plan A,B,C,F,K or L that is sold in Kanas.
They only have this right if they switch to Original Medicare (when you use the red,white, and blue card) – not if a switch is made to another Medicare Advantage Plan.
Beneficiary must apply for a policy:
As early as 60 calendar days before the date the health care coverage will end, but no later than 63 calendar days after the health care coverage ends. Medicare supplement coverage can’t start until the Medicare Advantage Plan coverage ends.
The beneficiary may also join a Medicare Prescription Drug Plan. If you would like assistance with this process you may contact the Kansas Insurance Department at 1-800-432-2484 or in Sedgwick County you may contact SHICK at 316-660-0100 or 316-660-5210.
For more information on the new plans availalbe all over the US you may visit CMS.gov.
Sedgwick County SHICK will be hosting Medicare Plan Finder events around the county. At these events individuals will learn how to use the Medicare Plan Finder to shop and enroll themselves into a Medicare Part D or Medicare Advantage Plan.
Computer skills are strongly suggested.
Sedgwick County SHICK is sponsoring many Open Enrollment Events in the county where individuals may schedule an appointmnet at a location near them. At these events a trained Medicare Counselor will sit down with you and your drug list to find the best Medicare Drug Plan for you.
It is important to re-evaluate you prescription drug costs each plan year. In 2012 SHICK saved Sedgwick County Medicare beneficiaries an average of $838 on annual prescription drug costs.
Medicare will many times deny ambulance claims the first time they are billed. This is a reaction to fraud and abuse in the Medicare system dealing specifically with ambulance claims. Unfortunately all are punished for the actions of a few bad apples. A famous example from the SHICK Education and Outreach Coordinator is of a doctor in Western Kansas who ordered an ambulance for each one of his patients who needed to go to the hospital from his office. The hospital was directly across the street from his practice, but since he owned the ambulance company he ordered it so that he could bill Medicare for the ride.
Most ambulance rides will be paid for if the Medicare beneficiary or their advocate takes the time to appeal the denied claim. It is not a difficult task, but will take some time. Here are the steps you should follow:
1. Contact the doctor that treated you and ask for a letter to describe your condition when you were transported.
- You or someone present at the time can also write a letter to describe the situation.
- Medicare pays when it would have been dangerous to your health or life to have been transported in a regular vehicle.
- Be specific in your letter as to what you couldn’t do at the time of transport.
- You will need a Medicare Summary Notice that has thisEMStransport listed on it. If you have not received a Medicare Summary Notice for this claim:
- Call 1-800-633-4227.
۔ The voice activated system will ask if you want English or Spanish. Say the word “English” or “Spanish”.
۔ You will be given options of billing, claims, prescription drug plans, or preventative services. Say the word “billing”.
. Then they will ask about the type of bill and give you options, such as physicians and ambulance. Say “ambulance” or press 6.
۔ The voice will ask “What State?”. Say “Kansas”. You will be connected to Topeka.
b. OR, if you use a computer, go to the Medicare web site: http://www.Medicare.gov.
۔ Go to the first page of this web site, at the top of the left hand column, click on my.medicare.com. Follow the steps to register. You will be assigned a password which will be mailed to you. Using your Medicare number and password, you can access your Medicare Summary Notice. Print a copy.
- Sign the last page of the Medicare Summary Notice and give your phone number.
- Copy the letters and the Medicare Summary Notice. Keep a copy at home and mail the other set to Medicare at the address on the front page, upper right hand corner, of the Medicare Summary notice.
- Allow 6 – 8 weeks to receive a response from Medicare.
Do not rely on the ambulance or EMS company to file this appeal for you. You must file your own appeal. If EMS bills are ignored many times the EMS company will file with the IRS and at tax time the money will be collected from your refund.
Recently a beneficiary called SHICK, she was very distraught about the amount of mail she was receiving now that she was turning 65. Her husband had recently passed away and he had taken care of all of the financial issues in the past. She was wondering about what mail is really important to keep and take notice of as your Medicare eligibility date approaches.
I have some idea of the things that a beneficiary will receive in the mail and the new and improved Medicare website has a link with the names of each item you will receive, in addition to specific information about each piece.
Click here for more
The Open Enrollment Period is quickly approaching; it runs October 15 through December 7. Most people with Medicare will be deciding on what plans to enroll in for 2013. Some may even decide to completely drop out of their Medicare Part D plan or Medicare Advantage Plan without enrolling into a new plan. Your situation will depend on how you disenroll from the plan.
If you are joining another Medicare Part D or Medicare Advantage Plan you do not need to do anything to disenroll from your current plan. A new enrollment automatically disenrolls you from your current plan. For example, you belong to the Medicare Part D Plan with the H Company in 2012, you enroll in the Medicare Part D Plan with the C Company for 2013, this automatically disenrolls you from the H Company and you do not need to do anything else. The same rule applies if you change Medicare Advantage Plans, or if you join a Medicare Advantage Plan that includes Part D from a Medicare Drug Plan.
If you are leaving your Medicare Part D plan or your Medicare Advantage Plan and you are not joining another plan you will need to write a disenrollment letter. The letter should include your name, address, telephone number, and Plan Member ID. State that you would like to disenroll from the plan. You should call the plan you are disenrolling from to find the address where this letter needs to be sent. SHICK advises that you keep a written record of this conversation (who you spoke to, what time it was, the date, what phone number you called them from, and what was said). You must sign the letter and then mail it AFTER October 15, but well BEFORE December 7. SHICK would also advise sending the letter certified mail, return receipt requested. This way you will have a signed record that the company did indeed receive the letter, on what date, and who received it.
It does not happen very often, but plans do fight disenrollments, by taking the steps noted above you will have the proper information available to prove that you took the proper steps for your disenrollment.
Ever since Mitt Romney chose Paul Ryan as his running mate for the 2012 Presidential Election accusations have been flying back and forth about what each party wants to do to Medicare. Many seniors and younger individuals are concerned about what both sides want to do. The Kaiser Family Foundation is an excellent place to find factual information about what the future of Medicare may look like no matter which party wins.