Brenda’s Articles

SENIOR ARTICLE – October 2019

HOW MEDICARE CHANGES IN 2020 WILL IMPACT BENEFICIARIES

There are many changes in Medicare 2020. These changes will impact all current & future Medicare beneficiaries. Below are the changes to keep your informed.

Medicare Changes in 2020: Starting in 2020, there will be no more first-dollar coverage plans available to those who are considered Medicare eligible after 2020. First-dollar coverage plans are Medicare Supplement Plans that leave you with zero out of pocket costs. The Medicare Part B premium will also increase.

The Three Medicare Supplement Plans considered first-dollar coverage plans are:
Plan C
Plan F
High Deductible Plan F

Why First-Dollar Coverage Plans are Being Discontinued: The reasons is some members of Congress believing Medicare beneficiaries are over-using healthcare services. With no out of pocket costs, playing it safe was priceless. By making everyone meet the Medicare Part B deductible, legislators hope to prevent beneficiaries from running to the doctor for every minor ailment. Lots of debate on this issue!

How Medicare Changes in 2020 Will Impact Beneficiaries: These changes will Only impact beneficiaries who are NOT considered “Medicare-eligible until after 2020. As long as you turned 65 prior to 1 January, 2020, you can continue to enroll in these First-Dollar coverage plans after they have been discontinued. These are being discontinued to those who are not considered Medicare Eligible until AFTER 2020. For those enrolled in a First-Dollar coverage plan, you are “GRANDFATHERED” in. You DO NOT need to make any changes to your coverage unless you are simple comparing benefits and/or rates to see if there is a better plan for you – such as: health needs have increased or less health care than previously needed. Again, as long as you are Medicare-eligible BEFORE 2020, you can still sign up for the First-Dollar coverage plan after they’re discontinued!

For Those “Medicare-Eligible” After 2020: For beneficiaries that are NOT eligible for Medicare until after 2020, you still have alternatives that will keep yours out of pocket costs LOW! The only different between the alternative plans listed below and First-Dollar coverage plans is the Part B Deductible, which is $185 as of 2019.

Alternatives to First-Dollar Coverage Plans: One alternative to Plan C is Plan N. Plan N is considered a cost-sharing plan. You pay a Co-pay of up to $20 for doctor visits and up to $50 in the emergency room. One good thing about Plan N is if you go to Urgent Care, vs your primary care physician or emergency room, there is NO Co-Pay!

Another Alternative to Plan C is Plan D. Plan D offers the same protection as Plan C, with the Exception of covering the Part B deductible. If you do not want the Co-Pays that come with Plan N, then Plan D is the way to go. Neither Plan D or Plan N covers excess charges. If you want coverage for Excess charges, you would go with Plan G. An Alternative to Plan F is Plan G. Aside from the Part B deductible, Plan G is the exact same plan like Plan F. Plan G is a good bet!! If you want the fullest possible coverage. Once you meet the annual Part B deductible, you should not have any further expenses for services covered by Medicare. Plan N is a good choice if you’re looking to same money on Premiums, pay a small Co-Pay, and are not concerned about excess charges. EXCESS CHARGES AREN’T ALLOWED in some states, and even where permitted, not all providers charge them. In fact, only 3% of providers charge excess charges.

Projected Medicare Premiums for 2020: As of now, it looks like the 2020 Medicare Part B premium will be $144.30. That’s an increase of $8.80 from 2019. The Part B deductible is projected to increase from $185 to $197 in 2020. The Part A deductible is projected to increase from $1,364 to $1,410 in 2020.

Veterans/Spouses: Tricare For Life is Medicare wraparound coverage for Tricare beneficiaries. You are eligible for Tricare For Life if you are entitled to Medicare Part A & Part B, regardless of your age…in other overseas locations, Tricare For Life is the primary payer. Remember: Tricare For Life pays AFTER Medicare and OHI for Tricare-covered health care services.

Speak to a Licensed Agent Today: Official today, 15 October is the Open Enrollment Period until 7 December 2019.

Still confused? I highly suggest going to www.medicare.gov and/or call your current agent or a Medicare Specialist. If anyone needs a Medicare Specialist, feel free to contact me and I will refer some Medicare Specialists for you to contact. No cost – and will help you with your current health care needs. Plan for 2020 – DO NOT WAIT… Also, contact Alamo Area Council of Governments (AACOG) as they have trained specialist who can assist.

*article from Medicare – General Information
Brenda Dever-Armstrong, CEO/CSA
The Next Horizon Seniors & Military Advocate/Resources
Bus. Ph: 210-275-3002

Medicaid Versus Medicare: Who Covers Nursing Home Costs?

When I meet with potential clients & my veterans, one of the questions asked often is: Who covers nursing home costs? Medicare or Medicaid (we help to qualify for Medicaid). Because staying in a nursing home may be covered by either Medicare or Medicaid, it can be confusing to determine which program will over your family member’s length of stay. There are some important differences.

MEDICARE COVERAGE OF NURSING HOME COSTS
The person must:
Have been hospitalized for medically necessary “inpatient” hospital care for at least three consecutive days, not counting the date of discharge.

Be admitted to the nursing home within 30 days after date of discharge from the hospital.

Require skilled nursing or rehab care on a daily basis for a condition for which the patient was hospitalized, and receiving a physician’s order that care us needed.

THE DIFFERENCE BETWEEN SKILLED CARE & CUSTODIAL CARE
Skilled care is care that can only be administered by professional (physician or nurse) or technical personnel, and which will prevent further deterioration in the patient’s health. Examples include: intravenous feeding, injections, insertion of catheters, application of sterile dressings, treatment of skin ulcers, and therapeutic exercises of various kinds (physical therapy). Less medically-intensive and critical personal care services- even if performed by a nurse-are not considered skilled care.
If the care the patient requires is not considered “skilled care” as defined above, “it is called “custodial nursing home care.” This is a type of long-term care which is typically received in a nursing home. Only Medicaid – NOT Medicare-covers “custodial nursing home care.”

THE CO-PAY RULE
Medicare will only cover a patient for a maximum of 100 days (per separate spell of illness) – if it covers the patient at all! During days 1-20, Medicare will cover the “entire” cost of the nursing home stay. For days 21-100, the patient must pay a co-pay, which is currently set at $161 per day. If care is needed beyond the 100 day limit – or if the patient is no longer needing skilled or rehab care “before” 100 days have passed – then the patient either pay privately, be covered by some form of insurance or qualify for Medicaid.

MEDICAID RULES FOR SKILLED NURSING PAYMENTS
Medicaid is a “need-based” program, meaning that the patient cannot have more than a certain minimal amount of assets and income in order to be covered. Medicare, on the other hand, is available regardless of the patient’s income or assets. If they meet the other assets, if they meet the other requirements listed above. Also, there is no mandate that a patient require skilled or rehab care in order to be covered by Medicaid, as there is for Medicare.

NOTE: DUAL-ELIGIBILITY
Finally, keep in mind that it is possible to be covered by Medicare and Medicaid, simultaneously. Such individuals are known as “dual Eligibility” which means Medicaid covers those expenses not covered by Medicare. Example: Such as paying medicare premiums and cost-sharing requirements and light custodial care.

If you have questions regarding if you can qualify for Medicaid (good program!), contact me any time. Ph: 210-275-3002……

Brenda Dever-Armstrong, CEO/CSA/Owner
The Next Horizon Seniors & Military Advocate/Resources/Placement
deverb@att.net
www.nexthorizonlocators.com

Beware Of Offers For A Free Cancer Screening

SENIORS & MILITARY AUGUST ARTICLE: SENIOR ARTICLE
BEWARE OF OFFERS FOR A FREE CANCER SCREENING…..

Crooks may be fishing for your data so they can commit Medicare fraud……

One of the country’s newest Frauds, is someone calls or at a Networking function and a person asks “Do you have any direct relatives who had cancer and would like a Free DNA test to check for the disease?” They say it is Free, but asks for your Medicare number. This is happening all over the country! In many cases Medicare has been billed from $6,000 to, in one case, $30,000.

These tests are being marketed to you as Free without the understanding that Medicare will be billed!! BE WARY OF A FREE CANCER SCREEN!!

Your 11 digit Medicare number is valuable to crooks. It is important to keep it Secure!!

Several groups/or people representing (so they say) a company that does Free DNA and are going to Senior communities offering to swab people’s cheeks for genetic material for purported DNA cancer checks, according to many Senior communities across the U.S. For those in Senior communities, the Front Desk or Marketing Director should ask for those offering Free DNA test to ask for their credentials…then have those working at the SR communities to contact Medicare and ask if they know of this company or person…..Even then they can have “fake” IDs…..DO NOT fall for this Scam! Contact your medical doctor’s office and ask if they know of the Free DNA test.

Recently, in one of my Networking groups, a “representative supposedly” gave us his card and asked the questions similar to the information mentioned above. One of our top Medicare insurance Representative told the man to get out….. He has been reported to the State…. He was part of a Scam…..

Always check with your physician and ask about you needing a DNA screening.

Brenda Dever-Armstrong, CEO/Owner/CSA
The Next Horizon Seniors & Military Advocate/Resources/Locator

How To Be Heard In Washington

SENIORS & MILITARY JUNE ARTICLE: SENIOR ARTICLE
HOW TO BE HEARD IN WASHINGTON

Here are some strategies on how you can get your ideas and concerns to those who matter!

MEET IN PERSON: Face-to-face visits are the most effective way to sway power brokers. Town hall meetings and other public events are often lightly attended, so those who show up can get their say!

WRITE A LETTER OR EMAIL: Personalized notes carry weight! Do address people respectfully. Direct your mail to your own members of Congress.

VOLUNTEER: There are organizations already fighting for your concerns.

JOIN A GROUP: Many of the issues you care about have citizens groups. These grassroots organizations can turn into opinion – especially in Washington.

BE CREATIVE: Sometimes being in the right place at the right time.