Mr. Jones is able to live within his $1300 Social Security check, but the cost of of his prescription medications take a big bite out of his income.  I was able to make his family aware that  their father, who  is covered by Medicare and has limited income and resources, may be eligible for Extra Help — available through Social Security — to pay part of his monthly premiums, annual deductibles, and prescription co-payments.

 To qualify for the extra help, the recipient must be receiving Medicare and have:

 •           Income limited to $16,335 for an individual or $22,065 for a married couple living together. Even if  annual income is higher, he still may be able to get some help with monthly premiums, annual deductibles, and prescription co-payments. Some examples where income may be higher include if he and, if married, his wife:

            —Support other family members who live with them;

            —Have earnings from work; or

            —Live in Alaska or Hawaii.

 •           Resources limited to $13,070 for an individual or $26,120 for a married couple living together. Resources include such things as bank accounts, stocks, and bonds. We do not count the primary residence or car as resources.

If you think that you or your parent may be eligible, Social Security has an easy-to-use online application. Find it at www.socialsecurity.gov/prescriptionhelp. To apply by phone or have an application mailed to you, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask for the Application for Help with Medicare Prescription Drug Plan Costs (SSA-1020). Or go to the nearest Social Security office.

 I was happy to be able to help my client save an estimated $4,000 a year on Medicare prescription drugs.

The Acting Administrator of the Centers for Medicare and Medicaid Services (CMS) Acting Administrator  has  announced the redesign of the statement that informs Medicare beneficiaries about their claims for Medicare services and benefits. The form will include the following new features:

• A clear notice on how to check the form for important facts and potential fraud;
• Clearer language, including consumer-friendly descriptions for medical procedures;
• Definitions of all terms used in the form; and
• Larger fonts throughout to make it easier to read.

The redesigned MSN is already available to beneficiaries who use  mymedicare.gov. In 2013, Medicare recipients who rely on paper copies of the Medicare Summary Notice (“MSN”) will start to recieve the redesigned form as well.

I recently wrote about new regulations that make it clear that Medicare should cover rehabilitation services that help patients maintain their current condition, even if they are not improving.  Among other benefits, he new MSN will make it easier for patients to make sure that reimbursement for rehabilitation services is not being terminated for a reason inconsistent with these regulations.

As reported in today’s Los Angeles Times, the Department of Health and Human Services has announced that 3.6 million people in the Medicare program saved $2.1 billion on prescription drugs in 2011. This is the result of both enhanced use of generic drugs and the closing of the Medicare Part D “donut hole,” which is one of the few aspects of the Affordable Care Act that went into effect before 2014.  Assuming the law is allowed to stand, the savings will continue to increase, as the payment gap diminishes each year before closing entirely in 2014. 

Medicare coverage for pharmaceuticals under Part D (including the “donut hole”) was originally created under President George W. Bush.

Source/more: Los Angeles Times

Are you aware of the changes to Medicare in the upcoming year? This is the first post in our “Medicare Premiums and Deductibles For 2012” series, which also appears at http://www.talkeldercare.com.

According to the Centers for Medicare & Medicaid Services (CMS) Office of Public Affairs, Medicare Part A premiums will be increasing by just $1 per month, and the deductible will increase by just $24.  “For Medicare Part A, which pays for inpatient hospital, skilled nursing facility, and some home health care, about 99 percent of Medicare beneficiaries do not pay a premium since they or their spouses have at least 40 quarters of Medicare-covered employment,” reported the CMS.

Pay very close attention to how the changes will affect patients of different ages. “Some enrollees age 65 and over and certain persons with disabilities who have fewer than 30 ‘quarters of coverage’ obtain Part A coverage by paying a monthly premium set according to a statutory formula,” reported the CMS. “This premium will be $451 for 2012, an increase of $1 from 2011. Those who have between 30 and 39 ‘quarters of coverage’ may buy into Part A at a reduced monthly premium rate which is $248 for 2012, the same amount as in 2011.”

 The deductible for inpatient hospital admittance will be another one of the many changes. “The Part A deductible paid by a beneficiary when admitted as a hospital inpatient will be $1,156 in 2012, an increase of $24 from this year’s $1,132 deductible.  The Part A deductible is the beneficiary’s cost for up to 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries must pay an additional $289 per day for days 61 through 90 in 2012, and $578 per day for hospital stays beyond the 90th day in a benefit period. For 2011, per day payment for days 61 through 90 was $283, and $566 for beyond 90 days.”

For beneficiaries in skilled nursing facilities, the daily co-insurance for days 21 through 100 in a benefit period will be $144.50 in 2012, compared to $141.50 in 2011.

 If you have any questions about how these changes will affect you or your loved one, consult a professional or patient advocate.

 The information provided in this post is from a recent press release from the Centers for Medicare & Medicaid Services (CMS) Office of Public Affairs

It has already been widely reported that there will be a Cost of Living  increase to Social Security benefits in 2012, for the first time in three years.  This 3.6% increase affects disability benefits under the SSI and SSDI programs, as well as Retirement Benefits.

For a single person on SSI, this will increase her maximum monthly benefit from $674 to $698.  And a retiree with a monthly benefit of $1,600 will receive almost $700 more over the course of the year.  That person should wait a few more weeks before deciding on where to spend that extra cash.  Medicare had been prohibited from increasing the Part B premium during the two years when there was no cost of living increase,  but that ban has now been listed.  While some feared that the agency might hold back between a quarter and a third of the additional benefit for this purpose, the increase of $3.50 per month only amounts to about 10% of the COLA increase. 

In another change, Medicare has added a week to the Open Enrollment period during which you can add, or drop, Part D (prescription drug) coverage; change your carrier for your Part D and/or Medicare Advantage Plan, or switch from an Advantage plan to Original Medicare.  However, they have also moved the dates up significantly.  Whereas last year, changes could be made from November 15 through December 31, this year, the enrollment period opened on October 15, and remains open through December 7, 2011. The changes will become effective on January 1, 2012.

According to a Post on http://newoldage.blogs.nytimes.com/, Medicare’s website, www.medicare.gov, is visited more than 2.5 million times a month by people looking for information, ordering replacement cards or applying for benefits. 

Part of that page is titled Ask Medicare. This section, containing excellent information geared toward family caregivers, has recently been re-designed to make it easier to use.   The site includes basic information on eligibility and coverage, how-to instruction on filing claims,  links to other organizations, and an outstanding library of downloadable fact sheets and pamphlets.   In addition, you can sign up for an e-mail newsletter that provides updates on changes to benefits.  You can also read other caregiver’s stories, and share your own.  In view of all the rumors about what is and is not happening to Medicare, you should be aware of this great source of information directly from the agency.

If  you have had to use Medicare for a hospital stay this year, you probably noticed that the co-pays and deductibles have increased. Here is a quck summary:

Medicare Part A Deductible:   $1,132  (was $1,110 in 2010)

Co-pay for hospital stay, days 61-90: $283/day   (was $275/day in 2010)

Co pay for hospital stay, days 91-150: $566/day  (was $550/day in 2010)     Remember that the patient pays 100% after day 150)

Skilled nursing facility co-pay, days 21-100: $141.50/day (was $137.50/day in 2010.     There is still no co-pay for days 1-20)

The Basic Part B premium is still $96.40/month unless those premiums were not withheld from your social security check in 2010, in which case the premium will be $115.40 in 2011.  Also, the Part B deductible has increased to $162 in 2011, from $155 in 2010.

Supplemental insurance policies that cover your co-pays and deductibles should be offsetting these increases, although you may find that premiums have increased, as well.

Last month, I posted a brief summary of the 4 parts of Medicare.  Today, I want to make sure everyone knows about a new benefit that was added this year, as a result of the Affordable Health Care Law (Health Care Reform).

Up until now, Medicare only covered your care once you were sick, Now, they will cover the cost of an annual “Wellness Visit” or physical by your primary care physician for everyone who has been enrolled in “Part B” for at least a year, and who has not had their “welcome to Medicare” exam within the last 12 months.

The following services are included in the Annual Wellness Exam:

1. A review and update of your medical and family history

2.  Measurements of height, weight, body mass, blood pressure, heart rate, lung function and other routine measurements

3.  Advice and referrals to help reduce risks to your good health, such as weight loss, stress reduction, fall prevention and smoking cessation

4.  Establishing or updating each person’s screening schedule for the next 5-10 years for appropriate routine screenings such as mammograms, PAP tests or tests for prostate cancer, appropriate to the age and risk factors of each patient

The exam will also include tests to check for cognitive impairment.  Early detection of cognitive concerns give the best opportunity not only for treatment, but for families to plan for the current and future care of someone whose cognition may be declining.

As long as you participate in Part B, there is no co-pay or other cost for this annual exam. 

At the same time that stories about cut-backs (both real and proposed)  in benefits for seniors are filling the news media, many benefits programs are underutilized because people just don’t know they exist.   For example, as a result of the new Health Care legislation, you cannot be charged a co-pay for some preventive procedures.  In addition, a new government definition of poverty may allow more seniors to be eligible for state benefits.  

The National Council on Aging hosts an excellent website at www.benefitscheckup.org, which is a comprehensive tool to find and apply for public and private benefits programs across the country.  You may want to put this site in your browser to stay current on what’s available for you and your family.