medicare

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Medicare Part B: Let’s Review Some More Detail

by Kristin P. Sinclair – A Accu Tax – August 15, 2018

medicare

Abdominal Aortic Aneurysm Screening

This is a one-time covered test.

So if you and your Doctor Feel that you need to have this test done again sometime after the initial testing, this would be an example of you having some out of pocket costs for the testing.

There is a potential way to get several items reviewed and supply your Doctor with the results. Many of you have heard of Life Line Screening. You can have several tests done for a low fee. All in the convenient location of where the Life Line Screening is being done in your area.

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Part B covers 2 types of services, and it’s great to have those protections

by Kristin P. Sinclair – A Accu Tax – August 15, 2018

Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.

Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.

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Medicare and Yes, I Have Choices

by Kristin P. Sinclair – Charleston SC – August 15 2018

Other items to include in your decision making when it comes time think about health care.
Which Health Care practitioners(s) you wish to offer your health care during the year. Does the provider accept Medicare, if yes, then they will accept your Medicare supplement as well.

Next question, when the health care provider accepts Medicare, do they accept the Medicare Advantage plan you are considering. Well, you need to verify that before you make you plan decision. Health Care providers have the option to either accept a Medicare Advance Plan as an insurance option, or possibly they could make a choice to not accept Medicare Advantage plans. Many Advantage Plans are Network Based.  Many Advantage Plans have a geographic area that offer the particular plan design. The Providers that accept the Medicare Advance Plan will usually be geographically accessible to that specific plans area.

Original Medicare is a Federal Program, Insurance products which work with the Original Medicare follow both Federal and State Guidelines.  Original Medicare will provide coverage with in the United States. Medicare Part A offers coverage to help with the costs for a Medically necessary  in patient hospital stay(s), with applicable Deductible and Co-Insurance cost sharing. When you select  a  Medicare Supplement plan, you are selecting a plan to help fills the gaps in Original Medicare.
Medicare Part B is the out patient care portion of medicare, Medicare Part B has an annual deductible and co-insurance cost sharing as well, the Medicare Supplement plan you select will offer coverage  to help fill gaps in the Original Medicare.

Helping to fill the gaps in the Original Medicare is going to reduce your out of pocket costs associated with health care.

Medicare Advantage Plan often you must use providers who accept your plan, and the plan could have limits on where you can travel and still have access to benefits if not in an emergency situation. And If you travel away from home for a period of greater than 2 months, you might need to change your plan, because of the amount of time you have chosen to be away from home.  Medicare Advantage plans have specific geographic regions, states, or counties that they offer coverage. MA will have annual contracts with Medicare, they must be as good as Original  Medicare and they will have Out of Pocket limits annually which can change per annual period.  Often the MAPD (Medicare Advantage Prescription Drugs) will be one policy choice for Hospital, Out patient and Drug plan coverage.

Stand Alone Prescription Drug plans are approved  Federally,  Center for Medicare Services, and  are State specific.  Stand Alone Medicare Part D covers the medications which are not administered under Medicare Part A or Medicare part B, Medicare Part D medications will usually be the medications you fill at your preferred local pharmacy or the mail order service your Part D provider has in place for your benefit as a potential cost saving opportunity when you seek a 90 mail order alternative. Using your plans  Preferred Mail order provider might offer you savings through out the Annual Period. A Medicare Part D plan will help round out your coverage when you select a Medicare Supplement.

From Oct 15th though Dec 7th each annual period you have what is called the annual Enrollment period, also called the Open Enrollment period. This is a time that you will review various Medicare Part plan and various Medicare Part C plans to decide what change you will make for the coming year. If a change is indicated.

However, Medicare Supplement or MediGap plans do not have the Annual Enrollment Period.
You can keep your plan as long a you pay your premiums. You have the opportunity to change your Medicare supplement plan any time of the year. As long as you can pass any underwriting requirement which might be applicable.

If you move to another state, you have guarantee issue rights so long as you make your change within 63 days of the change of residents.  Always keep a record of which plan you have and keep your letters you receive from your plan pertaining to your rights. Medicare has protections in place for your benefit.  We live in a mobile culture. It is great that we have the protections available to us, especially after our life time of work. We certainly deserve the protections that Medicare makes available to us.

Kristin P Sinclair
Rock Hill SC
updated August 2018

 

Kristin P. Sinclair (803)329-0615
Charlotte NC, Rock Hill SC and Charleston SC
August 2018

* For those under age 65 that have Medicare Coverage due to a disability, and suffer End-Stage Renal disease there may be limitations to their coverage options.

KPS: More information available at Medicare.gov

 

 

 

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When is it Best to Buy a Medicare Supplement ?

by Kristin P. Sinclair – Charleston SC – April 5, 2018

The very best time to buy your Medicare supplement is during your Open Enrollment Period(OEP). Normally this period lasts for six months starting with the first day of the month you are 65 or older and are also enrolled in Medicare Part B. For those under age 65* there may be additional Open Enrollment Periods in certain states.

During your Open Enrollment Period an insurance company cannot refuse to sell you any Medicare Supplement Policy they offer; charge you a higher rate than that company might charge someone in good to excellent health; or make you wait for your coverage to begin. Please note that the insurance company may make you wait for up to six months for pre-existing condition coverage. That is a condition that you would have prior to your Medicare Supplement coverage starting. This period of time is called a pre-existing condition waiting period. After six months, your Medicare Supplement Policy will cover any pre-existing conditions.

If you make a change from one Medicare Supplement to another after becoming Medicare eligible, and you have not had a lapse in coverage with your prior provider; then you will have underwriting.   you can shorten, the period where a waiting period would be applicable. It is possible to shorten or eliminate any pre-existing condition waiting periods if you have Creditable Coverage before you apply.

An insurance company cannot subject you to any pre-existing condition waiting period if you have been covered by your employer health plan which is Creditable Coverage; if you are still working full time and opted to delay Part B until you have decided to move your coverage to include your Medicare Part B coverage, or if you have had at least six months of Creditable Coverage. Please note that you cannot have had a 63 day break in coverage between your Creditable Coverage and your Medicare Supplement coverage.

You need to include your letter of creditable coverage with your application unless you are new to Medicare Part B.

It is also important to keep in mind that your Medicare Supplement rights are based upon when you enroll in Medicare Part B. For those age 65 and older, your Medicare Supplement Open Enrollment Period begins when you enroll in Medicare Part B. This period cannot be change or repeated. Thus, if you have employer or union group health coverage that is as good or better than original medicare, then you may want to wait until later to enroll in Medicare Part B. Most group health coverage provides benefits similar to Medicare Part B; and also having Medicare Part B might be an unnecessary duplicate expense. Worse yet, your Medicare Supplement Open Enrollment Period might expire before you need it.

In summary, for those age 65 and over, when you are first eligible you have the right to buy any Medicare Supplement Policy offered in your state. This gives you more choices, and normally lower monthly premiums. So during the Open Enrollment Period, a person with health issues can buy a Medicare Supplement for the same lower prices as those with no health issues.

 

Kristin P. Sinclair (803)329-0615
Charlotte NC, Rock Hill SC and Charleston SC
April 5, 2018

* For those under age 65 that have Medicare Coverage due to a disability, and suffer End-Stage Renal disease there may be limitations to their coverage options.

KPS: More information available at Medicare.gov

 

 

 

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What Are Medicare Supplements ?

by Kristin P. Sinclair  – A Accu Tax  – August 2018

Medicare Supplements are policies sold by private insurance companies. Medicare supplements are designed to help pay many of the health care cost not covered by Original Medicare.

Medicare Supplement plans are standardized. Meaning the basic plan design with a Letter Designation such as Plan F or High Deductible Plan F, Plan G,  Plan L or Plan N, has a standard set of benefits for that particular Letter used to describe what basic standard features are in the plan. Some companies will offer Value Added Benefits above and beyond the Supplemental Benefit.

Some companies will not have a plan which has added Value Added Benefits above and beyond the Supplement Benefit. Some companies will indeed have Value Added Benefits, so as a consumer you will want to ask your agent about things which you as a consumer are interested in to determine a plan which might be suitable for you needs.

 

Updated in Charlotte NC and Charleston SC

by Kristin P. Sinclair   A Accu Tax – Rock Hill SC

(803)329-0615   August 2018

KPS: More information is also available at Medicare.gov

 

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Part B covers 2 types of services, and it’s great to have those protections

by Kristin P. Sinclair – A Accu Tax – August 15, 2018

Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.

Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment

Part B covers things like:

  • Clinical research
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health
  • Inpatient
  • Outpatient
  • Partial hospitalization
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

2 ways to find out if Medicare covers what you need

  1. Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
  2. Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on 3 main factors

  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

 

For more information, view the official medicare.gov website: https://www.medicare.gov/

Kristin P Sinclair

@Sinclair Financial Solutions

803-329-0615

August 15, 2018

Rock Hill, SC 29730

 


Medicare Premiums for High Income Households

by Kristin P. Sinclair – A Accu Tax – April 4, 2018

If your household includes high income wage-earner(s) then your Medicare Premiums could also include Income Related Monthly Adjustment Amounts (IRMAA). Qualifying high-income also includes Interest, Dividends, or Capital Gains and other forms of ordinary income as well. These additional premiums are based upon your income from the two prior tax years.

If you have questions about your Part A or Part B bill amount or Part A or Part B insurance, then call Social Security at 1-800-772-1213. You can also write or visit any Social Security office. TTY users should call 1-800-325-0778.

  1. If you have questions about your IRMAA Part D bill amount, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
  2. If you need help paying your Medicare costs, call or visit your State Medical Assistance (Medicaid) office, and ask for information on Medicare Savings Programs. You can also contact your State Health Insurance Assistance Program (SHIP). To get the phone numbers for your state, visit Medicare.gov/contacts, or call 1-800-MEDICARE.
  3. For more information about this bill, visit Medicare.gov and type “CMS-500” in the Search box. • CMS does not discriminate in its programs and activities. To request this publication in an alternate format, please call 1-800-MEDICARE or e-mail AltFormatRequest@cms.hhs.gov. TTY users should call 1-877-486-2048.

What if I don’t pay my Part A or Part B premium?

You’ll lose your coverage, and you must still pay the total premium amount you owe. You can only reapply for Medicare during the General Enrollment Period from January 1 through March 31 each year. If you reapply, your coverage will start on July 1 of that year, and you may have to pay a higher monthly premium amount for Part A as well as a lifetime late enrollment penalty for Part B.

What is IRMAA and why do I pay for it?

This charge may include an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra amount you must pay for Part B and Part D coverage because you have a higher income. If you have IRMAA Part D, then you are billed monthly and it is included in this bill. Your Part D plan premium is different, and you must pay the plan premiums to your Medicare drug plan. If you have IRMAA for Part B, it is included in your Part B premium amount. Your IRMAA can change each year. For more information about IRMAA, visit www.SocialSecurity.gov. What if I don’t pay my IRMAA Part D amount? You’ll lose your Part D coverage, even if it is part of your Medicare Advantage plan (like an HMO or PPO) or employer coverage. If you sign-up for Part D later, then you will still have to pay any IRMAA for Part D you owe from prior years. You may also have to pay a monthly penalty for as long as you have Part D coverage.

If Medicare is billing you additional premium for your Medicare Part B or your Medicare Part D, then a good reference tool to use to understand these extra premium charges are CMS-500 Form.

UNDERSTANDING THE “MEDICARE PREMIUM BILL” FORM (CMS-500) can be found on the website: www.Medicare.gov

Updated by Kristin P. Sinclair: A Accu Tax

in Charleston SC and Rock Hill SC

December 1, 2017 (803)329-0615

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11 Questions for Home Health Care Providers

by Donn J. Sinclair, MBA – March 15, 2018

When recovering from an injury or illness, your Medicare coverage and your Medigap or Medicare Supplement may pay some of the Home Health Care costs that you incur. When selecting a home care agency for you or a loved one, there are important questions to ask when interviewing home health care agencies.

  1. Private duty home care – what year did the agency first offer that service ?
  2. State licenses – are the agency staff and home health care agency properly licensed in your state ? More specifically, properly licensed to provide care level your physician ordered ?
  3. Which home health care agency staff member coordinates with the patient’s physician to implement the physician developed plan of care ? The plan is evaluated and updated by the agency on what schedule ?
  4. What daily notes are maintained to monitor the progress of the patient ?
  5. Who and how is quality of care supervised and updated ? How frequent are unscheduled agency supervisory visits on the agency staff ?
  6. What are the home health care agency ongoing training mandates for their caregivers ? Who supervises the training ?
  7. How and by whom are after normal business hour emergencies handled ?
  8. Does the home health care agency have on staff nurses, social workers, physical therapists, and other qualified professionals available to provide needed in home care ? If not, with which providers does the home health care agency have an established working relationship ?
  9. How do you obtain a written copy of the home health care agency’s privacy policy, ethics code, and mission statement ?
  10. What screening techniques are used to screen caregivers ? Do these include reference checks, driving records, credit checks, and criminal background investigations ?
  11. Are the home health care agency caregivers W-2 employees or W-9 subcontractors ? Are there any home health care agency incidents of failure to file payroll tax reports, or incidents where the agency failed to pay taxes on a timely basis ?

When it comes to selecting a home health care agency, you should follow the Boy Scouts motto “Be Prepared”. Make certain that you and your loved ones get the care they require and deserve. Also make certain that Medicare and your Medicare Supplement pay as they should for the care received.

 

Donn J. Sinclair, Winthrop MBA

in Charlotte NC and Charleston SC

December 5, 2017   (803)329-0609

DJS: More information is available at Medicare.gov

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