JustCare

Tag: Benefits

  • Medicare might cover more dental services in a limited way

    Medicare might cover more dental services in a limited way

    For years, Democrats in Congress have tried to add a dental benefit to Medicare without success. But, now, Susan Jaffe reports for Kaiser Health News that the Biden administration is proposing to change Medicare rules so that more people receive Medicare-covered dental services. However, Medicare is only planning to cover a limited suite of dental benefits for a small cohort of additional people.

    Today, Medicare’s coverage of dental benefits is limited to services that are necessary for treatment of another health condition. Those services include wiring teeth in connection with surgery to fix a broken jaw as well as removal of infected teeth in advance of a kidney transplant or radiation treatment for people with cancer in their neck or head.

    The Biden administration is proposing to expand the number of conditions for which dental services would be needed. For example, it might cover medically necessary removal of infected teeth for people with breast cancer who receive chemotherapy and radiation. Or, Medicare might cover services to treat a dental infection for people needing organ transplants beyond kidney transplants.

    It appears that the government’s goal is to expand dental coverage for people being treated for health conditions  in which dental services could substantially help their health outcomes. People getting hip and knee replacements, for example, might receive dental services if their teeth are infected. That said, Medicare would not cover medically necessary follow-up dental care.

    Also, for unknown reasons, the Centers for Medicare and Medicaid Services (CMS) does not appear to be considering covering dental services for the large cohort of people with Medicare who have diabetes. Medicare covers insulin, diabetic supplies and a range of services for these 16 million people. Dental care to address periodontal disease could help lower their blood sugar levels. One recent report from the National Institutes of Health found that nearly 6o percent of people with Medicare have periodontal or gum disease.

    If CMS expands dental benefits, coverage would begin in 2023. It is not clear how much CMS would pay for these dental services.

    Here’s more from Just Care:

  • 2023 Medicare and You Handbook continues to mislead on Medicare Advantage

    2023 Medicare and You Handbook continues to mislead on Medicare Advantage

    The 2023 Medicare and You Handbook is now available for your reading pleasure. Unfortunately, it continues to mislead and confuse in significant ways about Medicare Advantage. Though the Centers for Medicare and Medicaid Services (CMS) would like you to believe otherwise, Medicare health plans administered by corporate health insurers–euphemistically called Medicare Advantage–cover fewer costly services, often from lower quality providers, than traditional Medicare.

    Here’s what’s seriously misleading and what’s true in the Medicare Handbook:

    • The Handbook says: Medicare Advantage plans “may have lower out-of-pocket costs” than traditional Medicare. Here’s what’s true: You could spend as much as $7,550 out of pocket if you need costly care. However, so long as you are healthy or forgo needed care, you will likely spend less on your health care. The problem is that you need health insurance to protect you in the event you need costly care. It’s of far less importance if you’re healthy.
    • The Handbook says: Medicare Advantage plans “must cover all medically necessary services that Original Medicare covers.” Here’s what’s true: You have the same Part A and B benefits in theory as people in traditional Medicare. In practice, Medicare Advantage plans have their own rules as to what services are medically necessary. They tend to be far more restrictive than Original Medicare, second-guessing treating physicians, whom they have hand-picked for their networks, as to what care is medically necessary. So, Medicare Advantage plans are likely to cover fewer services for shorter periods of time and, sometimes, from lower quality providers. And, the government is unable or unwilling to oversee them and hold them accountable when they do not do so. Only in theory are Medicare Advantage plans required to cover all medically necessary services that Original Medicare covers.
    • The Handbook says: Medicare Advantage plans “may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.”  Here’s what’s true: You may have extra “benefits” like vision, hearing and dental, but these benefits tend to be extremely limited in scope and tend to require you to pay large out-of-pocket costs.
    • The Handbook says: With Medicare Advantage plans, “you can’t buy and don’t need Medigap,” supplemental coverage that picks up costs that Medicare does not cover. Here’s what’s true: You can’t buy Medigap, but you likely would be better off with it if you need costly care. Without supplemental coverage, most people in Medicare Advantage, unlike people in traditional Medicare with supplemental coverage, are constantly having to choose between their health care and other basic needs. Or, they could be pushing themselves into medical debt.

    Here’s what the Medicare Handbook does not say:

    The government pays corporate health insurers a flat upfront payment to cover care for enrollees through Medicare Advantage, with little if any regard to the cost or quality of services each plan offers. These insurers have a compelling financial incentive to spend as little as possible on enrollees’ care and pocket as much of the money they receive as possible. While there is technically a limit on the amount they can pocket, they have ways to game that limit.

    Here’s more from Just Care:

  • Do you know about these free and low-cost benefits?

    Do you know about these free and low-cost benefits?

    Judith Graham reports for Kaiser Health News on several programs that offer free and low-cost benefits to help older adults cover the cost of basic needs. Today, millions of people are not taking advantage of them. Here’s how to get some of these benefits.

    There are literally thousands of programs intended to help older adults pay for health care, food, transportation and housing, among other needs. Some are targeted to people with low incomes and assets and others are open to everyone.

    How can you learn about these programs? Contact your local Area Agency on Aging (AAA). To reach your AAA, visit the Eldercare Locator, a service of the federal Administration on Aging, or call 800-677-1116.

    Reach out now! Plan ahead. Know what’s available and how to apply. Check out these federal programs:

    • Supplemental Nutrition Assistance Program provides help paying for food. But, it is estimated that more than 13 million people over 60 who could benefit from SNAP–71 percent of those eligible–are not receiving this help. Benefits for single older adults are typically over $100 a month.
    • Medicare Savings Programs provide help paying Medicare premiums, and sometimes also deductibles and out-of-pocket costs. The benefit is worth more than $170 a month. But. around three million eligible older adults  are not receiving these benefits. They are available through your Medicaid office.
    • Help paying Medicare Part D prescription drug costs is available through the Low-income Subsidy (LIS) program, sometimes called the Extra Help program. This benefit can be worth more than $400 a month. But, more than three in ten older adults are not receiving this help.
    • Federally Qualified Health Centers offer free and low-cost primary health care services. They are located in thousands of places throughout the US.

    You might also qualify for:

    • Home-delivered meals.
    • Legal assistance for older adults facing foreclosures and evictions.
    • Property tax break programs.
    • Home Energy Assistance Program or HEAP, which helps to pay your electric bills.

    Here’s more from Just Care:

  • Social Security benefits projected to increase 8.6 percent in 2023

    Social Security benefits projected to increase 8.6 percent in 2023

    Inflation is taking a huge toll on Americans. If there’s any silver lining, it’s that people receiving Social Security benefits should see their largest benefit increase in more than 40 years. CBSNews.org reports that Social Security benefits are projected to rise 8.6 percent in 2023; that said, Social Security benefits should increase far more.

    How does the Social Security increase translate to dollars? It will mean about $142.60 more each month for the typical person on Social Security. The total average monthly check should rise to $1,800.

    Since last April the Consumer Price Index is up about 8.3 percent. It’s up about 8.9 percent for urban wage earners and clerical workers, the CPI-W. Social Security bases its cost of living adjustment for older Americans on a somewhat different calculation.

    Today, 69 million Americans receive Social Security benefits. This year they saw a 5.9 percent cost of living adjustment. That increase is lower than the overall cost of living increases typical older adults are facing. Older adults spend a lot more than younger people on health care.

    Some of the Social Security benefit increase will go to the cost of the Medicare Part B premium, which is likely to increase next year. Last year, it rose 14.5 percent or a total of $21.60.

    Then again, $11 of the increased Medicare Part B premium this year is attributable to the projected cost of Aduhelm. Since the Centers for Medicare and Medicaid Services ended up deciding not to cover Aduhelm except in rare instances, people are already spending $11 more in Medicare premiums than they should be.

    Because Social Security checks do not keep up with the inflation older adults see, the value of their benefits is estimated to have eroded 40 percent. As a consequence, an increasing number of older adults and people with disabilities rely on food banks and food stamps. A better COLA index would be the CPI-E, which factors in rising health care costs more heavily.

    Here’s more from Just Care:

  • CMS proposes to expand access to Medicare benefits

    CMS proposes to expand access to Medicare benefits

    As anyone who has spent time trying to navigate Medicare knows, the rules are too often complicated and whacky. The Centers for Medicare and Medicaid Services (CMS) plans to fix some of the whackier rules and expand access to Medicare benefits. The proposed new rules would eliminate many of the waiting periods people must endure in order to have Medicare coverage.

    If finalized, the proposed rules would improve Medicare enrollment and eligibility, expanding coverage to older and disabled Americans. Right now, people who sign up for Medicare during the three months after they turn 65, must wait two or three months before their coverage begins. And, everyone who enrolls in Medicare during the annual General Enrollment Period between January and March must wait until July 1 for their coverage to begin.

    Under the proposed rules, everyone who enrolled in the three months after their 65th birthday month, during the Initial Enrollment Period, would be covered the month after they enrolled. And, everyone who signed up for Medicare during the General Enrollment Period–every January through March–would also be covered the month after they enrolled.

    In addition, CMS is proposing special enrollment periods to protect people who delay enrolling because of a natural disaster or because their employer or health plan misled them about the Medicare enrollment rules. Special enrollment periods would also extend to people losing Medicaid coverage and to others on a case-by-case basis because of exceptional circumstances beyond their control.

    The rules would reduce the number of people eligible for Medicare who are uninsured awaiting coverage. The rules would also protect more people from having to pay a penalty for failing to enroll in Medicare Part B when they are first eligible. Right now, people who do not sign up when they are first eligible pay a 10 percent Part B premium penalty for every year they delay enrolling.

    “Health care is not just about mending bones or dispensing pills. It’s about giving people peace of mind that comes with having coverage when you need it,” said U.S. Health and Human Services Secretary Xavier Becerra. “That’s why we’re proposing this rule today to help reduce delays, eliminate gaps, and expand access to care for people with Medicare.”

    The rules are designed to support President Biden’s Executive Orders on Transforming Federal Customer Experience and Service Delivery to Rebuild Trust in Government and Continuing to Strengthen Americans’ Access to Affordable, Quality Health Coverage.

    For free health insurance counseling from State Health Insurance Assistance Programs (SHIPs), visit shiptacenter.org or call 1-800-MEDICARE for your SHIP’s phone number.

    Here’s more from Just Care:

  • Medicare Advantage benefits: Appearances v. reality

    Medicare Advantage benefits: Appearances v. reality

    The Commonwealth Fund’s latest report on Medicare Advantage “benefit design” provides what I would call the standard take, highlighting Medicare Advantage’s out-of-pocket cap and “additional benefits,” as if those are the most important differences. It also assumes that what you see with Medicare Advantage is what you get rather than explaining that appearances belie reality with Medicare Advantage.

    The report questions some of the lack of detail available about Medicare Advantage additional benefits. But, the report overlooks the biggest point about Medicare Advantage plan benefits–they tend to be withheld, delayed and denied a lot more than people might imagine.

    People with Medicare (and everyone else) should be able to assume that the health plan they enroll in will cover all the medical treatments that they need. But, each Medicare Advantage plan has different prior authorization and specialty referral requirements, provider networks, and out-of-pocket costs. Each also has different proprietary rules for when they will pay for particular treatments and different rates of inappropriate delays and denials of care. All of these elements are part of the “benefit” package and can mean the difference between getting needed care and being forced to forgo it.

    Medicare Advantage plans often rely on proprietary algorithms to determine whether care is covered. They always make their own decisions about medical necessity that lead to their spending nearly 25 percent less on medical and hospital care than traditional Medicare. Medicare Advantage plans cover fewer services and fewer costly services than traditional Medicare. The Office of the Inspector General has found that Medicare Advantage plans engage in widespread inappropriate delays and denials of care and coverage.

    You can’t know what you need to know about a Medicare Advantage plan’s benefits before you enroll. The consequence: You can’t meaningfully distinguish among Medicare Advantage plans and you take a huge risk when you enroll. The Commonwealth Fund’s experts warn that people know little about the extra benefits Medicare Advantage plans offer–who gets them, how frequently, where, and at what cost to them. Putting aside additional benefits, people know little about the standard benefits Medicare Advantage plans cover–who gets them, when, how frequently, where, and at what cost to them. For example, Medicare Advantage plans must cover physical therapy, but they decide–with no meaningful oversight– when it is warranted, how often an enrollee will get treatment, from whom and the copay.

    The Fund highlights that nine in ten Medicare Advantage plans offer dental, vision and/or hearing benefits. But, it does not explain that narrow provider networks and high out-of-pocket costs keep a large number of people from taking advantage of these benefits. Rather, it says that Medicare Advantage “may have more limited provider networks or prior-authorization requirements for some services” as if this is simply a possibility when it fact it is the norm.

    On the issue of costs, the report explains that lack of standardization of costs in Medicare Advantage keeps people from knowing what their costs will be in different Medicare Advantage plans. The majority of people in Medicare Advantage plans are in HMOs, which have no out-of-pocket cap for out-of-network care, an issue which the report omits; and, out-of-pocket costs are a barrier to care for many low- and middle-income enrollees.

    Also of note and overlooked in the report: The cost of supplemental coverage in traditional Medicare, which has no out-of-pocket cap, tends to be far lower than the out-of-pocket cap for in-network care in Medicare Advantage. Moreover, we do not know typical out-of-pocket costs in Medicare Advantage because no independent reliable data is available.

    For sure, costs in Medicare Advantage can be very high for people whose medically necessary care is wrongly denied or not available in-network, potentially keeping people from getting needed care. For example, many Medicare Advantage plans do not have centers of excellence in-network that people may want to use for complex conditions. If enrolless can’t afford to pay out of pocket, they can be forced to forgo medically necessary care.

    Here’s more from Just Care:

     

  • Roundup: 2022 Medicare benefits and more

    Roundup: 2022 Medicare benefits and more

    We’re already three months into the new year. It seems time to put together all the information you might need to be on top of your Medicare health care costs and how to save money in 2022.

    What are your typical costs? Even with Medicare, health care costs can be quite high. The typical person spends more than $6,000 out of pocket on premiums, deductibles and coinsurance.

    What are the advantages of traditional Medicare and the risks of Medicare Advantage plans?  Unlike Medicare Advantage, traditional Medicare covers your care from most doctors and hospitals in the US without administrative obstacles. The key reason people do not opt for traditional Medicare is that they need to buy supplemental coverage to fill coverage gaps. because traditional Medicare has no out-of-pocket cap. (People with Medicaid and some people with retiree benefits from their jobs have that coverage.) Supplemental coverage can cost more than $2,000 a year. But, once you have Medicare supplemental coverage, your out-of-pocket costs are quite small. Medicare Advantage has an out-of-pocket cap, but depending upon the plan you choose, you could be responsible for as much as $7,550 out of pocket, posing a serious financial barrier to care. You can’t buy supplemental coverage to fill gaps in Medicare Advantage and generally are limited to coverage for care from a restricted network of doctors and hospitals.

    How to save money on care Medicare does not pay for?

    How to save money on drugs?

    How to save money on emergency care?

    Who to call with questions about Medicare? Avoid agents and brokers, many of whom profit from steering you to coverage that benefits them and might not benefit you. Instead, for free unbiased assistance, call your State Health Insurance Assistance Program or SHIP.

  • Coronavirus: Medicare should pay for at-home rapid tests

    Coronavirus: Medicare should pay for at-home rapid tests

    The conundrum: Older adults, even those who are vaccinated and boosted, are most prone to getting Covid-19. Yet, as of now, Medicare is not covering at-home rapid tests. Michelle Andrews reports for Kaiser Health News on why the Biden administration is requiring corporate insurers to cover these tests but not Medicare.

    The Biden administration now requires all corporate health insurers, including those offering coverage through the state health insurance exchanges, Medicaid and CHIP, to cover eight monthly at-home rapid coronavirus tests. But, people with Medicare do not have coverage for these tests. Medicare laws prevent Medicare from covering self-administered diagnostic tests, like the rapid tests, even though they are so important for containing the pandemic.

    As you likely know, the Covid-19 tests are hard to come by. They are not available at most pharmacies. And, when available, quantities tend to be limited. So, coverage of these tests might not help much for many people.

    Still, everyone, including people with Medicare, are able to get four free rapid at-home tests through the Biden administration. They need only go to  covidtests.gov. They also can get free tests community health centers. This web site has additional information on where to get free Covid-19 tests.

    Medicare covers rapid antigen and PCR testing if performed by a lab at not charge to patients. However, be prepared: In order to get more than one free test a year, you must have a doctor’s order.

    Here’s more from Just Care:

  • Biden simplifies access to Social Security and other government benefits

    Biden simplifies access to Social Security and other government benefits

    Justin Sink and Jennifer Jacobs write for Bloomberg on an executive order just signed by President Biden that makes it much easier for people to collect Social Security and many other federal government benefits. People over 65 are likely to benefit most.

    Today there are many programs to help Americans in need that are underused, such as the Medicare Savings Programs and Medicaid. Millions of people who qualify for these programs are not benefiting from them. Sometimes people don’t know about them. Other times people cannot overcome the hurdles needed to meet eligibility requirements.

    The Biden administration wants to eliminate or reduce these hurdles. It is developing on online tool to simplify the process for claiming Social Security benefits. It is also developing an online tool that makes it easier for people with Medicare to save money on their drugs and health care.

    In addition to these tools, the administration is developing other helpful tools for people in need. It is creating a single portal for service members to access benefits. And, it will create an online portal for people who have been affected by hurricanes, tornadoes and other natural disasters.

    People with low incomes will have access to a new tool that makes it easier for them to prove eligibility for food and other benefits.

    President Biden is focused in eliminating what he calls the “time tax.” This “tax” is the price people pay because of delays accessing benefits. There’s every reason for them not to have to wait, to get them immediately.

    In addition, the Biden administration is focused on making it easier and faster to get through security at the airport. (Already, I can tell you firsthand that at Miami International airport you no longer need to show your boarding pass at security. Your driver’s license provides all the needed information.)

    On top of all this, President Biden is pushing hard to have Congress pass the Build Back Better Act, which would expand the social safety net significantly, with an infusion of $1.75 trillion. It would reform the tax code, add new government programs and invest in projects to address climate change. Senator Joe Manchin has been resisting support of the legislation in its current form, holding up its passage.

    Unfortunately, several programs designed to help Americans during the pandemic are about to expire, including a freeze on student loan payments and expanded child tax credits.

    Here’s more from Just Care:

  • Social Security benefits often don’t cover even basic necessities

    Social Security benefits often don’t cover even basic necessities

    Lorie Konish writes for CNBC.com on the lack of funding in Social Security and the need to increase Social Security benefits. Millions of retirees are struggling to pay for basic necessities. Congressman John Larson argues that Congress should not kick the can down the road. How quickly will Congress act?

    President Biden advocated during his presidential campaign for raising Social Security checks to at least 125 percent of the federal poverty level. He also said that people with pension income should not see their Social Security benefits reduced. Representative Larson seeks to increase benefits.

    President Biden and Congressman Larson want to increase payroll contributions for people with high incomes to help offset the cost of raising Social Security benefits for people with low incomes.

    The average annual Social Security benefit today is $18,500. But, some people–predominantly women and people of color–receive as little as $12,880, less than the federal poverty level. And 40 percent of people depend heavily–if not exclusively–on Social Security income to cover their expenses.

    The Social Security Fairness Act would end the policy of reducing the Social Security income of people who have federal, state or local pensions. But, it would not increase benefits to people who did not also have federal, state or local pensions.

    While Democrats hold a majority in both the House and the Senate, it is razor thin. Time will tell how much the Democrats can accomplish.

    Here’s more from Just Care: