Monday, March 2, 2015

Traveling outside the U.S.? Know this about Medicare

You may be surprised to learn that Original Medicare does not pay for health care services or supplies you get outside the U.S. except in very limited situations. Medicare considers the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa to be a part of the U.S. 
On your cruise for example, Original Medicare may cover medically necessary health care services you receive on board the ship within the territorial waters adjoining the land areas of the U.S. However, Medicare will NOT pay for health care services you get when a ship is more than 6 hours away from a U.S. port when you receive the services, regardless of whether it’s an emergency.
Original Medicare will provide coverage for out of country travelers only if their situations meet very specific exceptions as outlined in your Medicare & You Handbook. If your circumstances do not match the allowable exceptions, you will be responsible to pay the full cost to the health care provider. If your situation matches one of the allowable exceptions, you still pay the coinsurance or copayments and deductibles you would normally pay if you received these services or supplies in the U.S.
Medicare drug plans (Part D) cannot cover prescription drugs you buy outside the U.S. so be sure to bring a sufficient supply of your prescription medications with you.
If you have a Medicare Advantage Plan or Medicare Supplement, you may be entitled to additional coverage for health care services you receive outside the U.S. Advantage Plan coverage may vary so it’s best to give your insurance agent a call and ask them about your coverage before you begin your trip.
While I make every effort to provide you with up to date, accurate information, these are general guidelines. Your situation or circumstances may be different. For answers to your life, health or Medicare plan questions please contact me at Mutsko Insurance Services, LLC, 440-255-5700 

Tuesday, February 24, 2015

Do you want Medicare to share info with your family?

By law, Medicare must have your written permission to use or give out your personal medical information. If you want to allow Medicare to give out your personal health information to someone other than you, (including family members) you need to let Medicare know in writing. 

For a copy of the appropriate form, go to www.Medicare.gov, click on “Forms, Help and Resources” and download the “Medicare Authorization to Disclose Personal Health Information Form.”  Instructions and mailing address are included with the form.

You will find detailed information on Medicare's privacy practices by going to medicare.gov/forms-help-and-resources/privacy-practices/privacy.html

Monday, February 23, 2015

Rumors and Alarming Information

Have you had this happen to you?

You’re reading through your email and one sets your nerves on edge.

The email looks and sounds official, but makes a startling claim. You believe it because it was sent by someone you trust. 

The problem is that the message may be FALSE.

I’ve recently received calls from frightened clients who have heard about dramatic changes in Medicare. One stated that “Obamacare” will not pay for surgery for people over the age of 70. Another claimed that patients age 76 and older must be admitted to the hospital by their primary care physicians in order to be covered by Medicare. Both are completely false.

There are no provisions in the health-care law that authorizes changes in care based on age. In fact, the Independent Payment Advisory Board which was established to help control the growth in Medicare costs is prohibited from rationing care, from making decisions about what benefits will or won’t be covered, and from increasing beneficiaries’ premiums or cost sharing.

If you receive emails with alarming claims about Medicare or “Obamacare,” you can do some detective work to check the validity of a story by looking it up on factcheck.org or snopes.com.

In the meantime, you have my commitment that I will keep you informed of any major changes that will affect Medicare, Medicare Advantage Plans and the Affordable Care Act (Obamacare.) Important updates will be reported on my website, in our newsletter and in articles I write for local newspapers and blogs.



Saturday, February 21, 2015

Got your shingles shot? Pneumonia vaccine? Medicare can help.


Vaccines play an important role in maintaining good health. But, not all vaccines are intended for everyone. Your first step should always be to check with your health care provider to find out what vaccines he or she recommends for you. Then, if you’re uncertain, call your insurance provider or Medicare office to see if you are following their rules for covering the cost of these vaccines.
 
Here are some general guidelines:

Flu shot
Medicare Part B pays for one seasonal flu shot with no co-pay. If you have a Medicare Advantage plan, you will not be charged for a flu shot if you visit an in-network provider.

Shingles shot
Medicare Part B does not pay for the shingles vaccine. However, all Medicare  Part D plans are required to cover the vaccine and its administration.
Part D plans have very specific rules about how to get the shingles vaccine. For example, a plan may only cover the injection if you get it in a health provider’s office and not a pharmacy. Some plans might also ask that you pay your doctor upfront for the vaccine and then seek reimbursement.
Ask your Part D plan about its specific coverage rules for the shingles vaccine.

Pneumococcal (pneumonia) vaccine
Medicare Part B pays for one pneumococcal vaccine with no co-pay. Under certain circumstances, Medicare will also pay for a second type of vaccine for certain high-risk individuals. Medicare Advantage members cannot be charged for the shot if they receive it from an in-network provider.

Your doctor or other health care provider may recommend services more often than Medicare covers. Or, they may recommend services that Medicare does not cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand the costs of your care.

Have more questions on Medicare? Join me for Getting Started with Medicare. We cover all the basics you should know before you enroll in Medicare. For a  complete list of dates and times, go to  www.mutskoinsurance.com/seminars.The class is for educational purposes only and no plan specific benefits or details will be presented.

If you have questions on insurance, please contact me at 440-255-5700.

Thursday, February 19, 2015

I have health insurance through work. Is there any reason to sign up for Medicare when I turn 65?

In most cases, you can delay enrolling in Medicare Part B if you are working and covered by your employer’s health insurance after age 65.

Under the law, people who work beyond age 65 for organizations with 20 or more employees must be offered the same health insurance benefits for themselves and their dependents as is provided to younger employees. You cannot be required by your employer to take Medicare or a different kind of insurance when you turn 65. Also, your employer cannot drop your coverage, raise your rates or offer you an incentive to enroll in Medicare and drop your employer-provided health coverage.
 
If you work for an employer with 20 or fewer employees, the rules are different. Your employer can exclude you from their group plan when you turn 65, making Medicare Part B a viable coverage option.
 
Regardless of the size of your employer, Medicare encourages those who qualify for Part A to enroll when they become eligible. In most cases, you will not have to pay a premium for Part A as long as you or your spouse contributed enough Medicare payroll taxes to qualify.
 
When you decide to retire, Medicare offers a special enrollment period to complete your enrollment without penalty. It is best to enroll before your employer sponsored plan ends so everything is in place when you retire.
 
Have more questions on Medicare? Join me for Getting Started with Medicare. In this class, we cover all the basics you’ll want to know before you enroll in Medicare. The class is offered at local colleges, libraries and community education programs throughout the area. You’ll find a complete list of dates and times at www.mutskoinsurance.com/seminars.The classes are for educational purposes only and no plan specific benefits or details will be presented.
 
For guidance on your specific insurance questions, please contact me at
440-255-5700.

Monday, February 2, 2015

Last call for Affordable Care enrollment

Deadline to enroll is February 15.

Time is running out to get signed up for health insurance for 2015. Open enrollment closes this Sunday, February 15. 

There's going to be a last minute rush to get signed up. If you intend to get insurance, call me today at 440-255-5700 so we can beat the deadline . . . and any last minute scrambling for your information.

If you are over age 26 you are required to have health insurance by February 15.The next open enrollment period does not begin until this fall. If you do not have insurance, you will be subject to penalties for being uninsured of $325 per individual and $162.50 per child or 2% of your income, whichever is more. 

Call me TODAY at 440-255-5700.

Wednesday, January 28, 2015

Do you know the difference between Medicare Supplements and Medicare Advantage Plans?

There are some very important differences.

When it comes to Medicare, you have a number of options including Original Medicare, Medicare Supplements and Medicare Advantage Plans. Here’s a short explanation of each of these:

Original Medicare is the federal insurance program for people age 65 or older, certain younger people with disabilities and people with End-Stage Renal Disease. While Original Medicare will cover a big part of your medical bills, it does not cover 100% of them. Your out-of-pocket costs will include deductibles, coinsurance and copays in addition to your premiums. These costs can add up quickly if you have a serious illness or medical condition.

Medicare Supplement Insurance (sometimes referred to as Medigap Insurance) is insurance coverage sold by private companies that you add to Original Medicare Part A & B. The purpose of a Medicare Supplement is to help pay the out-of-pocket costs not covered by Original Medicare.

A Medicare Advantage Plan is a government-approved alternative to Original Medicare. Advantage Plans are offered by private companies that contract with Medicare to provide all Part A & B benefits, plus additional benefits and services. With an Advantage Plan you will pay Part B premium plus the Advantage Plan premiums, often as low as $0. Prescription drug coverage may be included. With an Advantage Plan, your out-of-pocket costs will include copays, deductible and coinsurance. 

One of the most important benefits of Advantage Plans is that annual out-of-pocket costs are capped. Once you reach a pre-set limit, your plan will cover 100% of your hospital costs for the remainder of the year. There is no annual cap with Original Medicare.

There are a number of other issues to take into account before you decide which is right for you, including whether you travel out of the state or country, your prescription drug regimen and whether you need additional coverage for vision or dental care. Please contact me at 440-255-5700 or lmutsko@mutskoinsurance.com to go over your specific situation.