Monday, April 27, 2015

Ambulance service? Helicopter transport? What will Medicare pay?

Medicare helps pay for emergency transportation when you've had a sudden medical emergency, and your health is in serious danger because you cannot be safely transported by a car, taxi or other means.

For example, Medicare covers emergency ground ambulance services to a hospital, critical access hospital (CAH), or skilled nursing facility (SNF) when you’re in shock, unconscious, bleeding heavily or you need skilled medical treatment during transportation.

Medicare may also pay for emergency ambulance transportation in an airplane or helicopter if your health condition requires immediate and rapid transportation that cannot be provided by ground services. For example, a life threatening car accident.

Medicare will only cover ambulance services (ground or air) to the nearest appropriate medical facility that’s able to give you the care you need. Coverage for emergency transportation depends on the seriousness of your medical condition and whether you could’ve been safely transported by other means.

Non-Emergency Ground Transportation. Medicare may provide limited, medically necessary non-emergency ambulance transportation if your situation meets the following three conditions: (1) ambulance transport is needed to obtain treatment or diagnose a health condition (2) other transportation would endanger your health and, (3) you have a written order from your doctor stating that ambulance transportation is necessary because of your condition.
For each type of covered ambulance transportation, Medicare pays 80% of the Medicare approved amount after you meet the yearly Part B deductible. Medicare's payment may be different if you get services from a hospital-based ambulance company. All ambulance providers must accept Medicare assignment, meaning they must accept the Medicare-approved amount as payment in full.

Lack of access to alternative transportation alone will not justify Medicare coverage. Medicare will never pay for ambulette services (a wheelchair-accessible van that provides non-emergency transportation for people with disabilities.)

If you have a Medicare Advantage Plan, Supplement or other Medicare health plan, what you pay and the rules for ambulance coverage may be different.

For more information on Medicare, join me for my class, Getting Started with Medicare where we cover all the basics. You’ll find a complete list of dates and times at classes are for educational purposes only and no plan specific benefits or details will be presented. I hope to see you there.

Monday, April 20, 2015

Credit monitoring for Anthem customers

Earlier this year, Anthem discovered that the personal information of many of their customers had been accessed by cyber attackers. As a fellow Anthem customer, I share your concerns, but I want to assure you that Anthem has the situation well under control. Anthem responded immediately, strengthening their security measures and arranged the following steps to protect your identity.

Anthem has engaged AllClear ID to protect the identity of their customers for two (2) years at no cost to the customers. If you are or have been an Anthem customer, the services of AllClear ID are automatically available to you with no enrollment required. 

AllClear SECURE is standing by if you need identity repair assistance. If a problem arises, simply call 1-877-263-7995 and a dedicated investigator will do the work to recover any financial losses, restore your credit and make sure your identity is returned to its proper condition.

AllClear PRO offers additional layers of protection including credit monitoring and a $1 million identity theft policy. In addition, for a child under age 18, AlllClear ID ChildScan identifies acts of fraud against children. You will need to enroll to use the AllClearPro services. For more on this, visit and click on the AllClear ID link.

As a further safeguard, do not open emails that are designed to appear as if they are from Anthem and contain a “click here” link for credit monitoring. These emails are NOT from Anthem. Anthem is not calling members regarding the cyber-attack and is not asking for credit card information or Social Security numbers over the phone.

Please contact Anthem at 877-263-7995 if you have additional questions concerning the security of your personal information.

Friday, April 17, 2015

Check out my newsletter today

Our April Newsletter was posted today on our website. Please click here to read it online and learn more about steps being taken by Anthem concerning their security breach, my plans to help seniors with caring for their pets, the Vetsnet program and more.

While you're there, sign up to receive future issues via email.

Monday, April 13, 2015

Do you know all you should about Medicare?

Do you know what's covered and what's not?  

Do you know the difference between Medicare and a Medicare Advantage Plan?

We'll cover these and so many other important topics at my class, Getting Started with Medicare, a 90 minute interactive workshop. It is especially helpful for people turning 65, those going on Medicare for the first time or anyone who wants to make the most of their Medicare benefits. 

Plan now to attend. For a complete list of upcoming seminars, please visit our website at   

Preregistration is required. Please register by calling the phone number listed for the class you wish to attend. These events are only for educational purposes and no plan specific benefits or details will be shared. Some venues charge a nominal fee. 

Thursday, April 16, 2015
Polaris Career Center – Berea High School
6:30 pm – 8:30 pm
165 E. Bagley Rd., Berea, OH 44017

Monday, April 20, 2015 
Lorain County Community College, Elyria Campus
6:00 pm – 8:30 pm
1005 N. Abbe Rd., Elyria, OH 44035

Wednesday, April 22, 2015
Hudson Community Ed & Rec
6:30 pm – 8:00 pm
2440 Hudson-Aurora Rd., Chagrin Falls, OH 44022

Monday, April 27, 2015
SELREC – Brush High School
7:00 pm – 8:30 pm
4875 Glenlyn Road, Room D105, Lyndhurst OH 44124

Tuesday, April 28, 2015
Kenston Community Education-Middle School
6:30 pm – 8:00 pm
17425 Snyder Rd., Chagrin Falls, OH 44023
440-543-2552 x 2566

Tuesday, May 5, 2015
Mandel JCC
6:00 pm – 8:00 pm
26001 South Woodland, Beachwood, OH 44122

Thursday, May 7, 2015 
Lorain County Community College, Lorain Campus
6:00 pm – 8:30 pm
102 Erie St., Lorain, OH 44035

Monday, May 11, 2015
Willoughby Hills Library
6:00 pm – 8:00 pm
35400 Chardon Rd., Willoughby Hills, OH 44094

Tuesday, May 12, 2015 
Chagrin Falls Community Education
7:00 pm – 8:30 pm
342 E. Washington St., Chagrin Falls, OH 44022

Thursday, May 14, 2015
Polaris Career Center - Strongsville High School
6:30 pm – 8:30 pm
20025 Lunn Road, Strongsville, OH 44149

Tuesday, May 19, 2015
Lorain County Community College – Brunswick Campus
6:00 pm – 8:00 pm
50 Pearl Road, Brunswick, OH 44212

Thursday, May 21, 2015
Andover Library
2:00 pm – 4:00 pm
142 W. Main Street, Andover, OH 44003

Friday, April 10, 2015

Yikes! Cost of penalties for no health insurance are going up in 2015

We don’t have health insurance but I was still shocked when my tax guy told me that we have to pay a penalty because we don’t. He also said that the fines for not having health insurance are bigger next year . . . $325 per adult, $162.50 per child or 2% of income up to $975 per family. 

What can I do now?

You, like many other Americans, are learning that there is a cost for not having health insurance. Your tax preparer told you the correct amount of the fines you will pay if you do not have creditable health insurance coverage or an exemption for 2015:

$325 per adult
$162.50 per child
or 2% of income up to $975 per family

The good news is that the Center for Medicare and Medicaid Services (CMS) is providing a Special Health Insurance Enrollment Period through April 30, 2015 that is open to those who did not have health coverage in 2014 and, as a result, will have to pay a penalty when they file their 2014 taxes. There was concern that many people like you are learning only now about the tax penalty when you file your taxes, long after the Affordable Care Open Enrollment closed. Without the special enrollment period there would be no way for you to obtain health insurance and avoid another bigger penalty next year.

You are eligible to enroll before April 30 if:
·         You didn't know until after Open Enrollment ended that the health care law required you and your household to have health coverage, or you didn’t understand how the requirement would impact you and your household
·         You owe or have paid the fee for not having coverage in 2014
·         You aren’t already enrolled in 2015 coverage through the Health Insurance Marketplace
            Those who do not have an exemption and go without health coverage in 2015 will be subject to penalties noted above.

If you want to learn how you can take advantage of this special enrollment period for health coverage, please give me a call at 440-255-5700 or email me. I will review all your options with you and find the right insurance plan to fit your needs and budget. For more information, visit our website at

Wednesday, April 8, 2015

Don't agree with a Medicare decision? File an appeal

If you disagree with a coverage or payment decision made by Medicare or your Medicare Advantage plan you have the option to file an appeal. You can file an appeal if you are denied one of the following:

  • Your request for a health care service, supply, item or prescription that you think you should be able to get.
  • Your request for payment for health care service, supply, item or a prescription drug you already got.
  • Your request to change the amount you must pay for a health care service, supply, item, or prescription drug.
You can also appeal if Medicare or your Advantage plan stops providing or paying for all or part of an item or service you think you still need.

Where to begin?

If you are thinking about filing an appeal, talk to your doctor, health care provider or supplier. Ask them to provide any information that will support your appeal. Read your plan materials or contact your insurance agent or plan for details about your appeal rights. Medicare and all companies that provide Medicare Advantage plans are required to help you file an appeal.

The appeals process has 5 levels. If you disagree with the decision made at any level of the process, you can generally go to the next level. At each level, you'll be given instructions in the decision letter on how to move to the next level of appeal.

You have the right to appoint a representative to help you file an appeal.
Your representative can be your insurance agent, a family member, friend, attorney or doctor or anyone you choose to act on your behalf. One of the many benefits of having an insurance agent is having someone to act as your advocate. Your insurance agent knows you, your plan and the process for filing an appeal and provides this service at no additional charge.

If you have questions about any part of the appeal process, call 1-800-MEDICARE ((1-800-633-4227) or go to for more information.