Saturday, October 2, 2010


TOPICMedicare and the Health Care Reform Bill

QUESTIONI’ve heard so many different things about how the new health care reform bill will affect my Medicare. Can you tell me what changes to expect?

ANSWERThere are no drastic changes taking effect and all changes benefit you.

There are no changes to your Medicare Parts A and B benefits.

If you have a Medicare Part D prescription plan and enter the coverage gap or “Donut Hole” this year (2010) you will receive a $250 rebate. The rebate will increase over the next several years and eventually the coverage gap will be eliminated in 2020.

The Annual Enrollment Period for Medicare Part D Prescription Plans and Medicare Advantage plans has been changed and extended for 2011. The Annual Enrollment Period for 2011 will begin October 15th and go through December 7th. The Annual Enrollment Period for 2010 remains the same, November 15th through December 31st. There will be a reduction in the number of plans offered and companies offering plans that begin January, 2011.

New plan models for Medicare Supplement Plans C and F will be developed and implemented by 2015.

Safeguards have been put in to place to prevent overpayments from the government to Medicare Advantage Plans as well as assure Medicare Advantage Plan members are receiving adequate care under these plans.

If you would like more details on any of the provisions of the Health Care Reform Bill that affect your Medicare benefits you may ask a specific question or request a scheduled time to talk with me by clicking Ask A Question.

SOURCE: , search for Publication 11467. If you are currently enrolled in Medicare, you should have received this publication in the mail.  

Tuesday, June 8, 2010

Medicare Part B Physician Services Fees

Physician Services Fees

QUESTION:  I have received bills from the doctors who treated me from a recent hospitalization. I thought my Medicare covered all but my deductible for hospital stays.

ANSWER:  Medicare Part A covers room, board, general nursing and miscellaneous services and supplies after you pay a deductible of $1,100(for 2010) per hospitalization. Your doctors’ fees or “physician services” are covered under Medicare Part B. Medicare Part B pays 80% of Medicare approved amounts after you pay a deductible of $155 (this $155 deductible is in addition to your Medicare Part A deductible). You are responsible for 20% of those charges. Each charge may not exceed the Medicare Part A deductible but this can add up pretty quick if you have had a serious illness or injury and been treated by several doctors.

Some Medicare Supplements would pay those approved charges that Medicare Parts A and B do not pay.

SOURCE:, Medicare and You 2010 Handbook; page 20

Monday, May 24, 2010

Medicare Part B Enrollment

Declining to Enroll in Medicare Part B

QUESTION: I am covered for health insurance on a group health plan. Do I have to enroll in Medicare Part B ?

ANSWER: No, but there could be some consequences to not enrolling, so do your homework!

Be sure you understand the benefits offered on your group plan. Make sure there are no gaps in your coverage.

The most critical concern comes should you ever leave or loose that group coverage. In most cases, once group coverage ends you will enter a special enrollment period that runs for eight months from the time your group coverage ends. Failing to enroll in Medicare Part B during the initial enrollment period or your special enrollment period may result in a penalty being added to your Medicare Part B monthly premium once you enroll.

SOURCE: ; search for publication 10043.

Thursday, May 20, 2010

Medicare and Other Health Insurance

Choosing Medicare or Group Health Coverage

QUESTION: I am retiring in a few months. I am covered on my wife’s group health plan through her job. Should I stay on my wife’s insurance or go on Medicare?

ANSWER: There are a couple important things to consider in making your decision.

First, determine if Medicare is primary or secondary to your insurance.

The number of people employed usually determines if Medicare is the primary insurance or the secondary insurance. Medicare is usually (but not always) secondary to insurance provided by businesses that employ a large number of people. Medicare is primary to insurance provided by small employers (less than 20 employees). If Medicare is secondary to your insurance, there is a good possibility you will be better off staying on your current plan. If Medicare is primary its probably not going to be the best value cost wise. Your employer’s HR department can tell you if Medicare is primary or secondary to your insurance.

Your premium cost is another consideration. Compare the cost of both options and the benefits provided. Medicare will cost, on average for a 65 year old, around $250 per month for Medicare Part B premiums, a Medicare supplement and a Part D Prescription Plan.

SOURCE: Medicare and Other Health Benefits: Your Guide to Who Pays First, A booklet available from The Centers for Medicare & Medicaid Services. I will be happy to e-mail you a copy of the booklet. Click the “Ask A Question” button and request “Who Pays First” Booklet.

Thursday, May 6, 2010

Medicare Part D Enrollment Periods

Enrolling in a Medicare Part D Prescription Plan

QUESTION:  My drug costs are going up. I would like to get a Medicare Part D Prescription Plan.

ANSWER:  Unless you meet one of the following conditions for an exception, you will have to wait for annual enrollment to enroll in a Medicare Part D Prescription Plan.

Those exceptions are:
- You are new to Medicare
- You recently moved outside your current plan’s service area
- You recently moved in or out of a nursing home
- Certain situations where you receive financial assistance in paying for your premiums
- You have lost or are losing employer coverage

Annual enrollment has been set by the healthcare reform bill to begin October 15, 2010 and run through December 7, 2010. THIS IS A CHANGE FROM PREVIOUS YEARS. Once enrolled, your plan will begin January 01, 2011.

Should you choose to enroll in a Medicare Part D Prescription Plan during annual enrollment and you don’t meet one of the above exceptions, you may be subject to a penalty added to your plan premium. This penalty is 1% of the monthly cost of the average premium in you geographic area, multiplied by the number of months you have gone without enrolling in a plan. For example, if the average premium is $36 per month, 1% of $36.00 is 36 cents. If you have gone without enrolling in a plan for 12 months, $4.32 ( .36 x 12 months ) may be added to your new plan premium each month.

SOURCE:, Medicare and You 2010 Handbook; pages 63-67.

Saturday, April 17, 2010

Medicare Part B Excess Premium

“Medicare Part B Premium”

QUESTION:  I am new to Medicare and recently received a bill from Medicare stating I owe an additional amount for my Medicare Part B premium. I don’t understand this bill.

ANSWER:  The standard Medicare Part B monthly premium for first time enrollees in 2010 is $110.50 per month. If your yearly income is more than $85,000, ($170,000 for a couple) then you will pay an increased premium based on your income. The Internal Revenue Service supplies your tax filing status and income information to the Social Security Administration each year. I imagine, based on the information you have given me, that your income information was updated and your income exceeded the standard premium guidelines for 2010, hence your bill for additional premium. Not a good surprise to find out you owe more money. The surprise factor might have been avoided by contacting the Social Security Administration early, up to three months prior to the month you turn 65. You may also appeal this increase, if you think it is in error, by contacting the Social Security Administration ( 1-800-772-1213 ).

SOURCE: ; select (#4) 2010 Part B Premium Amounts for Persons with Higher Income Levels. Also available in the Medicare and You Handbook.

Wednesday, April 14, 2010

“Welcome to Medicare” Physical Exam

QUESTION:  I turned 65 this month and am on Medicare. I called my doctor’s office about scheduling a physical exam but they told me Medicare might not pay for it. Is that right?

ANSWER:  In your case, NO, that’s not right. You are allowed a one-time preventive physical exam within the first 12 months that you have Medicare Part B. Because you just turned 65 and have Medicare, this physical will be covered. After this first time, Medicare does not generally cover preventive physical exams. Your doctor’s office is aware of this provision and may not have realized you were in your initial 12 months of having Medicare Part B.

You may have received a letter from Medicare advising you of this benefit. It might be a good idea to take that letter or print out the information about this physical exam from the website and take it with you to your doctor appointment.

I’ll be happy to send you a copy of the information. Just click “ask a question” and request Welcome to Medicare Physical info.

SOURCE:; search for One-time “Welcome to Medicare” Physical Exam.