The 2021 Medicare & You Guidebook is available and you can download it here.
When downloading the digital version, it will open in your Acrobat document reader, or in your browser. A tip for finding what you want, instantly, is to hit the Control and F button at the same time on your keyboard. This will bring up the FIND feature in your reader.
Then, type in a word or phrase you are looking for. The reader should show you how many instances of that word or phrase exist in the entire book and you can click the down arrow to move from the first to the second, and so on.
This is how we zero in on things such as the Special Election Periods, Trial Right scenarios, Guarantee Issue Periods, and more.
The 2021 Medicare & You book is slightly less controversial than those in the past. CMS (Center for Medicare and Medicaid Services) has been leaning more and more toward promoting Medicare Advantage plans and this bias has started to come through in their Medicare guide book.
In 2018, the non-profit Medicare Rights Center, in a joint letter with the Center for Medicare Advocacy and Justice in Aging, wrote a letter to the Administrator of CMS urging corrections in the proposed guidebook for 2019.
They stated, “First, in several places, the Handbook suggests that Medicare Advantage is the less expensive alternative for beneficiaries. This is an overstatement. There are many variables determining whether enrollment in a Medicare Advantage plan may be more or less expensive for any particular Medicare beneficiary…. The repeated suggestion that Medicare Advantage can save beneficiaries money does not fairly represent these realities.”
The letter went on to point out that various descriptions throughout the book give the false impression that the benefits of Original Medicare are the same as the benefits in Medicare Advantage.
When the guidebook was first read by many of our clients, they found it to be confusing, contradictory, and inaccurate to their experience with Medicare. This again points to the benefit of using an independent Medicare professional who can interpret the realities of Medicare and how it works in the real world. This only comes from experience.
We are here to help and our service is always free. 1-800-729-9590
Can you use your Medicare Supplement plan at the Mayo Clinic? Yes. Depending on which Medicare Supplement plan letter you have, you may or may not be responsible for paying “Excess Charges”.
The most important question, then, is not whether or not they accept Medicare, as we cover in the video, but whether the specific procedure that you wish to have done is covered by Medicare.
Medicare Supplement plans only supplement what is APPROVED by original Medicare. If Medicare approves the procedure and pays their 80%, the Supplement plan, also known as Medigap, will fill in the remaining portion, subject to your deductible and possible co-payment, depending again on which Medicare Supplement plan letter you signed up for.
In this video, we go over the details of how Medicare and Medicare Supplements are accepted at the Mayo Clinic. Also, for those on a Medicare Advantage plan, you must look very closely at your plan and communicate with Mayo on it, as these private plans are most often not accepted at centers of excellence like the Mayo Clinic.
According to the internet archive, the last time the Ways and Means Committee report on AARP was available at its location on the congressional website was December 25, 2018. Some time shortly thereafter, before the new year of 2019, the file has been removed.
A Google search of the file name will show that it has been referenced in thousands of other websites and news reports, however, a click on those links, pointing back to the Ways and Means Committee website now shows, “FILE NOT FOUND.”
As the original report from 2011 was newsworthy and enlightening, the Senior Savings Network has decided to post the original report here, in its entirety. See the original report:
Until it is removed, too, here is the video talking about the report, from the Ways and Means Committee’s Youtube channel:
Medicare Advantage Practics Draw Scrutiny from HHS
The Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) has published the findings of an investigation into claims denials for members of Medicare Advantage Plans. The report concluded that there is a profit motive, stating specifically, “A central concern about the capitated payment model used in Medicare Advantage is the potential incentive for MAOs to inappropriately deny access to services and payment in an attempt to increase their profits.”
Medicare Advantage plans are becoming a popular choice for seniors as they enter Medicare years (65 year’s old) and often has a monthly premium of $0. The monthly premium is subsidized by the government’s payment to private insurance companies who then manage the care the senior receives. The incentive to closely scrutinize what is approved for care is what amounts the insurer’s profit – that is, the difference between the government’s monthly pay for the senior’s care, at a fixed rate, versus the actual cost of care provided.
Most seniors joining Medicare Advantage plans are aware that there are usually network limitations and restrictions on providers where they can seek treatment. This is the most recognized trade-off for a very low, or even zero monthly premium in comparison to original Medicare and a Medicare Supplement, which pays what Medicare does not pay, typically 20% of medical costs. Unlike original Medicare, however, the restrictions put in place on most Medicare Advantage plans go beyond merely agreeing to abide by a network of contracted providers and having co-payments when services are utilized.
The OIG study found that during 2014-2016, Medicare Advantage plans overturned 75% of their own preauthorization and payment denials, overturning approximately 216,000 denials each year. Even more, denials were overturned when the beneficiaries went further into the appeals process, beyond the first stage. The report states, “The high number of overturned denials raises concerns that some Medicare Advantage beneficiaries and providers were initially denied services and payments that should have been provided.”
The alarming conclusion of this study points to the fact that only 1 percent of denials were appealed to the first level during the examined period. This means that 99% of denials to beneficiaries went unchallenged and those services were just not provided. When 75% of appeals were ultimately won by the beneficiary, it would appear that most beneficiaries are not aware of the success rate or the appeals process at all.
At the Senior Savings Network, seniors are shown the options available to them when they are joining Medicare. These options include original Medicare and a Supplement, which offers the freedom of choice to visit any doctor and any hospital that accepts Medicare; or a Medicare Advantage program with its inherently unique set of network and procedure conditions. The Medicare Supplement route means that the senior can travel from coast to coast, without restriction, and there are no significant deductibles, pre-authorization procedures, or maximum out of pocket concerns when seeking the care their chosen physician feels is best for them, as long as the procedure is deemed medically necessary by Medicare.
While the Medicare Advantage network can be searched to see if the beneficiary’s doctor is within the network, that network can still change during the plan year, as doctor and hospital contracts are not always calendar-year contracts and providers can choose to leave the networks. A provider leaving the Medicare Advantage plan in the middle of the plan year does not provide the beneficiary with a Special Election Period to change plans. In that scenario, the beneficiary must stay in the plan and simply choose a different plan-authorized doctor or hospital. A recent story from the Mississippi Clarion Ledger on October 29, 2018 “Hospitals Dropping Medicare Advantage agreements leaves patients in lurch” reported, “North Mississippi Health Services CEO Shane Spees recently told the Northeast Mississippi Daily Journal that only 4 percent of his company’s patients use Humana Medicare Advantage, but they account for 85 percent of payment denials for all payers.
The benefits within a Medicare Advantage plan, as announced at the beginning of the year are fixed for the duration of the calendar year, but not beyond that one-year period. This means that a member of a specific Medicare Advantage plan who signed up for a set premium (or no premium), after finding out that their favorite doctor is in the network might find that the next year the premium, co-payments, and provider networks have changed. This is announced in their “Annual Notice of Change” received by the members in October which outline what changes will happen to their program on the next January 1.
Conversely, with original Medicare and a Medicare Supplement plan, the benefits of the Supplement are guaranteed renewable. This means that the benefits are guaranteed not to change in the future as long as the premiums for that plan continue to be paid. This provides more certainty with regard to the future benefits of their chosen plan. While the monthly premiums can change, the benefits and freedom to choose any Medicare doctor or hospital from coast-t0-coast, does not.
In their audit, the OIG recommends that the Center for Medicare & Medicare Services (CMS) “enhance their oversight of Medicare Advantage contracts, including those with extremely high overturn rates and/or low appeal rates, and take corrective action as appropriate.” It was also recommended that CMS implement strategies to communicate with beneficiaries in a clearer way about the appeals process available to them. The Medicare Advantage appeals process can be quite daunting and has various layers of complexity.
Seniors in North Carolina are facing more challenges with regard to Medicare Advantage plans.
Many are finding that Medicare Supplement (Medigap) is a far better way to go than the ever-shifting sands of Medicare Advantage, as shown in a recent story by the Charlotte Observer, which showed that over 57,000 North Carolina seniors are losing their Medicare Advantage plans in 2015.
Seniors on Medicare Supplement plans are guaranteed renewable, with the same benefits they signed for, for life. The benefits on Medigap plans cannot be changed, and this means stability.
Seniors who are 75, 80, 85 years old should not have to compare nuances of changing co-payments, doctor networks, and new requirements that are constantly changing on Medicare Advantage plans each time the one-year contract expire.
Seniors looking for a second opinion on their Medicare plans should call the Senior Savings Network at 1-800-729-9590.
This video seeks to answer the question, based on a letter written in on someone with cancer that wants to go to MD Anderson Cancer center, yet had a Medicare Advantage Plan.
Medicare Advantage can limit your cancer coverage. Be sure to check the Medicare Advantage coverage on chemotherapy. Often, it is only 80{57afd372ef552335ba870edf523b8e4a4ddf98dad7cf21c72091c800f1bfac05} of the cost. That’s no better than just being on Medicare, because Medicare Part B already covers just 80{57afd372ef552335ba870edf523b8e4a4ddf98dad7cf21c72091c800f1bfac05} of the cost of chemo.
A Medicare SUPPLEMENT, however, is different than Medicare Advantage. The Medicare Supplement fully covers cancer and cancer treatments.
All of the Medicare Supplement plans are standardized. There are no hidden tricks or small print. They’re accepted by every doctor that accepts Medicare.
Obamacare will have a significant impact on Medicare Advantage, starting in the 2014 plan year.
Seniors should be cautious when considering staying on their existing Medicare Advantage plan, as many of the plans now have a different (higher) maximum out-of-pocket costs. Many plans have gone from $3,400 maximum out-of-pocket per year up to the max: $6,700 out-of-pocket.
This means if you have a catastrophic health event that requires multiple hospitalizations, doctor visits, physical therapy treatments, etc. these costs can quickly add up to the maximum, $6,700 before you are done with the cost sharing on the Medicare Advantage plans.
If this health event happens late in the year, you can see the reset of the $6,700 limit on January 1, meaning that you are on your own to hit that limit again, fully, before the health plan takes over all costs.
See these videos on the impact of Obamacare on Medicare Advantage:
These are specific ways that Obamacare will impact seniors on Medicare:
Seniors seeking to drop Medicare Advantage should first check on Medicare Supplement quotes before returning to original medicare.
This is easily done by visiting the Senior Savings Network, a free service to seniors that compares all available Medicare Supplement plans to find the best deal in the market.
