Medicare Part D – Open Enrollment Ends Dec. 31- Don’t Miss It!

What’s all the fuss about the Medicare Prescription Drug Program?

Open enrollment started on November 15th and runs to December 31st. This is the time when anyone can change from one plan to another without paying a premium penalty. If your parent is already enrolled in a program, you may be wondering why you need to worry about this.

Medicare and health care advocates in every state are trying to get the word out that the rates are changing. There are major rate increases coming to the most subscribed plans, while some of the smaller plans are decreasing rates. Here in California rates in some plans are increasing by 31%.

All seniors should reevaluate their Medicare Drug plans to see if it still makes sense to stay where they are.  They can check Medicare’s website for help with choosing a plan that covers the specific prescriptions that they need at a cost they can afford. It is important to do it now before the enrollment period ends.

Can there really be that much of a difference?

Yes.

This year doing nothing could be very expensive for your parent. Monthly premiums could increase substantially. Or, you may discover that required medications are not covered by your plan. 

And, of course, there is the highly confusing problem of the “donut hole.” I don’t know who invented this “cute” name but it is a gap in coverage that can take a lot out of your pocketbook.  Here’s how it works:

You enroll in a plan and pay a monthly premium. You pay for your prescriptions until the deductible is reached. Once you have met the deductible of $265, the basic prescription drug plan will pay 75% of your drug costs and you will pay the remaining 25% until your total drug costs reach $2,400.

Then, you are responsible for 100% of your drug costs between $2,401 and $5,451.25. This gap in coverage, the “donut hole”, requires that you pay $3050.25 out of your own pocket before Medicare pays any more for you.

While this is happening, you are still paying your monthly premium. If you get to December 31st without going past $5451.25 prescription costs, there is no additional help. You start the new year meeting the deductible again.

Once your total drug costs reach $5,451.25, the basic prescription drug plan will pay 95% of your additional prescription costs and you will pay up to 5% (or a small co-payment) of your remaining drug costs for the rest of the calendar year.

Each insurance company that offers Medicare Drug coverage has the option to add benefits. Each company can also determine which drug they will or won’t cover. Some companies will pay for certain generic drugs during the coverage gap while others pay nothing.

There are so many plans, with different options,  that vary from state to state, that you need to evaluate before you sign up.  It’s just plain confusing!

Fortunately, every state has Health Insurance Counseling and Assistance Programs. You can find someone in your area to provide free counseling about the plans that would be right for you. You can attend workshops on choosing the best plan.

Before you contact the Health Insurance Counseling and Assistance Program in your area, it’s a good idea to figure out your total drug costs for the past year and make a list of your regular prescriptions so you can compare it with the list of approved drugs for each plan.

It’s work to do this, I know. It is so tempting to just stay with the plan your parent already has.

Don’t do it! Make time now for your parent (or yourself) to find the best plan that is available. You’ll be glad you did.

How To Help Your Aging Parents – Medical Billing

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By CK Wilde for 3GenFamily Blog

It wasn’t until Dad mailed me the collection notice that I realized he was losing his ability to track and pay his medical bills. He had complained during our phone chats on several occasions that the hospital had messed up his billing. They kept phoning him to get him to pay his bill.

He insisted that he had paid the bill– $124.34. The hospital billing staff asked him to send a copy of the cancelled check. But, Dad adamantly refused to go through the work of getting the cancelled check. It was the hospital’s mistake for losing the payment.

I was dumbfounded by his vehement refusal to deal with a straightforward problem. Ironically, in his younger days, my father had been a stickler for financial details. As a young adult, I would have gotten a scalding rebuke for failing to take action on something like this.

His unusual behavior was a warning that his dementia was beginning to impair his judgement, while his anemia left him so fatigued that even a trip to the bank seemed like an overwhelming task. I didn’t recognize it for what it was. I thought he was just being obstinate.

Being 3000 miles away, I tried to get my father to read his checkbook to tell me the check number for that hospital bill. Then, I went online to see if that check had cleared. The check number he gave me had been cashed but it wasn’t anywhere near the correct amount for the bill. I looked for another check with the amount $124.34. I didn’t see any in that month that matched.

I told my father that the only thing to do was pay the bill. He refused. No amount of reasoning worked. So I made a deal with him — I would pay the bill and he would reimburse me.

Grudgingly, he agreed.

My father had already signed a power of attorney giving me the authority to handle his finances and one for health care, too. So, I began learning first hand about Medicare, supplemental heath coverage and prescription drug benefits.

Dad had to sign a form to allow me to access his online medical insurance claims and to speak for him to the insurance representatives. I left instructions for them to phone me first since Dad’s hearing was poor.

I paid the bill. Dad eventually reimbursed me. The collection notices and phone calls stopped.

It wasn’t until a couple of months after my father’s death that I found the entry in his checkbook. Dad was right all along. He had paid the hospital within days of receiving the bill. But, he was so certain he remembered the correct check number that he never looked it up. I was too far away at that time to double check it myself.

The story doesn’t end there.

Another billing mistake almost happened today. I started to pay a doctor’s bill for my father’s estate and discovered that it was more than it should have been.

The doctor is supposed to bill Medicare first. After Medicare determines what it will pay, the doctor sends the bill to the supplemental insurance.

Only after the supplemental insuror has completed the claim, should the doctor bill the patient for any balance due. But this latest bill didn’t show any payment from the supplemental insurance, so I checked the online claims information.

The supplemental insuror had rejected the claim because documentation was missing. Well, sometimes paperwork does get lost. You need to follow up to get another copy sent.

I called and spoke to the medical billing person in the doctor’s office. She pulled up the records on her computer. She stated that my father owed this amount of money. I asked if she sent it to the supplemental carrier.

She said, “Yes.” And promptly read my father’s account number for the insurance.

I asked her, “Why do the online records say your claim was rejected for lack of documentation? The amount you are billing doesn’t appear to include any payment from the supplemental insurance.”

People do make mistakes (including me). Where there is an honest mistake, you can hear the surprise in the person’s voice. “How did that happen?” Sometimes, they laugh self consciously.

There was no surprise in this woman’s voice. There was no admission of a mistake. “We understand your concern . . . we will make sure it gets handled.” She was billing my Dad for the entire amount rather than resubmit the bill to the insuror with the information that was needed. Efficient but totally lacking in ethics.

I wish I could say this was the only mistake I have found. Unfortunately, billing mistakes have happened so many times in the past 9 months of settling my father’s estate.

How many elderly patients pay too much because they don’t have the patience or focus to follow up?

If you have been wondering how you can help your aging parents, discuss helping them with tracking medical bills. Have your parents collect everything (bills, medicare statements, supplemental insurance statements) in a folder. Set up online access to insurance if its available. Make a regular date to go over the bills each month before anyone writes checks.

You may need to make phone calls for your parents. Be aware that privacy rules prevent the insurors from talking with you about your parents’ account unless your parents have given permission in writing.

You’ll be providing peace of mind and possibly saving money for your parents, too.