Aug13

CMS to Allow Medicare Advantage Plans to Restrict Access to Drugs Covered Under Part B

When a person has Part B of Medicare typically any medication that is administered at the doctor’s office, or in the hospital, are covered by Medicare. This also was the case for Medicare advantage plans, aka Part C of Medicare. However, per CMS this is about to change for Medicare advantage plans. The new rule will allow Medicare advantage plan providers to not cover certain medications administered by a provider(doctor/hospital). For Example: Drugs used in durable medical equipment, anti-rejection drugs for people who had Medicare when they got a transplant, and some chemotherapy agents, as well as drugs that are both supplied by and administered by a provider. Here is a nice piece by Casey Schwarz of the Medicare Rights Group filing us in on the changes.

CMS to Allow Medicare Advantage Plans to Restrict Access to Drugs Covered Under Part B

Casey SchwarzAugust 9, 2018

This week, the Centers for Medicare & Medicaid Services (CMS) announced that next year, Medicare Advantage (MA) Plans will be able to limit options for people who get Part B-covered drugs by using many of the same tools plans currently use in Part D. The Trump administration argues that this will enable plans to negotiate better prices for the “preferred” medications – those that the plan will cover as a first-line treatment. Other drugs will only be covered if a person tries the preferred medication first and it doesn’t work or causes them harm, also known as step therapy.

Until now, MA plans were not permitted to place this type of restriction on medications covered under Part B. Part B drugs include drugs used in durable medical equipment, anti-rejection drugs for people who had Medicare when they got a transplant, and some chemotherapy agents, as well as drugs that are both supplied by and administered by a provider. Plans that have both MA and Part D coverage will be permitted to create combined step therapy requirements where a preferred Part B-covered medication must be tried before a non-preferred Part D-covered treatment.

These restrictions, which are common in Part D plans, can make comparing plans more difficult. While CMS requires plans to announce to enrollees that they intend to use this flexibility in the Annual Notice of Change, they do not require plans to send personalized or targeted notices to people currently taking, or who have a diagnosis that might require, the affected medications. Medicare Rights is concerned that it will be especially challenging to compare plans where Part B step therapy is used unless there are updates and improvements to the Medicare Plan Finder tool.

Aug6

Does Medicare Cover Chiropractic or Acupuncture?

By Tom Matteson - blog

Medicare does cover chiropractic care, but does not cover acupuncture at this time. Here is a great article by Medicare FAQ that jumps into the topic with both feet.

Often times, in the weeks following an injury or when pain becomes too much to deal with, patients will seek the support of a chiropractor, or acupuncture specialist. Both acupuncture, and chiropractic care, were created to treat moderate to high level pain and discomfort.

However, one concern that always comes to mind is out-of-pocket expenses, which can definitely add up. So naturally, this has Medicare beneficiaries wondering just how much of these treatment costs are covered by their Medicare plan, if covered at all.

Chiropractic Care vs. Acupuncture

Like stated above, both of these methods of treatment were created to relieve pain or discomfort. Before looking into the cost difference between the two, you may consider what each form of treatment entails. It is best to look further into both before deciding on the best option for you.

Chiropractic

Chiropractic care is a very hands-on process. For chiropractic treatments, the physician uses his or her hands to adjust the patients muscles and joints. This is done to generate better movement to tight muscles and gain better usage of affected joints.

Neck pain, back pain, headaches, or anything that may cause a disruption in the nervous system, are usually a common reason patients seek chiropractic care. Patients who receive this form of treatment typically feel results immediately after leaving the appointment.

However, chiropractic care does come with a few possible risks. Amongst them, are risks of having a stroke or unintentionally adding pressure to the injury. The risk is low with certified practitioners, but with constant shifting of muscles and joints, you could possibly end up being be more susceptible to injury.

Acupuncture

Unlike chiropractic care, acupuncture is not as much of a hands-on method for reducing pain. Acupuncture is done by inserting needles into the surface of the skin. This is a practice that will stimulate certain parts of the body to alleviate pain, and can also help to treat several other medical health conditions.

In fact, several acupuncture patients have reported that this treatment has helped cure their depression, anxiety, and several other mental and physical issues. Again, like chiropractic care, acupuncture does come with some low risks. Acupuncture risks can include bleeding or bruising from the needles, infection, and in some cases can stimulate labor for pregnant women.

If you are considering acupuncture treatment, just be sure you choose a licensed practitioner.
It is important to note that, while both are proven effective and useful options, there are differences in what Medicare plans will cover.

Does Medicare Cover Chiropractic Care

Yes, Medicare covers chiropractic services, if they are medically necessary. Luckily, Medicare currently has no cap on how many times you can see a physician for necessary chiropractic appointments.

If you are enrolled in Medicare Part B, 80% of the cost for chiropractic care will be covered by Medicare. If you have the Original Medicare, and don’t have any other additional insurance, you are responsible for paying your Part B deductible, and a 20% coinsurance for your appointments.

You may also be required to pay for any additional tests that are ordered by your chiropractic physician. This can include, x-rays, any extra physical or massage therapy, and even, coincidentally, acupuncture. The specific amount of money owed will depend on several factors, including:

Any other insurance you have.
The facility that you seek care from.
How much your individual doctor charges.
Where you get your tests and services.

Do not go into this treatment with no knowledge of the average estimate of payment. Talk to your doctor, and get all of your questions answered before committing to a certain recommendation they’ve made.

Is Acupuncture Covered by Medicare

Unfortunately, no. At this time, acupuncture specifically is not covered by your Original Medicare plan. Medicare typically does not cover services that are not considered medically necessary. Medicare will cover other types of therapy, like physical, occupational, or speech therapy. However, acupuncture is not part of those types of therapy yet.

If you should decide to seek the help of a professional acupuncturist, it is important to be quoted on prices for the entire process. Patients typically get the initial first visit cost, and tend to forget any additional costs for follow up appointments or extra care.

Find out how many appointments you’ll need to attend. If there are any additional costs, and how often you’ll need to attend follow-up visits.

Acupuncture and Chiropractic Coverage with Medigap

What is Medigap? Medigap provides you with any additional coverage you may need when paying for your medical needs under Medicare. So are acupuncture and chiropractic care part of the additional coverage?

At this time, Medigap plans do not cover any costs that deal with acupuncture.
While acupuncture is not covered by Medigap, chiropractic care is covered by Medigap. In fact, Medigap Plan C and Plan F cover 100% of your Part B deductible, on top of your 20% coinsurance.

If you combine your Medicare and Medigap plans, any medically necessary chiropractic work will be completely covered, at no cost to you.

Does Medicare Advantage Cover Chiropractic and Acupuncture?

When it comes to Medicare Advantage plans, we hit a bit of a grey area with coverage for chiropractic care or acupuncture treatment. Each Medicare Advantage plan is different from the next. So one plan may offer high fees and less benefits, while another offers low fees and more benefits.

At this point, it may be tough finding a Medicare Advantage provider that covers acupuncture. It may be worth looking into though, if it is something you truly feel is a priority for your health.
The same answer goes for chiropractic services. Although it is usually much easier to come across, the prices and plans will vary.

Jul24

Medicare Groups Publish Paper To Include Oral Health In Medicare Part B

By Tom Matteson - blog

The Center for Medicare Advocacy is pushing Medicare to include dental care in Medicare Part B. One of the big things Medicare has not covered in the past was dental. A diverse group of Medicare advocates have published a white paper that tackles the subject head on.

White Paper Stresses Importance of Oral Health Care Benefit for Older Adults

FOR IMMEDIATE RELEASE

Contact: Matthew Shepard

July 19, 2018 – Washington, DC – The Center for Medicare Advocacy, along with a diverse group of partners, released a white paper, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care. This white paper is an interprofessional, collaborative effort written and published by leaders in the consumer, healthcare and dental fields, including the American Dental Association, Center for Medicare Advocacy, the DentaQuest Foundation, Families USA, Justice in Aging, Oral Health America and the Santa Fe Group.

With an expected 72.1 million seniors living in the United States by 2030, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care, examines the need for oral health care to be integrated with, and elevated to, the same importance as the rest of health care in Medicare. Says Center for Medicare Advocacy Senior Attorney Wey-Wey Kwok, “Medicare’s dental exclusion is misguided given the clear connection between oral health and overall health. The time has come to include an oral health benefit that covers preventive services, disease management, and necessary procedures for all Medicare beneficiaries.”

Medicare plays a key role in providing health and financial security for 59 million older people and younger people with disabilities. However, traditional Medicare does not include coverage for routine oral health care like checkups, cleanings and x-rays, or restorative procedures like fillings or bridges, tooth extractions and dentures. The Center for Medicare Advocacy is committed to working with our many dedicated partners to advance access to quality oral health care for Medicare beneficiaries by adding an oral health benefit into Part B, which will improve overall health and quality of life for millions of older adults and people with disabilities.

An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care looks at many aspects of adding an oral health benefit to Medicare, including medical necessity, costs and the need for legislative changes. Top findings include:

70 percent of all Medicare recipients lack or have limited dental insurance and fewer than half access dental care each year.
Cost is the number one reason that older adults have not gone to the dentist in the past year.
Integrating dental coverage in Medicare would close disparities in dental use and expense between the uninsured and insured and among older adults with few financial resources and limited oral health education.
Surveys show that consumers widely support adding oral health coverage to Medicare and prioritize two categories of care: checkups and pain treatment.
71.2 percent of dentists agree that Medicare should include comprehensive dental benefits and a majority indicated they were willing to comply with typical Medicare practice requirements.
The ADA recently commissioned a study that analyzed the cost structure for various dental benefit designs within Medicare. This study estimated that a comprehensive benefit without dollar value caps would cost the federal government between 31.4 billion dollars in 2016 dollars, $32.3 billion in 2018; the estimated base premium increase for a Part B benefit would be $14.50 per beneficiary per month. ADA input to this white paper does not constitute endorsement of inclusion of a dental benefit under Medicare at this time. The ADA is currently investigating a number of options to serve the dental care needs of a growing elder population.

An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care recommends the addition of a comprehensive oral health benefit to Medicare Part B as it covers outpatient services. Such a benefit would be amended to include dental services using the medically necessary and reasonable standard that applies to all Part B services. Advantages to the inclusion of Part B include:

Ensures that everyone enrolled in Medicare will receive the oral health benefit.
Provides the greatest number of beneficiaries access to a basic level of oral health care, encouraging equitable health solutions and provider participation.
Simplifies a potentially confusing program and process for providers and beneficiaries.
Uses established protections for both Medicare beneficiaries and providers, alleviating the need for a new system and bureaucracies.

To move an oral health benefit in Medicare Part B forward, Congress must pass legislation to remove the statutory exclusion in Section 1862(a)(12) of the Social Security Act. They must establish dental coverage in Part B, permit payment for preventive services prescribed in the dental benefit and define the dental services in the Medicare Statute.

“Research demonstrates that oral health disparities exist for many racial and ethnic groups, by socioeconomic status, gender, age and geographic location. This underscores the need to approach oral health disparities as a component of social justice,” says Center for Medicare Advocacy Policy Attorney Kata Kertesz.

The recommendations included in An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care stress the necessity of an oral health benefit for older adults. Read more about the medical necessity, costs, proposed structure and legislative changes needed at oralhealthamerica.org/medicaretoolkit.

Jul18

Traveling Overseas When On Medicare: What You Need To Know.

By Tom Matteson - blog

Traveling overseas when on Medicare can be a tricky situation, because original Medicare A and B does not cover foreign travel, and Medicare advantage plans also do not cover foreign travel. However, if you choose to keep Medicare and get a Medicare supplement plan, foreign travel is covered. Here is a great article by Lindsay Engle that explains how it works.

How Baby Boomers are Getting Medicare Overseas Travel Coverage

February 13, 2018 by Lindsay Engle

Baby Boomers are getting Medicare overseas travel coverage by signing up for a Medigap or Medicare Supplement plan. You may be surprised to know that Medicare by itself does not cover most expenses outside of the United States. There are many reasons why Original Medicare beneficiaries choose to invest in additional coverage, especially when traveling is a priority.

Many people have big plans for what they will do once they retire. Baby boomers are taking advantage of their newfound freedom by traveling the world. Studies show that baby boomers are consistently finding ways to travel affordably, and a lot of them have a travel bucket list. This tendency to research their destinations means they are willing to plan ahead, and insurance coverage is something retirees should definitely be considering in their travel plans.

When you retire, you may have big dreams to see the world. Have you thought about what will happen if you get injured in a foreign country? What are baby boomers doing to make sure they have overseas travel coverage?

Foreign Travel and Medicare Overseas

It’s important when considering your options and retirement plans to know what Medicare Parts A and B will cover when you are traveling. As a general rule, traditional Medicare pays only for medical care in the United States. There are some unique circumstances where Medicare overseas will cover 80% of your emergency care outside of the US.

These include:

Cruise ships no more than 6 hours from a US Port
Direct driving routes between Alaska and the US
Situations in which you are sick in the United States but the nearest hospital that can treat you is in another country
If you live in the U.S., but the nearest hospital to your home is in another country

This means the chances of you getting medical coverage under Medicare when traveling in a foreign country are very slim. Fortunately, there are solutions to this dilemma.

Travel insurance vs. Medical Insurance

Medicare Plan G

The best way to ensure that you are covered when traveling overseas is to pick up a Medigap plan. For example, Medicare Plan G provides coverage for foreign travel for baby boomers. Plans C, D, F, M, and N also provide some foreign travel coverage. Medicare Supplement Plan G is one of the most common plans for baby boomers.

This supplemental policy helps you cover out-of-pocket costs which are not covered by traditional Medicare. It also will help pay for part of your emergency medical expenses when you’re outside of the United States.

What Will be Covered?

Medicare supplement plans for foreign travelers cover a certain amount of services. Their foreign care coverage is designed to protect you in case of an emergency. It is not designed for routine care or testing.

Baby Boomers can expect that their supplement care foreign travel plan will cover emergencies that begin during the first 60 days of their trip. Baby Boomers who plan on traveling during retirement should invest in travel coverage via a Medigap plan at their first instance of eligibility. Although there is a small deductible, this can provide protection in many situations and will normally pay 80% of the fee for medically necessary emergency care.

What Kind of Travelling Do You Plan on Doing?

While you don’t need exact specifications, it’s good to know approximately how often and for how long you’ll be traveling in the years to come. This is because even Medigap plans have certain limitations when it comes to coverage in foreign countries. Do you think you’ll be out of the country for months at a time? Or will you be taking planned trips for shorter lengths of time?

Limitations

If you plan on living overseas or plan on taking long extended trips to foreign countries, you may need to consider additional coverage such as travel insurance. If you are living overseas part of the year, you may be able to invest in a private insurance plan from the country that you are living in. However, this should be an addition to your Medigap coverage if the United States is your residence. This will ensure that you are covered in case of emergency during foreign travel and have the most protection possible.

Traveling is a great way to spend retirement. There is a big world out there to see, and you shouldn’t feel limited by fear of health expenses. With these options, you should be able to travel freely with minimal risk of out of pocket costs for emergency healthcare.

Jul9

Telemedicine And Medicare

By Tom Matteson - blog

Telemedicine and Medicare Coverage: Telehealth

Telemedicine is becoming more and more popular. Here is a great article by MedicareFAQ that has some really good information.

Leaving your home when traveling to and from your medical visits can sometimes seem like an intimidating task. Especially if it’s difficult for you to travel.

With Telemedicine, also known as Telehealth, seniors will have the option to stay in the comfort of their own home to receive medical attention. Thus, avoiding the stress and trouble of attending appointments, routine check-ups, hospital stays, or any other aspect of medical health care.

What is Telemedicine

Telemedicine is essentially a way for patients to meet with doctors virtually, to be diagnosed and treated in remote locations. While this is a new service, Telemedicine is projected to lower some cost aspects of health treatments. As well as improve the way health is being monitored for seniors.

At this point in time, telemedicine is a well recognized service. It’s increasingly becoming the more chosen option when looking into health care services.

Benefits of Telemedicine

Aside from staying remote, when moving from place to place can be too physically demanding, telemedicine comes with five major benefits.

Telemedicine technology provides you with the opportunity to seek health care at your convenience from any device that has a camera and microphone. Wherever you are, health care is available to you in the palm of your hands.
Sitting in an office, anticipating your appointment, can be inconvenient and add stress to an already stressful situation. With telemedicine, you eliminate the waiting room process before your appointment. Not sitting in a waiting room also means there is less of a possibility to receive or spread sickness.
Often times a patient may feel disconnected with their health care provider when attending in-person physician visits. Telemedicine provides you the opportunity to build a better relationship with your physician. Without meeting in person, communication about health care will be key, therefore strengthening the relationship between a doctor and patient.
With telemedicine, you are presented a better opportunity to connect with more physicians and better doctors. For example, you may be sick, and needing a physician in a particular field, that could be located cities, or even states away. Traveling may be difficult for you, but you will have access to communicate with those people from a remote location.
If the doctor is happy, the patient is happy! While the benefits for patients in telemedicine seem almost endless, it also benefits the physicians! When the doctor chooses to go the telemedicine route, they will have more time for necessary medical activities. If they have the ability to take care of their patients in a more efficient way, then they have more time to assist others in need and possibly even gain more knowledge in their own field!

Health Care Providers with Medicare in Telemedicine

Medicare typically limits the health care providers you can seek telemedicine services with. With Medicare, health providers that are eligible for telemedicine are:

Nurse Midwives
Dieticians/Nutrition Specialists
Physicians
Nurses
Psychologists/Social Workers

Telemedicine and Medicare Coverage

Anyone who is a beneficiary of Medicare Part B qualifies for most telemedicine services. Just like in-person doctor visits and consultations with Medicare, you are responsible to pay for your portion of the cost for telemedicine services.

If you are enrolled Medicare Part B, you’ll typically pay 20% of the approved Medicare amount for telemedicine services, after meeting your Part B annual deductible.

If you are enrolled in a Medicare Advantage Plan, provided by a private insurance company who is contracted with Medicare, the cost for telemedicine health care would be the same as the cost for in-person health visits.

Telemedicine services covered by Medicare include, but are not limited to:

Physician consultations
Health check-ups
Mental health counseling

Please note, it is important to contact your telemedicine physician first. This is to see if they participate in Medicare to ensure your coverage applies with their offered services.

If they do not currently take part in telemedicine technology, and it is something you are interested in participating in, we suggest looking for an office in your area that can accomodate your needs.

How will Telemedicine impact Medicare Beneficiaries

Telemedicine will provide a more comfortable and convenient medical health care experience. It’ll also save the patient travel expenses for routine check-ups and other charges that come from visiting a doctor in person.

While those are very noteworthy and valuable benefits, telemedicine technology is still new. It will continue to positively impact Medicare beneficiaries in the future.

In 2015, Medicare extended their beneficiary coverage to several new telehealth services, and they continue to research and grow.

The demand for telemedicine through Medicare is continuously increasing. While the telemedicine industry is still working out a number of challenges and sometimes even legal issues, it is a rapidly growing service.

In the upcoming years, as telemedicine becomes more popular with Medicare, Medicare beneficiaries can expect telehealth practices to reduce medical costs, improve the process of medical monitoring, and create a higher-quality health care administration for seniors.

Whether your new to Medicare, or are currently enrolled, give us a call to make sure you’re taking advantage of all the benefits you deserve. Get help with the out of pocket costs left up to the beneficiary to pay.

Jun26

535,000 Seniors Will Be Loosing Their Medicare Cost Plans This AEP

By Tom Matteson - blog

What is a Medicare Cost Plan?

Medicare cost plans are similar to Medicare advantage plans in some ways but have additional benefits that are not a typical of most Medicare advantage plans. Like a Medicare advantage plan, a Medicare cost plan may provide benefits that Original Medicare doesn’t, and like Original Medicare, it allows you access to out-of-network health care providers if you continue to have Medicare Part A and Part B. If you choose to go out of the plan’s service area, you may still be covered by Original Medicare. Your deductibles and coinsurance amounts may apply. Unlike Medicare advantage plans, you can typically enroll in a Medicare cost plan even if you’re only enrolled in Medicare Part B. You can sign up or drop the plan anytime, instead of having to wait for the Annual Enrollment Period. Medicare cost plans are offered by private insurance companies who contract with Medicare. In Many cases they are often sponsored by employer or union groups. The plan may or may not include coverage for prescription drugs, or other benefits not available under Original Medicare. One of the main benefits of a Medicare cost plan VS a traditional Medicare advantage plan is that you do not lose your Original Medicare benefits, and have the option to go out of network for health-care services without restriction. This may be an attractive option if you plan on doing any traveling in retirement.

Twelve States Are Loosing Their Medicare Cost Plans

There are disruptions in Medicare cost plans in 12 states and the District of Columbia this year. Cost plans won’t be renewed by CMS in counties that have at least two competing Medicare advantage plans that meet certain enrollment requirements. As a result, up to 535,000 current policy holders nationally could be impacted for the upcoming 2019 AEP. This change will trigger a special election period for people enrolled in these types of plans to go back to original Medicare. Which would then allow them to purchase a Medicare supplement plan with out having to qualify medically. They could also transition to a traditional Medicare advantage plan as well, but they more than likely will have those network restrictions, which was why they went with the Medicare cost plans to begin with. Below is an estimated break down of how many people will lose their plan at the end of the year, due to this change. If you live in one of these states and have received a letter from your current carrier informing you of this change. Please give MIC a call and we can help you sort out all your options. Toll-Free: 855-830-6099

State	Number of Enrollees
Minnesota	403,465
Maryland	43,378
Texas	28,607
Virginia	23,077
Colorado	17,865
Iowa	9,708
Washington, D.C.	6,133
Illinois	1,829
California	1,076
Arizona, Florida, Nebraska, and New York	593

Jun19

Tips For Avoiding Problems With Dentures

By Tom Matteson - blog

Dentures are always a big concern for seniors, because Medicare does not cover dental. Not to mention most private individual dental plans pay very little towards dentures. In turn it, leaves seniors paying for the majority of the cost of dentures. Here is a great article by MedicareFAQ to help your dentures last.

Tips for Seniors on Avoiding Denture Problems

June 13, 2018, MedicareFAQ

√]Oral care is important for everyone, especially those with dentures. Dentistry is beginning to focus on preventative maintenance and widespread use of fluoride, the result is a fewer number of people with dentures.According to the American Academy of Periodontology only one out of four people ages 65 and older have lost all their teeth. Dentures that do not fit properly is a very serious issue for seniors. When seniors have ill-fitting dentures, the can develop mouth sores that risk infection and make it difficult to talk or eat.

Improper dental care can lead to extensive tooth decay and gum disease, dentures can be used to replace teeth that have been removed. While dentures may fix the missing teeth problem, they can come with some issues of their own. Dentures can also require just as much, if not more care than natural teeth.

Dentures Can Become Necessary

When you don’t go to the dentist regularly you can develop tooth decay and gum disease. Dental insurance is something most seniors don’t have. “Does Medicare cover dentures?”, is a common question many seniors ask.

The simple answer is Medicare doesn’t typically pay for dental treatment or dentures. With certain medications or medical conditions that can cause oral health problems and accelerate tooth loss, you can see why this is a problem.

Dry mouth and other oral health problems can also make teeth and gums more prone to cavities and infections. Tooth decay and gum disease are among the top 5 dental issues for baby boomers. Seniors need affordable dental coverage to ensure a healthy mouth and a happy life.

Dentures That Don’t Fit

Dental adjustments can be made when dentures are not as comfortable as possible. If they are your first-time dentures or if you have had them for a long time, your dentist can refit the denture, so sores don’t occur.

If sores do occur see your dentist as soon as possible, they shouldn’t be ignored. Dentures that don’t fit are a common problem among denture wearers, and it can be a painful problem. Properly fit dentures should rest snugly against the gums and not slide around, pain shouldn’t be an issue. Ill-fitting dentures will constantly rub the gums and create what is called an epulis (callus) that requires oral surgery for removal.

If you have had your dentures for a while, then expect natural changes in the gums and jaw over time. Gums change and the bone underneath the gum can shrink, this change is slow, and seniors may not realize it. Seeing a dentist to be sure dentures fit properly and have any dental screenings needed preformed.

Fixing Dentures That Don’t Fit

Ill-fitting dentures can be fixed by your dentist no matter what the cause. An ill-fitting denture may cause lesions on mucosa and inflammatory overgrowth could appear; repairing, relining or rebasing the denture will solve the problem.

Repairing: Dentures can fracture during use or they may drop on a hard surface. The key of repairing is the accurate reassembling and alignment of the broken parts in their original position. Dental laboratories can usually repair cracked teeth or tooth loss in a denture.
Relining: Relining is the correction of denture adaptation to underlying tissues by the addition of a new resin material to its fitting surface without changing its occlusal relation. Additional material is added to the tissue side of a denture to improve its adaptation to the supporting mucosa. This can either be done in the office or in a lab.
Rebasing: Rebasing is a process of re-adaptation of a denture to the underlying tissues by replacing the denture base material with a new one without changing its occlusal relation. Dentists will do rebasing when the existing denture base is unsatisfactory.

Tips for Seniors on Avoiding Denture Problems

Dentures require as much care as natural teeth. The following tips are recommended for denture wearers:

Give your new dentures time, getting used to them may be uncomfortable at first. New dentures will usually require more adjusting from your dentist after the first fitting.
Scheduling your adjustment is necessary if you begin to see sores on your gums or tongue. Dentures will need to be adjusted by your dentist. The dentist will place a soft, gum-like material in the denture to provide a cushion.
Start a nutrition shake habit. Getting the nutrition needed can be hard when you are adjusting to your new dentures. Drinking a nutrition shake meal replacement will ensure you are getting the nutrients you need daily.
Take your dentures out. You should remove your dentures for at least 4 hours a day. When you take your dentures out be sure to store them in a denture solution or water to help it hold its shape. Soaking your dentures at night is recommended; remove the dentures, clean them and soak them in denture cleanser overnight to preserve the quality of your dentures. Be sure to store dentures properly, away from children and pets. Dentures can break easily and will break if dropped even a few inches.
Monitor your weight. Losing and gaining weight can impact how well your dentures fit. If you have a significant change in weight you should schedule an appointment with your dentist to check the fit and make any adjustments.
A small amount of denture cream should be all you need. Denture creams used properly can work very well at sealing the denture. You should not rely on denture cream to force your dentures to fit. If your dentures are ill-fitting you need to see your dentist for an adjustment.
Go to the dentist. Regular dental visits will allow your dentist to check your dentures and clean any remaining teeth that may hold your dentures in place. Even if you have no natural teeth you should still have your mouth examined annually for signs of gum disease and oral cancer.

Good oral habits are needed daily. Brushing regularly can remove bacteria and food particles that lead to gum irritation and infection. You should brush your dentures every day and night just like natural teeth. Dentures can still build up plaque and tartar like natural teeth. Use a toothpaste and toothbrush designed for use with dentures. Regular toothbrushes are abrasive enough to scratch the dentures.

Dental Coverage

We know Medicare will not cover dentures; the next commonly asked question, “Does Medicare have any dental coverage?” The simple answer is that Medicare will not cover routine dental care. It is imperative that seniors obtain dental coverage.

Improper dental care will lead to extensive tooth decay and gum disease, dentures will be needed to replace lost teeth. Dental coverage can be affordable and is always necessary. Dental insurance providers can offer expansive coverage and may include all the routine dental services that you will need.

With dental coverage you will not need to worry about changing benefits and you typically don’t need to renew the plan each year. Dental plans will allow you to add family members who reside with you. Some plans will allow you to use any dentist, others will not. It is important that you choose a plan that fits your dental needs, you will use the coverage.

Jun11

Bring Awareness to Elder Abuse! June 15th is World Elder Abuse Awareness Day.

By Tom Matteson - blog

Elder Abuse is a serious issue in our society. It should not be tolerated at all! June 15th is Elder Abuse Awareness Day. Below is an article by the Administration For Community Living that has some pretty sobering numbers and links to some helpful resources.

Each year, an estimated 5 million older adults are abused, neglected, or exploited. Older Americans lose an estimated $2.6 billion or more annually due to elder financial abuse and exploitation, funds that could be used to pay for basic needs such as housing, food, and medical care. Unfortunately, it occurs in every demographic and can happen to anyone—a family member, a neighbor, even you. It is estimated that only one in five of these crimes are discovered.

World Elder Abuse Awareness Day (WEAAD) was launched on June 15, 2006 by the International Network for the Prevention of Elder Abuse and the World Health Organization at the United Nations (UN). WEAAD aims to provide an opportunity for communities around the world to promote a better understanding of abuse and neglect of older persons by raising awareness of the cultural, social, economic, and demographic processes affecting elder abuse and neglect. In addition, WEAAD is held in support of the UN International Plan of Action acknowledging the significance of elder abuse as a public health and human rights issue. This observance serves as a call-to-action for individuals, organizations, and communities to raise awareness about elder abuse, neglect, and exploitation.

Access the latest World Elder Abuse Awareness Day campaign materials available from the USC Center on Elder Mistreatment.

Please contact the National Center on Elder Abuse at 1-855-500-3537 or ncea-info@aoa.hhs.gov with any questions.

May31

Medicare Supplement Plans Continue To Experience Increase In Membership

By Tom Matteson - blog

Medicare Supplements plans are experiencing steady increases year over year. Here is a great article By Insurance Forums staff, with data provided from Mark Farrah.

Enrollment in Med Supp plans grew 3.8% in 2017 according to latest MFA data

By: Insurance Forums Staff

May 30, 2018

Medicare Supplement carriers experienced another year of membership growth as the number of Medigap beneficiaries continues to increase, according to the latest report from Mark Farrah Associates (MFA) released last week.

Many leading managed care organizations, Blues plans, regional plans and multiline carriers compete in the Medicare Supplement (also known as Med Supp or Medigap) arena. Based on performance data filed in annual financial statements from the National Association of Insurance Commissioners (NAIC), enrollment in Medicare Supplement plans was almost 13.1 million as of Dec. 31, 2017, up 3.8% year-over-year. MFA identified 193 distinct carriers that filed annual data with the NAIC. This brief provides an overview of the Medicare Supplement market with insights about competitive positioning and standardized plan type preferences.

With approximately 4.5 million members, UnitedHealth, with its longstanding AARP partnership, continues to dominate the Medigap sector. Breakdowns of in-force policies show that carriers issued policies to more than 5.4 million new members from 2015 through 2017. Carriers reported an aggregate of 7.6 million members covered by older policies that had been issued prior to the year 2015.

Medicare Supplement Snapshot

Medicare Supplement carriers added approximately 480,000 covered lives to their portfolios between Dec. 31, 2016 and Dec. 31, 2017. About 35% of this market growth is attributed to UnitedHealth’s membership increase. In terms of standardized plans, the number of beneficiaries enrolled in the most popular plan – Plan F – increased by 181,000. In addition to having the most comprehensive benefits, Plan F provides “first-dollar coverage”, meaning it covers the annual Medicare Part B deductible.

Per the graph below, Plan F enrolled almost 7.1 million Med Supp members and accounted for 54% of the market. However, due to a provision in the Medicare Access and CHIP Reauthorization Act of 2016 (MACRA), beginning Jan. 1, 2020, Plan F will no longer be an option for newly eligible Medicare enrollees, whereby supplemental plans covering the Part B deductible can no longer be purchased. Beneficiaries who continue to pay their existing Medicare Supplement Plan F premium will not lose that coverage.

As expected by industry experts, the policy change has begun a shift in growth from Plan F into Plans G and N which are widely seen as viable alternatives to Plan F. In 2017, Plan G grew by 393,000 members, a growth rate of 31%, while membership in Plan N grew approximately 138,000, or 12%.

Note plan type “P” for Pre-Standardized is used for policies issued prior to the enactment of the Omnibus Reconciliation Act (OBRA) of 1990, which standardized benefits for Medicare Supplement plan types. Plan type “O” or “Other” is used by carriers in a few states including Massachusetts, Minnesota, and Wisconsin that receive waivers to the standardized Medicare Supplement regulations.

Medicare Supplement remains an attractive line of business for carriers. Med Supp plans collectively earned $29.9 billion in premiums and incurred $23.2 billion in claims during 2017, up from 2016. The aggregate loss ratio (incurred claims as a percent of earned premiums) was 77.7% in 2017, a slight decline from 77.8% in 2016.

Top competitive rankings in the Med Supp market have remained consistent year over year. With its AARP contract, UnitedHealth continues to hold 34% of the market with 4.5 million members; a 4% increase from Dec. 2016. Mutual of Omaha ranked second with 9% market share and 1.2 million members as of Dec. 31, 2017. Aetna supplanted Health Care Service Corporation (HCSC) as the third largest plan in 2017 with HCSC falling to the fourth spot. Anthem remains in the fifth ranking position for market share. While not currently in the top 5, Cigna experienced strong growth, increasing by 170,000 members, or 68%, over 2016. The majority of Cigna’s growth was in their Plans F & G.

The top 10 companies command almost 69% of the Med Supp market with nearly 9 million members. The balance of 4.1 million enrollees is distributed across a wide array of other insurance companies selling Medicare Supplement products.

The Medicare Supplement market continues to grow as people 65 and over comprise an increasing proportion of the population. With approximately 62 million Medicare beneficiaries in the U.S., Medigap policies are a popular option for seniors because they can help pay some medical costs not covered by Original Medicare. Therefore, opportunities abound for health insurance carriers to broaden their senior market portfolio and expand product options in order to keep up with industry trends. As always, MFA will continue to monitor enrollment and plan performance in this competitive segment.

Charts courtesy of Mark Farrah Associates’ Medicare Supplement Market Data; Health Coverage Portal™

May29

Three Medicare Part D Companies Own Half The Market: What You Should Know

By Tom Matteson - blog

United Health Group, Humana, and CVS Health own 55% of the market in the Medicare Part D arena. Here is a great article by the Kaiser Foundation on what you should know about Your part D provider and how they stack up.

Medicare Part D in 2018: The Latest on Enrollment, Premiums, and Cost Sharing

By: Juliette Cubanski, Tricia Neuman, and Anthony Damico
Published: May 17, 2018

Summary

This analysis presents findings on Medicare Part D enrollment, premiums, and cost sharing in 2018 and key trends over time, based on data from the Centers for Medicare & Medicaid Services (CMS).

Enrollment: In 2018, 43 million of the 60 million people with Medicare have prescription drug coverage under a Medicare Part D plan; most (58%) are covered under a stand-alone prescription drug plan (PDP) but a growing share (42% in 2018) are in Medicare Advantage prescription drug plans (MA-PDs), which also provide other Medicare-covered benefits. More than 12 million Part D enrollees receive premium and cost-sharing assistance through the Part D Low-Income Subsidy (LIS) program.
- Three firms—UnitedHealth, Humana, and CVS Health—account for over half (55%) of all Part D (PDP and MA-PD) enrollees in 2018 (Figure 1).

Figure 1: Three firms—UnitedHealth, Humana, and CVS Health—cover over half of all Medicare Part D enrollees in 2018

Premiums: Monthly Part D PDP premiums average $41 in 2018, but premiums vary widely among the most popular PDPs, ranging from $20 per month for Humana Walmart Rx to $84 per month for AARP Medicare Rx Preferred. Overall, average monthly PDP premiums increased by a modest 2 percent in 2018.
Deductibles: More than 4 in 10 PDP and MA-PD enrollees are in plans that charge no Part D deductible, but a larger share of PDP enrollees than MA-PD enrollees are in plans that charge the standard deductible amount of $405 in 2018.
Cost sharing for generics and brands: Most Part D enrollees face modest cost-sharing amounts for generic drugs but can face much higher cost sharing for brands and non-preferred drugs, and a mix of copayments and coinsurance for different formulary tiers. For example, for PDP enrollees, median cost sharing ranges from $1 for preferred generics to $37 for preferred brands, and a 40% coinsurance rate for non-preferred drugs.
Specialty drugs: More than 4 in 10 Part D enrollees are in plans that charge 33 percent coinsurance for specialty tier drugs, defined by CMS as drugs that cost at least $670.

Findings

Enrollment

More than 43 million Medicare beneficiaries, or 72 percent of all Medicare beneficiaries nationwide, are enrolled in Part D plans.

This total includes plans open to everyone and employer-only group plans for retirees of a former employer or union (Figure 2). Most Part D enrollees (58 percent) are in stand-alone prescription drug plans (PDPs), but a rising share (42 percent in 2018, up from 28 percent in 2006) are in Medicare Advantage prescription drug plans (MA-PDs), reflecting overall enrollment growth in Medicare Advantage.

Figure 2: Medicare Part D enrollment has grown steadily since the program started in 2006 and now totals 43.4 million beneficiaries in 2018

In 2018, three Part D sponsors account for more than half of all Part D enrollees and two-thirds of all PDP enrollees.

UnitedHealth, Humana, and CVS Health cover more than half (55%) of all beneficiaries enrolled in Part D in 2018, and two-thirds (67%) of all stand-alone PDP enrollees (Table 1). UnitedHealth and Humana have had large market shares since the program began, while enrollment in CVS Health has grown over time through acquisition of other plan sponsors (Figure 3).

Figure 3: Humana, CVS Health, and UnitedHealth have the most stand-alone PDP enrollees in 2018; enrollment in CVS-sponsored PDPs has grown through consolidations

The proposed mergers of CVS Health and Aetna, and Cigna and Express Scripts would result in further consolidation of the Part D marketplace. If these mergers go through, four firms—the two merged firms plus UnitedHealth and Humana—would cover 71 percent of all Part D enrollees and 86 percent of stand-alone drug plan enrollees, based on 2018 enrollment.

The ten largest sponsors of Part D plans account for nearly 90 percent of all enrollment.

UnitedHealth has maintained the top position since the Part D program started, and in 2018 provides coverage to nearly one quarter of Part D enrollees, when PDP and MA-PD enrollment is combined (Table 1). Among all plan sponsors, UnitedHealth has the most MA-PD enrollees in 2018, while CVS Health has the most PDP enrollees.

At the state level, UnitedHealth is the top firm in terms of 2018 Part D enrollment in 26 states and territories, and is one of the top 3 firms in 44 states/territories (Figure 4, Table 2). Humana is the top firm in 17 states/territories, and is one of the top 3 firms in 41 states/territories.

Figure 4: UnitedHealth, Humana, and CVS Health are one of the top 3 Part D firms by enrollment in many states/territories

CVS Health, which sponsors PDPs but not MA-PDs, is the top Part D firm in only 6 states/territories, but is among the top 3 firms in 35. Together, three firms—UnitedHealth, Humana, and CVS Health—occupy all of the top 3 spots in terms of Part D 2018 enrollment in 19 states and territories (in varying orders).

Among PDPs, at the plan level, SilverScript Choice PDP (sponsored by CVS Health) has the most enrollees in 2018, covering more than 1 in 10 Part D enrollees, or 4.6 million (Table 3). This total is nearly double that of the second most popular plan, AARP MedicareRx Preferred (sponsored by UnitedHealth), with 2.6 million enrollees.

PREMIUMS

PDP premiums have risen modestly in recent years; for 2018, the average PDP premium is $41 per month.

PDP enrollees are in plans with an average monthly premium of $41 in 2018, a modest 2 percent increase over 2017 but up by 11 percent since 2015 (Figure 5). The combined average Part D premium for PDP and MA-PD enrollees is $32 in 2018. This is lower than the average for PDPs due in part to the ability of MA-PD sponsors to use rebate dollars from Medicare payments for benefits covered under Parts A and B to lower their Part D premiums. The average MA-PD premium is $34 in 2018, which includes Part D and other benefits.

Figure 5: The average monthly premium for stand-alone PDPs increased by a modest 2% in 2018 to $41, but has risen 11% since 2015

Premiums for 7 of the 10 most popular PDPs increased in 2018, and continue to vary widely across plans.

Monthly premiums for 2 of the 10 largest PDPs–AARP MedicareRx Preferred and Humana Enhanced—increased by more than $10 in 2018 (Figure 6). Premium decreases among the top PDPs were generally of a smaller magnitude; for example, the average monthly premium for SilverScript Choice, the PDP with the most enrollees, fell by $3.

Figure 6: Average monthly premiums for 7 of the 10 most popular stand-alone PDPs increased for 2018

Monthly premiums in 2018 vary widely among the most popular PDPs. Premiums range from $20 per month for Humana Walmart Rx to four times more—$84 per month—for AARP Medicare Rx Preferred.

Among the top 5 PDPs, those plans with lower premiums in 2018 than in 2017 generally have higher enrollment in 2018 than in 2017, and vice versa.

Among several of the top PDPs, there appears to be an inverse relationship between premium changes from 2017 to 2018 and the year-to-year change in voluntary enrollment among enrollees who are not receiving low-income subsidies (LIS). (Low-income enrollees may be reassigned automatically in response to premium increases under certain circumstances.)

For example, the monthly premium for SilverScript Choice fell by $3 for 2018 (from $29 to $26), and its non-LIS enrollment increased by 12 percent between 2017 and 2018 (Figure 7). By contrast, the premium for AARP MedicareRx Preferred increased by $12 for 2018 (from $72 to $84), and its non-LIS enrollment decreased by 10 percent between 2017 and 2018. These enrollment changes take into account both enrollment of new Part D enrollees and plan changes by current enrollees.

Figure 7: Among the top 5 PDPs, those plans with lower premiums in 2018 than in 2017 generally have higher enrollment in 2018 than in 2017, and vice versa

The one exception to this inverse relationship among the top 5 PDPs was Humana Walmart Rx, which experienced a 6 percent increase in enrollment despite a $3 premium increase for 2018 (from $17 to $20). This could be related to the fact that, despite its premium increase for 2018, the Humana Walmart Rx PDP is among the lowest-premium PDPs available in almost all regions in 2018; while some PDPs have lower premiums, they are not available nationwide.

DEDUCTIBLES AND COST SHARING

In 2018, more than 4 in 10 Part D enrollees are in plans that charge no deductible for drug coverage.

While more than 4 in 10 PDP and MA-PD enrollees (45%) are in plans that charge no deductible, a larger share of PDP enrollees than MA-PD enrollees are in plans charging the standard deductible amount of $405 in 2018 (46% and 3%, respectively), while a larger share of MA-PD enrollees than PDP enrollees face a partial deductible amount (Table 4). As a result, the weighted average Part D deductible is higher among PDP enrollees than MA-PD enrollees in 2018 ($213 and $129, respectively).

Cost Sharing for Generic Drugs

Around 2 in 10 Part D enrollees have a $0 copayment for preferred generics, but many pay $10 or more for other (non-preferred) generics.

In 2018, 19 percent of PDP enrollees and 24 percent of MA-PD enrollees have a $0 copayment for preferred generics (Figure 8). Median cost sharing for preferred generics is $1 for PDP enrollees and $3 for MA-PD enrollees in 2018, a reduction from earlier years (Table 5).

Figure 8: Around 2 in 10 Part D enrollees have a $0 copayment for preferred generics, but many pay $10 or more for other (non-preferred) generics

For drugs on the second (non-preferred) generic tier—a tier that became common in 2012—median cost sharing is $6 for PDPs and $12 for MA-PDs. Nearly 4 in 10 PDP enrollees (37%) and 70 percent of MA-PD enrollees pay between $10 and $20 for generics on this tier.

Cost Sharing for Brand-Name Drugs

For preferred brands, most PDP enrollees pay copayments less than $40; most MA-PD enrollees pay $45 to $47.

The vast majority of Part D plans (both PDPs and MA-PDs) charge copayments for preferred brand-name drugs rather than coinsurance. Among Part D enrollees in plans that use copayments for preferred brands, enrollees typically face lower copayments in PDPs than MA-PDs (Figure 9). Nearly two-thirds of PDP enrollees (62%) are in plans charging less than $40 for these drugs, while a similar share of MA-PD enrollees (63%) are in plans charging at least $45. Median cost sharing for preferred brands in 2018 is $37 for PDP enrollees and $45 for MA-PD enrollees.

Figure 9: For preferred brands, most PDP enrollees pay copayments less than $40; most MA-PD enrollees pay $45 to $47

For non-preferred drugs, half of PDP enrollees pay coinsurance between 40% and 50%; most MA-PD enrollees pay copayments between $90 and $100.

For non-preferred drugs (or non-preferred brands; 5-tier plans use one or the other), nearly all PDP enrollees pay a coinsurance rate, whereas most MA-PD enrollees pay a copayment amount. Half of PDP enrollees pay coinsurance of 40 percent or more for non-preferred drugs, while among MA-PD enrollees in plans charging copayments for non-preferred drugs, most (89%) pay between $90-$100 (Figure 10).

Figure 10: For non-preferred drugs, half of PDP enrollees pay coinsurance between 40% and 50%; most MA-PD enrollees pay copayments between $90 and $100

Whether one group of enrollees faces higher average out-of-pocket costs than the other for non-preferred drugs cannot be assessed because of the different approaches to cost sharing that each plan type uses; in particular, the actual out-of-pocket cost that PDP enrollees face who pay coinsurance for non-preferred drugs depends on the list price of the drug.

Cost Sharing for Specialty Drugs

More than 4 in 10 Part D enrollees are in plans charging 33 percent coinsurance for specialty tier drugs.

Close to half of PDP enrollees (45%) and more than 4 in 10 MA-PD enrollees (42%) are in plans that charge the maximum 33 percent coinsurance rate for specialty drugs, defined by CMS as those that cost at least $670 per month (Table 4). Only those plans that waive some or all of the standard deductible are permitted to set the specialty tier coinsurance rate above 25 percent.

LOW-INCOME SUBSIDIES

Three in 10 Part D enrollees receive additional subsidies for Part D coverage through the Low-Income Subsidy program.

More than 12 million Part D enrollees (29%) receive low-income subsidies (Figure 11). These additional financial subsidies, also called “Extra Help,” pay Part D premiums for eligible beneficiaries, as long as they enroll in PDPs designated as premium-free “benchmark” plans, and also reduces cost sharing. Six in 10 low-income subsidy (LIS) enrollees (61%, or 7.6 million) are enrolled in stand-alone PDPs. The other 4.9 million LIS enrollees are in standard MA-PDs, Medicare Advantage Special Needs Plans (SNPs), Medicare-Medicaid plans participating in financial alignment demonstrations, cost plans, or PACE plans.

Figure 11: In 2018, 6 in 10 Part D enrollees receiving Low-Income Subsidies are enrolled in stand-alone PDPs, while more than one-third are in MA-PDs

More than 1 million LIS beneficiaries pay premiums for Part D coverage, even though they may be able to obtain coverage with no premium, either through a benchmark PDP or through a zero-premium MA-PD.

In 2018, 1.2 million LIS beneficiaries (10% of all LIS beneficiaries) pay a premium for Part D coverage, even though they may be able to obtain coverage without paying a premium. This total includes 0.9 million PDP enrollees who are not enrolled in benchmark PDPs, and more than 0.3 million MA-PD enrollees who are enrolled in MA-PDs that charge a premium. MA-PDs are not designated as benchmark plans by CMS, although most of the LIS enrollees in MA-PDs are currently enrolled in zero-premium plans.

CMS reassigns some LIS beneficiaries in PDPs to a premium-free PDP during open enrollment if their previous PDP loses benchmark status and charges a premium. But other LIS enrollees are not reassigned by CMS because they have actively selected the plan they are in, whether it is a PDP or an MA-PD.

On average, the 1.2 million LIS beneficiaries paying Part D premiums in 2018 pay $26 per month, or more than $300 per year (Figure 12). This amount is up 13 percent from 2017 and is nearly three times the amount in 2006.

Figure 12: In 2018, 1 in 10 Low-Income Subsidy enrollees pay an average of $26 per month for Part D coverage, even though they might be able to obtain coverage with no premium

Methodology

This analysis focuses on the Medicare Part D marketplace in 2018 and trends over time. Data on Part D plan availability, enrollment, and premiums were collected primarily from a set of data files released by the CMS on a regular basis:

Part D plan landscape files, released each fall prior to the annual enrollment period. These files include basic plan characteristics, such as plan names, premiums, deductibles, gap coverage, and benchmark plan status.
Part D plan and premium files, released each fall. These files include more detail on plan characteristics, including premiums charged to LIS beneficiaries, the portions of the premiums allocated to the basic and enhanced benefits, and the separate drug premiums for MA-PDs.
Part D plan crosswalk files, released each fall. These files identify which plans are matched up when a plan sponsor changes its plan offerings from one year to the next.
Part D contract/plan/state/county level enrollment files, released on a monthly basis. These files include total enrollment by contract and plan at the state and county level. We use March enrollment counts for enrollment-weighted analysis in this report. Enrollment files suppress totals for plans with 10 or fewer enrollees.
Part D Low-Income Subsidy enrollment files, released once annually (in March for 2018). These files include total enrollment counts for LIS enrollees. As with the other enrollment files, we exclude plans with small enrollment counts in estimates that are plan-enrollment weighted.
Medicare plan benefit package files, released each fall. These files supply detailed information on the benefits offered by plans, including cost-sharing amounts for each formulary tier, tier labels, and the different cost-sharing amounts for standard and preferred cost-sharing pharmacies, where applicable.
Medicare penetration files, released on a monthly basis. These files are used to estimate average counts of plans available per beneficiary.

For analysis of changes in premiums for the top 5 PDPs and changes in non-LIS enrollment, we calculated the percentage change in premiums and enrollment between March 2017 and March 2018. We did not measure the change in non-LIS enrollment that occurred during the open enrollment period specifically.

For analysis of cost sharing for formulary tiers in PDPs and MA-PDs, we did not analyze which drugs are on what tier under each type of plan and whether this has changed over time, factors which would also influence enrollees’ out-of-pocket costs

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Blog

Medicare does cover chiropractic care, but does not cover acupuncture at this time. Here is a great article by Medicare FAQ that jumps into the topic with both feet.

Chiropractic Care vs. Acupuncture

Chiropractic

Acupuncture

Does Medicare Cover Chiropractic Care

Is Acupuncture Covered by Medicare

Acupuncture and Chiropractic Coverage with Medigap

Does Medicare Advantage Cover Chiropractic and Acupuncture?

The Center for Medicare Advocacy is pushing Medicare to include dental care in Medicare Part B. One of the big things Medicare has not covered in the past was dental. A diverse group of Medicare advocates have published a white paper that tackles the subject head on.

Foreign Travel and Medicare Overseas

Medicare Plan G

What Will be Covered?

What Kind of Travelling Do You Plan on Doing?

Limitations

Telemedicine and Medicare Coverage: Telehealth

Telemedicine is becoming more and more popular. Here is a great article by MedicareFAQ that has some really good information.

What is Telemedicine

Benefits of Telemedicine

Health Care Providers with Medicare in Telemedicine

Telemedicine and Medicare Coverage

How will Telemedicine impact Medicare Beneficiaries

What is a Medicare Cost Plan?

Twelve States Are Loosing Their Medicare Cost Plans

Tips for Seniors on Avoiding Denture Problems

Elder Abuse is a serious issue in our society. It should not be tolerated at all! June 15th is Elder Abuse Awareness Day. Below is an article by the Administration For Community Living that has some pretty sobering numbers and links to some helpful resources.

Medicare Supplements plans are experiencing steady increases year over year. Here is a great article By Insurance Forums staff, with data provided from Mark Farrah.

United Health Group, Humana, and CVS Health own 55% of the market in the Medicare Part D arena. Here is a great article by the Kaiser Foundation on what you should know about Your part D provider and how they stack up.

Medicare Part D in 2018: The Latest on Enrollment, Premiums, and Cost Sharing

Summary

Findings

Enrollment

More than 43 million Medicare beneficiaries, or 72 percent of all Medicare beneficiaries nationwide, are enrolled in Part D plans.

In 2018, three Part D sponsors account for more than half of all Part D enrollees and two-thirds of all PDP enrollees.

The ten largest sponsors of Part D plans account for nearly 90 percent of all enrollment.

PREMIUMS

PDP premiums have risen modestly in recent years; for 2018, the average PDP premium is $41 per month.

Premiums for 7 of the 10 most popular PDPs increased in 2018, and continue to vary widely across plans.

Among the top 5 PDPs, those plans with lower premiums in 2018 than in 2017 generally have higher enrollment in 2018 than in 2017, and vice versa.

DEDUCTIBLES AND COST SHARING

In 2018, more than 4 in 10 Part D enrollees are in plans that charge no deductible for drug coverage.

Cost Sharing for Generic Drugs

Around 2 in 10 Part D enrollees have a $0 copayment for preferred generics, but many pay $10 or more for other (non-preferred) generics.

Cost Sharing for Brand-Name Drugs

For preferred brands, most PDP enrollees pay copayments less than $40; most MA-PD enrollees pay $45 to $47.

For non-preferred drugs, half of PDP enrollees pay coinsurance between 40% and 50%; most MA-PD enrollees pay copayments between $90 and $100.

Cost Sharing for Specialty Drugs

More than 4 in 10 Part D enrollees are in plans charging 33 percent coinsurance for specialty tier drugs.

LOW-INCOME SUBSIDIES

Three in 10 Part D enrollees receive additional subsidies for Part D coverage through the Low-Income Subsidy program.

More than 1 million LIS beneficiaries pay premiums for Part D coverage, even though they may be able to obtain coverage with no premium, either through a benchmark PDP or through a zero-premium MA-PD.

Methodology