- Dialysis and Medicare: ESRD patients will be able to freely enroll in Medicare Advantage in 2021
- Life Insurance Ads: The important, value-added information, isn’t included in the ads (grrr)
COVID-19 and Medical Identity Fraud
COVID-19 is affecting the Medicare population, with people greater than 60 years old representing a significant high-risk category. With the public health concern associated with COVID-19, Medicare beneficiaries have been specifically targeted with offers of COVID-related tests or supplies.
While your Medicare card no longer displays your Social Security number, there are other fraud schemes that can still use your medical identity. Medical identity theft can result in unlawful claims, treatment, prescriptions or medical devices, under your name. It can be very time-consuming and costly to resolve medical identity theft: the protections against credit-card charges are limited to $50, there is no such limit under fraudulent charges that result from medical identity theft.
The bottom line is that Medicare will not place an unsolicited call to you. That means:
- Beneficiaries should be cautious of unsolicited requests for their Medicare or Medicaid numbers.
- Unsolicited offers of COVID-19 tests or supplies should be treated with suspicion. While your Medicare card no longer displays your Social Security number, there are other fraud schemes that can still use your medical identity.
- A physician or other trusted healthcare provider should assess your condition and approve any requests for COVID-19 testing. Medicare will cover COVID-19 testing, but only those accompanied by a healthcare provider’s order. If Medicare or Medicaid denies the claim for an unapproved test, the beneficiary could be responsible for the cost.
- Do not give your personal or financial information to anyone claiming to offer HHS grants related to COVID-19.
- Legitimate contact tracers will never ask for your Medicare number or financial information.
During this extraordinary public health situation, it can be tempting to accept offers to help, but you should use your common sense and remember that unsolicited requests for personal, private information should be handled with great caution.
- ESRD Patients Will Welcome 2021 Because Medicare Advantage Will Be Available
- Deep dive into financial options, insurance, and the effect that COVID-19 will have.
- I finish with a rant against the way that financial products are explained to people by “experts”
I am a regular expert contributor to Bob’s subscription site. I am interviewed here, discussing the BENES Act, as it appears on thestreet.com (Booyah!)
Thanks to Bob Powell, as always. You can follow him on Twitter: (https://www.twitter.com/@RJPIII). You can check out his subscription site: https://www.thestreet.com/retirement-daily/
Spaces Limited: October 5, 1PM ET
I don’t think there will be more than one of these in the public this year. Once the registration limit has been met, I will have no power to increase it.
I don’t think that my schedule will allow further sessions. Here is a sample of my speaking schedule heading into autumn (subject to change, I have ongoing discussions with certain organizations).
If you cannot see it on this email, here’s the link: https://maximizeyourmedicare.com/ask-jae/medicare-abcs-virtual-info-only-session/
Little Deal: Trump Signs Executive Orders On Drug Prices
This affects prescriptions covered by Part B, not Part D. So while this is something, the scope of this is limited. There are other complicated clauses, but there are conditions set, that are unlikely to be met, so therefore meaningless. (link)
Little Deal (for now): Pre-authorizations Begin for Certain Medicare Part B Services
This doesn’t sound great. There is a new process for a limited (for now) list of outpatient procedures. This is a limited list, it remains to be seen if it expands.
Medicare Advantage policyholders can face this now, for a much wider list of procedures. For Medigap, this would be new. This can easily become a very Big Deal.
The complete list of procedures that require Pre-Authorization is here. (link)
Big Deal: Medicare Advantage Will Be Available for End-Stage Renal Disease Patients (!)
This is a big deal. In the past, ESRD patients could not enroll in Medicare Advantage (there are exceptions for those who had grandfathered plans). That changes in 2021.
- result in a HUGE decline in out of pocket expenses for ESRD patients, and especially for those pre-65 Medicare beneficiaries, who qualify for Medicare due to SSDI.
- result in pressure at Medicare Advantage carriers, who are not going to be compensated by the full expected cost of new ESRD patients.
Number of those in the US: 500,000. (link)
For pre-Medicare health insurance policyowners, pre-authorizations by an insurance carrier, prior to many healthcare services, is a standard practice. In many cases, pre-authorizations can be difficult to obtain, and/or policyholders can experience delays in receiving services.
Generally speaking, this does not occur to Medicare beneficiaries, with notable exception of home healthcare service recipients in certain states, under a Review Choice Demonstration (RCD) for Home Health Services. For the overwhelming majority of healthcare services under original Medicare, pre-authorizations are not required. Pre-authorizations can be used to deter fraud with respect to durable medical equipment
Pre-authorizations have recently been introduced to certain hospital procedures conducted on an outpatient basis, under a new program that took effect on July 1, 2020. This applies to a limited number of hospital outpatient department (OPD) services. The following hospital OPD services will require prior authorization, when provided on or after July 1, 2020:
- Botulinum toxin injections
- Vein ablation
For Medigap policyholders, this would be a new development. And as long as the service is deemed to be reasonable and medically-necessary, Medigap carriers will pay for the 20% of the Part B approved charge amount.
Medicare Advantage policyholder may have encountered a pre-authorization requirement, a process that is used in the large majority of Medicare Advantage plans, according to the Kaiser Family Foundation (“Prior Authorization in Medicare Advantage Plans: How Often Is It Used?,” October 18, 2018).
If a pre-authorization is denied, there is a formal appeals process at Medicare. For those covered by Medigap, the process begins by filing for a reconsideration with Medicare. For Medicare Advantage policyholders, the appeal process begins with the Medicare Advantage insurance company.
The complete list of procedures that require Pre-Authorization is here: https://www.cms.gov/files/document/cpi-opps-pa-list-services.pdf
For more information about Medicare, the website for Mr. Oh’s book, Maximize Your Medicare: Qualify for Benefits, Protect Your Health, and Minimize Your Costs: https://www.maximizeyourmedicare.com
The BENES Act (S. 1280/H.R. 2477) has been in the works since 2018. It is meant to address problems with enrolling in Medicare Part B. 760,000 pay a late enrollment penalty for Part B, according to estimates.
The BENES Act would:
- Send notices to beneficiaries about their upcoming 65th birthday, so that people are aware of Medicare enrollment dates.
- Change the General Election Period, the period to enroll in Part B, to be the same as the Annual Election Period (October 15 – December 7.
- Change the delay in coverage date of Part B when you enroll after the month of your birth date.. Currently, if you enroll in the month after your birth month, then there are delays in your Part B coverage date.
- The BENES Act would solve some other delays as well, such as the Special Enrollment Period vs IEP conflict. Currently, when both occur at the same time, the delay in coverage takes priority, and the result is that the Part B coverage date is not the one intended by the beneficiary. If this seems complicated and convoluted: it is.
- Introduce a Special Enrollment Period for those on COBRA, who want to enroll in Medicare Part B, but cannot, due to a misunderstanding about COBRA. Note: currently COBRA does not count as “health insurance” for Medicare purposes, and people unknowingly are subject to Part B Late Enrollment Penalties. In addition, those applicants currently are required to wait until the Open Enrollment Period, which runs from January 1st – March 31st of each year. Even from that point, Medicare Part B coverage would not begin until July 1.
This, and more, on the Maximize Your Medicare Weekly Video: https://youtu.be/YV8UY-SNYw8
Find out more about Medicare: https://www.maximizeyourmedicare.com
- The BENEs Act is slowly making its way through Congress, with bipartisan support (oy vey!)
- I am interviewed by Art Lewis, Medicare beneficiary. I have appeared on his shows almost 20 times over the years
An Early Look at the Potential Implications of the COVID-19 Pandemic for Health Insurance Coverage (click here to read).
Commonwealth Fund = top of the class thinktank. The stunning takeaway is the huge number of people that have lost health insurance coverage due to unemployment.
What is unknown and unreported here:
How many then enrolled in private health insurance?
How many are now newly uninsured after all is said and done? Update: we have estimates now: at least 5,000,000 (link).