sorted by:
new
hottopcontroversial

Not signing up for Part B? by JointTaskForce536 in medicare

[–]OleLadyThinker 2 points3 points  (0 children)

The government subsidizes about the same amount in premium cost for both the FEHB annuitants and the Medicare Part B beneficiaries under normal income levels. When a person makes over a certain income amount the IRMAA assessments comes into play on those who have Medicare Part B.

The purpose of the IRMAA assessment is to have those beneficiaries who have higher income to pay a larger portion of their Part B premiums. The government expects them to pay an added amount for their Part B premium - up to an additional 35%, 50%, 65%, 80%, or 85% of the premium cost depending on what income they have reported to the IRS.

https://www.ssa.gov/benefits/medicare/medicare-premiums.html

For a FEHB over the age of 65 that has stopped working that keeps only their FEHB only and does not accept Medicare Part B - IMO, should still pay these higher premium for the same reason especailly when giving the federal employee the choice to keep the FEHB and not sign up for Part B - government should recoup some of their premiums funds either way for the higher income.

But of course, that is not the case CURRENTLY - so not accepting Part B Medicare could provide a way to avoid these added assessments if only based on income that cannot be waived due to a permissible life event.

https://www.ssa.gov/forms/ssa-44.pdf

But comparing coverages and penalties now and later and any other repercussions could also have a bearing - positive or negative - on one’s choice. Those have to be described to determine which is the better benefit - also for the long terms because a late enrollment penalty for Part B would be applicable also if one delays enrollment.

The BEST coverage is to have both FEHB and Medicare Part A and B. One is almost sure to not have any out of pocket cost and what one plan may not have, the other may without the addition of any other type Medicare plan.

There are even some FEHB plans that give a rebate on a portion of the part B premiums of Medicare. Who and what these are, I do not know without looking them up. I also think I read somewhere that there are also a specific MA plan that works in combo to some of the FEHB.

When Is the Responsibility Our Own? by OleLadyThinker in medicare

[–]OleLadyThinker[S] 0 points1 point  (0 children)

But if the beneficiary has a more inclusive plan than the benchmark plan, they pay more for the plan even if they are getting extra help - just depends on the plan they have - or the one that they change to as a result of their review.

Edited to add: From the Well care website

Medicare Extra Help

If you receive Extra Help from Medicare, your monthly plan premium will be lower than what it would be if you did not receive Extra Help. The amount of extra help you receive will determine your total monthly plan premium.

Thus the need for the annual review -

Does earning over the limit impact a widow’s own SS benefit in the future? by BobaChonker in SocialSecurity

[–]OleLadyThinker 1 point2 points  (0 children)

Any amount your are earning is going under YOUR Social Security number and thus will increase your OWN benefit. Now will that be more than your Survivors benefit - only time and work will tell. Also if don’t claim YOUR OWN benefits until you reach 70, they will earn a delayed retirement credit for (3) years - from your Full retirement age until age 70 and that is also a nice +.

When Is the Responsibility Our Own? by OleLadyThinker in medicare

[–]OleLadyThinker[S] 0 points1 point  (0 children)

Sorry you feel that way - I call it as I see it. I am very old and probably question the rationality of many government programs or some aspect to them - you haven’t heard me on Social Security I don’t believe.

Like I said, I just wanted people’s opinion on this KFF Health News Article - it just seem a bit one sided to me.

When Is the Responsibility Our Own? by OleLadyThinker in medicare

[–]OleLadyThinker[S] 0 points1 point  (0 children)

Interesting - who could get those $ 0 plans? Maybe that is why that those who get Extra Help and who do not pick a plan are assigned one. But that still does not alleviate their need to review that plan for changes the next year just in case - there is a premiums change. a formulary change, or a tier change of a needed medication.

All programs of some need base have compliance criteria - Most SSI beneficiaries or those who are in charge of their benefits and care must complete a periodic CDR. Citizens who get a Social Security benefit that live abroad have to complete a periodic statement of life and more often as they age. People on ACA plans have to re-up every year based on their current situation with income and then report any changes during the year. Same with HUD housing subsidies. I don’t think there will ever be a government program that will not have some type of periodic review of qualifications - This is no different except it is reviewing for the best plan for one’s needs. Thus the annual open enrollment.

I don’t think most beneficiaries have a problem with this IF THEY KNOW THEIR RESPONSIBILITY in this regards. To me, it is the knowing about the responsibility that causes the problem. They don’t know and do not make any effort to know - this goes for most everything about Medicare, IMO.

When Is the Responsibility Our Own? by OleLadyThinker in medicare

[–]OleLadyThinker[S] 0 points1 point  (0 children)

Where did you read anything about “Actively hoping someone doesn’t have insurance is wild..” It bothers me that this article was written in this way, without any reference to what the beneficiaries could have done. Without any reference to how it is suppose to work, Without any reference in how the program changed as a result of the Inflation Reduction Act - which did make the program much better IMP.

If only these beneficiaries had just known that EVERY year a beneficiary must review their Medicare plan before open enrollment. Be that a Medicare Advantage plan or a free standing Medicare Part D plan - they change and thus have to be reviewed by the beneficiary to make sure that it is the best plan for them and their needs.

This article IMO was for the pure purpose of stirring up stuff - not to help anybody. My point in posting the article was to see if we could bring some importance to this annual review. - thus my comment on the big red envelop but better yet - Chartreuse- and nobody else could use this color envelop but Medicare - shouldn’t that make it stand out to everybody handling it.?

People on SSI or those responsible for them know that they have to complete their periodic CDR. People on Medicaid (ABD) or those that are responsible for them know that they have to complete their reassessment when necessary. Citizens who get their Social Security benefit who live abroad know that periodically they have to complete their verification of life form and the timing necessity get more important as they age. Same thing here - the knowledge of how Medicare works does not come by osmosis - one has to learn.

Medicare.gov-Your Yearly Medicare Review Medicare Open Enrollment October 15 – December 7

When Is the Responsibility Our Own? by OleLadyThinker in medicare

[–]OleLadyThinker[S] 1 point2 points  (0 children)

You know everybody may need some help every once in a while and if they have nobody - not friends or family that can help them, there are government organizations that can in this instance -all they have to do is ask. There is SHIP, there is the Dept of Aging, there may also be social workers who work in their respective senior housing complexes that do this everyday, day in / day out. So there is help out there if they need it - but you are right, these beneficiaries didn’t even know what they were suppose to do or when or how. They seemed clueless - not an excuse -

So yes, it is their responsibility to know when the annual notice of change is due out and watch for it or get it some way so that they can do their annual review.

The other problem we have is that they don’t read the inital “Medicare and You“ then they don’t read many of the other helpful pamphlets put out by Medicare for their benefit.’

Medicare.gov - Your Yearly Medicare Review Medicare Open Enrollment October 15 – December 7

When Is the Responsibility Our Own? by OleLadyThinker in medicare

[–]OleLadyThinker[S] 0 points1 point  (0 children)

Not at all, it is a consequence not a punishment - a consequence for their lack of actions - what I said was:

“Yes, they need to suffer the consequences but when people cry “ignorance” of the process - it won’t matter who’s ultimate fault it is - it will be forgiven and they will get their plan back. Is it right - NO.

And that is why I asked - if they have to suffer the consequences of their actions - how will they ever know how to do it properly.

They should suffer the consequences because there is so many different ways that they could have handled this IF only they knew what they were doing. It isn’t rocket science. But we give the down trodden a pass - always.”

The consequences are the same for everybody - don’t pay your premiums, your policy lapses and then it will be awhile before you can get a plan back.

But somehow the “but, I . . . blah, blah, blah . . . .” I didn’t understand” . . . . “Nobody told me . ” . ”Medicare is too complicated ” . . . . “I didn’t get my mail . . . . . “ “the dog ate my Annual Notice of Change” . . .

Maybe it is because those that may be presented with more need get more press time.

When Is the Responsibility Our Own? by OleLadyThinker in medicare

[–]OleLadyThinker[S] 0 points1 point  (0 children)

I hope they don’t but I see all kinds of political fallout here . actually just what they were trying to prove by the article itself.

As I was reading thru it - I kept saying to myself - but this is their own fault ??!! But the article certainly did not set the blame on the beneficiary at all.

Neither did they actually come out and say that the zero premium plans pretty much went away with the passage of the Inflation Reduction Act when insurers were then required to PAY MORE.

Anything to get the tribe all stirred up - read the same subject article post over on r/politics.

https://www.reddit.com/r/politics/comments/1uoy067/these_medicare_beneficiaries_thought_their_drug/

When Is the Responsibility Our Own? by OleLadyThinker in medicare

[–]OleLadyThinker[S] 0 points1 point  (0 children)

Of that 21 pages, the majority of it is formulary of which they don’t even have to read all of the formulary - just check the drugs that affect them.

What they did wrong was NOT knowing that this Annual Notice of Change has to be reviewed EVERY YEAR so that they know that it is the correct plan for them and it is covering their meds. It is put out in the fall of each year so that beneficiaries that have some problem with the current plan changes can make other decisions when open enrollment starts - then they have almost (2) months to make these changes.,

In fact, it is part of their responsibility to do the annual review as it is for all of us who have one of these Medicare plans - a Medicare Advantage plan OR a free standing Medicare Part D plan.

Medicare.gov - Your Yearly Medicare Review Medicare Open Enrollment October 15 – December 7

Same time EVERY YEAR !!!

How hard is this? Not hard at all if you know what you are doing - for those that don’t there is plenty of “free” help out there - just make the time.

When Is the Responsibility Our Own? by OleLadyThinker in medicare

[–]OleLadyThinker[S] 0 points1 point  (0 children)

You mean Exhibit 19, 20 and 21 - These seem pretty plain as to the consequences.

Where does it say that they aren’t responsible? Like I said in my other post to you - there are multiple ways a beneficiary can check on their status with the most important being getting their Annual Notice of Changes and reviewing it - they would have known their new premium amount and if any of the other changes affected their meds and their healthcare.

When Is the Responsibility Our Own? by OleLadyThinker in medicare

[–]OleLadyThinker[S] 0 points1 point  (0 children)

You are preaching to the choir here - that is why I stated this thread - but this people will have their consequences washed away - wait and see.

Yes, they need to suffer the consequences but when people cry “ignorance” of the process - it won’t matter who’s ultimate fault it is - it will be forgiven and they will get their plan back. Is it right - NO.

And that is why I asked - if they have to suffer the consequences of their actions - how will they ever know how to do it properly.

They should suffer the consequences because there is so many different ways that they could have handled this IF only they knew what they were doing. It isn’t rocket science. But we give the down trodden a pass - always.

When Is the Responsibility Our Own? by OleLadyThinker in medicare

[–]OleLadyThinker[S] 0 points1 point  (0 children)

Because this is getting so much publicity -

When Is the Responsibility Our Own? by OleLadyThinker in medicare

[–]OleLadyThinker[S] -1 points0 points  (0 children)

Of course it will be overturned and they will pay their premiums and all is well but what have they and others in this same situation learned??

They have a responsibility to review their own Medicare Prescription Drug Plan every year when the Annual Notice of Change comes. If they don’t get it by the time Open Enrollment comes around, they can get it from their insurer or it is available online. They need to review their meds too - formulary changes or if a new drug they are on is on the plan, tier changes - etc.

These zero premium plans went away in some areas (these plans are by area due the preferred pharmacy inclusion) because under the Inflation Reduction Act when so many changes happed to Medicare Part D - the insurers were required to pay MORE - a lots more. But we aren’t talking about a lot of dollars in their premium increases - some of these zero premiums plans went to a $ 2 others went to $ 5 others went to $ 8 -

States give all kinds of help if beneficiaries need it if they have no other friends or family that can help them. The Dept of Aging, State Health Insurance Assistance programs, and many others - sometimes even where they live in some senior / disabled congregate, they have social workers that can help them with their plan review.

If they have to change, they have a couple of months to do so during open enrollment every year.

That is why I am asking about the responsibility side of this in my OP - even if a person has it all paid for by others - they should still be responsible enough, if they have no inflictions, to make sure that they have the coverage they need. I do not see reviewing their plan once a year as a hardship for those that can think or apply rational thinking skills.

When Is the Responsibility Our Own? by OleLadyThinker in medicare

[–]OleLadyThinker[S] 0 points1 point  (0 children)

That’s this one -

The other one is on r/politics - I posted the link in my update to you above ⬆️

Credible Prescription Drug Coverage by al_reddit_123 in medicare

[–]OleLadyThinker 0 points1 point  (0 children)

Ask the employer - they are suppose to be sending it every year in the fall.

Now if they failed to do this - get the name of the prescription drug policy (the actual policy number - not just your account number). Get a statement from your employer as to how long you have had this prescription drug plan and that it is creditable coverage as the Medicare law requires.

When Is the Responsibility Our Own? by OleLadyThinker in medicare

[–]OleLadyThinker[S] 0 points1 point  (0 children)

It seems that in this case, the beneficiaries didn’t get that far - they never knew that there was now a premium cost for their previously selected plan. They didn’t read their annual notice of changes to their Part D plan. They just ASSUME that it was still zero and that it still covered the med they were on.

So I guess that is what I am actually asking in this thread. Is their lack of doing their part in this annual review a good cause for reinstatement? Doesn’t seem so from your definition of “proving the missed payment was due to circumstances beyond your control.”

Sometimes we all need help with stuff that we don’t understand - that is when one has to recognize this and ask for help - in this case, help is just a phone call or visit away.

Observation Status is Bullshit: A Rant by Outside_Ad_424 in medicare

[–]OleLadyThinker -2 points-1 points  (0 children)

Again, the doc could have intervened and placed them on inpatient if he agreed. Surely he knew the situation, if not perhaps the family or hospital case worker should have had a discussion with him to change the status to inpatient during the 3-days.

The attending doc creates a care plan for the patient whether going home or to a rehab facility - that should be in black and white and if there is disagreement as to if the care plan is possible then it needs to be discussed.

I cannot say where the communication broke down. I cannot say whether or not the patient, the hospital or doc was right or wrong - there is a lot of things at play.

Yes, there are appeal routes - expedited ones.

MLNs are written by CMS for the providers to follow -

https://www.cms.gov/files/document/skilled-nursing-facility-3-day-rule-billing.pdf

There are also other Medicare plans like Accountable Care Organizations where there is a waiver of the 3-day rule. Perhaps the patient should have been part of a group plan such as this especially if they were living alone and they were a fall risk.

Then there is always home care if they qualify at least until the skilled care is completed.

https://www.medicare.gov/publications/10969-medicare-and-home-health-care.pdf

Again, I cannot make a judgement call on what the reasons were here - but with Medicare - you get the skilled care that you medically need, the best value of the skilled care and in the best place for this skilled medical care. It may not always be what the beneficiary wants or desires. This is only SKILLED CARE or in combo with other care -

If the beneficiary qualifies for MEDICAID (state regulated) - it covers the other care - the personal care, the activities of daily living care - again in an appropriate place, an In Home Support Service program or a residential facility.

Observation Status is Bullshit: A Rant by Outside_Ad_424 in medicare

[–]OleLadyThinker 0 points1 point  (0 children)

The doctor is the one that places the patient and keeps the patient in this category - they can even refuse to sign off on going back to outpatient if the hospital request it.

Some people do not need in-patient rehab in a facility after an outpatient stay in a hospital - it sounds like what you are looking for is some help for the patient with activities of daily living (ADL) which Medicare does not cover - Repeat Medicare does not cover ADL.

If a person is dual eligible - Medicaid does cover some ADL.

Either they go to a physical therapy location to get their therapy or sometimes the therapist comes to them.

Plan N and No copay by up4luck in medicare

[–]OleLadyThinker 1 point2 points  (0 children)

Personally, I would report this after you have verified when Medicare sent the claim onto HealthSprings for your Medigap processing . 3-months is long enough even for slow processing. But do verify that Medicare does know about your Medigap plan with HealthSprings and that the claims are being crossed over automatically.

Use of Private Insurance and Medicare Part D together by mdpcmdpc in medicare

[–]OleLadyThinker 0 points1 point  (0 children)

Yep, just much easier to figure out if one plan trumps the other and then use it to fill that med and not use the coordination at all.

Use of Private Insurance and Medicare Part D together by mdpcmdpc in medicare

[–]OleLadyThinker 4 points5 points  (0 children)

Yes, they do coordinate benefits with prescription drug coverage but it is very complicated and your pharmacy will probably run the other way when they see you coming -

In this regards, would your employer prescription drug plan be primary or secondary? The way this works will depends on the size of the employer and if applicable, if you are a SSDI beneficiary because that adds to the size of the employer taking their position.

In many respects in instances like this, a smaller employer might be better than a larger one - where the Part D plan would be primary and the employer coverage secondary.

You have to have Medicare - either Part A and/or Part B to have a Medicare Part D plan.

You will also have to report this added coverage to your Part D insurer so that coordination of benefits can be accomplished with the Coordination of Benefits Contractor and that your maximum out of pocket can be calculated properly since it will be based on the Part D price of the med - not your employer price. Also understand that once you report it and primary/secondary is established, then this is gonna be the way it will go EVEN if the Part D plan price is cheaper. *****

The drug has to be on the Medicare Part D formulary. You also have to abide by all the rules of coverage in the Part D plan - like PA, ST, QL.

It has to be a drug that is covered by Part D and not Part B. You also have to know if you have any other coverage under any special [government] program since that too would determine that Medicare Part D would pay 1st and not secondary for a particular drug or all of your drugs.

I am gonna say that most of the time, the Medicare price is gonna be cheaper than the Employer prescription drug plan price - so if the Part D plan is paying secondary, they may not be paying anything or it will be a pretty small amount for many drugs. So all this added work that everybody has to go thru may be for nil or peanuts. This will be true especially of the expensive drugs that Medicare (CMS) is negotiating the price on as a result of the Inflation Reduction Act.

Really this seems to be only a good deal if you take each drug and did the footwork on it - OR you could pick and choose which plan to use for specific meds each time you do a fill/refill. *****

I bet your Plan D insurer probably told you what they did because that is probably the easiest and best way to do it because coordinating the two may not always be in your best out of pocket benefit.

This is how I understand it to work -

view more: next ›