Tag Archives: Medicare

Social Security is NOT CALLING YOU!

Yes, I’m back. I’ve been debating video vs. blog and will be bringing my fun facts and face here very soon. I was tempted to do a video in my pajamas, glasses, uncombed hair and bad lighting for this post…because what I look like is so unimportant compared to this message.

PLEASE, DO NOT RESPOND IN ANYWAY TO A CALL THAT SAYS YOUR SOCIAL SECURITY NUMBER IS SUSPENDED AND YOU MUST CALL BACK. JUST DON’T DO IT.

My husband and I receive these calls almost weekly at this point. This week I received the call three times in 30 minutes. Even after blocking the number of the first two calls, the same robo-call came in on a different phone number.

I’ve seen warnings everywhere, but of course, this is my field, so I do see posts from AARP, Social Security, Retirement websites….all of whom have tried to get this message out. I am certain I have told my elderly mom to tell her friends this is a scam. Many of my own friends and relatives have called me asking if they should return the call. So it is not common knowledge that this is a scam.

But here’s the kicker. My smart, sweet Mom got the call three times yesterday in 30 minutes and was so certain it had to be legit. She returned the call and when a man answered and said: “Why are you calling?” my mom replied: “I don’t really know.” And the man disconnected. This makes me think that they are running so many scams, they aren’t sure which one you’re calling about so they can pretend to be whoever you are frightened of.

Please, please please pass this information to everyone: young and old, sick and well, informed or uninformed. We’ve got to stop the bleeding of stealing from good people. The only way to accomplish this is to educate and remove the fear of saying: “Nope, I’ll call my friend, daughter, son, accountant, the police before I call you back.” Let’s fight this together.

After I get dressed, I’ll do a video. After all, Halloween is over, don’t want to scare the kids! I love you all, I do! Stay safe.

“You Just have to Laugh………when it’s funny, but get mad when they’re trying to rip you off!!!”

I’m Back! And Now…the “Road to Medicare…”

I know it’s been a long time in coming. Most of you follow me on Facebook, so we haven’t truly been out of touch. But, wow! My life has been an amazing roller coaster of wonderfulness since Christmas. Yes, my last blog was about re-entering the Caregiving world. Truth be told, I was not happy about that. And it wasn’t even that dramatic. Well, it was for my husband, who had a serious leg injury, but for me it was “vanilla-caregiving-101.”

Since then, I’ve spent almost two months with my daughter welcoming our new grandchild and then a hasty return to presentations, TV appearances, having a caregiving script-in-hand read by professional actors, and working on getting more gigs to tell the world to get #prepared for the tsunami of caregiving!

I have neglected this blogosphere and I return renewed. I was truly thinking about what best serves my readers. And to look at my most well-received posts, I would say you guys love to laugh……….but even more, you love to be informed. So, like Bob Hope and Bing Crosby, our journey is going to be those “Road to…………” movies where we can have a laugh or two, but I’m going to teach you what I learn about all this aging, caregiving. long-term health care, Medicare, Medicaid, Social Security, nursing home, Elder law, estate issues blather as best I can.

Today…….the “Road to Medicare!” This could be 327 posts or more. In fact, it’s so chock-full of road blocks, potholes, orange cones, warning lights and yes, even smooth paving that we could have a blog about only this.

Lo and behold, I know someone who does that! And in my inbox this morning, she sent me three myths of Medicare. I had already decided to talk to you about our Medicare experience after dinner with friends last night when everyone was chiming in about signing up…and there in my inbox was Universe confirmation that yup, we need to talk about this.

My husband will turn 65 soon, and since I try to take my own advice, we called the Medicare Guru and asked her to guide us a bit. We are fortunate to have retirees’ insurance, and since I won’t turn age 65 for AGES (um hmmmm, had to say that), we knew this could be shark-infested waters. If we made a mistake in the sign-up process we could suffer some real financial consequences. The Guru gave us sage advice and the following week my hubby went online to sign up for Medicare.

Five minutes into a seven-minute process I hear, “Cathy!” Uh-oh. I run to the office to see consternation all over my husband’s face. There’s a trick question. Are you covered by your employers’ health care plan? Yes, we are, sort of. No box for that answer. I know it means, are you currently employed with health insurance? I know that because, well, because I know that. But lots of people don’t know that. Right next to the trick question on the computer screen is a teeny, tiny button with a question mark in a circle above it that says, “help.”

“Push that button,” I say to my husband. He looks at me like I told him to engage the nuclear codes. But he does it with a rivulet of sweat poring down his forhead. Right there in black and white it says, “this does not mean retiree insurance.” Hmm! Okay then. Up until that moment, my husband would have answered that one question, the only trick question for him, incorrectly. And that could’ve caused some real problems for us in the immediate future. And that is one teeny, tiny problem with signing up for Medicare.

Below are the three myths that the Medicare Guru, Joanne Giardini Russell at Boomer Health Group shared in my email today. You can reach Joanne or her associate Gwynn Sharick-Elberson at 248-871-7756. It’s free to talk to them. They are super nice! Tell them Cathy sent you! You will love them.

Joanne Giardini-Russell

810-599-7116 – mobile

248-871-7756, ext 101 – office

Check out this Video

Check out this video: https://share.vidyard.com/watch/rApnWNNRYtwo3KBSW58Y42?

Yay! It’s Open Enrollment……….or is it?!?

Today is a guest post from a Medicare Guru, Joanne Giardini-Russell, who I was lucky enough to find. I was going to paraphrase, but nope, read the whole thing. Such huge and I mean HUGE mistakes are made when it’s time to sign up for Medicare. So yes, YOU DO NEED HELP. This is the reason why:

Medicare – 5 Tips for the Season

It’s that annual time of year! The ads come out, your neighbors, siblings and friends starting buzzing and asking “what plan do you have? Why do you pay anything – I pay nothing and love my plan… You should have…” Right?

Can I interrupt the fanfare for a few minutes? My company helps people make good Medicare decisions. That’s all we do. 100% Medicare. So, we watch you all making the same mistakes just about every hour on the hour!

This short article will point out a few of the most common problems that we see:
• That friend that pays nothing and tells you that you’re overpaying? They most likely
have an HMO style Medicare Advantage plan. They likely don’t know that if they step
out of their network, they may have zero coverage. If they have chemo or radiation
enter their world? They’ll pay 20% of a large number. If they need 18 sessions of PT?
They’ll pay $30 each time. If they want to go to Mayo Clinic? They can’t. Moral of the
story? Don’t listen to your friends.

• When agents and insurance companies tell you annually “you can change your plan next year if you don’t like this one”. Whoa, not so fast. Some people can, some people can’t.
There are two types of products to supplement your Medicare coverage. There is
Medigap and Medicare Advantage. Most people that learn about the two usually want
Medigap. But, there’s a catch – you have to medically qualify for the product at times.
SO, if you can pass the health underwriting in the year after “you don’t like your plan”
than, yes – welcome aboard the Medigap train!

• Pre-existing conditions. They DO exist after you turn age 65 and hit Medicare eligibility! We’re so ingrained with group insurance and generally no pre-existing condition worries but they DO reappear with Medicare. This relates to Medigap coverage. Here’s the
rule: When you are NEW to Medicare’s Part B (and I don’t care if you are starting Part B
at age 65, age 72, age 75, etc. – the important part is that you are starting it), you have a
six-month window of opportunity to purchase a Medigap contract with no health
questions asked of you. So, when you and I are speaking, and you tell me that you have
MS and get infusions that cost $30,000 twice a year and you are starting Medicare? We
are going to have a serious conversation and I’m doing everything in my power to steer
you to a Medigap contract.

• A giant hole in Medicare-Land: People not being introduced to nor understanding the
basic premise that “there are two products to pick from to become your supplement”.
The world tends to focus on Medicare Advantage (think corporate profits or agent
commission might have something to do with this? Yes, sarcasm injected). You need to
understand what you are buying and the limitations of your product if there are any.
Make an informed decision.

• If you buy a Medigap contract, you can go to any doctor or hospital in the country that you choose. As long as they take Medicare (the majority do), you may go. We find that
at age 65, most people want choice and control over their healthcare. With Medicare
Advantage you will have networks and restrictions.

So, those are some of the problems that we see over and over again. There are dozens of other issues (prescriptions, Cobra, Obamacare, etc.) but if you know these 5 things, you’ve become a Medicare genius amongst your friends and family.
We’ve designed our firm to help you navigate Medicare issues almost in the way that I raised my children. Not to insult anyone’s intelligence, but we assist you as if you were 5 years old.

Meaning we lay out the steps rather simply.

Example. You call for advice and the response is “please go get Part A and B of Medicare and come back to me and I’ll help with your product”. That is Greek to you, generally. Online? In person? Where? What do I need? Boomer Health Group will instead send you a video tutorial with the forms that you need to fill out. You’ll get guidance as to step A, then B, then C. You finish step A? Come back for step B. We’re not the folks assaulting your phone and mailbox with Medicare solicitations.
Best of luck navigating the season! We’re here to help as needed.
Boomer Health Group
248-871-7756

And a special thanks to Joanne at Boomer Health Group. Call her. Really.

“You Just Have to Laugh…..and get Prepared….”

 

 

It Ain’t Gettin’ Any Easier!

Pretty much every day, I am alarmed by little stories I find by scanning information about Elder issues.

My new friend Joanne Giardini-Russell, a true Medicare Guru, wrote an article this week about one of her clients who continued to go to work up to age 71. That, in itself, wasn’t a big surprise to me. If 60 is the new 40, working to age 70 or older,  is bound to happen more and more. Many of us actually like working.  Sure, many must keep working, and that is another article, for sure. But many people do work well into their 70’s and even 80’s. And those same hard-working people are often horrified about seemingly innocuous decisions they made (or didn’t make, by omission) and how they have placed themselves or their spouse into true fear of imminent destitution. Because of runaway health care costs.

You see, this guy’s venial sin was working too long and not retiring…..his mortal sin was not getting good information about how this affected his health insurance….more specifically Medicare. Suffice it to say that Joanne is trying to help this couple who have blown through more than $30,000…YES, THAT IS THIRTY THOUSAND DOLLARS…. of their own money, even though he had group insurance at work.

I don’t know this unfortunate couple’s story. But my guess is, they were not educated at work, they did not know how to use Medicare to their advantage at age 65, they did not take advantage of all the options at work for short-term disability and long-term disability, even if it required a contribution, and so on.

Those of us in this field are trying hard to get everyone to see the advantage of advanced planning instead of crisis planning. We are trying to work with your Financial Advisors,  your HR people at work, and quite frankly, anyone else who will listen, including you.

Find us. Ask us to come to your work and speak. Ask us questions on the internet machine!

Buy our books, yeah I said it. But let me ask you a question, if anyone could have saved thirty dollars, three thousand dollars, or thirty thousand dollars, by buying a book for fifteen dollars, would that be worth it? Yes, my friends, I think it would. #WhoMovedMyTeeth?

 

There is tons of good information out there. But you must find the experts, read things, ask questions and take action. Now is the time if you are a Baby Boomer, now is the time if your parents are in their 50’s and 60’s.

Oh, and to you Millennials and Gen-Xers….it’s never too late!

 

“You Just Have to…… Get Your Sh%$#@# Together…..and then you can Laugh all the way to the bank!”

Joanne doesn’t even know I’m telling you about her….so she will see this when you do.  If If you have any inkling that you want to discuss what you should do about signing up for Medicare:

Check out my friend Joanne at :

Boomer Health Group

Joanne Giardini-Russell, Medicare Guru

http://www.boomerhealthgroup.com/

 

 

Hot Fun In the Summertime…..

Yay! It’s summer…..

If you are a Baby Boomer, or a baby,  or anyone…..it’s summer and you want to take a vacation! But guess what?!? People get sick on vacation, too!

I attended a Medicare seminar with my Mom the other day…and that is so another story…but one little-unnoticed tidbit stood out for me….Medicare won’t pay for your vacation illness, sort of.

Did you ever notice that everything we need to care about in aging is ‘sort of?’ I sort of have a knee problem; Insurance sort of covers that; Eggs are sort of good for you;  You sort of shouldn’t drink with that medication. I digress, sort of.

We finally reach the age where we want to travel, travel, travel and there’s a big ol’ mousetrap in the middle of it. You will be entering a Rube Goldberg universe of obstacles if you don’t prepare.

If you go on vacation with Medicare all by itself and don’t take any of its friends…nope, no good, won’t pay if you trip on the gangplank of the water taxi in Venice, or puke your way through the Galapagos Islands. Certain Medigap policies will cover you for 80% of the cost in your first two months of travel. Medicare Advantage might cover some aspects of an emergency, sort of.

So it’s all kinda’ sorta’.  You want to have a vacation and not just in the summer. You want to travel for fun and fun and more fun, while you’re healthy and can pay for it. C’mon universe…I earned this!

So what can you do?

  1. Call your insurance provider and ask…Do you cover travel? Domestically and abroad? Believe it or not, some Medicare Advantage will not cover you from state-to-state, so if you’re a snowbird….yikes! Check it out.
  2. Do you pay for airlifting? Getting me home from the Machu Picchu where I fell climbing the Stairs of Death on Wayna Picchu cause I forgot I wasn’t a Millennial? Do you?
  3. How do I file a claim for unexpected medical expenses when I get home?
  4. What if my preexisting condition requires some unexpected medical care while I’m traveling, do you cover that? Presumably, if you have a preexisting condition, your health insurance carrier already knows that.

But what can you do that’s best?

Dig down deep in your heart and your pocketbook and buy travel insurance. Make sure it covers all these possibilities. Because the truth of the matter is, it’s a few extra hundred dollars. If you’re paying thousands to take a glorious trip, don’t be cheap or chintzy now. Rest assured, you will probably not use it. And then thank your lucky stars, if you need it.

 

Bon Voyage!  Love ya’, mean it!

“You Just have to Laugh…..”

©2018 Cathy Sikorski

And You Thought “Mooning” Went Out With Hot Rods…………

In the beginning of 2017, Medicare implemented the new Medicare Outpatient Observation Notice which seems to have the same effect as the old ‘mooning’ we think about from American Grafitti.

You see, MOONing in Medicare (sounds like a love song from Cole Porter, doesn’t it?) means that within 36 hours of entering a hospital, if you will not be admitted, but only kept under  “observation,” they must inform you with a written explanation.  This is the form, if you’d like to see it!

MOON FORM

The problem with this form is the unintended consequences it might have for you, if you are on Medicare, or your loved one, if you are a caregiver for someone who is on Medicare.

If a patient is placed under observation, typically in the Emergency Room, and is never formally “admitted” to the hospital, Part A hospitalization of Medicare does not pay. In other words, you are paying as an outpatient.  For a quick trip to the ER (is there such a thing?) that’s no big deal. After all, the Part A deductible is $1340.00 so you may not even spend that much if you’re only there a few hours.

However, if you are there a few days, and you stay on observation, it is likely that you will start racking up fairly high medical costs with co-pays for every service you are getting. Not to mention any drugs, that likely will not be covered by your Part D while you are in the hospital. It’s complicated, scary and could be costly.

The worst result could be that you are sent to rehabilitation, and because you never met the “admitted to the hospital for 3 days” requirement to have Medicare pay for at least 20 days in that rehabilitation center, you are now responsible for a significant bill coming out of that rehabilitation center. This has happened to people to the tune of thousands of dollars.

So what can you do?

This advice comes directly from this AARP article, which oddly was written before MOON became a regulation and before the MOON form existed. So I have added two of my own suggestions at the end:

Medicare: Inpatient or Outpatient?

  • Ask about your status each day you are in the hospital, as it can be changed (from inpatient to observation, or vice versa) at any time.
  • Ask the hospital doctor to reconsider your case or refer it to the hospital committee that decides status.
  • Ask your own doctor whether observation status is justified. If not, ask him or her to call the hospital to explain the medical reasons why you should be admitted as an inpatient.
  • If, after discharge, you need rehab or other kinds of continuing care but learn that Medicare won’t cover your stay in a skilled nursing facility, ask your doctor whether you qualify for similar care at home through Medicare’s home health care benefit, or for Medicare-covered care in a rehabilitation hospital.
  • If you go to a skilled nursing facility and have to pay for it yourself, you can try formally appealing Medicare’s decision. When you receive your quarterly Medicare Summary Notice, make a copy and highlight the facility’s charge. Send this to the address provided on the notice with a letter saying you want to appeal Medicare’s decision of noncoverage on the basis that you should have been classified as an inpatient during your hospital stay and not placed under observation. If this is denied, you can go to a higher level of appeal, following instructions on the denial letter.

Additionally,

  •         You can refuse to sign the form. All that does is make the hospital sign it, and make them a bit testy. But it signifies that you do not accept this and hopefully is evidence on Appeal that you were trying to fight the observation status.
  • You can take your patient home. I am not recommending this, especially if the whole reason you are fighting ‘observation status’ is because your patient is very sick and you are certain they will end up in the hospital, a rehab center, or a skilled nursing facility after this event. But one of the problems with Medicare is that they penalize hospitals for re-admissions. So discussing the possibility that you might take your loved one home, that might force a re-admission, may move them to admit your loved one.

Sometimes this feels like the “Art of War,” when dealing with healthcare issues. Being forewarned is being forearmed, as they say. Seems like anything is better than being MOONED!

“You Just have to Laugh…..”

©2018 Cathy Sikorski

ALMOST EVERYONE IS FALLING FOR THIS NEW MEDICARE CARD SCAM! PROTECT MOM!

This is so important, that I scrapped my blog for today, for this. And since it is Friday afternoon, I’m going to repeat it again early next week. Please, for the love of God, tell your parents, your Seniors,  your neighbors, your friends,  even your enemies and maybe your pets…… that bad, bad people are scamming those with Medicare about their new cards.  THEY ARE FREE and NO ONE WILL CALL YOU ABOUT THEM:

NEW CARDS MEDICARE FRAUD ALERT: YOUR NEW CARD IS FREE!

Don’t Pay Those Medical Bills.

Yes, I said it. Countless times I have run into weary-worn caregivers who are frustrated by the overwhelming cost of care. According to AARP, out-of-pocket (OOP) costs for caregivers can be upwards of twenty percent of a caregiver’s income.

https://www.aarp.org/caregiving/financial-legal/info-2017/out-of-pocket-cost-report.html

And this is only getting worse.

I often find that clients of mine or even those I’m caring for are quick to pay any medical bill that comes to their mailbox. I encourage you to STOP that right now. We in caregiving and Elder healthcare know that there are many documents that come to our door that say: ‘This is Not a Bill.” And yet it looks like a bill, it sounds like a bill and it often has wording that indicates, “your share of expenses.” I’m sure you’ve found, as I have, that with my mother’s generation:”If it’s a bill, you pay it.” Even if it just ‘looks’ like a bill, many seniors will pay it, just to get it off their plate and to do the right thing.

Unquestionably, we should not pay something that says, “This is Not a Bill.” I’ve been able to either take those away, sneak them out of the house, or train my caregivees not to pay them. That has made a significant in-road into this problem. But it is the real bills that can cost you more than you know.

I tell the tale of a bill I received for my brother-in-law from the hospital for $4500.00, after his death. He had excellent health insurance and was ill for many months prior to his death, so this bill seemed far too exorbitant based on what I knew about his insurance. Every month for a year, I received this bill. Every two or three months, after I called to inquire if they had submitted it correctly to insurance, if they had processed the bill, or if they had calculated all the insurance discounts, they would tell me to wait as the bill was still in process. But they continued to send me the bill, even though they were waiting for payment.

I could have paid that bill ten times before it was properly processed. The actual final bill was $0.00. Yes, zero dollars and zero cents. Just try getting back $4500.00 you’ve overpaid because you were hasty to ‘pay’ a bill. And as I alluded to at the beginning of this article, often caregivers pay these bills out of their own pocket. Don’t do that either, if you can help it, ever. That discussion is for another day.

But for now, when you receive a bill, make sure it is correct. Make sure it has been processed both by Medicare and your Medigap policy, if you have one. Make sure you have received all your proper discounts. Don’t ever be afraid to call and question a bill. Never be afraid to wait, just wait and see if the bill has been processed properly. You can and will save yourself money, frustration and maybe even some heartburn.

Then perhaps you can have the last laugh!

“You Just have to Laugh……….”

©2018 Cathy Sikorski

Be Like Peg…….

I recently got a phone call to return to great group of women and speak again. But this call went a bit differently than most conversations:

Mrs. K: Hi, Cathy! We were so happy to have you speak last year, but I think you need to return.

Me: Well, I would love to, is there anything particular you’d like me to talk about?

Mrs. K: Yes. I want you to give them the ‘SCARY TALK.”

Now, this is a group of mature women, church ladies, in fact, so I was pretty sure she didn’t mean she wanted me to give the sex talk. On the other hand, there are quite a few widows in this group…so maybe, they wanted a refresher course?  Maybe they didn’t remember my expertise?

Me:  So, Mrs. K., do you mean the SCARY TALK that I mentioned in passing about how healthcare costs and nursing home costs can truly make you destitute? Or……something else ( I wanted to make sure we were on the same page, my youthful good looks may have intrigued her to think something else.)

Mrs. K:  Absolutely. It’s time these women realized that there is terrifying information out there that they need to have. It’s time they got truly prepared.

 

What is going to happen to my money?!?

Me: I couldn’t agree more, but you need to let them know this is the SCARY TALK. No more “fun-and-games-Cathy.”  This will have to be the “I’m-not-even-kidding-Cathy.”

Mrs. K: Yes, you’ve warned me, I will warn them, and there is no time like the present.

So I went back and gave them the “SCARY TALK,” which, in my defense,  at my last talk while they were laughing and laughing at my granny panties (you have to come to a talk to see that one) I did suggest that they should have me back to give them the blood-curdling news.

They survived. It was a bit ugly.  But I actually got a thank you note for the shocking and intimidating information about the nursing home and healthcare crisis that may befall everyone in that room.

I’m on a mission now, not waiting until Halloween to give the SCARY TALK, it just may save people from horrendous consequences.

If you want the SCARY TALK…..let me know…..I’ve got it down pat.

“You Just Have to Laugh…..and get informed, and get prepared, and then you can Laugh Again!”  And then you’ll be like Peg!

Meet Beautiful Peg..She’s 106, nothing scares her!

©2018Cathy Sikorski

 

With Facebook Friends like this…Who Needs Enemies?

Two years ago, my Mom called me, practically in tears.

“Roberta was so mean to me,” she said.

I’m thinking, “who the hell is Roberta?”.

“She’s from my medical insurance carrier. I called to ask her why a bill wasn’t paid and she said I should never have been given this insurance and I’m going to have to pay back every penny from the last 15 years.”

“And,” she went on with a worried tone, “you told me to NEVER pay a medical bill. So I don’t know what to do.”

“Calm down, Mom. We will get this worked out. It will be okay.”

My first reaction was this:

I did tell my Mom never to pay a medical bill because her insurance covers everything.

My mom has Tricare For Life Medical Insurance. This insurance is for Veterans and their families, spouses, widows, children. My Dad died in a helicopter crash as an Army pilot on October 10, 1961. My mother had five children all under the age of 10 and was pregnant with her sixth child. So I kind of think my Mom is entitled to this insurance.

The thing is, Mom never claimed this insurance until my step-father passed away in 1998. She didn’t even ask for it. She already had Medicare and AARP. But when she applied for her widow’s the Veteran’s Administration made her jump through all kinds of hoops with documentation and then GAVE her this insurance.

My mom is a Virgo.

Why does that matter? She has kept every single piece of paper that has ever come into her life. So she has every piece of documentation that transpired fifteen years ago with the Veteran’s Administration. The VA put her on the wrong insurance.

So two years ago, they began threatening an 87-year-old widow, who raised her family of six children without a father, a man never even made it to 30 years old, that she would be thousands of dollars in debt to them because of their mistake.

After talking to seven different people at seven different government administrative places which most people never even heard of, we refiled all the documentation from 15 years ago.

I wrote much of this post two years ago.  And much of the problem has been resolved after mountains of paperwork and dozens of phone calls…one that occurred while I was drinking in Times Square. Hey, if they call, you answer, because they may never call back.

I said this two years ago, probably after the drinking incident in Times Square:

 I know from the last 25 years of caregiving and jumping through administrative hoops that this story will not have an easy ending. There’s going to be reams of paperwork. There will likely be boatloads of nastiness. There may be a lawsuit. But in my best, Scarlett O’Hara voice: “As God is my witness….my mother will never pay one dime to fix this problem.”

There’s one small problem that persists. The government agencies just can’t agree and  are trying to collect $687 from my sweet ol’ mom that they think they are owed from overpayments. I still have people in all these agencies working on it and I have not yet caved to paying money to make it go away, but still…..I am amused by the latest missive from one of the insurers trying to collect funds:

Fun things to do while fighting with Insurance
Like us On Facebook……Indeed.

Hmmmm…..I’m struggling with that friend request.

©Cathy Sikorski 2018