Tag Archives: Medicare Part B

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….”

 

 

Medicare….not for the weak……

As I continue down this unrelenting path of caregiving, even in death, I can’t help but see the irony in statements that come my way like, ” what are you doing now that your brother-in-law has died?”

I’ll tell you what I’m doing:

“Hello, Medicare? I’ve now sent you a request for permission to speak to me as Executrix of my brother-in-law’s estate with all the supporting documents. I’ve waited the requisite 50 days for you to process it. I’ve waited longer than that because the first instructions I received were to take those documents to my local Social Security Office, which resulted in absolutely nothing, and now I have finally received a letter saying you will talk to me. Yay.

Medicare Person: What can I help you with?

Me: I’m trying to find out when a claim I have submitted will be paid?

Medicare Person: Why did you submit the claim Ma’am?

Me: Because the provider refused to submit it. They provide drugs and drug paraphernalia to the nursing home where my brother-in-law was residing at the time. They insist that they can only bill for the drugs to Part D Medicare and they have no authority to submit for the other items like IV poles, IV flushes and anything needed to actually administer the drugs.

Medicare Person (the THIRD Medicare person, because the first two couldn’t find the other conversations I’ve had and insisted that no such conversations took place). Yes, I’ve found the conversations you’ve had on April 4th , 11th, and 22nd.

Me: The last person I spoke with who connected me with you said she couldn’t find those conversations.

Medicare Person: Well, you’re both right. She can’t see these conversations, she’s in a different department.

Me: So, she couldn’t transfer me to you without wasting 30 minutes of my time and me insisting I speak to this department?

Medicare Person: I apologize for that Ma’am.

Me being Silent,

Medicare Person: Well, Ma’am I can’t find your claim. it takes 50 days to process.

Me: I filed that claim 120 days ago, and when your Medicare person CALLED ME ON APRIL

Provisions for speaking to Medicare
Provisions for speaking to Medicare

22 while I was standing in the middle of Times Square, and I popped into the closest restaurant and ordered a $12 glass of wine while on hold with your person, she told me that she was looking at my claim, it was paid to the nursing home and they would have to pay the provider. Then she proceeded to send me the wrong Medicare notices so I could prove to the nursing home, they owed the provider and the Estate of my brother-in-law was not liable for this bill.

Medicare Person: I can’t find that claim Ma’am. And so the only thing I can do is request a review.

Me: Okay

Medicare Person: I’m not allowed to request a review until 150 days has passed and it’s only been 120 since you filed the claim. A denial can take up to 150 days to process.

A missing claim is like a missing person. Maybe they went missing on their own. Maybe they are just at a friend’s house and forgot to tell you. Maybe they will use a credit card and then we can trace where they are and stop all this nonsense. But instead of waiting 48 hours, you have to wait 150 days. Imagine telling any person you’ve ever worked with that it will take 150 days to look at a piece of paper you sent them.

Medicare Person and I  then went on to discuss the many fun and esoteric ways that Medicare can screw up a claim.

Medicare Person: I know this is complicated and confusing Ma’am.

Me: I understand perfectly, everything you’ve told me. It’s not complicated or confusing to me, it’s just crazy! (Yep, I really did say that).

Medicare Person: Well, I know it seems complex, but we train for WEEKS to process this, so it would be harder for you to understand.

WEEKS? WEEKS? I’ve been dealing with Medicare for 25 years. And in all your weeks of training, the best you guys have ever given me is ridiculous, arbitrary waiting periods to process claims, a myriad of departments who don’t speak to each other, wrong information that has cost me precious time, and heartburn without the doughnut, wine or deep-fried food I deserve to go with it.

So glad your weeks of training have made you an expert.

I didn’t say any of that, I just got out my corkscrew and toasted the Universe for the never-ending supply of blog posts!

You Just Have to Laugh…………

© Cathy Sikorski 2016