Tag Archives: Medicare Part D

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

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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……

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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

The best laid plans……………

Caregivers, Humor, Multiple Sclerosis, Uncategorized, , , ,

I have literally spent more than 10 hours (probably more like 20) trying to figure out what new Medicare insurance plan to choose for my brother-in-law. He currently pays for his insurance through his former employer. They have chosen to get out of the business of supplying insurance carriers for their retirees, so by the end of May, all retirees have to choose a new Medicare Plan.

When I first got the booklet for this, I was sure it was a scam. These Medicare Insurance companies that ‘help’ you choose a plan are suspect to me. But I called his employer. All I wanted to know is if it was a scam. I didn’t want any specific information about my BIL or his account as a retiree.

I had to jump through a billion hoops (this is not included in the 10 hours above), prove my POA status, give them all my BIL’s vital statistics and THEN, they needed a PIN number. Somehow, the one I had was expired. So I asked for a new PIN which had to be snail-mailed to me.  I finally convinced the representative to at least just tell me if the Medicare company was a scam. She relented and said no, it was not a scam….but that was ALL she was going to tell me until I got my new pin number.

business-19156_1280Already, I’m exhausted. But I push forward. I go on the website. I enter every medication, every doctor and all the vital stats. Two hours later, they give me a proposal of 18 Medigap policies to compare with 26 Medicare Advantage policies and 20 Medicare Part D Prescription Drug Plans to add to the comparison. For those of you who may struggle with math, that is 64 plans I should look at to compare and contrast to choose the best one for my BIL. And choose, I must, because as of May 31, 2015, they will automatically cancel his current insurance.

This got me thinking, What if this information was sent to my BIL and he had no one to help him wade through it? First of all, it’s a website. There are  in fact, still some people, many of the  Medicare Age Variety who are not computer savvy, hell, who don’t even have a computer. Yes, snobby Medicare helpers, everyone on the planet doesn’t have a computer. Now my BIL is very computer savvy, but he can’t really type anymore.
And he doesn’t really read anymore, because comprehension and retention elude him often. And he for sure, isn’t going to decide to read through Medicare plans as a fun hobby.

I am considered an expert in this field of Elder Law issues, including Medicare Insurance. And I completely UNDERSTAND what I’m reading. I am expected to find the nuances and loopholes in 64 different plans that best serves my BIL. And even I find this daunting.

And once I choose I am in a quandary. This special circumstance where they are cancelling his policy is considered an opportunity for open enrollment with no underwriting. In other words, nobody is looking at the fact that he has a myriad of health issues which would kick him out of any health insurance otherwise. So once I’m there, I’m never going to be able to leave without a problem.

My point is this. I’m exhausted. My severly disabled BIL, on his own would have probably missed this whole need to do this and be without health insurance. How many retirees from this major Fortune 500 company are struggling with this project? Even though it’s a great website and the advisors are pretty good at their job…I KNOW WHAT I’M DOING, AND IT’S STRESSING ME OUT.  The choosing is a nightmare.

I know, three months from now I’m going to hear from the new insurance company that Oh that’s not covered, oh that has a huge copay, oh he can’t have that NEW drug that he wasn’t on when you chose this plan.

The only thing that makes me laugh now is laughter of relief. But don’t worry, I’m plotting revenge somehow and you will be the first to know!

“You just have to Laugh…..”

© 2015 Cathy Sikorski