Our Blog

Tag: SHIP

Medicare Open Enrollment ends December 7th

Posted on

Medicare Open Enrollment ends December 7th

Open Enrollment is coming to a close soon. Every year Medicare gives you the opportunity to review your coverage and make changes. This year the Open Enrollment period is October 15 to December 7.

This is when people with Medicare can change their Medicare health plan and prescription drug coverage for 2014. Information on 2014 plans has been available since the beginning of October. People with Medicare can call 1-800-MEDICARE or visit www.medicare.gov for plan information. If a person is satisfied that their current plan will meet their needs for next year, they don’t need to do anything.

What can you do during Open Enrollment?

From October 15 to December 7 you can

  • Join or switch a Medicare Prescription Drug Plan
  • Join or switch a Medicare Advantage Plan

During this period you should take time to review health and drug plan choices and choose the plan that fits your needs. Coverage begins on January 1, 2014.

Each year, Medicare Advantage and Medicare Drug Plans can change costs and coverage. Plans will mail an Evidence of Coverage/Annual Notice of Change to you. This notice gives details about plan coverage, costs, etc for the next year. Some plans may choose to leave Medicare and no longer offer the plan you have, meaning you’ll have to find a new plan during Open Enrollment. If this is the case your plan would have mailed you a notice of non-renewal.

To learn more about available plans visit- Medicare Plan Finder on Medicare.gov

You can also:

  • Visit your plan‚Äôs website
  • Refer to the Medicare & You handbook
  • Call 1-800-MEDICARE (1-800-633-4227)
  • Or contact your State Health Insurance Assistance Program (SHIP)¬† at 1-800-792-8820 or http://www.state.nj.us/humanservices/doas/home/sashipsite.html

Medicare Billing Issues- Be Informed

Posted on

Medicare Billing Issues

 In the August/September issue of Renaissance magazine (http://www.njfoundationforaging.org/Ren_AugSep_WEBa.pdf), NJFA featured an article on observation status at the hospital versus being admitted. The article talked about how this can not only mean that seniors would see a bill for the time spent at the hospital, but that it also affected Medicare’s coverage of post hospital treatment at a rehab facility.

Medicare Part A is your hospital insurance and covers inpatient admissions to the hospital. There have been a few articles and news stories about these instances where a hospital changes a patient to observation status and therefore Medicare A does not cover the stay consequently, the patient is left with a bill. Furthermore, if that patient might benefit from a stay in a Skilled Nursing Facility for rehabilitation, then Medicare will not cover that either as a 3 day inpatient hospital admission is required in order for Medicare to cover an inpatient rehab stay.

Another issue recently cited in a New York Times article is that the Federal Government is concerned with inaccurate billing and coding by hospitals due to the new electronic record system. They feel there may be “upcoding”- increasing the severity of a patient’s condition or treatment as a means of profit. The Federal Government is also concerned about “cloning”- where information about one patient is repeated in other records.

Certainly there are many advantages to electronic medical records, both in cost and efficiency. However there needs to be tight guidelines and monitoring of these practices to make sure that fraud or abuse are not taking place in the system. The Federal Government issued a letter to several National hospital associations indicating that they are concerned about accurate billing in use of the electronic medical records system.

What does this mean for Medicare recipients? Make sure you talk to your doctor and anyone treating you in the hospital. Being an educated patient is your best defense; asking the hospital staff what you are being tested for; having open communication about your status and asking if they’ve communicated with your primary physician. It is also important to review your Medicare statements when they come and if you see anything that you feel  is incorrect to report it.

Know your resources. You can contact the following organizations with assistance understanding or navigating your Medicare coverage, as well as report possible fraud or abuse or other concerns, such as appeals.

Medicare- http://www.medicare.gov or 1-800-MEDICARE

Medicare Rights Center- http://www.medicarerights.org/ or 1-800-333-4114

SHIP (Statewide Health Insurance Assistance Program) 1-800-792-8820

Senior Medicare Patrol- 887-SMP-4359

County Office on Aging- 1-800-222-3737