Tag Archives: Medicare

NY Medicare Advantage plan closes

Effective Jan. 1, 2016, Touchstone Health HMO, Inc. in New York will no longer be offering coverage of Medicare Advantage benefits in the following service areas: Bronx, Queens, Kings, Richmond, New York, Westchester, and Orange counties. Approximately 10,000 Touchstone Health HMO enrollees have the opportunity to return to Original Medicare and could be in the market for a new Medicare Supplement  or Advantage plan. CMS requires MA organizations to send a letter of termination notifying affected customers when their plan will end.

If you know anyone that needs assistance just send them my way!

Changes to Medicare 2016

The headline this year may be that Medicare will pay for end-of-life counseling.  “So far, the 2016 change getting the most attention is that Medicare will pay clinicians to counsel patients about options for care at the end of life. The voluntary counseling would have been authorized earlier by President Barack Obama’s health care law but for the outcry fanned by former Republican vice presidential candidate Sarah Palin, who charged it would lead to “death panels.” Hastily dropped from the law, the personalized counseling has been rehabilitated through Medicare rules.”

However, cost-control efforts may be the more interesting piece – attempts to “fostering teamwork among clinicians, emphasizing timely preventive services and paying close attention to patients’ transitions between hospital and home.”  These changes focus on Accountable Care organizations (“ACO’s”) conceptually allowed under ObamaCare.  This year you will be able to pick your ACO, previously you could just opt out.

For the full article, click here.

Medicare Copays announced for 2016

2016 MEDICARE PART A

 

Part A is Hospital Insurance and covers costs associated with confinement in a hospital or skilled nursing facility.

 

WHEN YOU ARE HOSPITALIZED FOR: MEDICARE COVERS  

YOU PAY

 

1-60 DAYS

 

Most confinement costs after the required Medicare deductible

$1,288

DEDUCTIBLE

 

 

61-90 DAYS

 

All eligible expenses after patient pays a

per-day copayment

$322 A DAY

COPAYMENT as much as:

$9,660

 

 

91-150 DAYS

All eligible expenses after patient pays a

per-day copayment (These are Lifetime Reserve Days that may never be used again)

$644 A DAY

COPAYMENT as much as:

$38,640

151 DAYS OR MORE  

NOTHING

YOU PAY ALL COSTS
SKILLED NURSING CONFINEMENT:

Following an inpatient hospital stay of at least 3 days and enter a Medicare-approved skilled nursing facility within 30 days after hospital discharge and receive

skilled nursing care

 

 

All eligible expenses for the first 20 days; then all eligible expenses for days 21-100 after patient pays a per-day copayment

 

 

After 20 days

$161 A DAY

COPAYMENT as much as:

$12,880

 

2016 MEDICARE PART B

 

Part B is Medical Insurance and covers physician services, outpatient care, tests, and supplies.

 

ON EXPENSES INCURRED FOR:  

MEDICARE COVERS

 

YOU PAY

ANNUAL DEDUCTIBLE Incurred Expenses after the required Medicare deductible  

$166 Annual Deductible

MEDICAL EXPENSES

Physicians’ services for inpatient and outpatient medical/surgical services; physical/speech therapy; and diagnostic tests

 

 

80% of approved amount

 

 

20% of approved amount*

CLINICAL LABORATORY SERVICES

Blood tests; urinalysis

 

Generally100%

of approved amount

 

Nothing for services

HOME HEALTHCARE

Part-time or intermittent skilled care; home health aide services; durable medical supplies; and other services

 

100% of approved amount; 80% of approved amount for durable medical equipment

 

Nothing for services; 20% of approved amount* for durable medical equipment

OUTPATIENT HOSPITAL TREATMENT

Hospital services for the diagnosis or treatment of an illness or injury

 

Medicare payment to hospital, based on outpatient procedure payment rates

 

Coinsurance based on outpatient payment rates

 

BLOOD

 

80% of approved amount after first 3 pints of blood.

First 3 pints plus 20% of approved amount* for additional pints
EXCESS DOCTOR CHARGES

(Above Medicare-approved amount)

 

0% above approved amount

 

All costs

 

*On all Medicare-covered expenses, a doctor or other healthcare provider may agree to accept Medicare assignment. This means the patient will not be required to pay any expense in excess of Medicare’s approved charge. The patient pays only 20% of the approved charge not paid by Medicare.

Physicians who do not accept assignment of a Medicare claim are limited as to the amount they can charge for covered services. In 2016, the most a physician can charge for services covered by Medicare is 115% of the approved amount for nonparticipating physicians. Note: In New York, the most a physician can charge for services covered by Medicare is 105%

of the approved amount for nonparticipating physicians. For routine office visits covered by Medicare, a nonparticipating physician can charge up to 115% of the fee schedule amount.

Medicare Premiums to rise, but no cost of living increase this year!

New Medicare Beneficiaries, and high earners, are going to get hit with substantially higher premiums.  Those currently on Medicare that are not high-earners will continue to pay $104.90 this coming year.  New Medicare Beneficiaries will pay $159 in 2016.

From the Wall Street Journal

“The rise in premiums seems increasingly likely because the Social Security Administration is expected to announce Thursday that low inflation means Social Security beneficiaries won’t get a cost-of-living increase for 2016.

About 3.1 million more participants would be subject to the rise because of their incomes. The Medicare trustees projected that single individuals earning between $85,001 and $107,000—and couples earning $170,001 to $214,000—would see monthly premiums rise from $146.90 a person this year to $223 in 2016.”

For the full article, click here.

From the New York Times:

“A quirk in the laws governing Medicare and Social Security will expose millions of Americans to a staggering 50 percent increase in their premiums for the part of Medicare that covers doctors’ bills, known as Medicare Part B. It is imperative that Congress pass legislation to protect low- and middle-income people who cannot pay that much.

The problem is that Social Security recipients will not get a cost-of-living increase in 2016, but Part B premiums are projected to rise. The roughly 70 percent of beneficiaries who are “held harmless” will pay the same premium as last year. That means the increased cost will have to be made up by the other 30 percent, because of the rule that premiums must cover one-quarter of Part B costs. This group includes 2.8 million new enrollees, 1.6 million people who don’t collect Social Security benefits and 3.1 million higher-income beneficiaries.”

For the full article, click here

 

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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