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MEDICARE 911 – When You Have Questions That Need Immediate Answers

Medicare’s Annual Enrollment Period
Open enrollment begins on October 15 and lasts until December 7. During this time, you should consider your health care needs for 2021 and decide whether you need to make any changes in your coverage.

This self-assessment is especially critical now as the country continues to grapple with COVID-19, an illness that disproportionately affects older Americans.

During open enrollment, enrollees decide between original Medicare or a Medicare Advantage plan, an alternative that relies on private health insurance plans. You can switch from Original to MA or shift from an MA plan back to Original Medicare. You can change MA plans and can also decide whether to enroll in a Part D prescription drug plan or change plans if you already get your drugs through a Part D policy. Any changes you make will take effect in January 2021. If you are happy with what you have now, you do not have to do anything.

You can get personalized help as you ponder your open enrollment decisions. Medicare.gov has an online chat feature available during open enrollment, and the toll-free Medicare hotline, 800-MEDICARE (800-633-4227), is open 24 hours a day, seven days a week.

A Reminder of Medicare’s Parts

  • Part A covers hospital and hospice care and some skilled nursing services after you’ve been in the hospital.
  • Part B includes doctor visits, diagnostic tests and other outpatient services.
  • Part C is Medicare Advantage, which combines Part A, Part B and, usually, Part D, which helps pay for prescription drugs.
  • Part D helps cover the cost of outpatient FDA-approved prescription drugs.

New for 2012
Medicare Advantage plans are expanding the availability of extra services, particularly for the 73 percent of beneficiaries who have chronic health conditions. These benefits range from meals at home to transportation to health appointments to nutrition counseling to safety improvements to your home. Not all MA plans are offering these benefits, so look carefully at their coverage descriptions on the plan-finder site.

Medicare Fraud
Medicare fraud is unfortunately becoming more common, and there are many ways that you can become a victim:

  • People using your Medicare or health plan member number for services
  • People calling to ask for your Medicare or health plan member numbers
  • People trying to bribe you to use services you do not need
  • People going door-to-door or on email, to sell you healthcare items or services you don’t need

If you note anything suspicious that could be fraudulent billing, report it to Medicare by calling the phone number on your ID card or 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. You are not required to identify yourself when reporting a suspected fraud. If your suspicion is confirmed and leads directly to the recovery of Medicare money, you may get up to $1,000 as a reward.

Medicare and Covid-19 Testing
Covid-19 testing is covered by Medicare.

Medicare and Preventive Care Services
Medicare DOES pay for preventive care, including screenings such as mammograms and colonoscopies, and immunizations. You should stay up-to-date on all the recommended cancer screenings and other exams such as annual physical exams and blood pressure checks. Hospitals and healthcare facilities have strict safety practices to protect you during a visit for medical care, screenings or testing.

The Donut Hole
The donut hole is a gap in Medicare prescription coverage that temporarily limits what most Medicare Part D drug plans pay for prescription costs. It’s a threshold that you reach when your spending on co-pays reaches a certain amount. While you are in the gap, your drug costs will be higher. Not everyone falls into the gap but the danger of it is that the higher costs can be unaffordable; as a result, people may stop taking essential medications. There is an option, though, to self-pay for prescriptions, because those costs will not be counted toward your total. You may be able to find lower costs at independent drug stores. You do not have to use Medicare Part D to pay for your prescriptions.

Getting a Replacement Medicare ID Card
You can request a replacement Medicare card by contacting Social Security at www.ssa.gov. To make your online request, you will need your:

  • Name as it appears on your most recent Social Security card
  • Social Security number
  • Date of birth

Your Medicare card should arrive in the mail in about 30 days.

If you prefer, or if you are unable to use the online request to obtain a replacement Medicare card, call Social Security at 800-772-1213 (TTY 800-325-0778).

Telemedicine and Medicare
Perhaps your doctors have offered you the option of a virtual visit, or a telemedicine visit. Medicare is covering telemedicine visits FOR THE TIME BEING – during the pandemic – but has not yet decided if this policy will be extended long term.

Medicare and Flu Shots
Medicare does pay for flu shots. This is more important than ever this year, because we are already at risk of contracting the COVID 19 virus. Flu viruses change every year, so you need a flu shot every flu season. You can get your flu shot from your PCP, at a senior center, a pharmacy or from another healthcare provider.

If You Have Difficulty Paying for Your Medications
You can apply to the Extra Help program, which provides Medicare Part D prescription drug coverage at low or reduced cost for people with incomes under a certain level. You can also ask your pharmacist for guidance – he or she may know of options or may be able to find lower cost alternatives for you.

Medicare and You
Every year, Medicare enrollees receive a handbook that details Medicare coverage and explains any changes for the coming year. You can choose a paper copy or an electronic copy.

Medicare Does Not Cover:

  • Most dental care and dentures
  • Cosmetic surgery
  • Hearing aids and exams for them
  • Eye exams related to prescriptions for glasses
  • Routine foot care

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