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  • Working past 65? Here’s what to know about Medicare

    If you plan to work past 65 and keep the health insurance you’ve had from your job, you’re likely to wonder what, if anything, you need to do about enrolling in Medicare.

    About one in six older Americans now remains in the workforce beyond what was once the traditional retirement age. And the number of older workers will only grow over time.

    One reason is that Social Security now requires you to be at least 66 to collect your full retirement benefits. Retiring earlier means a smaller Social Security check.

    Then, too, a number of sixty-something workers continue to pursue their careers because they can’t afford to retire. Still others simply prefer to stay engaged and on the job.

    Whatever the reason for postponing your retirement, you still need to consider Medicare as you approach your 65th birthday and qualify for the health care coverage.

    First, you should visit with your company’s human resources manager to determine how your employer-provided insurance will fit with Medicare. That’s also true for anyone turning 65 and receiving health care through a working spouse’s group plan.

    Most workers will want to sign up for Medicare’s Part A, which usually has no monthly premium and covers hospital stays, skilled nursing, home health services and hospice care.

    Of course, like most rules of thumb, there’s always an exception. And this one is no different.

    If your employer coverage takes the form of a high-deductible insurance plan with a health savings account, you should defer enrolling in Part A. That’s because the Internal Revenue Service forbids you to continue contributing to your tax-advantaged savings account once you have Medicare.

    When you sign up for Medicare’s Part B, which covers doctor appointments and other outpatient services, mostly depends on how large your employer is.

    If your company or your working spouse’s company has 20 or more employees, your employer-provided insurance will remain your primary coverage and will pay your bills first. You can delay enrolling in Part B until you stop working.

    If you or your spouse’s company has fewer than 20 workers, Medicare will become your primary coverage, and your employer coverage will be secondary, so you should sign up for Part B.

    Assuming that you’re not yet receiving Social Security benefits, you’ll need to enroll in Medicare by contacting Social Security at 800-772-1213 orwww.socialsecurity.gov.

    Completing the online application is fairly simple and typically takes 10 to 30 minutes.

    You should do this during what’s called your “initial enrollment period,” which runs from three months before the month you turn 65 to three months after your birthday month. For example, if your 65th birthday is in September, you can sign up any time from June 1 until Dec. 31.

    There’s also the question of whether you’ll need to enroll in Medicare’s prescription drug coverage, also known as Part D, when you turn 65 or whether you can put off that decision.

    Again, you should consult with your company’s benefits manager. If your employer plan includes drug coverage that’s at least comparable to Part D coverage, you won’t need to sign up right away.

    When you do finally stop working, you’ll be able to enroll in Medicare (Parts A or B) without risking a late penalty during a special eight-month enrollment period.  You’ll also have two months to select a Medicare drug plan without a penalty.

    To learn more about how your employer health plan works with Medicare, visitwww.medicare.gov/publications and view the booklet “Medicare and Other Health Benefits: Your Guide to Who Pays First.” Or call 800-633-4227 to request a free copy.

    Understanding how your insurance choices fit together as you continue working beyond 65 will help you get the best care for your dollars.

    By Bob Moos
    Southwest public affairs officer
    U.S. Centers for Medicare and Medicaid Services
     

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  • COMMENTARY: Medicare steps up its fight against diabetes

    Diabetes affects as many as one in four older adults with Medicare. It costs hundreds of billions of dollars to treat and results in the loss of tens of thousands of lives every year.

    If we could better control diabetes, we’d be taking a huge leap toward creating a healthier America.

    Diabetes occurs when your body doesn’t make enough insulin or doesn’t respond to the insulin it does make. Insulin is what your body uses to process sugar and turn it into energy.

    When too much sugar stays in your blood, it can lead to serious complications and even life-threatening problems, including heart disease, strokes and kidney damage.
    Medicare is committed to fighting the diabetes epidemic.

    If you’re on Medicare and at risk for diabetes, you’re covered for two blood sugar screenings each year at no out-of-pocket cost to you. Risk factors include high blood pressure, a history of abnormal cholesterol and triglyceride levels, obesity or a history of high blood sugar.

    If you’re diagnosed with diabetes, Medicare will help pay for blood sugar self-testing equipment and supplies, as well as insulin and other anti-diabetic drugs. In the event of diabetic foot disease, it will also help pay for therapeutic shoes or inserts as long as your podiatrist prescribes them.

    Because living with diabetes can pose day-to-day challenges, Medicare covers a program to teach you how to manage the disease. With a written order from your physician, you can sign up for training that includes tips for monitoring blood sugar, taking medication and eating healthy.

    If you’d like to learn more about how to control diabetes, visit Medicare’s website at www.medicare.gov or call Medicare’s 24/7 help line at 1-800-633-4227 and visit with a counselor.

    In addition to the 30 million Americans with diabetes, another 86 million live with a condition known as pre-diabetes, where blood sugar levels are higher than normal but not high enough for a diabetes diagnosis.

    Pre-diabetes is treatable. But only one in 10 people with the condition will even know they have it. Left untreated, one in three will develop the full-blown disease within several years.

    Confronted with those statistics, Medicare is ramping up its efforts to prevent diabetes among the millions of Medicare beneficiaries who are at a heightened risk of developing it.

    Several years ago, Medicare partnered with YMCAs nationwide to launch an initiative for patients with pre-diabetes. The pilot project showed that older people could lose weight through lifestyle counseling and regular meetings that stressed healthy eating habits and exercise.

    About half of the participants shed an average of 5 percent of their weight, which health authorities say is enough to substantially reduce the risk of full-blown diabetes. Through adopting a healthier lifestyle, people diagnosed with pre-diabetes can delay the onset of the disease.

    Based on the trial program’s encouraging results, Medicare is now expanding its coverage for diabetes prevention. Using the pilot project as a model, it will help pay for a counseling program aimed at improving beneficiaries’ nutrition, increasing their physical activity and reducing stress.

    If you have Medicare’s Part B medical insurance and are pre-diabetic, you’ll be able to enroll in a series of coaching sessions lasting one to two years and conducted by health care providers as well as community organizations like local senior centers. There will be no out-of-pocket cost.

    Medicare is currently recruiting partners to offer the program so that it will be widely available to beneficiaries.

    Diabetes can be a terribly debilitating disease. It can mean a lifetime of tests, injections and health challenges. Every five minutes in this country, 14 more adults are diagnosed with it. And in the same five minutes, two more people will die from diabetes-related causes.

    If we can prevent more diabetes cases before they even start, we can help people live longer and fuller lives, as well as save money across our health care system. 

    By Bob Moos
    Southwest public affairs officer
    U.S. Centers for Medicare and Medicaid Services.

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  • Retiring? You have a choice to make on Medicare

    When you retire and qualify for Medicare at 65, you’ll need to decide how you’d like to receive your health care benefits.

    Because you’ll be new to Medicare, you may not realize you have two options.

    One is to join the government’s fee-for-service program that’s existed for 53 years. The other is to buy a Medicare Advantage plan from a private insurer.

    The choice may seem bewildering at first, so let’s go over each option.

    With traditional fee-for-service coverage, you may go to any doctor, hospital or other provider that accepts Medicare. Medicare pays the provider a fee for the service you receive. Once you meet your annual deductible, Medicare typically covers 80 percent of the cost for your care.

    You have a few choices for covering the other 20 percent:

    • You may use your retiree health plan from your former employer, if you’re retired and have such a policy. Some retiree plans may cost less or provide more benefits than other supplemental coverage.
    • You may qualify for Medicaid, if you have limited income and savings. Besides helping with your out-of-pocket costs like deductibles and co-insurance, Medicaid may pay for your monthly Medicare premiums.
    • If neither of those applies, you may buy a “Medigap” policy from a private insurer to cover what Medicare does not. There are 10 kinds of Medigap plans, with different benefits, so you’ll need to decide which is best for you.

    If you choose the traditional fee-for-service program, you’ll probably also want to buy a prescription drug plan to go with your other coverage.

    Traditional Medicare remains the favorite among people wanting the broadest possible access to doctors, hospitals and other providers. When coupled with a supplemental plan, it also makes your health care costs relatively predictable.

    Still, 33 percent of all Medicare beneficiaries – including 33 percent of Louisiana residents with Medicare — now prefer to get their health care benefits through a private insurer. The number of people buying private Medicare Advantage plans has more than doubled over the last 10 years.

    With Medicare Advantage, insurance companies contract with the government to provide care. Every private plan must cover all the benefits that traditional Medicare covers. In some cases, Medicare Advantage plans may offer extra benefits, like routine hearing or vision care.

    Many plans charge a premium on top of the amount you’ll pay each month for Medicare’s Part B medical insurance, but there’s no need to buy a supplemental Medigap policy. Likewise, most Medicare Advantage plans include drug coverage with their other benefits.

    The premiums, deductibles and co-payments will vary from one Medicare Advantage plan to another. But all plans, by law, must have annual limits on their overall out-of-pocket costs.

    Unlike the traditional fee-for-service program, most Medicare Advantage plans require you to go to doctors and hospitals within their network of providers or pay more for getting care outside the network.

    Still, the private health plans have been especially popular among people with low to moderate incomes. They provide relatively affordable supplemental coverage, with lower premiums than those for Medigap policies.

    So, which is better — the traditional fee-for-service coverage or a private Medicare Advantage plan? That depends on your own circumstances and preferences. What’s best for one person may not work as well for someone else.

    To find out more about your options, you can visit www.medicare.gov and browse through the “Medicare and You” handbook. The website will also give you detailed information about the Medigap and Medicare Advantage policies available in your area.

    Becoming informed will help you select the health care option that best fits your needs. It will also help you avoid mistakes that may cost you money.

    By Bob Moos/Southwest regional public affairs officer for the U.S. Centers for Medicare and Medicaid Services

     

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  • Make the most of Medicare’s drug coverage

    Medicare offers prescription drug coverage to everyone with Medicare.

    It’s a good deal. Medicare subsidizes the outpatient drug benefit, generally paying about 75 percent of the program’s costs. Unless you already have comparable drug coverage through another source, you should consider getting it when you sign up for Medicare’s health care coverage at 65.

    There are two ways to get drug coverage. If you’re in Medicare’s traditional fee-for-service program, you can purchase a “stand-alone” drug plan from an insurance company. Or, if you decide to buy a private Medicare Advantage health plan, you can choose one that includes drug coverage.

    To find the “stand-alone” drug plans and the Medicare Advantage health plans with drug coverage available in your area, visit Medicare’s “plan finder” at www.medicare.gov/find-a-plan. You can also call Louisiana’s Senior Health Insurance Information Program for help at 1-800-259-5300.

    You’ll see there are significant differences in premiums and deductibles, in the co-payments the plans charge, in the particular drugs they cover and in the pharmacies they use. That’s why it’s important to look at your prescriptions and individual circumstances when comparing plans.

    Ask yourself: Which plans cover the drugs I take? Which plan gives me the best overall price on all my drugs? Which plans allow me to use the pharmacy I want? Which plans let me get drugs through the mail? What are the plans’ quality ratings, such as for customer service?

    You’ll discover that many plans place drugs into different “tiers.” The higher the tier, the greater your share of the cost will usually be. If you find that a prescription of yours is in a higher tier, you may want to ask your doctor whether there’s a drug in a lower tier that would work as well.

    You may also encounter plans that follow “step therapy.” That means you must first try a less-expensive drug that’s been proven effective for most people with your condition before you can move up to a costlier drug. However, your doctor can request an exception if the costlier drug is medically necessary.

    Medicare drug coverage is just like other kinds of insurance – you buy it to protect yourself if and when you need it. Even if you’re not on any prescriptions now, enrolling in a drug plan with a low premium guarantees you’ll have coverage should your health decline and you require medication.

    After you pick a plan that meets your needs, call the company offering it and ask how to join. You may be able to join online, by phone or by paper application. Don’t be alarmed when you’re asked to provide the number on your Medicare card during the enrollment process. In this case, it’s OK.

    The plan that’s best for you this year may not be the best next year. If so, you can switch to another plan between Oct. 15 and Dec. 7 each year. Indeed, it’s smart to check all your options every fall to make sure you have the plan that best fits your needs and pocketbook. Your new coverage then begins on Jan. 1.

    If you’re having difficulty affording medications, you may qualify for the government’s “extra help” program. Your annual income can’t be more than $18,090 if you’re single or $24,360 if you’re married. Also, your resources can’t exceed $13,820 if you’re single or $27,600 if you’re married.

    Generally, you’ll pay no more than $3.30 for each generic drug and $8.25 for each brand-name prescription in 2017. Forty-one percent of Louisiana residents with a Medicare drug plan get extra help. To apply, visit the Social Security website, at www.socialsecurity.gov/i1020, or call Social Security at 1-800-772-1213.

    People with Medicare have saved hundreds or even thousands of dollars each year thanks to their drug coverage. Be sure to make the most of yours.

    By Bob Moos
    Southwest public affairs officer
    U.S. Centers for Medicare and Medicaid Services

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  • Medicare can help patients manage chronic illnesses

    Caring for yourself when you have a chronic illness like diabetes or heart disease is hard work. When you have more than one such illness, it can sometimes seem overwhelming.

    Seventy percent of Louisiana residents with Medicare have at least two chronic conditions. They often must juggle visits to several doctors, as well as the separate trips for follow-up tests. Then they must make sure they’re taking the right medications at the right times.

    Managing a number of chronic illnesses all at once can quickly become a full-time job. Unless it’s done right, you can compromise your quality of life and possibly increase your risk of a long-term disability or an earlier-than-expected death.

    That’s why Medicare is encouraging your health care providers to work together more closely to coordinate the treatment of your chronic conditions, so that you can spend less time sitting in medical offices and more time doing whatever you enjoy.

    To keep you healthy, Medicare has expanded a benefit called chronic care management. It provides higher payments to doctors and other providers to help you live with chronic disease.

    Through this benefit, your health care practitioner will assist you in keeping track of your medical history, your medications and all of the other health care providers you see. You’ll receive a comprehensive care plan that outlines your treatments and goals.

    You’ll also have 24-hour-a-day, 7-day-a-week access to health care professionals for urgent needs from the comfort of your home. Does that sound like something that might interest you?

    To qualify for chronic care management services, you must be enrolled in Medicare’s traditional fee-for-service program, or you must be in the Medicaid program and receiving Medicare benefits. You also must have at least two chronic illnesses that pose a serious threat.

    The list of eligible diseases includes asthma, chronic kidney disease, chronic obstructive pulmonary disease, depression, hepatitis, heart failure, high blood pressure, HIV/AIDS, osteoporosis, schizophrenia and stroke, among others.

    If you think you might benefit, ask your doctor to explain the various services you’d receive, such as:

    • At least 20 minutes a month of chronic care management services
    • Personalized assistance from a dedicated health care professional who will work with you to create your care plan
    • Coordination of care between your pharmacy, specialists, testing centers, hospitals and more
    • Phone check-ins between visits to keep you on track
    • 24/7 emergency access to a health care professional
    • Expert assistance with setting and meeting your health goals

    Your out-of-pocket cost for chronic care management will be the same as your share for other Medicare Part B services, so you may have a deductible or co-payment. But if you have Medigap or retiree supplemental health insurance, you may not have to pay those out-of-pocket expenses.

    Also, chronic care management can help you avoid the need for more costly services. By acting now and managing your health, you may be able to head off hospitalization and more serious treatment in the future.

    Chronic care management means having a continuous relationship with a dedicated health care professional who knows you and your history, provides personal attention and helps you make the best choices for your health. For more about the program, call Medicare at 1-800-633-4227 or visit http://go.cms.gov/ccm.

    Navigating your way through the health care system can often be bewildering and time-consuming. Medicare’s chronic care benefit gives you and your loved ones the assistance you need to manage your medical conditions so that you can focus on the things you love.

    If that sounds right for you, talk with your doctor or nurse about the program.

    By Bob Moos
    Southwest public affairs officer for the U.S. Centers for Medicare and Medicaid Services

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  • Many of Medicare’s screenings come at no cost

    How often have you tried to ignore an ache or pain by telling yourself, “Maybe if I do nothing, it’ll go away.” Sometimes, that works. But wishful thinking isn’t the best way to take care of yourself.

    Medicare has put a new emphasis on preventive health care.

    A few years ago, Medicare mostly concerned itself with paying for your treatment after you got sick. Now, it’s also focused on helping you stay healthy and avoid diseases and illnesses in the first place.

    People with Medicare are entitled to a broad range of exams, lab tests and screenings to detect health problems early, when they’re most treatable or curable. Many now come at no out-of-pocket cost.

    Many immunizations are also free.

    To make sure you get started on the right foot, Medicare covers a “welcome to Medicare” visit with your physician during the first 12 months you’re enrolled in the Part B medical insurance program.

    Your doctor will evaluate your health, discuss any preventive services you may need, like shots or screenings, and make referrals for more care if required. There’s no out-of-pocket cost.

    You can make the most of your visit by coming prepared. That means bringing a complete list of your prescriptions, your family health history and your medical records, including immunizations.

    Medicare also pays for an annual wellness visit with your primary care doctor. This isn’t the same as an annual physical, since it isn’t a head-to-toe examination. But it does provide the same opportunity to discuss your health.

    Your doctor will develop a personalized prevention plan to keep you healthy. The visit also includes a review of your medications and routine measurements, like your height, weight, blood pressure and body mass index.

    More than 40 million older Americans with Medicare – including 573,000 Louisiana residents — received at least one preventive service at no cost to them last year.

    Here’s a rundown of some of these services:

    • Cardiovascular screenings check cholesterol and other blood fat levels. Medicare pays for the test once every five years.
    • Blood sugar screenings can determine whether you have diabetes. Based on your health, you may be eligible for up to two screenings each year.
    • Mammograms check for breast cancer. Medicare covers a screening every 12 months for women 40 and older and one baseline mammogram for women 35 to 39.
    • Medicare typically pays for a flu shot once every flu season, a pneumonia vaccination and, if you’re at medium to high risk, a hepatitis B shot.
    • Colonoscopies can find precancerous growths early. Medicare covers the screenings once every 10 years or, if you’re at high risk, once every two years. You pay nothing for the test itself. If your physician removes a polyp, you may need to pay 20 percent of the Medicare-approved amount for the doctor’s services and a copayment for the outpatient setting.
    • Prostate cancer screenings include a yearly PSA test and digital rectal exam for men 50 and older. The PSA test is free. You pay 20 percent of the cost for the rectal exam, after meeting your deductible.
    • Medicare pays for one depression screening per year. The screening must be done in a primary-care setting, like a doctor’s office, that can provide follow-up treatment and referrals.
    • If you’re a smoker, you qualify for eight free counseling sessions each year to help you quit.
    • Likewise, if you’re obese with a body mass index of 30 or higher, you may be eligible for free counseling sessions to help you lose weight.
    • Medicare pays for HIV screening for people at increased risk for the virus, people who ask for the test, or pregnant women. Medicare covers the test once every year or up to three times during a pregnancy.

    Keeping up-to-date with screenings and immunizations is important, so Medicare encourages you to visit mymedicare.gov and register. There, you can see a description of your covered preventive services, the last date you had a particular test and the next date you qualify for it again.

    By eliminating the out-of-pocket costs for many screenings and tests, Medicare’s new emphasis on prevention not only can save you money, it can help you take control of your health.

    It may even help save your life.

    By Bob Moos
    Guest Columnist

     

    Bob Moos is the southwest public affairs officer for the Centers for Medicare & Medicaid Services. ONLINE:cms.hhs.gov. Medicare Buttons by http://www.hirejon.com/medicare/ 

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