Unfortunately, due to COVID 19 restrictions on public meetings, in recent months I have not been able to present my class, Getting Started with Medicare, in libraries and through community programs. I will be resuming in-person classes once we are permitted to do so safely. You can find the most up to date class information at www.Mutskoinsurance.com/seminars.
While we often hear the complaints about Medicare, a recent survey showed that nearly 90% of Medicare enrollees are happy with their coverage and the care they receive. Your satisfaction will be determined in a large part by the Medicare coverage you select. Overall, I think you will find there is a lot to like about Medicare including:
Want to work after retirement? That can be a smart move for many seniors, but your post-retirement career shouldn’t make retirement less enjoyable. Mutsko Insurance Services wants you to enjoy the best quality of life at every state. If you are thinking of looking for a new job – which you can do so in in a number of convenient ways, including your smartphone – here are some search tips that can help find a new career, job, or business that will provide much more than just monetary benefits for your retirement:
Navigating life in the midst of a pandemic is hard for everyone, and if you’re caring for an elderly or disabled loved one, adjusting to this new reality can be even more challenging. You want to be sure your loved one is getting the very best care, but you don’t want to risk increasing their exposure to the virus (or your own). Everyone’s situation is unique, but we hope these tips will answer some of your biggest questions and concerns about providing care through such a challenging time.
Are you a family caregiver worried about how the COVID-19 crisis will impact long-term care for a senior loved one? With so many concerns over the vulnerability of senior citizens as well as the economic upheavals, it’s only natural to be concerned about the well-being of your older loved ones and yourself. So if you are looking for answers to your COVID-19 questions or long-term care concerns, this guide may prove helpful:
Like you, thousands of people have recently lost their jobs due to the health care crisis in this country. This comes at a time when having health insurance coverage is especially important to all of us, even the healthiest of people.
Here are a few options for you to look into:
Marketplace insurance plan
You can apply for a Marketplace insurance plan. The government’s Affordable Care Act (ACA) considers losing your health insurance as a life event that qualifies you for a Special Enrollment Period. The Special Enrollment Period (SEP) is defined as a time outside the yearly Open Enrollment Period when you can enroll in a new plan. In addition to losing your health insurance other qualifying life events include moving, getting married, having a baby, or adopting a child.
You have 60 days from the time you lose your health insurance to enroll in a Marketplace plan. Your change in income may qualify you to receive financial assistance to help pay for premiums and out-of-pocket costs. Make sure you have an estimate of your reduced income ready when you apply for your Marketplace plan.
Are you under age 26?
If you are younger than 26, the Affordable Care Act may allow you to be covered under your parent’s insurance plan. For details on how to get or stay on a parent’s insurance plan, go to www.healthcare.gov/young-adults/children-under-26
Check your Medicaid eligibility, even if you don’t think you qualify. Eligibility for Medicaid is based on your current monthly income. You can learn whether you qualify for this option by going to www.benefits.gov/benefit/5940 for more information.
Your former employer must offer this short-term extension of your company's insurance, but you will be responsible to pay the full premium yourself. While this is an expensive option, it may be a good choice for those who are receiving treatment for a chronic condition or cancer, for example, and don’t want to change health-care providers.
Please do not put off investigating your coverage option. It takes time to gather this information and get enrolled, so it is important for you to get started as soon as possible.
For questions concerning health insurance, including individual plans, Medicare Advantage plans, Medicare Supplements and more, please contact me at 440-255-5700 or [email protected].
Simply put, Telemedicine is the practice of medicine electronically using your computer, mobile phone or pad for a two-way conversation with your health care provider. With telemedicine, you can safely receive medical advice without ever having to leave the comfort of your home.
Telemedicine has been growing in popularity in the last few years. It has been used successfully for a variety of health issues including follow-up consultations with physicians, sore throats, counseling sessions, insect bites, rashes and other common ailments. It is not appropriate for emergency situations like heart attack or stroke, cuts or lacerations, or broken bones that require x-rays, splints, or casts. Anything that requires immediate, hands-on care should be handled in person.
A recent change now permits those on Original Medicare to use Telemedicine under specific circumstances. The policy change carries out a waiver of Medicare rules authorized by Congress under the Emergency Declaration authorized by the President and will remain in effect during the COVID19 outbreak.
According to the CMS website at www.cms.gov/newsroom:
“Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients. Coinsurance and deductibles apply.”
At a press conference on March 17, CMS announced that Medicare will now cover telemedicine for routine follow-up visits as well — so if you need to check in with your doctor for a chronic condition such as high blood pressure or type 2 diabetes, for example, you'll be able to do it via Skype or other technology instead of going in for an in-person visit. This option helps older people take care of many health concerns while they stay safely at home during the COVID19 outbreak.
The best way to know if—and to what extent—your current healthcare provider offers telemedicine services is to call and ask them directly. The practice administrator or manager should be able to explain what telemedicine services are offered, as well as the associated costs.
For your questions on insurance, including life, health, Medicare Advantage Plans and Medicare Supplements, call or email me at [email protected] or call 440-255-5700.
According to the Center for Disease Control and Prevention, approximately 88 million American adults—more than 1 in 3—have prediabetes. Of those with prediabetes, more than 80% do not know they have it.
It’s important to talk to your doctor about getting your blood sugar tested if you have any of the risk factors for prediabetes, which include but are not limited to:
If you have prediabetes, the CDC’s National Diabetes Prevention Program has a behavioral change program that can help you make lifestyle changes to prevent or delay type 2 diabetes and other serious health problems.
The program begins with 16 core sessions offered in a group setting over a 6-month period. In these sessions, you will receive training to make realistic changes in your diet and exercise and provided with strategies to control your weight. A specially trained coach will help motivate you.
Once you complete the core sessions, you will have six more months of follow-up sessions to help you maintain healthy habits and an additional twelve months of ongoing maintenance sessions if you meet certain weight loss and attendance goals during the first year.
The program is limited to Medicare Part B beneficiaries who meet the specific guidelines for the program. You can find details at www.cdc.gov/diabetes/prevention and ask your health care provider to provide you with a referral. If you are eligible, you will pay nothing for these services.
You can also find more information on Medicare’s coverage for diabetes in a Medicare publication, Diabetes Supplies, Services and Prevention Programs. It explains in detail coverage for diabetes medication, equipment, supplies, insulin pumps, therapeutic shoes, medical nutritional therapy services and more. For your copy of this publication you can go online to www.Medicare.gov/publication or call 1-800-Medicare to request a copy.
For your questions on life, health, Medicare Advantage Plans and Medicare Supplements, call or email me at [email protected] or call 440-255-5700.
As we get older, we face many different challenges from the ones we encountered during our younger years. Physical ailments, susceptibility to disease, cognitive decline, and mental health issues such as depression, anxiety, and loneliness can all play a role in a senior’s day-to-day routine, so it’s important to understand those issues and how to combat them. Staying healthy can include actions such as exercising daily and eating right, but it can also involve making home modifications or downsizing for safety’s sake. Here are four common problems that older adults face and how to navigate that stress.
Maintaining Daily Care
If you or a senior loved one find that daily needs — such as preparing meals, bathing, or safely navigating the house — are becoming overwhelming, it might be time to look into an assisted or independent living facility. Depending on your specific needs, you might want a home that offers a wide variety of assistance with daily tasks, or you may be more comfortable in a situation that offers some help but allows for more independence. The benefits of moving into a senior community are varied, but one great perk includes social opportunities. Loneliness and isolation are extremely problematic for older adults, causing everything from mood disorders to a decline in physical health, so these opportunities mean a lot to seniors who want to live an active, vital lifestyle. Do a little research and take some tours, as facilities differ in terms of services and cost; you’ll find independent living facilities typically range from $1,500 to $8,296 per month in Cleveland.
It’s important to know what your options are for financing a move to assisted or independent living. Health insurance and Medicare don’t cover this type of care, but Medicaid can help if you meet income qualifications. Many seniors sell their homes and use the funds to pay for the move, but you can also consider renting out your home instead, which will give you a monthly income.
Staying Safe at Home
Many seniors find it difficult to maintain their safety around the house due to physical conditions — such as a vision impairment — or because the home contains a lot of steps or clutter. If your home isn’t as accessible as you need it to be but you’re not ready to make a downsize, consider making some modifications that will help prevent falls and other accidents. To age in place safely, you’ll want to think about remodeling some areas of the home, such as the bathroom. This is one room that always benefits from safety improvements, and it can actually add value to your home. The cost to remodel a bathroom in Cleveland is between $4,692 and $11,208 on average.
A Lack of Physical Activities
After retirement, many seniors find that their schedules slow down and leave them with a lack of activity, which can take a toll on the body and mind. Daily exercise is a great way to combat this, and it can be something as simple as taking the dog for a walk or gardening. If the activity can be done with a friend, even better! This is a great opportunity for socializing and getting outdoors.
It happens to the best of us: The memory starts to play tricks, or we find we’re not as sharp as we used to be. Fortunately, there are several easy ways to combat cognitive decline, including playing games, doing puzzles, practicing a hobby, and staying social with friends and loved ones. Many seniors can play brain games and solve puzzles on senior-friendly tablets, many of which can be purchased for as little as $100 on Amazon.
It’s not always easy or fun to navigate getting older and all that comes with it, but the good news is there are several simple ways you can make changes that will benefit you. So, talk to your loved ones and keep communication open so they can help you implement those changes. Remember, you don’t have to go through it alone.
You may have heard that the coverage gap, often referred to as the ‘donut hole’, is closing in 2020. Unfortunately, closing the ‘donut hole’ does not mean your prescriptions will be free. You will still pay, but your share of the cost of generic drugs will be less in 2020 once you reach the coverage gap.
What you can expect in 2020
Medicare beneficiaries with Part D coverage will pay 25% of the costs of generic medications and 25% of any brand-name medications once they reach the gap. Some Prescription Drug plans may offer even greater coverage, but they all must cover at least this portion of the cost.
You may not reach the donut hole.
Both you and your Part D plan must spend a total of $4,020 on medications in 2020 before you will enter the donut hole. Here are a few strategies to help you avoid hitting this gap:
Plan now to put these strategies in place in 2020 to help keep your prescription costs in line. For your insurance needs, contact me at 440-255-5700 or [email protected] to set up an appointment.
Just because a medical bill shows up in your mailbox does not mean you should sit down and immediately write a check. While billing errors may be unintentional, a high percentage of them contain errors. It pays for you to take some time to make sure you are only being charged for the services you received. Here’s what you can do:
The initial bill you receive is a summary of your services prior to your insurance company processing their share of the costs. You should set aside this bill and wait until you receive an explanation of benefits (E.O.B) from your insurer.
The E.O.B is the document your insurance company provides that outlines what the insurance carrier covered and what costs will be your responsibility. Check this to see that the dates and doctors match, and that the amounts on your bill match your E.O.B. Other common errors to look for are duplicate charges, charges for tests or procedures that were cancelled, incorrect patient information and incorrect quantities of items or medications provided.
If you find something that doesn’t match your records, your next step is to call the medical provider’s billing department and request an itemized list of charges. If something on the itemized bill doesn’t match up with the care you received, your next step will be to dispute the bill.
You may have to spend some time on the phone getting a bill corrected. Be ready to make notes of all information regarding your disputed bill, including documenting all the names of everyone you talk to, the dates of your calls and all follow-up information provided to you. Don’t give up until you get answers that you understand.
One of the services I provide my customers is assistance with billing problems like these. There is never a charge for my services. It is one of the benefits of having me as your insurance agent.
I welcome your questions concerning life, health or Medicare insurance. Please contact me at 440-255-5700 or [email protected] to set up an appointment to discuss your needs.
Many people like to get away from the cold winter weather for a few weeks or months every year. Folks who are in good health may not give a lot of thought to how they would handle a medical emergency while on a cruise or enjoying warmer climates. The experienced traveler knows medical coverage depends on where your travels take you and what type of health care plan you have.
For example, if you have Original Medicare, you have coverage anywhere in the U.S. and its territories. This includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Problems sometimes arise when a traveler needs immediate care and is evacuated to a hospital in a foreign country. Original Medicare and many other health insurance plans do not pay for medical care, evacuations, prescriptions or supplies you receive outside the U.S. except in very limited situations.
If you are not on Medicare, your first step should always be to contact your health insurance agent or insurance company and ask for detailed information on your coverage while you are away from home. Many health insurance policies will cover you for care needed to treat an emergency, even when you are out of the country. You may be required to pay out-of-pocket and then submit for reimbursement after you return home.
Because of the varied limitations, it is a good idea to consider travel medical insurance, especially if you have a preexisting or chronic condition. Travel medical insurance policies are designed to pick up where your primary health plan leaves off and offer a choice of varying limits and coverage. If you do not have health coverage, some plans act as primary insurance while you are out of the country.
If you would like to learn more about travel medical insurance, call us at 440-255-5700 or email me at [email protected]. A travel medical insurance plan can be the difference between a trip ruined by unexpected illness or injury, versus a trip with access to quality care if an emergency arises.
Please note, this is general information and your circumstances or insurance coverage may be different. Always talk to your insurance company or agent to verify your coverage.
Did your Medicare Supplement drop your much-loved Silver Sneakers gym membership? Do you regret not enrolling in a Medicare Supplement when you first had the chance to do so? Or do you have an older Supplement such as Plan E, J, H & I and your premium is sky-high?
I have good news for you. There is a plan that has opened their underwriting and will accept anyone who wants to move to their plan without any health questions asked. The plan also provides Silver Sneakers as an extra service at no cost to you. You will need to act soon as the deadline to switch to this plan is December 31, 2019.
If you have frequent doctor or hospital visits, you already know that Medicare Part A and Part B do not cover 100% of your costs. Your share of out-of-pocket costs add up quickly. Medicare Supplement Insurance may save you money by covering the costs Original Medicare doesn’t cover, including deductibles, coinsurance, copayments and care you receive outside of the United States. With a Medicare Supplement, you can keep your same doctors and hospitals if they accept Medicare.
All Medicare Supplement policies must follow federal and state laws designed to protect you. Each supplement policy must offer the same basic benefits, no matter which insurance company sells it. Cost is usually the only difference between supplements with the same letter sold by different insurance companies.
Every person’s situation is different, and it is important to learn about all the different Medicare options including Original Medicare, Medicare Advantage plans, Medicare Prescription Drug plans and Medicare Supplements to find the coverage that fits your needs and budget. If you have questions about which type of coverage may work better for you, contact Laura Mutsko at 440-255-5700 or email me at [email protected].
Two of the most common types of Medicare Advantage plans are the Health Maintenance Organization (HMO) plan and the Preferred Provider Organization (PPO) plan. Both are managed by private insurance companies that contract with Medicare to provide all the benefits covered by Original Medicare. Here are some of the biggest differences between these two.
Medicare Advantage HMO plans provide all the benefits covered by Original Medicare through a specific network of health care providers. For the most cost-effective health care, you will need to use the physicians, hospitals, labs and other health care providers within your plan’s network. You may also need to choose a primary care physician who will act as your health care ‘gate-keeper’, providing you with referrals before you consult any specialists. The HMO’s network may be limited to a specific geographic area except in emergency situations. Premiums are generally lower with low or no deductible for HMO plans.
If flexibility is important to you, a PPO may be a better choice. Like an HMO, a PPO has a network of hospitals, physicians, specialists, and other health care providers, however their network will likely be larger. With a PPO, you will have the ability to visit any specialist, lab, or pharmacy without a referral from your primary care physician. If you find yourself in need of medical care when you are away from home, you can see any healthcare provider you choose. Your costs for care will be lowest if you receive care from those within your network. Although a Medicare Advantage PPO plan offers more flexibility, your out-of-pocket costs including premiums, deductibles and copays will likely be higher.
Plan benefits and their costs will vary depending on the insurance company and plan you choose. Contact Mutsko Insurance Services at 440-255-5700 or email me at [email protected] to discuss your needs. The key to finding the right plan for you is to strike a balance between the coverage you want and the premium you can afford.
If you do not have health insurance through a job, Medicare, a Medicare Advantage Plan, Medicaid, the Children's Health Insurance Program (CHIP), or other source of qualifying health insurance coverage, you have the option of turning to the Health Insurance Marketplace to get coverage.
For coverage in 2020, the Open Enrollment period in Ohio begins November 1, 2019 and extends through December 15, 2019. If you plan to enroll, be sure to complete your application and select your plan before December 15, 2019. In most cases, the new coverage will go into effect on January 1, 2020 for those who enroll before December 15 and make their first premium payment by the due date specified. Once you select a plan, you will be locked into that coverage for 12 months or until the next Open Enrollment period unless you cancel the plan.
If you miss signing up during Open Enrollment, you will not be able to enroll in a Marketplace health plan unless you experience one or more of the changes in circumstances that are identified as qualifying life events. If you have a qualifying life event, you will have a special 60-day opportunity to enroll in a Marketplace plan.
No matter what plan you select, I recommend you update your Marketplace application with your anticipated income for 2020 along with other household information. It is also a good idea to compare your current plan to other plans being offered in 2020, even if you intend to keep the same plan. Insurance companies can change coverage and costs every year. Your situation may have changed too. There may be a different plan with coverage and features that are a better match to your needs. You can start comparing plans beginning November 1, 2019.
If you are interested in receiving additional information or would like a quote, please visit our website at Mutskoinsurance.com and click on ‘Get a Quote.” Once we receive your information someone from our office will contact you. You can also call 440-255-5700 for an appointment. We look forward to helping you.
Medicare Part D is an optional federal government program that helps subsidize the cost of prescription drugs for Medicare beneficiaries. All Part D plans are administered by private insurance companies who have been approved by Medicare.
Part D coverage is available two different ways. Those who have Original Medicare can purchase a standalone Prescription Drug Plan that will add prescription drug coverage to their Parts A and B coverage. Others receive their Prescription Part D coverage with their Medicare Advantage plan. Although Part D coverage is optional, there may be premium penalties for those who do not sign up when they first become eligible unless they have other creditable coverage.
All plans are not the same. The monthly premiums vary depending on the type of prescription drug plan you select. Also, some plans charge an annual deductible. Other plans do not.
In addition to the monthly premiums and any deductible, you can expect to pay a co-pay or co-insurance for most prescription. Again, your share of the cost will be determined by the policy you choose, the type of prescription drug you are purchasing and whether it is brand name drug or a generic drug. For example, you might have to pay $5 for a generic drug, $25 for a “preferred” brand name drug and $40 for a non-preferred brand name drug. Your share of the cost may also be higher or lower depending on whether you use the pharmacies in your plan’s network.
In 2019, once you and your insurance carrier pay $3,820 on covered drugs, you will enter the coverage gap also called the donut hole. For complete information on the out-of-pocket costs while you are in the coverage gap and information on catastrophic coverage, please visit www.Medicare.gov and search for costs-in-the-coverage-gap.
The time to make changes in your Medicare Part D coverage is coming soon. During Medicare’s Annual Open Enrollment (October 15 to December 7) you can join a new plan or switch to a different plan that works better for you. Changes you make in your coverage during Open Enrollment will begin on January 1, 2020.
To learn more or to make changes in your coverage, please contact Mutsko Insurance Services at 440-255-5700 or email me at [email protected] to set up an appointment during Open Enrollment to discuss your needs.
Now is a good time to consider whether a Medicare Advantage plan is a good choice for you. If you decide to switch, you can do so during Medicare’s Fall Open Enrollment which begins on October 15 and runs through December 7.
Here are some key differences between Original Medicare and Medicare Advantage plans:
Medicare Parts A and B are commonly referred to as Original Medicare. Original Medicare is managed by the federal government and provides eligible individuals with coverage for doctors, hospitals and other health care providers. You pay a monthly premium for Original Medicare.
Medicare Advantage plans (Medicare Part C) are an alternative way to get your Medicare benefits. Advantage Plans are administered by private insurance companies who are required to provide the same level of coverage offered by Original Medicare. Some Advantage plans are offered at zero monthly premiums while others charge a monthly premium in addition to what you pay for Medicare Part B.
Medicare Advantage plans usually require you to use their plan’s network of doctors, hospitals, and other providers. If you go to a provider who is not in your plan's network, your services may not be covered or your costs may be higher. With Original Medicare there are no networks or referrals needed. You can go to any doctor, supplier, hospital or facility that is a Medicare provider.
Advantage Plans cap your annual out-of-pocket costs for medical services. Once you reach this limit, you will pay nothing additional for covered services. With Original Medicare there is no annual cap.
Prescription coverage (Part D) must be purchased separately for those with Original Medicare. Prescription coverage is included with many Medicare Advantage plans.
Many Advantage plans provide additional benefits not offered by Original Medicare, including coverage for routine dental and vision care, hearing aids, podiatry care, gym memberships and allowances for non-prescription medicines to name a few.
There are other differences between Original Medicare and Medicare Advantage plans. If you would like to learn more or are ready to make a change, contact me at 440-255-5700 or email me at [email protected] and we can go over all your options.
Many people are surprised to learn that Medicare does not cover 100% of their health care expenses. In addition to co-pays, deductibles and co-insurance, there is a list of healthcare services that are not covered by Original Medicare Part A, Part B or Part D. Here are some of the gaps to watch out for:
Medicare covers glaucoma, cataracts and macular degeneration, but it does not cover the kind of vision care we most often need, namely routine vision exams, contact lenses and eyeglasses.
It is estimated that around half of seniors more than 75 years old experience hearing loss. Unfortunately, even though this is such a common disability, Original Medicare does not provide coverage for hearing aids or the exam to diagnose hearing loss.
Medicare does not cover preventive dental cleanings, x-rays, fillings or root canals. You can also expect to pay out of pocket for dentures or oral surgery needed to combat gum disease. As a side note, Original Medicare does cover treatments that are essential before someone can undergo another procedure that is covered. An example of this would be extracting a decaying tooth prior to having heart surgery.
It is a good idea to consider additional medical coverage if you plan to travel outside the U.S. In most cases, Original Medicare will not cover your medical costs for accidents, routine care, or medical evacuations when you are outside the U.S.
Original Medicare does not cover most chiropractic treatments, cosmetic surgery, routine podiatry care or alternative medicine.
Fortunately, you can get coverage for these services and more with many of today’s Medicare Part C Advantage Plans. I can show you Advantage Plans that provide generous allowances for over-the counter medications, transportation to health care appointments and free membership in fitness clubs. In addition, many plans offer coverage for dental, vision, hearing, podiatry care and much more. If you would like to learn more, give me a call at 440-255-5700 or email me at [email protected].com. I look forward to helping you find the right plan for you.
When asked where they want to spend their retirement years, 9 out of 10 seniors prefer to stay in their own homes. Those who are most successful doing this, create a plan to age in place early on, while they are able to manage all aspects of living on their own. As they age, they already have a good idea of who and where to turn to for services and assistance to help them stay in their home, regardless of changes in their health, abilities and needs.
It is important not to wait to put together a plan. Start investigating companies or individuals who can take on some of the more physically challenging chores like window washing, yard maintenance and snow removal. Some seniors have a cleaning company come in once a month for an hour or two to tackle the tougher cleaning jobs. Your family is less likely to be concerned about you living alone if they see you are still able to manage your household.
The National Institute on Aging at www.nia.nih.gov is a good source for many other ideas. You can also do an online search for Aging in Place for a wealth of suggestions on meal preparation, transportation and medication management. Do an online search for Assistive Devices to find new products designed to make your everyday tasks easier to manage. You will find both high-tech and low-tech tools to do everything from remind you to take your pills to help putting on your socks. It’s amazing what is available.
As a part of your plan, be sure to look at the benefits provided by your health insurance plan. Some of today’s Medicare Advantage plans include optional services like transportation to and from health-related appointments, home helpers, assistive safety devices, prepared meals following a hospital stay and allowances for safety devices in your home. Having services like these available when you need them can go a long way in helping you maintain your independence.
If your Medicare Advantage Plan does not provide these services, I can help you find one that does. You can give me a call at 440-255-5700 or email me at [email protected]. I look forward to helping you find the right plan for you.
Drug interactions can be a real concern for anyone who regularly takes a number of prescription medications on a daily basis. But, you can take steps to reduce the risks.
Your pharmacists and doctors are your first line of defense. They are well-trained to review your medications and prevent drug interactions. Your first step should be to discuss your concerns with them and they will let you know if there is anything in particular you should watch for including potential side effects or adverse reactions. Be sure you know what each prescription is for.
For questions concerning health insurance, including Individual, Group, Medicare Advantage Plans or Medicare Supplements, please call me at 440-255-5700 or email me at [email protected]. I look forward to helping you.
Pneumococcal disease (often referred to as pneumonia) kills 18,000 adults 65+ each year. Older adults are at greater risk and face more severe side effects from pneumonia because immune systems weaken as we get older. The vaccines for pneumonia are especially important for those who have chronic diseases.
The pneumococcal vaccine is a cost-free benefit covered by Original Medicare Part B. The vaccine is a series of two shots typically given a year apart. Check with your doctor to see if you are up to date on this important element of your preventive health care plan.
According to the National Council on Aging, one in three adults contract shingles at some point in their life—the majority of whom are 60 years or older. Shingles is a very painful skin rash that is caused by the “reawakening” of the same virus responsible for chickenpox. If you ever had chickenpox, you are at risk for developing shingles.
Original Medicare, Part A and Part B, does not cover the shingles vaccination. To get this covered, you must be enrolled in a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage plan that includes prescription drug coverage. Depending on your plan benefits, you may have to pay a copayment or coinsurance amount. I recommend you contact your plan and follow their guidelines in order to make sure you are covered for this vaccine.
It is interesting to note that many people do not think they had chicken pox as a child. However, the Center for Disease Control recommends people 60 years of age or older get the shingles vaccine whether or not they recall having had chickenpox. Studies show that more than 99% of Americans aged 40 and older have had chickenpox, even if they do not remember getting the disease.
You can find more information about coverage for these and other vaccines at 1-800-MEDICARE or visit www.Medicare.gov. If you have a Medicare Advantage Plan, please call your Medicare Advantage Plan provider for more information on these and other vaccines.
For questions concerning health insurance including Individual, Group, Medicare Advantage Plans or Medicare Supplements, please call me at 440-255-5700 or email me at [email protected]. I look forward to helping you.
The VA provides a Medical Benefits Package that is a standard enhanced health benefits plan available to all veterans who served with honor. This plan includes both preventive and primary care, and offers a full range of outpatient and inpatient services within the VA health care system. Those who are enrolled are eligible to receive treatment at more than 1700 medical centers and outpatient clinics across the U.S.
While all veterans may be eligible for health care benefits, eligibility and cost of care are based on many factors including:
If you have access to the internet, I suggest you begin your research by visiting www.va.gov/health-care for an overview of the benefits you may be entitled to receive. You can also find helpful information on Lake County’s V.A. website at www.lakecountyohio.gov/veterans/Benefits and the Cleveland Regional Office website at www.benefits.va.gov/Cleveland. These websites provide a wealth of information to help you become familiar with the system.
Veterans living in Lake County are encouraged to reach out to the County’s Veterans Service Officers (CVSO). Their staff members are trained and accredited by the National Association of County Veterans Service Offices and are veterans who are paid to help you at no cost to you. They will explain your available benefits, assist you in obtaining necessary documentation, help you complete forms and applications and act as your advocate throughout the entire process. You can reach them by calling (440) 350-2904.
The VA itself strongly recommends that all veterans with VA health care also enroll in Medicare Parts A and B as soon as they become eligible (unless they have group insurance from a current employer). Having both Medicare and VA benefits greatly widens your coverage.
If you have insurance questions concerning Individual, Group, Medicare Advantage Plans, Medicare Supplements, Vision, Dental or other Life or Health insurance call me at 440-255-5700 or email me at [email protected]. I look forward to helping you.
We are finding a growing number of our customers are relying on the internet paired with their smart phones, tablets and other mobile devices to search for insurance information. However, we all know that not everything you find on the internet can be trusted so it’s a good idea to be cautious of the sites you visit.
Here are a few reliable resources:
Medicare.gov is the official U.S. Government site for Medicare. It is a one stop site for official Medicare benefit information including coverage options, costs, preventive services, blogs and videos. It is also where you can sign up for MyMedicare.gov, a free and secure way for you to access your personal information online, cutting down on the amount of paperwork Medicare routinely sends to you.
The Center for Medicare and Medicaid Services (CMS) recently introduced an easy to use tool called the “What’s Covered” app to give you accurate cost and coverage information on your smartphone or mobile device. Their goal is to make it easier for you to find the information that is important to you. You can download the What’s Covered App for free from your Apple or Android app store.
You can also visit the Mutsko Insurance Services website at www.mutskoinsurance.com for news, resources and updates on insurance matters. We recently updated our website, adding new downloadable forms and interactive features you will find helpful, including:
For more updates and interesting facts on insurance matters, become a facebook friend of Mutsko Insurance Services at www.facebook.com/MutskoInsurance.
Be careful. Never share bank information, social security numbers or other personal information with anyone you do not know and trust. If someone asks you for information of this nature, tell them you will contact them after you have independently verified their information. Then contact your bank, Medicare at 1-800-Medicare or Social Security Office to verify that the caller is legitimate.
If you have questions concerning Health Insurance including Individual, Group, Medicare Advantage Plans or Medicare Supplements, call me at 440-255-5700 or email me at [email protected]. I look forward to helping you.
The National Hearing Test is a telephone-based screening test developed with funding from the National Institutes of Health. You can take this confidential hearing test over a telephone and the results can help you decide whether you should seek a more thorough evaluation of your hearing.
The National Hearing Test is quick and convenient. When you register to take the test, you will be given an access code. You then call from a landline phone (not a cell phone) and enter your access code to start the test. You will be instructed to listen to numbers spoken through electronic noise and enter the numbers you hear on your telephone key pad. If you are doing well, the test becomes more difficult, making it harder for you to hear the numbers. If you are not doing well, the test gets easier. The test takes approximately ten minutes to complete.
Once you have completed the test, you will receive individual results for both ears. You can then use this information to decide whether you should see an audiologist to receive a more complete examination.
Untreated hearing loss can lead to a serious decline in your quality of life, causing social isolation, problems on the job, and embarrassment. This screening is particularly effective at detecting the most common forms of hearing loss which are age-related and those that result from exposure to loud noises. Similar tests have been used successfully in Europe and Australia.
The National Hearing Test is a simple, affordable and scientifically validated. It is provided on a non-profit basis and costs $8.00. AARP members can take the test for free once a year. To learn more about The National Hearing Test, please visit their website at https://www.nationalhearingtest.org.
If you are interested in learning more about insurance plans that provide coverage for hearing screenings, hearing aids or other services not covered by Original Medicare, call me at 440-255-5700 or email me at [email protected]. I look forward to helping you find the plan that’s right for you.
You are permitted to enroll in or make changes to your Medicare Supplement at any time throughout the year.
To be clear, a Medicare Supplement, sometimes referred to as Medigap Insurance, is not the same as a Medicare Advantage plan. Both are sold by private insurance companies. However an Advantage plan covers your Medicare benefits through a private insurer. While a Medicare Supplement works in conjunction with Original Medicare paying some of the health care costs not covered by Original Medicare such as copayments, coinsurance and deductibles. Some Medicare Supplements may also cover emergency treatment when traveling outside the United States. Medicare Supplements do not normally cover long-term care, vision care, dental care, hearing aids, eyeglasses, or private-duty nursing.
You should expect to pay a separate premium for a Medicare Supplement in addition to your Original Medicare premium. You will also need to purchase a separate Prescription Part D plan as this coverage is not usually included.
The best time to buy a Medicare Supplement is during your 6-month Medicare Supplement open enrollment period. During this time you cannot be turned down or charged more because of any health conditions. This period automatically starts the month you turn 65 and are enrolled in Medicare Part B (Medical Insurance). Once this open enrollment period ends, you may be subject to medical underwriting restrictions and your acceptance into a plan is not guaranteed.
You cannot have both a Medicare Advantage Plan and a Medicare Supplement. It is illegal for anyone to sell you a Medicare Supplement unless you have Original Medicare.
Falls are the leading cause of injury among older adults. A number of factors including physical changes as we age, health conditions and medications used to treat health conditions make falls more likely among older adults.
While a lift chair can be helpful in certain circumstances, you need to be aware of Medicare’s requirements before you purchase a chair at your local furniture store and try to send the bill to Medicare.
Medicare will cover a portion of the cost of a lift chair, but only the cost of the seat lift mechanism. They will only provide coverage when this type of assistive device is prescribed by an individual’s physician as durable medical equipment (DME). The lift chair will need to be purchased through a Medicare Approved DME supplier who accepts assignments. In addition, when you purchase the chair through an approved supplier, you can expect to pay 20% of the Medicare-approved amount for the seat lift mechanism and the additional cost of the chair. The Part B deductible applies.
Medicare will cover the cost of the lift mechanism only for individuals who have trouble standing because of severe arthritis in the hip or knees or other debilitating conditions. Lift chairs can be helpful for patients who would otherwise be unable to stand up or sit down from a chair without help. The individual must be able to walk once they are standing.
Your doctor may recommend a number of other assistive devices to help prevent falls. For example:
For other ideas, ask your doctor for a referral to an occupational therapist. He or she can help you come up with other fall-prevention strategies.
Medicare covers some of the above items as Durable Medical Equipment. For a complete list, go to www.Medicare.gov and search for Durable Medical Equipment. Some Medicare Advantage Plans now provide flexible coverage for items not covered by Original Medicare. Please check with your insurance
If you need to replace your Medicare card because you believe someone else is using your number, it is best to report this immediately to Medicare at 1-800-MEDICARE where they will help facilitate your request.
However, if you are requesting a replacement card because yours was lost or damaged, you have a number of options, depending on how quickly you need your new card and how comfortable you are with using online resources.
Option #1: MyMedicare.gov
The quickest way for you to get a replacement card is to log into your MyMedicare.gov account. Click on the My Medicare Card box on the upper right side of the page. It will allow you to view and print an official copy of your Medicare card. If you do not have a MyMedicare.gov account, you can create an account and then use this option to print out your replacement card.
Option #2: Contact Social Security
You can request a replacement Medicare card by calling Social Security at 1-800-772-1213, Monday through Friday, between the hours of 7 a.m. to 7 p.m. You can also visit your local Social Security office to request a new card.
If you have an online my Social Security account at www.ssa.gov, you can log into your account and select the “Replacement Documents” tab. Then select “Mail my replacement Medicare Card.” Your Medicare card will be mailed to the address you have on file with Social Security and will arrive in about 30 days.
Guard your Medicare Card
Only give your Medicare number to doctors, pharmacists, other health care providers, your insurers, or people you trust to work with Medicare on your behalf. If you forget your card, you, your doctor or other health care provider may be able to look up your Medicare number online.
Remember that Medicare will never call you uninvited and ask you to provide personal or private information. If someone asks you for your information, for money, or threatens to cancel your health benefits if you don’t share your personal information, hang up and call us at 1-800-MEDICARE (1-800-633-4227).