Displaying items by tag: medicare
New Medicare Cards Will Prevent Fraud - Identity Theft And Safeguard Taxpayer Dollars
Beginning in April The Centers for Medicare & Medicaid Services, or CMS, will mail new Medicare cards to all people with Medicare. It is a move to improve safety by removing Social Security Numbers from Medicare cards. The new cards will be mailed from April 2018 through April 2019.
New cards will feature a Medicare Beneficiary Identifier (MBI) to replace the social security number-based Health Insurance Claim Number (HICN) for Medicare transactions such as billing, eligibility status, and claim FISS/DDE submissions.
When Will You Get Your New Medicare Card?
The new Medicare cards will be mailed out on a flow basis determined by geographic location and other factors. Here is how the CMS website shows the mailing schedule, described as “Waves”:
Wave 1 (Cards mailed April – June 2018): DE, DC, MD, PA, VA, WV
Wave 2 (Cards mailed April – June 2018): AK AS, CA, GU, HI, MP, OR
Wave 3 (Cards mailed after June 2018): AR, IL, IN, IA, KS, MN, NE, ND, OK, SD, WI
Wave 4 (Cards mailed after June 2018): CT, ME, MA, NH, NJ, NY, RI, VT
Wave 5 (Cards mailed after June 2018): AL, FL, GA, NC, SC
Wave 6 (Cards mailed after June 2018): AZ, CO, ID, MT, NV, NM, TX, UT, WA, WY
Wave 7 (Cards mailed after June 2018): KY, LA, MI, MS, MO, OH, PR, TN, VI
The time period for this change will be April 2018 through December 31, 2019. During this period, providers will be allowed to use either the HICN or MBI (but not both) to exchange data with CMS. However, any NEW Medicare cards issued will only have the MBI.
Each new Medicare Beneficiary Identifier will contain unique, randomly generated characters. It will be 11 characters in length and will be made up of numbers and uppercase letters. Medicare beneficiaries will notice the MBI is clearly different from the HICN number. The new Medicare cards can be used as soon as they are received.
Congress Pushed For Change In Medicare Cards
Congress, the General Accountability Office, Medicare beneficiaries, and advocacy groups have pushed for this change to take the SSN taken off Medicare cards for a long time. On the Centers for Medicare & Medicaid Services government website it says, “the biggest reason we're taking the SSN off of Medicare cards is to fight medical identity theft for people with Medicare.”
B-Keep This In Mind:
- People who are enrolling in Medicare for the first time should be among the first in the country to receive the new cards.
- Your own new card will automatically come to you. You don't need to do anything as long as your address is up to date. If you need to update your address, visit your My Social Security account online.
- After you receive your new Medicare card, you should destroy your old Medicare card and start using your new card right away.
- Medicare will never call you uninvited and ask you to give personal or private information to get your new Medicare Number and card.
- Scam artists may try to get personal information (like your current Medicare Number) by contacting you about your new card. You should hang up and call 1-800-MEDICARE (1-800-633-4227) to report the scam.
These changes are in part a result of the Medicare Access and CHIP Reauthorization Act of 2015
The New Medicare Card Home Page has a “Check the status of your new card” section.
The CMS Downloadable File of the ‘Wave’ mailing schedule
Full Text of the Medicare Access and CHIP Reauthorization Act of 2015
The enormous cost of caring for patients with Alzheimer’s disease
The cost of caring for those with Alzheimer’s disease and other forms of dementia is expected increase $20 billion this year compared with last year, totaling more than $277 billion in 2018, according to a report released by the Alzheimer's Association.
The report, “2018 Alzheimer’s Disease Facts and Figures” showed that of the $277 billion cost, $186 billion will be paid by Medicare and Medicaid, , $60 billion will be out-of-pocket costs and $30 billion will be related to other costs.
What is perhaps even more startling is that this enormous cost of caring for patients with Alzheimer’s disease does not include the cost associated with Unpaid Caregiving. The topic of Unpaid Caregiving is one much discussed here on Senior Home Search.
Healthcare, long-term care and hospice care for people with Alzheimer's and other dementias are projected to increase to more than $1.1 trillion in 2050 - Alzheimer’s Association
In a sobering statement, Keith Fargo, Ph.D., director of scientific programs and outreach for the Alzheimer's Association said “Soaring prevalence, rising mortality rates and lack of an effective treatment all lead to enormous costs to society,” and relating to the effect on all of us he revealed “Alzheimer's is a burden that's only going to get worse.”
What can be done to reduce the tremendous cost of Alzheimer’s care?
Early diagnosis of Alzheimer's during the mild cognitive impairment stage of the disease could save the country as much as $7.9 trillion in healthcare and long-term care expenses, according to an accompanying special report titled “Alzheimer's Disease: Financial and Personal Benefits of Early Diagnosis,” which highlights new economic modeling data.
“The disease is better managed, there are fewer complications from other chronic conditions and unnecessary hospitalizations are avoided,” Fargo said. “The sooner the diagnosis occurs, the sooner these costs can be managed and savings can begin.”
Earlier diagnosis could save individuals approximately $64,000 each, but costs still would average $360,000 per person, according to projections.
Also in the reports:
- Deaths from Alzheimer's disease increased by 123% between 2000 and 2015. By contrast, the number of deaths from heart disease, the top cause of death in the United States, decreased 11% during that time.
- An estimated 5.7 million Americans of all ages have Alzheimer's dementia now, and 5.5 million of this total are people who are at least 65 years old.
- The number of people aged 65 or more years with Alzheimer's is estimated to increase by almost 29% to 7.1 million by 2025. The number of people aged 65 or more years who have Alzheimer's may almost triple to 13.8 million by 2050, barring the development of medical breakthroughs.
How Should We Address The Rising Cost Of Alzheimer’s And Dementia ?
Around the time of the release of this startling information about the rising cost of Alzheimer’s care, a group of 14 senators led by Sen. Susan Collins (R-ME), founder and co-chair of the Senate Alzheimer's Task Force, and Sen. Amy Klobuchar (D-MN) has asked President Trump to boost funding allocated for Alzheimer's research in the fiscal year 2019.
The Law Will Require Development Of A Strategy To Recognize And Support Family Caregivers
In January, Congress passed and President Donald Trump signed the RAISE Family Caregivers Act. The law creates a strategy to support millions of people who help loved ones remain in their homes.
Here is what the new law will require.
- Require HHS to develop, maintain and update a National Family Caregiving Strategy, offering resources and education opportunities to family caregivers in the United States;
- Require HHS to convene a Family Caregiving Advisory Council to advise it on recognizing and support family caregivers;
- Promote greater adoption of person and family centered care in all health and long-term services and supports settings; and
- Ensure older adults with disabilities and illnesses receive high quality care in their homes.
Senators Susan Collins (R-Maine) and Tammy Baldwin (D-Wis.) and Representatives Greg Harper (R-Miss.) and Kathy Castor (D-Fla.) spearheaded the legislation.
The bill as it moved through congress was also backed by AARP. “Family caregivers are the backbone of our care system in America,” said Nancy A. LeaMond, AARP’s chief advocacy and engagement officer. “We need to make it easier for them to coordinate care for their loved ones, get information and resources and take a break so they can rest and recharge."
These family caregivers have a big job, but some basic support — and commonsense solutions — can help make their big responsibilities a little bit easier.
We are grateful to Congress and “This is forward progress, but it should not be the end of the journey. - Charles Fuschillo, Jr., President and CEO of the Alzheimer's Foundation of America
Across America, family caregivers help parents, spouses, children and adults with disabilities and other loved ones to live independently. They prepare meals, handle finances, manage medications, drive to doctors’ appointments, help with bathing and dressing, perform complex medical tasks and more — all so loved ones can live at home.
So What Will The RAISE Family Caregivers Act Really Do?
The RAISE Family Caregivers Act requires the U.S. Secretary of Health and Human Services (HHS) to develop, maintain and update an integrated national strategy to support family caregivers. According to the Act, HHS will create a national family caregiver strategy by bringing together federal agencies and representatives from the private and public sectors (like family caregivers, health care providers, employers and state and local officials) in public advisory council meetings designed to make recommendations. The agency will have 18 months to develop its initial strategy and then must provide annual updates.
So we can say that the aim of this new law is certainly needed, well intentioned and could be of great help to the 40 million family caregivers with an elder or disabled loved one at home. What could be wrong with that?
What We See Is Wrong With The RAISE Act
Funding, simply put. Implementing any national strategy will create a large cost that our polarized Congress is unlikely to fund. The RAISE Act is supposed to help family caregivers keep working outside the home. The question is: Who is going to pay for the replacement caregiver when the family caregiver goes back to work? Respite options are to be included as part of the Act. That means that the family caregiver gets time off to rest. And what happens to the elder or disabled person when the family caregiver is getting that break? Someone has to pay for the actual cost of placing the care recipient in a facility temporarily or paying someone by the hour to care for them temporarily. We have no such national programs now. Strategizing about programs is not the same as paying for programs.
Age Related Illness and Disease
Alzheimer’s disease and Dementia are affecting seniors in growing numbers. The result is literally millions of people become family caregivers and are quitting their jobs to care for their loved ones part time or full time. Passing a law requiring an integrated strategy is fine, however funding research to find a cure for the sixth leading cause of death in the U.S., Alzheimer’s disease, is hugely important. Caregiving for a loved one with Alzheimer's can last 20 years.
The RAISE Act is an important step toward more fully recognizing the impending crisis in caregiving as the aging population continues to grow. As improved guidelines and policies develop from the legislation, funding will be required to relieve the 2015 AARP estimate of $470 billion in unpaid care and the 2016 AARP estimate of $7,000 in out-of-pocket expenses provided annually by family caregivers. - Kathleen Kelly, Executive Director - Family Caregiver Alliance
We have not seen as part of this new law, any mechanism for Funding caregiver relief, disease research, housing assistance for seniors or any other important caregiver related need. Referring this lack of funding, Charles Fuschillo, Jr., President and CEO of the Alzheimer's Foundation of America is quoted in a press release from GlobeNewswire: “We are grateful to Congress and “This is forward progress, but it should not be the end of the journey.”...This encouraging development is only the tip of the iceberg. A dire need remains for the federal government to pass a Fiscal Year (FY) 2018 budget which includes $2 billion—up from the current amount of $1.4 billion—for Alzheimer’s disease research at the NIH." (National Institutes of Health).
Caregiver Training, Medical Assistance And Financial Relief
According to AARP, family caregivers “commonly experience emotional strain and mental health problems, especially depression, and have poorer physical health than non-caregivers.” And they rarely receive training in providing care.
And 78% of them incur out-of-pocket costs due to caregiving, spending $6,954 a year, on average, according to AARP. That’s estimate of $470 billion in unpaid care each year. Recognizing and strategizing about this with a new law is not the same as funding a solution.
What Concerns Me Is What’s Missing In This Law
To be effective and not just a list Advisory Councils, Strategies, and Unfunded Departments, I see several main things that could be put in place rather quickly and which would provide much needed help for families faced with a senior caregiving situation. Consider the following:
- Allow family caregivers an amount stipulated on their tax return that funds their lost wages in regards to social security. In other words fill those gap years in their ss earnings with a stipend so they do not lose benefits they will need when they themselves retire.
- Congress needs to pass a law allowing Medicaid funds to be used to pay for Adult Foster Care Homes and not just nursing homes. These homes cost on average ½ of the cost of a nursing home, which is the only option open to those whose funds have run out. The care in these homes as good and many times proven to be better than traditional nursing homes. The smaller environment can be a great benefit to patients with forms of dementia and Alzheimer’s disease and the staff to patient ratio usually much better. Just ask, me I am a huge advocate for these homes.
- Allow family caregivers who leave work to care for a loved one to draw a caregiver wage from the government if they meet certain income requirements. If a person cannot financially leave a job to care for someone, that person ends up in a nursing home and that cost the government and the economy on average 8-10,000 per month per resident! Again you could pay a family caregiver a fraction of that, save money and the patient gets better care! It’s a win win solution.
Failure to enroll in Medicare Part D could cost you a huge late enrollment penalty.
Enrollment for Medicare Part D may be coming up for you soon. If you are approaching age 65 and will soon be eligible for Medicare you need to sign up for part D coverage as soon as you are eligible. You do not have to wait until open enrollment. Open enrollment is the time when you may look at other plans and change coverage if you are not happy with your current coverage.
If you have not enrolled in Medicare Part D, and are on Medicare, here are some things you should know.
Failure to enroll in a Medicare Part D plan or a similar plan such as an HMO or PPO that provides drug coverage could subject you to a penalty once you do sign up. This information is available to Medicare recipients however many still do not understand the facts about the penalties and so chose to go without coverage thinking ‘why should I pay for drug coverage when I am very healthy and take no medication’.
As with all insurance plans, coverage of healthy people paying premiums into the pool helps defray the costs of those who need to use the coverage. Because this is so, the government imposes a penalty on those who do not pay into that pool when they are eligible.
The penalty works like this: Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($34.10 in 2016) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium. The national base beneficiary premium may increase each year, so your penalty amount may also increase each year.
Here is an example from the Medicare.gov website:
Mrs. Martinez, a fictitious Medicare enrollee
Mrs. Martinez is currently eligible for Medicare, and her Initial Enrollment Period ended on May 31, 2012. She doesn’t have prescription drug coverage from any other source. She didn’t join by May 31, 2012, and instead joined during the Open Enrollment Period that ended December 7, 2014. Her drug coverage was effective January 1, 2015.
Since Mrs. Martinez was without creditable prescription drug coverage from June 2012–December 2014, her penalty in 2015 was 31% (1% for each of the 31 months) of $33.13 (the national base beneficiary premium for 2015) or $10.27. Since the monthly penalty is always rounded to the nearest $0.10, she paid $10.30 each month in addition to her plan’s monthly premium in 2015.
Here's the math:
.31 (31% penalty) × $33.13 (2015 base beneficiary premium) = $10.27
$10.27 rounded to the nearest $0.10 = $10.30
$10.30 = Mrs. Martinez's monthly late enrollment penalty for 2015
In 2016, Medicare recalculated Mrs. Martinez’s penalty using the 2016 base beneficiary premium ($34.10). So, Mrs. Martinez’s new monthly penalty in 2016 is 31% of $34.10 or $10.57 each month. Since the monthly penalty is always rounded to the nearest $0.10, she’ll pay $10.60 each month in addition to her plan’s monthly premium.
Here's the math:
.31 (31% penalty) × $34.10 (2016 base beneficiary premium) = $10.57
$10.57 rounded to the nearest $0.10 = $10.60
$10.60 = Mrs. Martin's monthly late enrollment penalty for 2016
So in simple terms, because she went without coverage for just under 3 years she could now have to pay almost $11.00 extra per month on top of her policy premiums for the rest of her life! That’s almost $130.00 per year. Yes the penalty will be recalculated every year, however it never goes away!
Now think about it, if a person was healthy at age 65 and they decided to go without coverage at an average cost of $33.00 a month (could be as low as $20.00) and then at age 75 they started to need medications when they apply for Part D coverage they would have to pay a penalty based on 120 months of non coverage which with the above example would be roughly $40.92 each month in addition to their monthly premium. That’s almost $500.00 per year!
“The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.” – medicare.gov
There are so many reasons to sign up for Medicare Part D as early as you can.
So give it some thought. Do the numbers yourself. That penalty could add up to thousands of unnessary dollars over the years past age 65, IF you do not sign up for Medicare Part D at the beginning.
Remember - Medicare premiums could be higher and more difficult to pay for if you do not sign up for Part D early.
And the fact is: “Medicare drug plans can disenroll members who don't pay their premiums, including the late enrollment penalty portion of the premium.” - Medicare.gov website (italics ours)
More and more of us are living longer, and we need a Long-Term care solution more than ever.
"About half of all senior citizens will need to spend about $138,000 for personal care over two years"
Yet, for one in seven, five years of care becomes necessary, and the cost "is far beyond the ability to pay.” This according to Howard Gleckman of the Urban Institute. And that five-year cost can exceed $250,000.
Now a nonpartisan group, the Long-Term Care Financing Collaborative, has called for a push for a new national universal policy for just that – Long Term Care for Seniors. The Urban Institute is a part of that Collaborative.
With a goal of getting employers to automatically enroll their employees in long-term care insurance policies at work, with employees paying regularly toward insurance from each paycheck, businesses would get insurance companies to offer long-term care insurance again after fleeing the market during the last few years, and getting people to enroll in more affordable insurance than has been offered previously.
Many Americans do not realize that Medicare and other health insurance plans will not cover long term care such as bathing, dressing and other help seniors often end up needing as they become frail or suffer debilitating diseases like Alzheimer's later in life. Referred to as ADL’s or "Activities of Daily Living", this is care that seniors and their families can be left with, often becoming a crushing financial burden.
The group emphasized that family responsibility will continue, but the collaborative wishes to lessen the burden. The Urban Institute has estimated that services delivered by family members total about $470 million each year.
"A woman in her 50s who leaves a job to care for aging parents loses an average of $300,000 in lifetime income," the collaborative reported. "Unpaid family caregivers lose an estimated $3 trillion in lost lifetime wages and benefits," while employers suffer $17 billion to $33 billion in lost productivity and absenteeism.
According to the group's research, about half of all senior citizens will need to spend about $138,000 for personal care over two years. Yet, for one in seven, five years of care becomes necessary, and the cost "is far beyond the ability to pay," said Howard Gleckman of the Urban Institute. The five-year cost can exceed $250,000.
What about Medicaid and Long-Term Care?
It’s true, regular health insurance doesn’t cover Long-Term care, and neither does Medicare. The Medicare program covers only short nursing home stays or limited amounts of home health care when a senior requires skilled nursing or rehab. It does not pay for custodial care, which includes supervision and help with day-to-day tasks. So will Medicaid fill that gap? Not necessarily. You can get help through Medicaid, the federal and state health insurance program for low-income people, but only after you’ve exhausted most of your savings, depleting a retirement nest egg quickly. The median cost of care in a semiprivate nursing home room now tops $80,000 a year, according to Genworth’s 2015 Cost of Care Survey.
And if you have to rely on Medicaid, your choices will be limited to the nursing homes that accept payments from the government program. Medicaid does not pay for assisted living in many states.
And so it is easy to understand why groups such as the The Long-Term Care Financing Collaborative see such an urgent need to address this growing problem, a lack of adequate and affordable Long-Term Care insurance. What is seen as a failure of policy makers to reach agreement on viable solutions has pushed the issue to the forefront.
Today, 10-12 million adults require supports that help them maintain the best possible quality of life, supports and services such as non-medical assistance and help with food preparation, personal hygiene, assistive devices, transportation, as well as help with activities such as bathing and eating. And the number is expected to double by 2030.
What is the Long-Term Care Financing Collaborative?
The Collaborative brings together national experts and stakeholders who cross ideological divides in pursuit of a common goal: to improve the way Americans pay and prepare for the non-medical care needed by our frail elders and people living with disabilities to live with dignity and autonomy through consensus-based, concrete policy recommendations. – Convergencepolicy.org
For more about the groups efforts, and a list of the groups participants, you can follow this link to the Long-Term Care Financing Collaborative.
Long-Term Care for Seniors is a need that is growing fast. It's good news to see this kind of effort toward finding a long term solution.
Three People Accused in Massive Medicare Fraud in Florida
The U.S. Justice Department is calling it the largest criminal health care fraud case ever brought against individual suspects. The $1 Billion health care fraud took advantage of Medicare in Florida, agents said.
Three people are accused of a massive fraud involving a number of Miami-based health care providers. Many assisted living facilities may also have been part of the health care fraud.
The three facing charges are all from Florida's Miami-Dade County; they are Philip Esformes, 47, owner of more than 30 Miami-area nursing and assisted living facilities; hospital administrator Odette Barcha, 49; and physician assistant Arnaldo Carmouze, 56, according to the Justice Department .
"Medicare fraud has infected every facet of our health care system," U.S. Attorney Wifredo Ferrer said Friday while indictments against the three were announced.
Included in the indictments are accusations of leading "a complex and profitable health care fraud scheme that resulted in staggering losses, in excess of $1 billion," said Special Agent in Charge George L. Piro of the FBI's Miami field office.
Community Mental Health Centers and Home Health Care Providers Received Payments
Investigators say Esformes access to thousands of Medicare and Medicaid beneficiaries were instrumental to perpetrate the fraud. How this will affect the future of Florida Medicare remains to be seen.
It was also announced that money, in the form of kickbacks, were paid to Esformes and his co-conspirators in return for "steering beneficiaries to other health care providers including community mental health centers and home health care providers, who also performed medically unnecessary treatments that were billed to Medicare and Medicaid."
"Many of these beneficiaries did not qualify for skilled nursing home care or for placement in an assisted living facility. However Esformes and his co-conspirators nevertheless admitted them to Esformes Network facilities where the beneficiaries received medically unnecessary services that were billed to Medicare and Medicaid."
Charges of conspiracy, money laundering and health care fraud against Esformes and Barcha were also included in the announcement.
I was on the forums these past few days and one of the threads was talking about how many days are covered by Medicare in a Nursing Home or Rehab after a hospital stay. The answers were all over the map and quite confusing I must confess, so I thought I would do a post about it to clear things up. I have always told my readers I am no expert, but when it comes to this subject I know it all to well. You see my mom has been in and out of rehab 3 times in the past 2 years so we know the rules by heart.
According to Medicare rules a person must have a qualifying hospital stay of at least 3 days, ( 24 hours) and be in need of further skilled nursing or rehab care in order for them to pay for the stay. The doctor and the physical therapy department at the hospital must agree that the patient would benefit from continued care or therapy at a nursing home or rehab facility.
It is important to note at this point that the patient needs to be an inpatient at the hospital for 3 days, and time spent in observation or the ER does not count. They have to be admitted to the hospital. This is very important!
Insurance companies and Medicare are putting increased pressure on doctors so that they do not admit patients. They have narrowed the guidelines for admittance and now many patients are ending up in observation for 1, 2 or 3 nights and then they do not qualify to go to rehab under Medicare.
If a person has a qualifying stay of 3 days then Medicare will pay for nursing home or rehab as follows:
1. Day 1-20 Covered 100%
2. Day 21-100 partial coverage with a 161.00 a day co-pay
3. Day 101 and beyond no coverage
Many Medicare supplement policies like the one my mother has will cover the copay on days 21-100 so there is no out of pocket for the patient. However this is something you should look into ahead of time so you know your coverage should you or a loved one be in this situation.
During the time in rehab the patient must continue to show that the services provided are helping them to improve. So if at anytime during their stay the team feels they have done all they can for the patient the team is obligated to discharge them, even if they have days left.
Now there is something to be said about having days left over. If the patient leaves rehab or nursing care and they need to be readmitted to the facility within 30 days and have days remaining they will have coverage through Medicare. If they use up all their days then they would have to wait 60 days and have another qualifying hospital stay of 3 days before Medicare would pay for skilled nursing care or rehab again. This would start their 100 day benefit period over again.
I am providing a link here that goes to the Medicare.gov site for skilled nursing care. It has more information for you.
I do hope this information helps you understand the process a bit better. If you have any questions or comments please feel free to contact me or leave a comment at the bottom. We always love to hear from you. Remember you are not on this journey alone.