The New Home care Benefit is Not What it Seems

    Beware of insurers trying to sell you on a new Medicare Advantage plan on the basis of the new home care benefit.     They will tell you that your insurance will pay for your bathing and housecleaning, but the conditions under which the coverage kicks in is very limited—and could be associated with some co-pays on your part.     Choose your Medicare Advantage plan on the access to clinicians you want...

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CMS Allow Your Medicare Advantage Plan to Pester You Even More

    This time, it’s about the price of your medication.     Starting next year, you’ll be receiving a monthly update regarding the least expensive  alternatives to the medications you’re on.     Will it help you lower you medication costs?  Perhaps.     But it will definitely take up a few minutes of your precious attention.     There’s no information on whether or not you can opt out of these contacts.  ...

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What Counts Toward a “Maximum Out-Of-Pocket?”

    Under Medicare Advantage, the term “Maximum Out-Of-Pocket,” can be misleading.     Not everything counts toward that amount.     You’re still going to be expected to pay for certain services even after your “Maximum Out-Of-Pocket” is reached.     What counts toward that total and what you’re still going to have to pay for depends on your plan.     That’s why this is an essential question to ask every time you...

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Nurse Practitioners as you PCP

A common question:   I have a nurse practitioner that I go as my “doctor.” Can I select her as my PCP?   Usually, no. But you can select her supervising doctor as your PCP and still go to your NP.   Just ask them first.   The best way to do this is through the office manager. They probably have a policy in place to do just this.   If you’re seeing them now...

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PPO vs. HMO

      What’s the difference between a Medicare Advantage PPO and HMO?     HMO (Health Maintenance Organization) You choose a personal doctor (also known as a PCP or primary care provider). They must approve all visits with a specialist and all testing, but not all medications—your specialist can still prescribe them without your PCP’s approval. You can only go to a specialist or hospital that is “in-network.” That is, on the list of approved...

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Beware! Changing From Medicare Advantage to Traditional Medicare is Fraught With Peril

For the first time, this year you could change your Medicare Advantage coverage outside of the open enrollment period.     But if you wanted to change back to Traditional Medicare, you wouldn’t be able to buy a Medicare supplement. You can only purchase those towards the end of the year.       Apparently, a large number of seniors didn’t realize this and they’re now stuck paying a significant part of their healthcare costs...

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The Little-Recognized Cost of Medicare Advantage

Medicare Advantage is all about collecting your data.     It’s how your health system and insurer gets paid by the government.     It’s also how they generate revenue from vendors looking to sell you something—especially things that the government, not you, has to pay for.     Health systems and insurers sell your data to these vendors.       That’s why, as soon as you sign up, you get drowned in marketing....

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If You Think Robocalls are Bad Now. . .

Medicare Advantage has released more rules allowing your doctor to obtain more information from you without being seen in the office.       The health systems which employs your doctor and your insurer have a lot of money riding on the collection of this information.       Prepare for Pestering.         You will be getting phone calls, texts and emails asking you to put on your remote sensor so they...

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Your Insurance Home Can Turn Your Benefits On and Off

Didn’t get the plan with dental benefits but now wish you had? Or wish you had a different drug plan?     All is not lost.     Contact your insurance home. See what they can do for you.     You might be surprised by how easily you can change your benefit.     Your insurer has only one goal—to retain you on their plan. If you approach it correctly, you might be able...

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