Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
SEPTEMBER 2002 NICA NEWS
QUESTIONS AND ANSWERS
Q: Recently the media has stated that there are new Medicare benefits for Medicare Alzheimer's patients, but are these really new benefits?A: This has been a hot topic in the news recently; however, the media coverage that stated Medicare is now covering treatment for Alzheimer's disease is misleading. There are no new Medicare Alzheimer's benefits.
In the fall of last year, Medicare became aware of a Medicare claims processing problem that resulted in some Medicare claims automatically being denied when physicians used a certain code alone for dementia, which includes Alzheimer's Disease. In September 2001, CMS directed their claims processing contractors to correct this problem as well as told them to instruct physicians to submit their Medicare claims using diagnostic codes that more accurately reflects the medical necessity of the service provided. Medicare Part B has always paid for medically necessary treatments that might benefit an Alzheimer's patient, or other patients, such as: pharmacological, physical, occupational, psychological and speech-languge therapies, medication management and evaluation visits. However, because in some instances, the diagnostic codes for these medically necessary treatments are not reflected on the Medicare claims, but only a primary diagnostic code for dementia, the claims were not being paid. Basically, the benefits have always been available, just not accessed by all that would qualify for the benefits, because medically necessary diagnostic codes were not being used.
Q. I am turning 65 but will continue to work. Should I sign up for Medicare Part B?
A. You may delay enrollment in Medicare Part B without penalty if you or your spouse continue to be actively employed and are covered by the employer's group health plan. Your employer must have 20 or more employees for you to delay enrollment in Part B without penalty. In this situation you can enroll in Medicare Part B during a special eight-month enrollment period when you retire (whether you keep employer-sponsored retiree insurance coverage or not). The Social Security Administration determines when you are eligible to enroll in Medicare. Call their toll-free number, 800-772-1213, with your specific questions. Ask Social Security to send information about your situation in writing. Keep this information on file.
If you or your spouse are employed and the employer has 20 or more employees you must be offered the same health insurance benefits under the same conditions offered to younger workers and spouses. The employer cannot provide a Medicare supplement insurance policy instead of regular group coverage when you work past age 65.
Employers with fewer than 20 employees are not required to offer health insurance coverage to employees over age 65. However, the employer may choose to do so.
Q: I am 65+ and retired on a Retiree Group Plan through my past employer. If the employer should go out of business, or the retiree plan is no longer offered through no fault of my own, what are my options?
A: This is such a good question since many large corporations have experienced down-sizing and some have even gone out of business. Retirees who are losing their employer retirement plans have guarantee issue rights for Medigap. If this happens, you have the right to buy Medigap plan A,B,C, or F that is sold in your state by any insurance company. You can buy the policy at the best premium price available, with no review of your medical records even if you have health problems. You will have 63 calendar days from the date your coverage ends to apply for a new Medigap policy.