Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
JUNE 1999 NICA NEWS
ISSUES
Guaranteed Issue Medigap
If you are 65 or older, enrolled in Medicare and your other health insurance stops for certain reasons, you are guaranteed the ability to buy a Medicare Supplement Policy.To qualify for this protection, you must apply for the new policy within 63 days of losing your other health coverage. A beneficiary must fall into one of the following categories in order to qualify:
- You were covered by an employer group health plan with benefits that supplemented your Medicare benefits and the plan stopped providing those benefits.
- You were enrolled in a Medicare Health Maintenance Organization (HMO) and your enrollment ended when you moved out of the service area, the plan's contract with Medicare ended, or you elected to leave the plan.
- You were enrolled in a Medicare Supplement policy and coverage stopped because the company became insolvent (bankrupt) or other involuntary termination of coverage, or the company misrepresented provisions of the plan.
- You were enrolled in a Medicare Supplement policy, dropped it to try a Medicare + Choice plan, and terminated the new Medicare + Choice coverage within 12 months.
- You enrolled directly in a Medicare + Choice plan when first becoming eligible for Medicare Part A and enrolled in Medicare Part B upon first turning 65, then disenrolled within 12 months.
The enrollment options apply when an individual who has been continuously covered is no longer covered in a health insurance plan and then applies for a Medicare supplement policy. However, the new application must be made within 63 days of the termination of the individual's previous coverage. Within this period of time, the individual is eligible for any plan that is allowed under the enrollment options.
Under this guarantee, companies selling Medicare supplemental insurance must sell you one of four guaranteed issue Medigap policies, Medicare Supplement Plans A, B, C or F. You are guaranteed to be sold Plan A from all companies or Plans B, C or F from companies that normally sell those plans. Your other option is to return to your previous Medigap policy with the same company, if the company still sells the plan you had.
QMB
In the fall of 1998, the Medicare & You pamphlet was published and sent to all seniors and Medicare recipients throughout the United States. The NICA Program Office had an increase in calls as a result of this brochure. This increase was due to information provided in the pamphlet which stated if "your monthly income is less than $1,603 for a couple or $1,195 for an individual and the balance of your bank account is less than $6,000 for a couple and $4,000 for an individual, you may qualify for financial help." The seniors and their families who read this statement felt the Federal Government was not only offering a new program, but had new guidelines for financial assistance.As a NICA volunteer, you may have a client that asks you about this information. The following is for your information.
- The Medicare and You pamphlet is a part of the Health Care Financing Administration's Medicare Education Campaign.
- The Medicare and You pamphlet was sent to all Medicare Beneficiaries that were already receiving Medicare Benefits.
- If you feel a client meets the mentioned financial guidelines, direct your client to call their local Department of Health and Human Services Medicaid office. They may be eligible for financial help.
If you would like more information regarding these programs, please call us at 402-471-2201. Additional information may also be found on the Internet under the heading of "Medicare Savings for Qualified Beneficiaries". Visit www.Medicare.gov
The Sunderbruch Corporation - Nebraska Focuses on Medicare Consumer Education
The Sunderbruch Corporation - Nebraska (TSCN) serves as an important resource for Medicare consumers in Nebraska through its statewide educational and advocacy activities. TSCN's goal is to protect and improve the quality of health care available to Medicare consumers by helping them understand the Medicare system and by giving them the knowledge they need to make informed choices about the health care they receive.TSCN distributes a free consumer newsletter, Medicare Today, to seniors throughout the state. Medicare Today provides Medicare consumers with information on their Medicare rights and responsibilities, preventative health care tips, and information Medicare consumers need to make informed decisions about their health and their health care.
Our staff of health education professionals also participate in health fairs and other senior events, provide a Speakers Bureau Service, and distribute a wide variety of informational brochures about important Medicare and health care topics.
The TSCN Speakers Bureau is a free service to all organizations serving the Medicare population and health-care related agencies. Experienced TSCN speakers can address a variety of topics, including your rights as a Medicare consumer, preventative health care opportunities, TSCN's role in promoting quality care for Medicare consumers, and other important issues.
If you would like to arrange a speaker for your group, include us in your next health fair or senior event, or add your name to our mailing list to receive Medicare Today, simply call us at 1-800-247-3004.
Medicare and the Mayo Medical Center
The Iowa ICA Program included in their newsletter, The Anchor, information about how the Mayo Medical Center interacts with Medicare. This is information worth repeating! Additional information on the Mayo Clinic can be found on the Mayo website: http://www.mayo.edu/Medicare Part A Mayo Medical Center is a participant in Part A Medicare. If you are hospitalized at Saint Mary's Hospital or Rochester Methodist Hospital, your Part A claim will be filed for you. Medicare payments will be sent directly to the hospital. You will receive an Explanation of Medicare Benefits form. If you have supplemental hospital insurance, Hospital Patient Accounts will file a claim for you.
Medicare Part B Mayo Medical Center is a participant in Medicare Part B. Mayo Medical Center will file a claim with Medicare for you. If you are a Minnesota resident, payment will be made directly to Mayo Clinic. An Explanation of Medicare Benefits form will be sent to you. If you live outside Minnesota, Medicare payments will be made directly to you and an Explanation of Medicare Benefits form will be sent to you in approximately four to eight weeks.
It is your responsibility to file a supplemental claim for clinic services. Clinic services include services provided by physicians in both the clinic and in the hospitals. A claim and filing instructions will be sent to you.
Charges for clinical laboratory services will not appear on your first Mayo Clinic bill. Charges for these services are first filed with Medicare and payments will come directly to Mayo Clinic. Charges for clinical laboratory services not covered by Medicare will appear at a later date on your monthly statement of account after payment has been received from Medicare for covered services.
Medical Assistance (Medicaid) Mayo participates with the state Medicaid programs of Iowa, Michigan, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wisconsin. This participation allows Mayo to provide services to and bill for patients from these states, with some restrictions. However, individual coverage may depend on you obtaining a written pre-authorization from your state Medicaid program.
If you have coverage through a state or Medicaid-sponsored managed care health plan, you may also need a referral from the health plan to receive coverage at Mayo. Mayo recommends checking with your state's Medicaid office or your managed care health plan to verify authorization requirements before your appointment.
Mayo is unable to provide service (except in emergency situations) to Medicaid patients from states other than those listed. A deposit will be required for services not pre-authorized, or from patients of non-participating states.
MEDSUP CLOSURES
The Following Medicare Supplement companies are no longer selling Medicare Supplement Disability Insurance:- Aid Association for Lutherans
- American Family Life Assurance Company of Columbus (AFLAC)
- American Insurance Company of Texas
- Continental Life Insurance of Brentwood Tennessee
American Family Life Assurance Company of Columbus (AFLAC) is no longer selling Medicare Supplement policies. It is, however, serving its current base of individual subscribers.
Kanawha is no longer marketing Medicare Supplement policies in Nebraska. Effective March 4, 1999, the company will terminate its marketing Forms 90595 A 1/95; 90595 B 1/95; Form 90595 C 1/95; Form 90595 F 1/95.
AUDIT SHOWS DRAMATIC DECLINE IN MEDICARE OVERPAYMENTS
Health Care Financing Administration Press ReleaseFebruary 1999
The U.S. Department of Health and Human Services today reported that improper Medicare payments to hospitals, doctors and other health care providers declined dramatically last year to the lowest error rate ever since the government initiated comprehensive audits three years ago. The findings are included in an audit report prepared by the Department's Office of Inspector General.
The error rate for fiscal year 1998 was an estimated 7.1 percent, representing estimated improper payments of $12.6 billion. This compares with an error rate of 11 percent in FY 1997, representing an estimated $20.3 billion; and 14 percent in FY 1996, representing an estimated $23.2 billion in improper payments.
"Today's report by the Inspector General is welcome proof that our zero tolerance policy against waste, fraud and abuse is paying off," HHS Secretary Donna E. Shalala said. "We still have a big job to do in eliminating improper Medicare payments, but with a 45 percent reduction in improper payments in just two years, we are making real progress."
This is only a portion of the press release. If you would like a complete copy call the NICA Program office at (402) 471-4506. This press release is also available on the World Wide Web at http://www.hhs.gov.
Stroke
Did you know that a Stroke is a brain attack? Dial 911 if this is happening to you or a loved one. For more general information on strokes, visit the website: www.strokematters.com
Reverse Mortgages
There is much controversy over the issue of reverse mortgages. When you approach your senior years, often times there is no mortgage remaining on your home. However, as a couple, you might be in need of money to pay for taxes, insurance money or repairs. To find out whether or not this financing will be of benefit to you, give the web site a visit at www.reverse.org
Medicare Benefits
As a reminder, anyone can visit the HCFA web site for answers to Medicare questions, including the deductibles for 1999 and the new benefits that began January 1, 1998 and are continuing through 2001. The web site address is www.medicare.gov
Are you a Federal Employee about to Retire?
The Office of Personnel Management, Retirement Information Office in Washington, D.C. (1-888-767-6738) now has a website to help answer questions on individual insurance plans. This site is located at www.opm.gov/insure
New National Center on Elder Abuse is Here
This center will focus on creating a service that truly supports and advances the field of elder abuse services and prevention. The new National Center on Elder Abuse (NCEA) has been configured to enhance communication channels between its staff and NCEA's constituents, including Adult Protective Services, law enforcement and court personnel, health care professionals, corporations, and others concerned with preventing and addressing elder abuse. The web site for additional information is www.gwjapan.com/NCEA or you can send E-mail them at NCEA@nasua.org
6 Ways to Cut Your Prescription Drug Costs
- Ask your doctor if lifestyle changes might help you avoid taking a given medication.
- Many doctors have no idea about drug prices. Ask your pharmacist about cheaper alternatives, and have your druggist call your doctor to discuss possible options.
Many of the newest drugs offer relatively minor advantages over older drugs, but cost many times more.
- If you don't trust generics, ask about generic drugs that are made by the manufacturer of the brand-name drug you like.
- Ask your doctor if there's an over-the-counter version of your prescription drug.
- Be creative. Sometimes drug companies charge nearly the same price for different doses of drugs. This means you might be able to buy 10mg pills and cut them in half for your required 5 mg dose. This can cut your drug bills in half; ask about it.
Note: Some pills have special "delivery /time-release" coatings, so they should never be crushed or cut before swallowing. Get an OK before you crush or cut pills.
- Shop around to find a pharmacy that gives you the lowest overall prices for the medications you need the most.
Then stick to that pharmacy. It has all your medication records in its computer file. The computer can spot possible duplications and drug interaction dangers.
You Must Follow these Directions Very Carefully!
Product manufacturers want to make sure you get the most out of their wares, so they provide very specific instructions on use:
On the Sears Hair dryer:
Do Not Use While Sleeping
On a bar of Dial Soap:
Directions: Use like regular soap.
Some Swanson TV dinners:
Serving Suggestion: Defrost.
On Nytol (a sleep aid)
Warning: May cause drowsiness.
On a Korean kitchen knife:
Warning: Keep out of reach of children.
On an American Airlines packet of nuts:
Instructions: Open packet, eat nuts.
Subject: Enrollment Percentages - Nebraska Participating Medicare Providers
From 1991 until 1997, the number of participating Medicare providers in the State of Nebraska has increased from 48.4 percent to 91 percent. The significance of this summary is that many providers are recognizing they want more individuals covered for the individual patient's benefit. While Medicare is not meant to cover all the cost of every medical need, certainly this graph shows that with the increase in providers, more patients are being served.| 1991 | 1992 | 1993 | 1994 | 1995 | 1996 | 1997 | 91-97 average |
|
| All Medicare Providers | 48.4% | 54.1% | 62.4% | 79.9% | 83.5% | 84.5% | 87.8% | 91.0% |
Medicare + Choice Scams
The Tennessee Senior Health Insurance Assistance Program (SHIP) notified us of Medicare + Choice scams that are emerging in that state. The three mentioned are these:
- A well-dressed man is going door to door and telling people he will "change over" their Medicare for $60.00. He is also asking people for their Social Security Number.
- Medicare beneficiaries are receiving calls from people trying to make an appointment to come to the beneficiary's house that evening to "fix their Medicare" or their Medicare card.
- Medicare beneficiaries received calls from people offering to help them with their Medicare and asking for their credit card number.
Please keep an eye out for similar types of scams happening in our state. If you hear of similar scams in your area, please report them to us right away. Remind all of your clients that they should
- Guard their Social Security Numbers as securely as they would guard a credit card number.
- No Medicare official charges to fix Medicare problems.
- No Medicare official makes home visits.