Jul24

Medicare Groups Publish Paper To Include Oral Health In Medicare Part B

The Center for Medicare Advocacy is pushing Medicare to include dental care in Medicare Part B. One of the big things Medicare has not covered in the past was dental. A diverse group of Medicare advocates have published a white paper that tackles the subject head on.

White Paper Stresses Importance of Oral Health Care Benefit for Older Adults

FOR IMMEDIATE RELEASE

Contact: Matthew Shepard

July 19, 2018 – Washington, DC – The Center for Medicare Advocacy, along with a diverse group of partners, released a white paper, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care. This white paper is an interprofessional, collaborative effort written and published by leaders in the consumer, healthcare and dental fields, including the American Dental Association, Center for Medicare Advocacy, the DentaQuest Foundation, Families USA, Justice in Aging, Oral Health America and the Santa Fe Group.

With an expected 72.1 million seniors living in the United States by 2030, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care, examines the need for oral health care to be integrated with, and elevated to, the same importance as the rest of health care in Medicare. Says Center for Medicare Advocacy Senior Attorney Wey-Wey Kwok, “Medicare’s dental exclusion is misguided given the clear connection between oral health and overall health. The time has come to include an oral health benefit that covers preventive services, disease management, and necessary procedures for all Medicare beneficiaries.”

Medicare plays a key role in providing health and financial security for 59 million older people and younger people with disabilities. However, traditional Medicare does not include coverage for routine oral health care like checkups, cleanings and x-rays, or restorative procedures like fillings or bridges, tooth extractions and dentures. The Center for Medicare Advocacy is committed to working with our many dedicated partners to advance access to quality oral health care for Medicare beneficiaries by adding an oral health benefit into Part B, which will improve overall health and quality of life for millions of older adults and people with disabilities.

An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care looks at many aspects of adding an oral health benefit to Medicare, including medical necessity, costs and the need for legislative changes. Top findings include:

70 percent of all Medicare recipients lack or have limited dental insurance and fewer than half access dental care each year.
Cost is the number one reason that older adults have not gone to the dentist in the past year.
Integrating dental coverage in Medicare would close disparities in dental use and expense between the uninsured and insured and among older adults with few financial resources and limited oral health education.
Surveys show that consumers widely support adding oral health coverage to Medicare and prioritize two categories of care: checkups and pain treatment.
71.2 percent of dentists agree that Medicare should include comprehensive dental benefits and a majority indicated they were willing to comply with typical Medicare practice requirements.
The ADA recently commissioned a study that analyzed the cost structure for various dental benefit designs within Medicare. This study estimated that a comprehensive benefit without dollar value caps would cost the federal government between 31.4 billion dollars in 2016 dollars, $32.3 billion in 2018; the estimated base premium increase for a Part B benefit would be $14.50 per beneficiary per month. ADA input to this white paper does not constitute endorsement of inclusion of a dental benefit under Medicare at this time. The ADA is currently investigating a number of options to serve the dental care needs of a growing elder population.

An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care recommends the addition of a comprehensive oral health benefit to Medicare Part B as it covers outpatient services. Such a benefit would be amended to include dental services using the medically necessary and reasonable standard that applies to all Part B services. Advantages to the inclusion of Part B include:

Ensures that everyone enrolled in Medicare will receive the oral health benefit.
Provides the greatest number of beneficiaries access to a basic level of oral health care, encouraging equitable health solutions and provider participation.
Simplifies a potentially confusing program and process for providers and beneficiaries.
Uses established protections for both Medicare beneficiaries and providers, alleviating the need for a new system and bureaucracies.

To move an oral health benefit in Medicare Part B forward, Congress must pass legislation to remove the statutory exclusion in Section 1862(a)(12) of the Social Security Act. They must establish dental coverage in Part B, permit payment for preventive services prescribed in the dental benefit and define the dental services in the Medicare Statute.

“Research demonstrates that oral health disparities exist for many racial and ethnic groups, by socioeconomic status, gender, age and geographic location. This underscores the need to approach oral health disparities as a component of social justice,” says Center for Medicare Advocacy Policy Attorney Kata Kertesz.

The recommendations included in An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care stress the necessity of an oral health benefit for older adults. Read more about the medical necessity, costs, proposed structure and legislative changes needed at oralhealthamerica.org/medicaretoolkit.

Jul18

Traveling Overseas When On Medicare: What You Need To Know.

By Tom Matteson - blog

Traveling overseas when on Medicare can be a tricky situation, because original Medicare A and B does not cover foreign travel, and Medicare advantage plans also do not cover foreign travel. However, if you choose to keep Medicare and get a Medicare supplement plan, foreign travel is covered. Here is a great article by Lindsay Engle that explains how it works.

How Baby Boomers are Getting Medicare Overseas Travel Coverage

February 13, 2018 by Lindsay Engle

Baby Boomers are getting Medicare overseas travel coverage by signing up for a Medigap or Medicare Supplement plan. You may be surprised to know that Medicare by itself does not cover most expenses outside of the United States. There are many reasons why Original Medicare beneficiaries choose to invest in additional coverage, especially when traveling is a priority.

Many people have big plans for what they will do once they retire. Baby boomers are taking advantage of their newfound freedom by traveling the world. Studies show that baby boomers are consistently finding ways to travel affordably, and a lot of them have a travel bucket list. This tendency to research their destinations means they are willing to plan ahead, and insurance coverage is something retirees should definitely be considering in their travel plans.

When you retire, you may have big dreams to see the world. Have you thought about what will happen if you get injured in a foreign country? What are baby boomers doing to make sure they have overseas travel coverage?

Foreign Travel and Medicare Overseas

It’s important when considering your options and retirement plans to know what Medicare Parts A and B will cover when you are traveling. As a general rule, traditional Medicare pays only for medical care in the United States. There are some unique circumstances where Medicare overseas will cover 80% of your emergency care outside of the US.

These include:

Cruise ships no more than 6 hours from a US Port
Direct driving routes between Alaska and the US
Situations in which you are sick in the United States but the nearest hospital that can treat you is in another country
If you live in the U.S., but the nearest hospital to your home is in another country

This means the chances of you getting medical coverage under Medicare when traveling in a foreign country are very slim. Fortunately, there are solutions to this dilemma.

Travel insurance vs. Medical Insurance

Medicare Plan G

The best way to ensure that you are covered when traveling overseas is to pick up a Medigap plan. For example, Medicare Plan G provides coverage for foreign travel for baby boomers. Plans C, D, F, M, and N also provide some foreign travel coverage. Medicare Supplement Plan G is one of the most common plans for baby boomers.

This supplemental policy helps you cover out-of-pocket costs which are not covered by traditional Medicare. It also will help pay for part of your emergency medical expenses when you’re outside of the United States.

What Will be Covered?

Medicare supplement plans for foreign travelers cover a certain amount of services. Their foreign care coverage is designed to protect you in case of an emergency. It is not designed for routine care or testing.

Baby Boomers can expect that their supplement care foreign travel plan will cover emergencies that begin during the first 60 days of their trip. Baby Boomers who plan on traveling during retirement should invest in travel coverage via a Medigap plan at their first instance of eligibility. Although there is a small deductible, this can provide protection in many situations and will normally pay 80% of the fee for medically necessary emergency care.

What Kind of Travelling Do You Plan on Doing?

While you don’t need exact specifications, it’s good to know approximately how often and for how long you’ll be traveling in the years to come. This is because even Medigap plans have certain limitations when it comes to coverage in foreign countries. Do you think you’ll be out of the country for months at a time? Or will you be taking planned trips for shorter lengths of time?

Limitations

If you plan on living overseas or plan on taking long extended trips to foreign countries, you may need to consider additional coverage such as travel insurance. If you are living overseas part of the year, you may be able to invest in a private insurance plan from the country that you are living in. However, this should be an addition to your Medigap coverage if the United States is your residence. This will ensure that you are covered in case of emergency during foreign travel and have the most protection possible.

Traveling is a great way to spend retirement. There is a big world out there to see, and you shouldn’t feel limited by fear of health expenses. With these options, you should be able to travel freely with minimal risk of out of pocket costs for emergency healthcare.

Jul9

Telemedicine And Medicare

By Tom Matteson - blog

Telemedicine and Medicare Coverage: Telehealth

Telemedicine is becoming more and more popular. Here is a great article by MedicareFAQ that has some really good information.

Leaving your home when traveling to and from your medical visits can sometimes seem like an intimidating task. Especially if it’s difficult for you to travel.

With Telemedicine, also known as Telehealth, seniors will have the option to stay in the comfort of their own home to receive medical attention. Thus, avoiding the stress and trouble of attending appointments, routine check-ups, hospital stays, or any other aspect of medical health care.

What is Telemedicine

Telemedicine is essentially a way for patients to meet with doctors virtually, to be diagnosed and treated in remote locations. While this is a new service, Telemedicine is projected to lower some cost aspects of health treatments. As well as improve the way health is being monitored for seniors.

At this point in time, telemedicine is a well recognized service. It’s increasingly becoming the more chosen option when looking into health care services.

Benefits of Telemedicine

Aside from staying remote, when moving from place to place can be too physically demanding, telemedicine comes with five major benefits.

Telemedicine technology provides you with the opportunity to seek health care at your convenience from any device that has a camera and microphone. Wherever you are, health care is available to you in the palm of your hands.
Sitting in an office, anticipating your appointment, can be inconvenient and add stress to an already stressful situation. With telemedicine, you eliminate the waiting room process before your appointment. Not sitting in a waiting room also means there is less of a possibility to receive or spread sickness.
Often times a patient may feel disconnected with their health care provider when attending in-person physician visits. Telemedicine provides you the opportunity to build a better relationship with your physician. Without meeting in person, communication about health care will be key, therefore strengthening the relationship between a doctor and patient.
With telemedicine, you are presented a better opportunity to connect with more physicians and better doctors. For example, you may be sick, and needing a physician in a particular field, that could be located cities, or even states away. Traveling may be difficult for you, but you will have access to communicate with those people from a remote location.
If the doctor is happy, the patient is happy! While the benefits for patients in telemedicine seem almost endless, it also benefits the physicians! When the doctor chooses to go the telemedicine route, they will have more time for necessary medical activities. If they have the ability to take care of their patients in a more efficient way, then they have more time to assist others in need and possibly even gain more knowledge in their own field!

Health Care Providers with Medicare in Telemedicine

Medicare typically limits the health care providers you can seek telemedicine services with. With Medicare, health providers that are eligible for telemedicine are:

Nurse Midwives
Dieticians/Nutrition Specialists
Physicians
Nurses
Psychologists/Social Workers

Telemedicine and Medicare Coverage

Anyone who is a beneficiary of Medicare Part B qualifies for most telemedicine services. Just like in-person doctor visits and consultations with Medicare, you are responsible to pay for your portion of the cost for telemedicine services.

If you are enrolled Medicare Part B, you’ll typically pay 20% of the approved Medicare amount for telemedicine services, after meeting your Part B annual deductible.

If you are enrolled in a Medicare Advantage Plan, provided by a private insurance company who is contracted with Medicare, the cost for telemedicine health care would be the same as the cost for in-person health visits.

Telemedicine services covered by Medicare include, but are not limited to:

Physician consultations
Health check-ups
Mental health counseling

Please note, it is important to contact your telemedicine physician first. This is to see if they participate in Medicare to ensure your coverage applies with their offered services.

If they do not currently take part in telemedicine technology, and it is something you are interested in participating in, we suggest looking for an office in your area that can accomodate your needs.

How will Telemedicine impact Medicare Beneficiaries

Telemedicine will provide a more comfortable and convenient medical health care experience. It’ll also save the patient travel expenses for routine check-ups and other charges that come from visiting a doctor in person.

While those are very noteworthy and valuable benefits, telemedicine technology is still new. It will continue to positively impact Medicare beneficiaries in the future.

In 2015, Medicare extended their beneficiary coverage to several new telehealth services, and they continue to research and grow.

The demand for telemedicine through Medicare is continuously increasing. While the telemedicine industry is still working out a number of challenges and sometimes even legal issues, it is a rapidly growing service.

In the upcoming years, as telemedicine becomes more popular with Medicare, Medicare beneficiaries can expect telehealth practices to reduce medical costs, improve the process of medical monitoring, and create a higher-quality health care administration for seniors.

Whether your new to Medicare, or are currently enrolled, give us a call to make sure you’re taking advantage of all the benefits you deserve. Get help with the out of pocket costs left up to the beneficiary to pay.

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