America's Benefit Specialist December 2022

MEDICARE MATTERS

line. Just under half of beneficiaries (49%) reported that they had read all or part of the Medicare & You handbook, and 44% said that they (or someone on their behalf) had visited the Medicare.gov website. Only 29% said they had called the helpline. The two new KFF analyses are based on Medicare beneficiary survey and claims data from CMS.

while the other half did not, according to the study. The same share (54%) reported they reviewed their current plan for potential changes in the kinds of treatments, drugs and services that would be covered in the following year. The analysis also finds Medicare’s official information resources are not widely used, especially the 1-800-MEDICARE help

lead to unexpected and avoidable costs, and disruptions in care for beneficiaries who stay put and do not at least review their options annually, as CMS recommended. Despite year-to-year changes in Medicare Advantage plans, about half (54%) of all MA enrollees reviewed their current plan for potential changes in premiums or other out-of-pocket costs for coverage in 2020,

CMS EXPANDS MEDICARE TO COVER MEDICALLY NECESSARY CONDITIONS REQUIRING DENTAL SERVICES

The Centers for Medicare & Medicaid released a final rule on November 1 saying it will now cover dental services for Medi care beneficiaries under certain conditions deemed medically necessary. The expanded dental coverage will go into effect January 1. The American Dental Association was pleased that CMS listened to many of the ADA’s suggestions on the draft rule, which the Association shared in comments filed September 2. In those comments the ADA told CMS it supported providing dental

coverage for the following instances, all of which are included in the final rule: • reconstruction of a ridge when per formed as a result of and at the same time as the surgical removal of a tumor • stabilization or immobilization of teeth when done in connection with the reduc tion of a jaw fracture • extraction of teeth to prepare the jaw for radiation treatment of neoplastic disease

• dental splints only when used in conjunc tion with medically necessary treatment of a medical condition • dental services—including both exam ination and treatment—prior to cardiac valve replacement, valvuloplasty or organ transplant procedures The final rule stated that Medicare pay ment would be provided if these procedures were done on an outpatient or an inpatient basis. Coverage would also be provided for ancillary services such as X-rays, anesthesia or the use of an operating room for medi cally necessary procedures that fall under the rule. The final rule does not expand Medicare to cover dental services for patients with conditions such as diabetes. CMS said it will continue to evaluate the issues surrounding such a benefit. CMS is also delaying cover age for dental treatment prior to immuno suppressant therapy or joint-replacement surgery. The agency also emphasized in the rule that the statutory definition of a physi cian, as well as the definition of a physician in the Medicare manual, includes dentists. In the final rule, CMS said it will also be implementing an annual review process to assess whether to include additional services under the Medicare medically necessary dental benefit.

CONFERENCES

July 10-11 Ms. Medicare 2023 Cleveland, OH www.msmedicare.org

March 28-29 Medicare Market Innovations Forum Orlando, FL www.medicaremarketin novations.com April 10-12 MedicareCon Las Vegas, NV https://medicarecon. com/

January 29-31 Medicare Marketing &

Sales Summit Las Vegas, NV

www.medicaremarket ingsalessummit.com

March 6-8 RISE National

Colorado Springs, CO www.risenational.com

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