America's Benefit Specialist November 2022

MEDICARE MATTERS

like to consider, you then can go into the plan details, the prescription drug coverages and other benefits. Remember to always secure a Scope of Appointment prior to discussing the Medicare Advantage or Stand-Alone Part D plans. Medicare Supplements and the Medicare Advantage plans offer great coverage options to the beneficiary. One is not better than the other but rather a matter of which type of plan design best fits their needs, both medi cally and financially. As the agent, you need to understand the differences and plans and present them clearly. It is also important to note that you will be reviewing the plans with your clients yearly to determine if the plan is still the best fit for their needs!

Advantage plan in addition to the other eligibility requirements. With any HMO plan, members can change primary care physician by contact ing the plan and requesting the change and usually if made before the 15th of the month they can begin seeing their new primary doctor the first of the next month. Disenrollment is also simple. If members change their mind prior to the plan’s effec tive date, they can cancel the application and enroll in a new plan. If they disenroll after the plan’s effective date, they need to submit a request in writing. The agent should discuss the options and consequences of the disenrollment as there are rules as to new plan eligibility and Part D. Once you have determined which type of coverage the Medicare beneficiary would

premium. There are plans in some areas also offering a giveback of some or all of the Part B premium. MA plans may also include additional benefits not offered by Original Medicare, such as dental, vision and transportation to doctor visits! The main disadvantage to Medicare Advantage plans is members typically must use an established network for medical care unless it is an emergency or urgent care. Networks may limit which doctors a mem ber may visit. For many services, a referral is required from the primary care physician to a specialist or for a treatment request. (Types of services waiving the referral requirement vary by plan.) Lastly, a beneficiary must be in an enroll ment period to be eligible to join a Medicare

Items and Services Not Covered under Medicare

by John Greene Vice President of Congressional Affairs NAHU jgreene@nahu.org

Just when you think you’ve seen everything that CMS has pro duced about Medicare, a NAHU member mentions a booklet you haven’t seen. Recently, someone referenced a PDF that I had never come across, and it gives a thorough description of services and supplies not covered by Medicare, such as: • excessive therapy and or diagnostic procedures • hospital-based services that could have been provided in a lower-cost setting like the patient’s home • unnecessary services based on the patient’s diagnosis, like transcendental meditation (this was an interesting one!) • custodial care that doesn’t require the continued attention of trained medical personnel • personal comfort items The booklet also covers exceptions to care that is generally not covered due to care being provided outside the U.S. Check out the booklet here: https://tinyurl.com/yfpywxx6.

36 ABS | benefitspecialistmagazine.com