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And thanks to advances in health care and our nation’s safety net, all of America’s seniors are “living longer. But here’s a sobering statistic that President Obama glossed over: About 10,000 people are now enrolling in Medicare every day.
That’s a record surge in Medicare enrollment, and it’s expected to continue for the next 15 years, as the Baby Boomers age into their golden years.
The CBO projects that 80 million Americans will be Medicare-eligible by 2035, if current trends hold.
And it has huge ramifications for the rest of our economy, and especially for the health care industry. It’s another reason why White House leaders are so insistent on changing how Medicare pays for patient care, in hopes of reining in federal spending.
And one driver for Aetna’s $37 billion acquisition of Humana is that Humana is a major player in the Medicare Advantage sector — a rapidly growing insurance market. There’s another demographic change worth noting: America’s fertility rate has reached a record low. While total births have been relatively constant — there are nearly 4 million children born in the United States every year — the number of children born per person has fallen dramatically, the CDC reports. The Mental Health Parity and Addiction Equity Act of 2008 required that private health plans cover both physical and mental health services equally. In 2013, you will pay 35% of the cost for mental health treatment after any deductibles are satisfied. Mental health care includes services and programs to help diagnose and treat mental health conditions.
Medicare Part A helps pay for mental health services that require you to be admitted to a hospital.
Medicare Part D helps pay for prescription medications needed to treat mental health conditions. An appeal is the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare plan.
Your request for a health care service, supply, item or prescription that you think you should be able to get. Your request for payment for health care service, supply, item or a prescription drug you already got. Your request to change the amount you must pay for a health care service, supply, item, or prescription drug.
You can also appeal if Medicare or your plan stops providing or paying for all or part of an item or service you think you still need. If you decide to appeal, first ask your doctor, health care provider or supplier for any information that may help your case.
Although we won’t go through all five steps of an appeal process, we can describe the first step. If you’re on Original Medicare, then every three months you’re mailed a Medicare Summary Notice, or “MSN.” An MSN shows all services or supplies that health care providers and suppliers billed to Medicare for your care during the three-month period. Generally, you get a decision from your Medicare contractor within 60 days after they get your request.
You have the right to ask the company that administers your Medicare Advantage plan to pay for, or cover, health care services or items you believe should be covered.
Appealing a decision for a Part D plan typically means working with your plan to get coverage for a prescription drug that you feel you need. Do you have Medicare Part D prescription drug coverage—either in a standalone plan or as part of a Medicare Advantage plan? Pharmacy Networks. If your Medicare prescription drug plan has a pharmacy network, be sure to use it.
Prescription Drug Discount Program. Your Medicare plan might offer a prescription drug discount program. It might be worth it to take a look at other programs that can help you lower your drug costs but might be offered outside of your plan’s prescription drug coverage. Prescription Discount Cards. Some private companies offer cards that help people save money on their prescription drugs.
State Prescription Discount Programs. The state you live in may offer additional prescription drug discount programs. If you’ve tried other options and are still struggling, or if your financial situation has changed since you enrolled in a Part D prescription drug plan, it might be worth looking for Extra Help. Changes in the eye can signal a range of health problems, from high cholesterol to liver disease to diabetes. Regular dilated eye exams can help detect many age-related eye diseases in the early stages.
Medicare Part B (medical insurance) covers a dilated eye exam to test for glaucoma once every 12 months for people at high risk.
It’s important to have a complete eye exam every year or two after age 65 to check for age-related eye diseases and other eye conditions. People who may need assistance with eye care costs can contact EyeCare America, which provides free or low-cost eye exams to eligible seniors.
Whether or not you changed your Medicare coverage during OEP, you’ll need to make sure you have current membership cards. The plan materials you should have—or should expect to get—depends on the kind of Medicare coverage you have for 2013.
Medicare Summary Notice (MSN) – this is a statement of medical services you should get in the mail every three months if you have Original Medicare. Annual Notice of Changes (ANOC) mailing – this document explains year-over-year plan changes.
Evidence of Coverage – this is usually included in the ANOC and includes a full description of all benefits included in your plan for 2013. Formulary – A formulary is a list of the drugs your plan will cover if you have a standalone Part D plan or a Medicare Advantage plan with prescription drug coverage. Since Medicare Supplement Insurance plans vary by state, and each plan is different, you should contact your plan directly with questions. Not hearing so well lately?  Here is some great information on the signs and the causes of hearing loss.
Hearing loss can contribute to social isolation, higher risk of falls, depression and dementia.
You want to see any doctor who is accepting new Medicare patients—even if you travel out of state.
You already have prescription drug coverage or don’t mind buying a standalone Medicare Part D prescription drug plan. If you have other insurance—like from an employer—that you want to keep, but you also want to take advantage of your Initial Enrollment Period. You like the convenience of having one type of coverage for each health care need—medical, hospital, prescription drug coverage, etc. You want the same coverage as Original Medicare plus extra benefits, like dental coverage, wellness services or a fitness benefit.
You have a chronic illness, like diabetes, and want a Special Needs Plan designed for your unique needs.
Your current insurance provider offers Medicare-approved plans and you’d be more comfortable sticking with a plan you know.
It’s important to make sure your Medicare coverage fits into your budget every year, especially if your situation has changed. The best time to make a change to your Medicare coverage is during the Medicare Annual Enrollment Period (AEP), October 15 to December 7 each year.


Other community resources include local insurance agents, your local Social Security Office and your State Health Insurance Assistance Program. Once you identify plans in your area, or if you already know which insurance company you want to use, you may want to call customer service representatives or go to each plan web site to further investigate the plans that interest you.
Medicare coverage isn’t the sort of thing that you can just decide on once and then forget about. Every year, the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) sponsors a nutrition education and information campaign focused on helping people make informed food choices and developing sound eating and physical activity habits.
What better time to learn about Medical Nutrition Therapy and whether it may be helpful for you? Medical Nutrition Therapy is a preventive service that may be covered under Medicare Part B.
A nutrition and lifestyle assessment, based on information you provide about your eating patterns, activity level, etc.
Nutrition counseling and goals, based on the nutrition and lifestyle assessment and on medical information, such as blood pressure or blood glucose numbers, provided by you and your doctor. Medical Nutrition Therapy can be helpful for many people with certain medical conditions, injuries or weight problems.
According to the American Diabetes Association, there is a direct link between diet and diabetes management. It’s important to note that Medical Nutrition Therapy is not the same as diabetes self-management education. If you qualify and you have a referral from your doctor, then Medicare will cover Medical Nutrition Therapy every year. Hearing loss in children is a fairly invisible disability and very easily confused with learning difficulties or lower IQ. Hearing loss in children is an invisible disability and easily confused with learning difficulties or lower IQ. Only 5% of hearing impaired have a profound loss that is easy to identify from a very early age, even without a hearing test. Around 20% of hearing impaired have moderate loss which begins to show as a child takes longer to learn to speak and has more difficulty understanding instructions.
Also the frustration of trying to understand the teacher in this situation can be exhausting and leads to behavioural issues. We believe every primary school child should have a hearing test when they start school and because the these early years at school are so critical, it should be simple as possible to continue screening for progressive or temporary hearing loss throughout the school year. We make universal screening simple and affordable for all and take away to barriers to pain-free implementation. The president also warned attendees not to race Diana Nyad, unless they wanted to get dusted by the 65-year-old swimmer. It also means that the total number of Medicare beneficiaries is expected to double within the next twenty years.
The government currently spends more than $10,000 per Medicare beneficiary every year, with costs spiking in an enrollee’s last years of life. But as the number of elderly Americans steadily climbs as a percentage of the population — about 20% of all Americans will be Medicare-eligible by 2030, up from 13% today — it will put increasing pressure on working-age Americans to support them.
At the time, Original Medicare covered mental health treatment at 50 percent after the Part B deductible. Beneficiaries paid a bigger share of the cost for mental health care than for other health care services.
Congress passed legislation that reduces how much Medicare beneficiaries pay for outpatient mental health treatment. Medicare covers outpatient and inpatient mental health care and prescription drugs you may need to treat a mental health condition. You usually get these services in a doctor or therapist’s office, in a clinic or in a hospital outpatient department.
You must get the screening in a primary care office or clinic that can provide follow-up treatment and referrals. Below in the article is some useful information for you or someone you know that is on Medicare.
Follow the instructions on the back of your MSN, and send the request for an appeal without the Redetermination Request Form. The decision is called a “Medicare Redetermination Notice,” and it can come as a separate notice or as part of your MSN. This request for services or supplies is called an “organization determination.” You can either ask for a determination yourself, or have your doctor or someone representing you ask for one. If you or your doctor thinks your health could be harmed by waiting that long, you can ask for an “expedited” or fast determination. Your plan will send you a written notice explaining why, and give you information on how to file an appeal. As with a Medicare Advantage plan, this usually involves either you or your doctor (or representative) working directly with the company that administers your Part D plan.
For more information, see the previous Medicare Made Clear blog post Medicare won’t cover a prescription I need—what now?.
If so, you likely chose the plan that would help you keep your prescription drug costs as low as possible. Copays are generally pretty low, and you could save even more by ordering a 90-day supply of your drugs at one time. This could be a separate program from your plan benefits, or it might be included in membership. If you think this might be worthwhile for you or someone you love, there are a number of programs that might meet your needs.
If you think this might be a possibility for you, a good first step is to talk to the pharmacist. Most times, you’ll pay a small yearly fee to get the card, which is usually good at a wide range of pharmacies.
To help offset some of the cost, many drug companies have programs that offer discounts on the drugs they make. To find out more, contact your state’s Department of Health and Human Services or State Pharmacy Assistance Program (SPAP). Extra Help is a Medicare program that helps people with limited income and resources pay Medicare prescription drug costs, including premiums, deductibles and coinsurance.
Some changes are visible, such as a yellowing of the white area around the iris (jaundice) that might indicate liver problems. The exam must be done or supervised by a doctor who is legally allowed to do the test in your state.
It also gives you information about costs, drug tiers and any special requirements certain drugs might have. Seniors with severe hearing loss can have five times the risk of getting dementia as those with normal hearing.3 In addition, the brain loses its ability to hear when deprived of sound.
Personal, medical and financial changes can mean your Medicare coverage no longer meets your needs.
The site is a great source of information about Original Medicare Parts A and B, including coverage and costs, which can change every year. These are sometimes sponsored by local or national organizations, like AARP, or insurance companies. Many company web sites have online tools that allow you to search and compare specific plans that have the features you’re looking for. Plan sponsors are required to provide this document, which gives a thorough description of what services the plan covers.


However, it is a key component of treatment for people with diabetes or kidney disease, including people who have had a kidney transplant. That makes sense, since blood glucose levels are affected by what you eat—specifically the carbohydrate foods you eat.
It covers three hours of one-to-one counseling the first year and one hour every year after that. You pay no copay and no deductible for the service, as long as you are qualified and your doctor prescribes it and refers you. The majority 75% have mild hearing loss which may not be noticed until the child gets to school for the first time. It is very easy to appreciate how even the most attentive parents can assume that the child is just less clever than the other kids and getting a hearing test may not be their first action to help their child. We automate admin tasks: anonymous test results uploaded directly to the cloud after every test, and notifications to parents and health authority automatically generated on school computers. Meanwhile, more doctors are hanging up their stethoscopes, as anunprecedented number of physicians hit retirement age. Over time, the cost will be consistent with coinsurance amounts for other medical services.
You pay nothing for this yearly depression screening if your doctor or health care provider accepts assignment. Medicare and all companies that provide Medicare plans are required to help you file an appeal. If you disagree with the decision made at any level of the process, you can generally go to the next level.
But no matter what type of Medicare plan you have, at any step of the appeals process, you can—and may want to—ask your doctor, health care provider or supplier for any information that may help your case, or other help.
Send it to the Medicare contractor at the address listed in the “Appeals Information” section of your MSN.
You provide the same types of information as what’s asked for on the form, and send it to the Medicare contractor listed. If your plan doesn’t decide in your favor, the appeal is reviewed by an independent organization that works for Medicare, not for the plan. But there are also quite a few programs out there specifically designed to help cut prescription costs for you or someone you love. Your plan might also have a special arrangement with certain pharmacies that could mean additional savings when you need to fill your prescriptions.
As an added bonus, you get your medicines delivered right to your mailbox—so no waiting in line at the pharmacy. Be sure to check with your plan before signing up for another savings program, so you can find out about any restrictions or requirements up front. He or she should be able to let you know about any discount programs—and if they’re available to Medicare recipients. If you’re interested in a prescription discount card and your plan gives you the “green light” to get one, you can generally find the most popular ones online.
To find out if the company that makes your drugs has any such programs, call the drug company or visit the Medicare.gov PAP page. It’s the only place in the body where doctors can see arteries, veins and nerves without using surgery. If you receive the test in a hospital outpatient setting, then you may pay a copayment to the hospital.
However, many Medicare Advantage and Medicare supplement insurance plans offer this coverage.
For example, if you have Original Medicare and a standalone Part D prescription drug plan, you will usually have two cards, one for Medicare services and one for your prescription drug coverage.
It’s good to know Medicare gives you the freedom and flexibility to get the coverage you need no matter how those needs change. Do you want to add a prescription drug plan or a supplement insurance plan to Original Medicare?
It also has an online tool that you can use to find Medicare Advantage, supplement insurance and prescription drug plans in your area. You might see notices for these events posted in your local newspaper or on bulletin boards in pharmacies, libraries, etc. You can ask for a copy to be sent to you or, often, view or download it from the company web site. Medical Nutrition Therapy can help you manage your carbohydrate intake so that the insulin in your body or that you inject can use it efficiently for energy. The service must be provided by a registered dietitian or a Medicare-approved nutrition professional. They will have learnt to speak later and arrive with a smaller vocabulary and in a noisy classroom without 1 to 1 adult communication for the first time, can get totally lost. Option to use traditional hardware and upload results via a mobile app or use our connected low cost audiometer that works without medical training and is reliable in the field. At each level, you’ll be given instructions in the decision letter on how to move to the next level of appeal.
However, regardless of your plan, you are allowed to ask for a copy of your file containing medical and other case information. Your pharmacist may also be able to help you find a discount card from a trustworthy company. Still other changes are in vision itself, such as a blind spot or blurriness that can have many causes.
And even if you didn’t change your current Medicare coverage and it was automatically renewed, you might still get or need new cards for the new plan year. If you were a plan member in 2012, you may have seen your plan’s ANOC in October, either online or in a mailing. Medicare Advantage plans offer you flexibility to choose the cost sharing that best fits your needs and budget. Original Medicare also doesn’t have an annual out-of-pocket expense cap, but Medicare Advantage plans do. Community events can be a convenient and personal way to get the information you’re looking for. You need to pay attention to your needs and to what plans are available to you, so you can make the best choice for you—every year. If your condition, treatment or diagnosis changes, then you may be able to get more hours of treatment covered. You may want to confirm with your doctor or the service provider that Medicare will cover the cost. If you haven’t gotten your new cards yet, call your plan or Medicare (see “For More Information” below). If you switched plans during OEP, you might have received your new plan’s ANOC with other plan materials or in a new member welcome kit. If you need to change plans because of a change in your life—like moving to another state—you could also qualify for a Special Enrollment period (SEP).



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