Independent Insurance Consultants would like to congratulate Miranda Ford for her achievement. Miranda has been awarded by UntedHealthcare Medicare & Retirement for the 3rd Quarter Top Producer. Miranda is a Senior Insurance Specialist at Independent Insurance Consultants, which is based out of Knoxville, serving clients in every county in Tennessee. She is a dedicated, hard worker, that takes pride in helping her clients. She strives to provide top notch customer service and to always put her clients first. Miranda specializes in Medicare insurance coverage, Medicare Part D plans, and also Medicare Advantage Special Needs Plans (for those who receive ‘extra help’, such as TennCare, Medicaid, QMB, and SLMB). Congratulations Miranda and keep up the hard work!
Original Medicare pays for many, but not all, health care services and supplies. Medicare Supplement Insurance policies, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like co-payments, coinsurance, and deductibles. Medicare Supplement Insurance policies are also called Medigap policies.
These plans are standardized, meaning all companies offer the same plans and benefits. Medicare Supplements do NOT include Medicare prescription coverage (Part D).
The best time to buy a Medigap insurance policy is during your Medigap Open Enrollment Period. This period begins 6 months before the first day of the month in which you’re 65 or older and enrolled in Part B and 6 months after this date. (Some states have additional Open Enrollment Periods.)
After this enrollment period, your option to buy a Medigap policy may be subject to health questions and a higher premium.
For more information on choosing the RIGHT Medicare Supplement and premium discounts, call us Toll Free at 1-866-691-5571.
Third Annual National Medicare Education Week Offers Help Before Open Enrollment Period
MINNETONKA, Minn. (Sep. 08, 2014) —
The third annual National Medicare Education Week begins Monday, Sept. 15, exactly one month before the start of Medicare’s annual Open Enrollment Period (Oct. 15-Dec. 7). The observance was created to help people learn more about Medicare.
Since National Medicare Education Week began in 2012, thousands of people have participated in educational events during the week in more than 60 cities across the country. This year, National Medicare Education Week events will be held for the first time in Boston, Salt Lake City and Richmond, Virginia; a full list of cities and events can be found at NMEW.com.
UnitedHealthcare, the largest business dedicated to the health and well-being needs of seniors and other Medicare beneficiaries, created National Medicare Education Week as an extension of its Medicare Made Clear initiative. The company celebrates the annual observance with the support of a variety of organizations and companies that share its commitment to helping seniors and other Medicare beneficiaries understand their health care coverage options.
Supporters of National Medicare Education Week include AARP, Ameriprise Financial, the Caregiver Action Network (CAN), the National Association of Area Agencies on Aging (n4a), Safeway, Target, Walgreens, Walmart and Sam’s Club, as well as health care providers, senior centers and other organizations in communities across the country.
“Health care decisions can have a significant impact on the well-being – and wallets – of seniors and other Medicare beneficiaries,” said Steve Nelson of UnitedHealthcare. “Medicare is not one size fits all, and finding coverage that meets each person’s unique needs requires thoughtful planning. We hope that National Medicare Education Week will motivate people to learn more about Medicare so they can feel better prepared to make confident coverage decisions during the Open Enrollment Period.”
According to the Medicare Made Clear Index, a 2013 survey conducted by UnitedHealthcare, 1 in 5 Medicare beneficiaries describes Medicare as confusing, and most are unable to correctly identify the health care expenses that Medicare Parts A, B, C and D cover. Baby boomers ages 60 to 64 who are approaching Medicare eligibility also reported low confidence in their Medicare knowledge, with 70 percent saying they have a “fair” or “poor” understanding of the program. Many were also unaware of important details about how and when to enroll in Medicare.
Education Opportunities in Local Communities and Online
During National Medicare Education Week, UnitedHealthcare will host dozens of Medicare education events in more than 15 cities. The company is expanding the number of Spanish-language events this year to better meet the needs of Hispanic beneficiaries and their caregivers. The company will host events in both English and Spanish in Dallas, Miami, Los Angeles and San Diego.
At the events, local UnitedHealthcare representatives will present information and answer some of the most common Medicare questions. Among the topics that will be covered are:
In collaboration with the Caregiver Action Network, a National Medicare Education Week supporter, UnitedHealthcare will make a customized version of the event presentation available on CaregiverAction.org. The presentation is designed to address the unique needs of family caregivers who help their loved ones navigate their Medicare enrollment decisions.
For more information about National Medicare Education Week, visit NMEW.com.
UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. The company offers the full spectrum of health benefit programs for individuals, employers andMedicare and Medicaid beneficiaries, and contracts directly with more than 800,000 physicians and care professionals, and 6,000 hospitals and other care facilities nationwide. Globally, UnitedHealthcare serves more than 45 million people in health benefits and is one of the businesses of UnitedHealth Group (NYSE:UNH), a diversified Fortune 50 health and well-being company.
Do you know the difference?
Medicare Advantage (Part C)
Medicare Advantage is a combination of two standard Medicare offerings: Part A, also known as Hospital Insurance; and Part B, also known as Medical Insurance. Premiums are often low and $0 Premium plans are available in many areas. Most Medicare Advantage plans also cover prescription drug costs, or Medicare Part D. Some plans even include dental, vision and hearing coverage as well.
Unlike traditional Medicare plans, Medicare Advantage is provided by private insurance companies.
Medicare Advantage provides extensive coverage for patients, but it also requires that patients abide by certain rules and guidelines outlined in the plan itself. For example, Medicare may only provide assistance if the patient visits a doctor or hospital that belongs to a Medicare-approved network. Also, certain prescription drugs may be exempt from coverage.
Many Medicare Advantage plans offer health club memberships and also provide patients with routine preventative exams, disease management programs, and transportation services to physician’s offices – services which aren’t covered under Parts A and B alone.
Medicare Supplements (Medigap)
Although Medicare is a great asset for the aging population and for those with disabilities, it often is not enough to cover all of their medical expenses. In response to this need, private insurance companies offer extended plans called Medicare Supplemental Insurance, sometimes called a Medigap policy, to help fill in those gaps in coverage.
While Medicare can and often does pay up to 80% of a patient’s medical expenses, the remaining 20% can still be a tremendous financial burden. Even routine doctor visits can add up over time, especially for those with chronic ailments who need frequent treatment.
Although these plans may cost more than Part C Medicare Advantage plans, there are few to any extra out-of-pocket expenses.
Still have questions? CALL US Toll Free 1-866-691-557 for your personal review
Pictured from left to right (Kevin Burchette-Agent Manager-EDC UnitedHealthcare Medicare & Retirement, Miranda Ford-Senior Medicare insurance associate, Blake McCoy-President & Founder of Independent Insurance Consultants)
Today marks a very important date for Miranda Ford, one of our Senior Medicare insurance associates. One and a half years ago Miranda started as a receptionist at Independent Insurance Consultants. After a few months, she made it known that she was a driven and very personable person that knew no strangers. After consideration of becoming a licensed insurance producer and joining our sales team, Miranda started her training and obtained her Tennessee Health insurance license. For the past year, her focus and passion has been helping Medicare beneficiaries choose the right coverage for their Medicare insurance and prescription drug needs. Miranda is certified with many of the major Medicare insurance carriers and has become a leader, not only in our Medicare solutions team, but also recognized state wide. Today, Miranda was awarded by UnitedHealthcare Medicare & Retirement as the 1st Quarter 2014 Top Producer Award! We want to congratulate and thank Miranda for her dedication to her clients, IIC, and of course UnitedHealthcare Medicare & Retirement. Congratulations Miranda, you did it!
Are you looking for an affordable dental plan with good coverage? Look no further... We are proud to offer a stand alone Dental plan insured by UnitedHealthOne. Monthly premiums start as low as $15 a month for up to $1,000 of coverage. Preventive Care has NO waiting period and NO deductible. Call us Toll Free 1-866-691-5571 to keep your smile beautiful.
Independent Insurance Consultants
Toll Free 1-866-691-5571
Coverage options outside Open EnrollmentOpen Enrollment for 2014 coverage is over. But you may still have options to get health coverage, including:
To qualify for a special enrollment period, one of the following must apply to you:
Learn more about coverage options including short term health insurance:
Independent Insurance Consultants
Toll Free 1-866-691-5571
I'll be 65 years old soon. When should I apply for Medicare?We generally advise people to apply for Medicare three months before turning age 65. You will receive a Medicare card about two months before you turn age 65. Your coverage will begin at age 65.
If you are already receiving Social Security benefits when you become eligible for Medicare, we automatically will enroll you in Medicare Parts A and B. However, because you must pay a premium for Part B coverage, you can turn it down.
Note: Residents of Puerto Rico and foreign countries do not get Part B automatically. They must elect this benefit.
Apply online for Medicare only, or call 1-800-772-1213 (TTY 1-877-486-2048) between 7 a.m. to 7 p.m., Monday through Friday. Likewise, you can apply for retirement benefits and Medicare together online.
If you live outside the United States, refer to Service Around the World.
We look forward to personally navigating you through the Medicare maze.
Independent Insurance Consultants
Toll Free 1-866-691-5571
Medicare Cost Sharing Programs
Qualifying Individuals (QI 1)
Cost sharing assistance for low income Medicare beneficiaries. You must meet criteria for one of the other Medicaid categories in order to get TennCare Medicaid.
Monthly Income Limit
Between 120% and 135% poverty
$1,149 - $1,293 (1)
$1,551 - $1,745(2)
This is a mandatory Medicaid eligibility category. State is required to pay Medicare Part B premiums for these individuals as long as federal funds are available. They are not eligible for TennCare unless they meet the criteria for one of the other eligibility categories. Eligibility for this program is determined by TennCare.
Qualified Disabled Working Individuals (QDWI)
Low income disabled working individuals under age 65 who are entitled to Medicare Part A. You must meet criteria for one of the other Medicaid categories in order to get TennCare Medicaid.
Monthly Income Limit
This is a mandatory Medicaid eligibility category. State is required to pay Medicare Part A premiums for these individuals. They are not eligible for TennCare unless they meet the criteria for one of the other eligibility categories. Eligibility for this program is determined by TennCare.
Qualified Medicare Beneficiaries (QMB)
Low income persons eligible for Medicare Part A. You must meet criteria for one of the other Medicaid categories in order to get TennCare Medicaid.
Monthly Income Limit
This is a mandatory Medicaid eligibility category. State is required to pay Medicare premiums, deductibles, and coinsurance for these individuals. They are not eligible for TennCare unless they meet the criteria for one of the other eligibility categories. Eligibility for this program is determined by TennCare.
Special Low Income Medicare Beneficiaries (SLMB)
Low income Medicare beneficiaries. You must meet criteria for one of the other Medicaid categories in order to get TennCare Medicaid.
Monthly Income Limit
Between 100% and 120% poverty
$958 - $1,149 (1)
$1,293 - $1,551 (2)
This is a mandatory Medicaid eligibility category. State is required to pay Medicare Part B premiums for these individuals. They are not eligible for TennCare unless they meet the criteria for one of the other eligibility categories. Eligibility for this program is determined by TennCare.
We will help you apply for Medicare Cost Sharing Programs:
Independent Insurance Consultants- Medicare insurance division
865-691-5571 Toll Free 1-866-691-5571
Fighting ‘Observation’ StatusBy SUSAN JAFFEEvery year, thousands of Medicare patients who spend time in the hospital for observation but are not officially admitted find they are not eligible for nursing home coverage after discharge.
A Medicare beneficiary must spend three consecutive midnights in the hospital — not counting the day of discharge — as an admitted patient in order to qualify for subsequent nursing-home coverage. If a patient is under observation but not admitted, she will also lose coverage for any medications the hospital provides for pre-existing health problems. Medicare drug plans are not required to reimburse patients for these drug costs.
The over-classification of observation status is an increasingly pervasive problem: the number of seniors entering the hospital for observation increased 69 percent over five years, to 1.6 million in 2011.
The chance of being admitted varies widely depending on the hospital, the inspector general of the Department of Health and Human Services has found. Admitted and observation patients often have similar symptoms and receive similar care. Six of the top 10 reasons for observation — chest pain, digestive disorders, fainting, nutritional disorders, irregular heartbeat and circulatory problems — are also among the 10 most frequent reasons for a short hospital admission.
Medicare officials have urged hospital patients to find out if they’ve been officially admitted. But suppose the answer is no. Then what do you do?
Medicare doesn’t require hospitals to tell patients if they are merely being observed, which is supposed to last no more than 48 hours to help the doctor decide if someone is sick enough to be admitted. (Starting on Jan. 19, however, New York State will require hospitals to provide oral and written notification to patients within 24 hours of putting them on observation status. Penalties range as much as $5,000 per violation. )
To increase the likelihood of being formally admitted, “get yourself in the door before midnight,” advised Dr. Ann Sheehy, division head of hospital medicine at the University of Wisconsin Hospital in Madison, Wisc. A new Medicare regulation — the so-called “pumpkin rule” — requires doctors to admit people they anticipate staying for longer than two midnights, but to list those expected to stay for less time as observation patients.
Although the rule applies now, Medicare officials won’t enforce it until April 1, having already pushed the deadline back. The American Medical Association and the American Hospital Association have called the pumpkin rule “impossible” to comply with and have urged that enforcement be delayed again until October.
“It doesn’t make any sense,” said Dr. Sheehy, who studied how the rule would have affected admissions at her hospital over an 18-month period and published the results in JAMA Internal Medicine. “Some patients will be admitted because they came in at the right time of day, not because they have more complicated medical problems.”
The two-midnight rule doesn’t change Medicare’s three-midnight rule, the one limiting post-hospital nursing home coverage. Officials at the federal Centers for Medicare and Medicaid Services declined comment for this story because of pending litigation seeking to eliminate observation status.
If you or a family member land in the hospital as an observation patient and think you should be admitted, it’s better to act sooner than later.
“I would talk to anyone who would listen to me,” said Terry Berthelot, a senior attorney at the Center for Medicare Advocacy, which offers a free self-help packet for observation patients. “Make as much noise as you can, because it’s much easier to change your status while you’re still in the hospital than to go through Medicare’s appeals process later.”
Ms. Berthelot suggests asking your regular physician to speak with the doctor treating you in the hospital about why you need to be admitted, based on your medical condition and risk factors.
“It’s got to be a medical argument,” said Ms. Berthelot. “You can’t say, ‘Mom will need rehab after this,’ or ‘We can’t take her home because no one can stay with her.’”
If that doesn’t work, sometimes a strongly worded letter or call from a lawyer describing the patient’s medical needs can be effective.
In some cases, help from a professional can make a difference. Shari Polur, an elder-law attorney in Louisville, Ky., recently hired a geriatric care manager to persuade a local hospital to admit her client. Since admission status can change from one day to the next, the manager, who is also a registered nurse, called the hospital every morning to make sure the patient was still officially admitted until she could be transferred to a nursing home.
If the situation isn’t resolved while you’re in the hospital and you require follow-up care at a nursing home, you’ll have to pay the bill of often thousands of dollars up front. At that point, Ms. Berthelot suggests, you should file what amounts to a special doubled-barreled appeal with Medicare.
It’s not for the faint of heart: the process is long and arduous, and it requires beneficiaries to first receive and pay for the care — often an expensive proposition — before seeking reimbursement.
And the legal arguments can be tangled. The Medicare appeals process typically addresses disputes over whether certain treatments or services rendered should have been covered. Observation patients have actually received hospital coverage and services a doctor says is medically necessary — so they don’t really have anything to appeal, said Marc Hartstein, director of Medicare’s hospital and ambulatory policy group, at a recent briefing in Washington.
“My limited understanding of this is that the patient cannot appeal a decision not to order or not to do something,” he said.
But observation patients may claim that they received treatment usually provided to admitted patients only in a hospital. Therefore, the hospital incorrectly billed Medicare for an outpatient service instead of for inpatient services. The patient should have been admitted and therefore qualifies for nursing home coverage.
“It’s absolutely confusing as heck,” said Michael Sgobbo, an elder law attorney in Charleston, S.C., who recently won an appeal on behalf of a 98-year-old woman who will be reclassified as an admitted patient. That means Medicare will pay her nursing home bill of nearly $10,000.
Lawyers at the Center for Medicare Advocacy recommend fighting observation care on two fronts.
First, follow the appeal instructions in the Medicare summary notice, a quarterly statement of services. Circle the charges on the statement from the hospital and explain that these items were inappropriately billed under Medicare’s Part B as outpatient services. They should have been billed under Medicare’s Part A for hospital services, because the patient received treatment that could only have been provided in a hospital. Mail the statement within 120 days (from the date on the statement) to the address provided for appeals.
Second, after challenging the hospital’s observation designation, file a separate appeal to seek reimbursement for the nursing home charges, said Ms. Berthelot. To begin, ask the nursing home to bill Medicare. You should receive a Medicare summary notice indicating that it did not pay the nursing home charges because the patient didn’t have the required three-day hospital stay. Circle those charges, and explain that the beneficiary was hospitalized for three days and received an inpatient level of care. Then send it within 120 days to the address provided for appeals.
Be prepared to dig in. If either appeal is denied, you must appeal again to the next level, following the instructions in the denial letters.
“Both appeals can take at least a year and are fraught with difficulty,” said Ms. Berthelot. “The reality is that most people can’t get through and those who do, get lucky.”
Some observation patients appeal and never get decisions, warned Diane Paulson, senior attorney at Greater Boston Legal Services. Some of her clients’ cases were dismissed because they were not admitted to the hospital — the very point they were challenging.
“You can’t appeal if you don’t have a denial,” she said. When that happens, the case falls into “a black hole.”
But the chances of winning improve as you continue to appeal, as Nancy and George Renshaw, of Bozrah, Conn., discovered. After spending nearly four years going through the process, a Medicare judge decided last February that Mr. Renshaw’s father should have been admitted to the hospital instead of classified as an observation patient. Medicare finally paid his nursing home bill, and in November the Renshaws received a refund of $4,410.
“I was shocked,” said Ms. Renshaw. “I never expected to see a penny of it.”
The original blog can be found here: