Debbie Perlman Blog

Below is a warning issued by the Drug Enforcement Administration (DEA) on counterfeit prescription drugs coming into the States from Mexico that are causing fatalities. Beneficiaries who use pain medication should be especially aware of this warning. Also, we have a new fraud alert on Opioid Fraud and Abuse. Opioids have killed more than 47,000 people to date, and  2.1 million Medicare beneficiaries have an opioid disorder. This alert discusses what opioids are, what opioid fraud and abuse looks like and where to report it. DEA issues warning over counterfeit prescription pills from Mexico The Drug Enforcement Administration is alerting the public of dangerous counterfeit pills killing Americans. Mexican drug cartels are manufacturing mass quantities of counterfeit prescription pills containing fentanyl, a dangerous synthetic opioid that is lethal in minute doses, for distribution throughout North America. Based on a sampling of tablets seized nationwide between January and March 2

Medicare is a valuable source of health insurance for people 65 and older, and making the transition from private health insurance involves some important decisions. These six steps can guide you through the process: 1. Enroll in Medicare Part B. Medicare’s Initial Enrollment Period lasts for seven months, beginning three months before you turn age 65. Most people automatically qualify for Medicare Part A (Hospital insurance) if they or their spouse paid Medicare taxes while working for ten years or more. However, Part B (Medical insurance) is voluntary and requires enrollment. Although there are special enrollment periods, delayed enrollment may result in a late fee with increased premiums and a gap in your health coverage. For 2016, the standard monthly premium for Part B is $121.80. While the “hold harmless rule” protects 70 percent of recipients from having their Social Security check lowered from one year to the next, Part B premium may increase to $149 in 2017 for weal

Enrolling in a Medicare plan is a big decision. While you’re able to switch plans each year if you’re unhappy (in some situations more frequently) you still want to choose the best plan for your needs the first time. This means taking your out-of-pocket costs into consideration along with other factors. Medicare covers a wide range of medical services, but most are not free. Here’s what you should expect to pay out-of-pocket throughout the year if you’re enrolled in a Medicare Advantage/Part C plan. Premiums Premiums are the amount you pay each month out-of-pocket for your Medicare Advantage (MA) plan. The estimated average monthly MA plan premium for 2019 is $28, this cost may vary significantly. Some could be $0, while others could have premiums over $200. To join an MA plan, you must also be enrolled in Medicare Parts A & B. It’s important to remember that Part B has a separate premium that you are responsible for paying even if you enroll in a Medicare Advantag

White House chief of staff Mick Mulvaney wants to see if the Medicare chief Seema Verma and the health secretary, Alex M. Azar II, can still work together. The acting White House chief of staff has summoned President Trump’s top two health policy officials to the White House on Thursday to assess whether the president’s health secretary and his Medicare chief can continue to work together, a senior administration official confirmed on Tuesday. White House aides said President Trump is still standing by his embattled administrator of the Centers for Medicare and Medicaid Services, Seema Verma, amid reports that she had requested that taxpayers reimburse her $47,000 for property stolen on a trip, including jewelry priced at more than $40,000.  But her feud with Alex M. Azar II, the health and human services secretary, has reached the president’s desk and the attention of the acting White House chief, Mick Mulvaney. For now, Mr. Trump is not expected to attend

A few years ago, my neighbors were in a car accident. Nothing too serious, thank goodness. They were, however, out of commission for a few weeks. As both were in their 80s and neither one able to drive during recovery, they needed home care – and a little extra help around the house. It’s important to plan for your health care needs, but sometimes life throws unexpected curve balls. And when that happens, you’ll need to know what’s covered.   Fortunately, there are ways you and your loved ones can get the necessary care at home. Here’s what you need to know. What’s home health care? It’s a range of health care services given in your home for an illness or injury. Things like: Covered by Medicare Skilled Nursing care (when given on a part-time or intermittent basis) Medical social services (counseling, help finding community resources) Medical supplies (wound dressings) Necessary durable medical equipment (walker, wheelchair, hospital bed) Physical, occupatio

Like the first tree to turn color in the fall, the Annual Notice of Changes is the first sign of the season – open enrollment season, that is. Reviewing and understanding this important document is the first step in making sure you get the coverage you need from your Medicare plan next year. 1. What is it? If you have a Medicare Advantage, Cost or Drug plan, the Annual Notice of Changes (ANOC) tells you about changes to your current Medicare plan benefits and costs that will take effect Jan. 1. Not sure what plan you have? Check out the bottom of this post for resources. Changes to premiums, covered services and costs You should see a side-by-side before and after listing of services and costs. Depending on your Medicare plan, these may include: Premium (the amount you pay each month) Deductible (the amount you pay before your plan kicks in) Copay (a flat fee that you pay for each service) Coinsurance (as opposed to a flat fee, this is a percentage you have

Recently, my mom fell and broke both her wrists. Between the trip to the ER, X-rays and follow-up visits, the cost of her health care really added up. Thankfully, her Medicare plan had a medical out-of-pocket maximum that limits the amount she has to spend each year.  Once she hits her out-of-pocket maximum, her plan covers all the costs for her medical care. She’s financially protected, even if she has another unexpected or expensive health care need. That’s why an out-of-pocket maximum is so important for people with a Medicare plan, especially those living on a fixed income. What is an out-of-pocket maximum? This is the limit on how much you might pay for medical care through copays and coinsurance in a year. Some people never get enough health care to hit their out-of-pocket maximum.  Think of your out-of-pocket maximum like a bucket. Every time you spend your own money on medical services or care, it goes into the bucket. Once the bucket is full, you’v

When I shop online, sometimes the company will suggest an item that pairs well with what I’m buying. If I’m buying a slow cooker, they might suggest a cookbook to go with it. I like that! I have the option to buy the slow cooker alone, or buy the items together. You can apply that same approach to buying a Medicare Part D plan. Buy it alone, or buy it with your health coverage. First, it’s important to know that Original Medicare includes Part A (hospital coverage) and Part B (doctor visits, outpatient care and supplies). But it doesn’t include coverage for most outpatient prescription drugs, like the medicines you take every day or for short periods of time. A Part D prescription drug plan would help pay for these types of medicines. Two ways to get a Part D plan You can buy a Part D prescription drug plan from a private insurance company that has a contract with Medicare. Here’s what you need to do to get Part D: Enroll in Medicare Part A or Part B, or b

You got the card in the mail and you’re officially a Medicare member. Congrats! Are you wondering what to do next? One of your first steps is to schedule your Welcome to Medicare visit. Everyone who signs up for Medicare can get one welcome visit covered by Medicare during their first year. For the visit to be covered, make an appointment with a doctor that accepts Medicare. If you want to see the doctor you’ve been going to for years, log on to your online account and search the list of doctors your Medicare plan covers (your network) or call your insurance company to double-check that your doctor accepts your Medicare plan. What happens at a Welcome to Medicare visit? The goal of a Welcome to Medicare visit is for the doctor to get an overview of your health. You’ll talk about your current health and anything else you might want to do to stay healthy. The visit includes: A review of your medical and family history A checkup to measure your height, weight, b

After feeling cooped up during our long winters, I’m eager to enjoy the great outdoors. Once the snow is gone, it’s time to tackle the lawn, trim the hedges and get the blooms ready. But let’s be smart about it; we can’t just jump into an activity we haven’t done for several months. A long day in the yard raking, mowing, planting and weeding can take a toll on your body, especially your back. Around 80 percent of adults will experience back pain at some point in their lives, and it’s common among people age 60 and older. Let’s look at ways we can enjoy a great hobby like gardening – and do it pain-free. Tips for gardening pain-free Start gardening slowly and build up your endurance. Pace yourself and don’t try to do everything in one day. As you get older, your endurance and exercise capacity might not be what they used to. Trying to do too much will put you at greater risk of injury and strain. The more you can strengthen the muscles that support your spine, the

A health insurance network is a group of doctors, hospitals and clinics that have agreed to provide plan members with health care services. When you enroll in an insurance plan with a network, in order to get the best value from your plan you must use those doctors and hospitals for your health care needs. If you receive care outside of your network (other than in an emergency) you could end up paying out of pocket for most of those costs. The size of the network depends on the insurance plan you choose. Usually, the larger the network, the higher your monthly premium will be. Many private Medicare plans, like Medicare Advantage plans, have limited networks, and this can mean lower premiums for you. But it’s not all about the costs. Limited networks make a lot of sense for meeting most people’s health care needs. Can a limited health insurance network actually be good for you? The short answer is yes. And here’s why. 1. Networks include high quality doctors and ho

Portland, Ore. (September 26, 2019) —The National Psoriasis Foundation, NPF, applauds Senator Lisa Murkowski (R-AK), Senator Doug Jones (D-AL), Senator Bill Cassidy (R-LA), Senator Margaret Hassan (D-NH), Senator Cindy Hyde-Smith (R-MS), and Senator Jacky Rosen (D-NV) for introducing the Safe Step Act. This legislation amends the Employee Retirement Income Security Act (ERISA) to require a group health plan (or health insurance coverage offered in connection with such a plan) to provide a robust exception process for step therapy protocols. Step therapy is a tool used by health insurance providers to control spending on patient’s medications. While step therapy can be effective in containing the costs of prescription drugs, in some circumstances, it can have a negative impact on patients including delayed access to the most effective treatment, severe side effects, and potentially irreversible disease progression. Currently, when a health care provider prescribes a t

Anthem’s Trends in Health Benefits 2018 report found that consumer-driven health plans (CDHPs) are gaining popularity among both employers and employees. But what is a consumer-driven health plan, really, and is it a good option for your business? The Benefits of CDHPs A consumer-driven health plan is a high-deductible health insurance plan that’s used in conjunction with a tax-advantaged savings account — either a health savings account (HSA), a flexible spending account (FSA) or a health reimbursement account (HRA). Enrollment in high-deductible health plans with associated savings accounts has increased by 50 percent since 2013. And the average employee-only premium for a CDHP is roughly $6,459 — nearly 10 percent lower than the average premium for a traditional preferred provider organization (PPO) plan. This makes CDHPs a more cost-effective way to offer health insurance, a crucial factor in attracting and retaining top employees. At the same time, these p

The continued success of value-based care depends on providers having the tools they need to collect and analyze data. In the past, those tools haven’t always been up to the task. But that’s changing — and just in time. Despite the momentum value-based care has seen, one recent HealthEdge survey found that many health insurance executives doubt these programs will grow much over the next two years — and 40 percent cited health care technology challenges as one of the primary reasons why. Perhaps the biggest obstacle value-based care faces has to do with collecting and crunching data. Providers work most effectively when they’re able to measure changes to patients’ health and identify clues that allow them to prevent — rather than just treat — health concerns. But that’s only achievable when physicians can collect and analyze relevant data, which many can’t. Fortunately, payers, providers, vendors, academics and others have been working on ways to overcome these

Offering your workforce health insurance for the first time is an exciting milestone. It’s a sign that your business is taking its next steps to something even bigger and better. Your employees will also appreciate the perk. Employees rate health insurance as the most valuable workplace benefit, a critical factor in their decision to either stay at a job or seek a new employer. As you begin offering health benefits, you want the process to be as smooth as possible, for you and your employees alike — especially when open enrollment (OE) enters the mix. Here’s how to make sure your employees have the information they need to make smart choices about their health insurance. Why Is an Open Enrollment Plan Essential? Even though your employees want health insurance benefits, they may not understand their plan itself. A health insurance literacy survey of 2,000 Americans with health insurance found that most of them overestimated their health insurance know-how. Despite w