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  • Initial Deductible:
    will be increased by $20 to $435 in 2020.
  • Initial Coverage Limit (ICL): 
    will increase from $3,820 in 2019 to $4,020 in 2020.
  • Out-of-Pocket Threshold (or TrOOP): 
    will increase from $5,100 in 2019 to $6,350 in 2020.
  • Coverage Gap (Donut Hole): 
    begins once you reach your Medicare Part D plan’s initial coverage limit ($4,020 in 2020) and ends when you spend a total of $6,350 out-of-pocket in 2020.
  • 2020 Donut Hole Discount: 
    Part D enrollees will receive a 75% Donut Hole discount on the total cost of their brand-name drugs purchased while in the Donut Hole. The discount includes, a 70% discount paid by the brand-name drug manufacturer and a 5% discount paid by your Medicare Part D plan. The 70% paid by the drug manufacturer combined with the 25% you pay, count toward your TrOOP or Donut Hole exit point. 
    For example: If you reach the Donut Hole and purchase a brand-name medication with a retail cost of $100, you will pay $25 for the medication, and receive $95 credit toward meeting your 2020 total out-of-pocket spending limit. 

    Medicare Part D beneficiaries who reach the Donut Hole will also pay a maximum of 25% co-pay on generic drugs purchased while in the Coverage Gap (receiving a 75% discount). 
    For example: If you reach the 2020 Donut Hole, and your generic medication has a retail cost of $100, you will pay $25. The $25 that you spend will count toward your TrOOP or Donut Hole exit point.
  • Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit**: 
    beneficiaries will be charged $3.60 for those generic or preferred multisource drugs with a retail price under $72 and 5% for those with a retail price greater than $72. For brand-name drugs, beneficiaries would pay $8.95 for those drugs with a retail price under $179 and 5% for those with a retail price over $179.
  • Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees: 
    will increase to $3.60 for generic or preferred drug that is a multi-source drug and $8.95 for all other drugs in 2020.
 
 
Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. It is also known as the Part D Low-Income Subsidy (LIS).

Extra Help eligibility

    1. If your monthly income is up to $1,581 in 2019 ($2,134 for couples) and your assets are below specified limits, you may be eligible for Extra Help (see the Extra Help income and asset limit chart for details). These limits include a $20 income disregard that the Social Security Administration (SSA) automatically subtracts from your monthly unearned income (e.g., retirement income).


Even if your income or assets are above the eligibility limits, you could still qualify for Extra Help because certain types of income and assets may not be counted, in addition to the $20 mentioned above.

  1. If you are enrolled in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you automatically qualify for Extra Help regardless of whether you meet Extra Help’s eligibility requirements. You should receive a purple-colored notice from the Centers for Medicare & Medicaid Services (CMS) informing you that you do not need to apply for Extra Help.

Extra Help benefits

The Extra Help program offers the following benefits:

Depending on your income and assets, you may qualify for either full or partial Extra Help. Both programs provide assistance with the cost of your drugs. To receive such assistance, your prescriptions should be on your plan’s formulary and you should use pharmacies in your plan’s network.

Remember that Extra Help is not a replacement for Part D or a plan on its own: You must still have a Part D plan to receive Medicare prescription drug coverage and Extra Help assistance. If you do not choose a plan, you will in most cases be automatically enrolled in one.

Earlier this year, a federal government systems issue prevented Medicare Advantage and Part D premiums from being automatically deducted from the Social Security payments of some people with Medicare. Normally, if a beneficiary elects, Social Security deducts the premiums and sends them directly to the plan. In this instance, the payments were not sent to the plans, and beneficiaries did not know that their plans were not receiving them.

While the issue has since been resolved and premium payments should be processed correctly moving forward, Medicare Rights remains concerned about the scope of the processing error and the potential impacts on beneficiaries—including confusion, financial hardship, and coverage losses.

According to the Centers for Medicare & Medicaid Services (CMS), affected individuals include those who were “enrolled either in a Medicare Advantage Plan or in a Medicare Prescription Drug Plan for coverage starting January 1, 2019” and chose to have their premiums automatically deducted from their monthly Social Security benefit, rather than pay the plan directly.

However, it’s not yet clear how many of these enrollees were affected, if those who were have been made aware, or how much they might owe. The Social Security Administration (SSA) notes that “Plans will be sending premium bills to those affected. If you are affected and haven’t already received a bill in the mail, you will soon. The first bill will likely be for a larger amount than usual to make up for the unpaid premiums.”

Importantly, plans must offer enrollees a “grace period” to repay the missed premium payments, which must last at least as long as the delay in billing. Plans also have the option not to pursue these outstanding payments.

CMS advises beneficiaries to call their plan directly with any questions or concerns. Medicare Rights’ Helpline counselors are also available at 800-333-4114, and enrollees may want to contact their local SHIP or 1-800-Medicare for assistance.

Medicare Rights appreciates federal agency and plan efforts to educate affected enrollees and we encourage them to continue to work together to hold beneficiaries harmless.

If you have a child under the age of 20, they can only qualify for medicare if they have End-Stage Renal Disease (ESRD). Additionally, to qualify for Medicare coverage, the child must:

  1. Need dialysis on a regular basis or require a kidney transplant
  2. And, have at least one parent who receives or is eligible for Social Security retirement benefits

Children over the age of 20 qualify for Medicare after receiving Social security disability insurance (SSDI) benefits for at least two years (24 months). Your child may be able to receive SSDI, even with no work history, if they:

  1. Developed a disability before age 22
  2. Have at least one parent who receives Social Security retirement benefits
  3. And, are unmarried

If your child is 18 or younger and does not qualify for Medicare, they may qualify for your state’s Children’sHealth InsuranceProgram (S-CHIP). S-CHIP is a program for families with low incomes. If your child is 19 or older, they may qualify for Medicaid.

Federal Indictments & Law Enforcement Actions in One of the Largest Health Care Fraud Schemes Involving Telemedicine and Durable Medical Equipment Marketing Executives Results in Charges Against 24 Individuals Responsible for Over $1.2 Billion in Losses

Hundreds of Thousands of Elderly and/or Disabled Patients Nationwide and Abroad Lured into Criminal Scheme; Center for Program Integrity, Center for Medicare Services, Takes Administrative Action Against 130 DME Companies That Submitted Over $1.7 Billion

One of the largest health care fraud schemes investigated by the FBI and the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) and prosecuted by the Department of Justice resulted in charges against 24 defendants, including the CEOs, COOs and others associated with five telemedicine companies, the owners of dozens of durable medical equipment (DME) companies and three licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $1.2 billion in loss, as well as the execution of over 80 search warrants in 17 federal districts.  In addition, the Center for Medicare Services, Center for Program Integrity (CMS/CPI) announced today that it took adverse administrative action against 130 DME companies that had submitted over $1.7 billion in claims and were paid over $900 million.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Sherri A. Lydon of the District of South Carolina, U.S. Attorney Craig Carpenito of the District of New Jersey, U.S. Attorney Maria Chapa Lopez of the Middle District of Florida, Assistant Director Robert Johnson of the FBI’s Criminal Investigative Division, Deputy Inspector General for Investigations Gary Cantrell of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Chief Don Fort of the IRS Criminal Investigation (CI) and Deputy Administrator and Director of CPI Alec Alexander of the CMS/CPI made the announcement.

Today’s enforcement actions were led and coordinated by the Health Care Fraud Unit of the Criminal Division’s Fraud Section in conjunction with its Medicare Fraud Strike Force (MFSF), as well as the U.S. Attorney’s Offices for the Districts of South Carolina, New Jersey and the Middle District of Florida.  The MFSF is a partnership among the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG.  In addition, IRS-CI and other federal law enforcement agencies participated in the operation.

The charges announced today target an alleged scheme involving the payment of illegal kickbacks and bribes by DME companies in exchange for the referral of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for back, shoulder, wrist and knee braces that are medically unnecessary.  Some of the defendants allegedly controlled an international telemarketing network that lured over hundreds of thousands of elderly and/or disabled patients into a criminal scheme that crossed borders, involving call centers in the Philippines and throughout Latin America.  The defendants allegedly paid doctors to prescribe DME either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen.  The proceeds of the fraudulent scheme were allegedly laundered through international shell corporations and used to purchase exotic automobiles, yachts and luxury real estate in the United States and abroad.

“These defendants — who range from corporate executives to medical professionals — allegedly participated in an expansive and sophisticated fraud to exploit telemedicine technology meant for patients otherwise unable to access health care,” said Assistant Attorney General Benczkowski.  “This Department of Justice will not tolerate medical professionals and executives who look to line their pockets by cheating our health care programs.  I commend the Criminal Division prosecutors and our partners from U.S. Attorney’s Offices and law enforcement agencies across the country for their unrelenting efforts to stop this alleged fraud before more money was stolen from American taxpayers.”

“Simply put, the law applies equally to all in South Carolina,” said U.S. Attorney Sherri Lydon.  “The same spoon that serves indictments on drug dealers, felons in possession of firearms, and corrupt officials will also feed those companies and individuals who engage in Medicare fraud.  White collar crime is not victimless.  All taxpayers will endure the rising cost of health care premiums and out-of-pocket costs as a result of fraud on our Medicare system.  I am honored to stand with our partners at the FBI, HHS-OIG, and IRS-CI, who led this outstanding and nationally significant investigation from right here in South Carolina.”

“The indictments we are unsealing today charge the defendants with running a complex, multilayered scheme to defraud our Medicare system and avoid detection by government regulators,” said U.S. Attorney Craig Carpenito.  “The defendants took advantage of unwitting patients who were simply trying to get relief from their health concerns.  Instead, the defendants preyed upon their weakened state and pushed millions of dollars’ worth of unnecessary medical devices, which Medicare paid for, and then set up an elaborate system for laundering their ill-gotten proceeds. We are proud to join our law enforcement partners in New Jersey and around the country to put a stop to this unscrupulous criminal activity.”

“Protecting the integrity of America’s health care programs is necessary to ensure that our citizens receive the care they have paid for and deserve,” said U.S. Attorney Chapa Lopez.  “The mammoth coordination and cooperation demonstrated among the various offices, districts, and agencies involved in this case leaves no doubt. We will leverage the full weight of our resources to combat fraud and abuse, wherever it is found.”

“Today, one of the largest health care fraud schemes in U.S. history came to an end thanks to close collaboration and coordination between the FBI and partners including HHS-OIG and IRS-CI,” said FBI Assistant Director Robert Johnson.  “Health care fraud causes billions of dollars in losses, it deprives real patients of the critical health care services they need, and it can endanger the lives of real patients so individuals like those arrested today can profit from their criminal activity.  Through today’s coordinated national effort, we put an end to this egregious and costly health care fraud scheme, and the public can rest assured the FBI will continue to make health care fraud investigations a top priority.”

“Our law enforcement officers are focused on preventing and uprooting health care fraud schemes like those alleged today,” said Deputy Inspector General for Investigations Gary Cantrell.  “These schemes divert money from taxpayer-funded federal health care programs into the hands of criminals.  Working closely with our law enforcement partners, our agency will continue to investigate and disrupt attempts to undermine Medicare and target beneficiaries.”

“The breadth of this nationwide conspiracy should be frightening to all who rely on some form of healthcare,” said IRS-CI Chief Don Fort.  “The conspiracy described in this indictment was not perpetrated by one individual.  Rather, it details broad corruption, massive amounts of greed, and systemic flaws in our healthcare system that were exploited by the defendants.  We all suffer when schemes like this go undiscovered and I’m proud of the work our agents did in working with our partners to uncover this complex scheme.”

“The Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity (CPI) is proud to work very closely everyday with our law enforcement partners to stop exploitation of vulnerable patients and misuse of taxpayer dollars,” said Deputy Administrator and CPI Director Alec Alexander.  “In this case CMS has taken swift administrative action and has suspended payments to 130 distinct providers thereby likely preventing billions of additional dollars in losses.  CMS remains committed to protecting the millions of beneficiaries we are honored to serve and to preventing fraud of all sorts in the Medicare and Medicaid programs.”

According to allegations in court documents, some of the defendants obtained patients for the scheme by using an international call center that advertised to Medicare beneficiaries and “up-sold” the beneficiaries to get them to accept numerous “free or low-cost” DME braces, regardless of medical necessity.  The international call center allegedly paid illegal kickbacks and bribes to telemedicine companies to obtain DME orders for these Medicare beneficiaries.  The telemedicine companies then allegedly paid physicians to write medically unnecessary DME orders.  Finally, the international call center sold the DME orders that it obtained from the telemedicine companies to DME companies, which fraudulently billed Medicare.  Collectively, the CEOs, COOs, executives, business owners and medical professionals involved in the conspiracy are accused of causing over $1 billion in loss.

The Fraud Section leads the Medicare Fraud Strike Force.  Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers

 

350,000 Americans bought LTCI policies in 2018

 Some 350,000 Americans purchased long-term care protection in 2018, including both traditional long-term care insurance as well as combination products.

The statistic is from a new report released March 26 by the American Association for Long-Term Care Insurance (AALTCI)

“Individuals understand the consequences associated with living a long life which often include the need for long-term care,” said Jesse Slome, director of AALTCI. “Those who want to have a plan continue to see value in products which can pay for costs associated with needing that care.”

According to the Association, of the roughly 350,000 individuals who purchased coverage, about 16% opted for traditional health-based long-term care insurance.

“The trend to combination products continues and they can be a very viable option,” Slome said. “Unfortunately many consumers are tainted by what they have read about older stand-alone policies. The traditional long-term care insurance policies offered today do not have the premium instability of the older policies.”

The growth of combination products in recent years has prompted more insurance companies to offer such products and to expand their offerings. “In the past, most of these policies were sold as single premium requiring a single payment of $50,000 to $100,000 per individual,” Slome said. “Today, insurers are offering flexible premiums which allow annual payments for this important protection. That’s far more consumer friendly and something buyers clearly prefer.”

You can go to these websites to see the ratings and/or grades for hospitals in our area.

Medicare Hospital Ratings

Hospital Safety Grades

Make healthy choices—Medicare can help!

People with diabetes may have heard that carbohydrates aren’t good for them. However, many carbohydrates provide vitamins, minerals, and nutrients for the body, and can be part of a healthful diet for people with or without diabetes. If you need help choosing foods that will support your health goals, Medicare can help.

Medicare covers medical nutrition therapy (MNT) services for people with diabetes or kidney disease. MNT services may include an initial nutrition and lifestyle assessment, individual or group nutritional therapy services, and follow-up visits to check on your progress.

A healthy diet includes a variety of nutritious foods from all the food groups, including carbohydrates. You may choose carbohydrates like fruits, vegetables, beans, whole grains, and dairy products, including low-fat or fat-free milk and yogurt. When you’re eating away from home, pick the healthier options.

Celebrate National Nutrition Month by creating a healthy eating plan and discovering physical activities that you enjoy. Find a combination of good foods and fun activities that fits your lifestyle.

FDA updates on angiotensin II receptor blocker (ARB) recalls including valsartan, losartan and irbesartan

IMPORTANT: Medications containing only amlodipine or hydrochlorothiazide (HCTZ) are not being recalled. Manufacturers are recalling medications containing amlodipine in combination with valsartan or losartan, and medications containing hydrochlorothiazide HCTZ in combination with valsartan or losartan.

Torrent again expands its voluntary recall of losartan; Hetero also voluntarily recalls losartan
Update [3/1/2019] Torrent Pharmaceuticals Limited is further expanding its voluntary recall to include 114 additional lots of losartan potassium and losartan potassium/hydrochlorothiazide combination tablets. This recall is due to unacceptable amounts of N-Methylnitrosobutyric acid (NMBA) in the losartan active pharmaceutical ingredient manufactured by Hetero Labs Limited.

Today, the agency also issued a press release to provide additional information about its ongoing investigation and another voluntary recall by Hetero/Camber Pharmaceuticals, which was announced on February 28, of 87 lots of losartan potassium tablets (25 mg, 50 mg and 100 mg). The recalled losartan potassium and losartan potassium/hydrochlorothiazide tablets are also manufactured by Hetero, which are distributed by Camber, and contain the impurity NMBA.

Torrent and Hetero/Camber are only recalling lots of losartan-containing medication with NMBA above the interim acceptable intake limits of 0.96 parts per million (ppm).

The agency also updated the list of losartan products under recall.

Aurobindo expands its voluntary recall of valsartan and amlodipine/valsartan
Update [3/1/2019] AurobindoPharma USA is expanding its voluntary recall to include 38 additional lots of valsartan and amlodipine/valsartan combination tablets. The recall is due to unacceptable amounts of N-Nitrosodiethylamine (NDEA) found in the medicine.

Aurobindo is only recalling lots of valsartan-containing medication where NDEA has been detected above the interim acceptable intake limit of 0.083 parts per million. FDA is working with manufacturers to reduce and remove nitrosamines from angiotensin II receptor blockers (ARBs).

The agency also updated the valsartan products under recall.

FDA updates table of interim limits for nitrosamine impurities in ARBs
Update [2/28/2019] FDA is posting the updated table of interim acceptable intake limits for nitrosamine impurities to reflect N-Nitroso-N-methyl-4-aminobutyric acid (NMBA) limits, which are the same as those for NDMA.

The agency will use the interim limits below to recommend manufacturers conduct a voluntary recall if laboratory testing confirms the presence of nitrosamine impurities in finished drug product. FDA is working with industry and international regulators to ensure products entering the market do not contain these impurities, but we are tolerating the impurities below the level established in the table for a short period of time to avoid a possible shortage of ARBs.

Find out which insurance companies sell Medigap policies in your area.

Medigap policies are standardized

Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as "Medicare Supplement Insurance." Insurance companies can sell you only a "standardized" policy identified in most states by letters.

All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.

Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which ones they offer. Insurance companies that sell Medigap policies:

  • Don't have to offer every Medigap plan
  • Must offer Medigap Plan A if they offer any Medigap policy
  • Must also offer Plan C or Plan F if they offer any plan

If you sign up for Medicare at age 65 on line you must have an active user name and password on SSA.Gov as well as a way for them to contact with a code to enter onto the application to proceed. They can either text you or email you this code.

Or you can go to your local Social Security office and apply. You can apply 3 months before your birth month the month of and 3 months after to be in your “initial enrollment stage”. It is important to note signing up after your birth month will delay the effective date of coverage.

Signing up for Medicare part B after your initial stage:

  1. If you miss your initial enrollment stage. You can apply for Medicare during the “general enrollment period” which is January 1 through March 31st with an effective date of
    July 1.
  2. If you continue to work and have credible coverage through your Employer or your spouse’s Employer you will have a special enrollment period which you can enroll into Medicare at anytime and you will have no penalty. There are 2 forms necessary to do this, forms CMS-408 and CMS-L564.

*There is a 10% penalty per year for not having Medicare in certain circumstances.

By Emily Brandon, U.S. News & World Report

The Social Security full retirement age is 66 for most baby boomers, and you receive a smaller monthly payout if you sign up at a younger age. Some retirees further delay signing up in order to qualify for larger monthly payments later in retirement. However, the Medicare eligibility age remains 65. So, if you want to wait until 66 or later to claim Social Security, you will have to sign up for Medicare separately at age 65.

Here's what you need to know about signing up for Medicare before claiming Social Security:

• Social Security and Medicare are separate decisions.
• Some people are automatically enrolled in Medicare.
• Remember to sign up for Medicare on time.
• Signing up for Medicare after you missed the Initial Enrollment Period can trigger penalties.
• Beneficiaries who work can avoid the Medicare late enrollment penalty.
• Be prepared to get a bill.

Don't wait until age 65 to start researching your Medicare options.

Consider each of these strategies if you plan to enroll in Medicare while delaying claiming Social Security.