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Arizona State Retirement System Changes

Sun, February 10, 2019 Published by

Are you an Arizona State Retiree who gets health insurance through your retirement plan? This year the Arizona State Retirement System (ASRS) announced a change in one segment of its retiree health insurance.

ASRS has traditionally had two plans to choose from: they offered both an HMO Plan (Medicare Part C) and a Medicare Senior Supplement (Original Medicare with Part B Supplement, also called a Medigap plan). If you previously had Medicare coverage through the ASRS HMO Plan, these new changes do not affect you. If, however, you had Original Medicare with a Senior Supplement through ASRS, the 2019 changes will affect your coverage.

Both ASRS plans rely on “passive enrollment,” which is a convenient way for people to keep their current plan from year to year. This year, however, retirees who had the Senior Supplement Plan (not the HMO) were passively enrolled out of Original Medicare and into a Preferred Provider Organization (PPO) through UnitedHealthcare (the same insurer who provides coverage for the HMO beneficiaries).

The “behind the scenes” problem with this change is that retirees were not informed that by enrolling in a Medicare Advantage Plan, they would lose “guaranteed issue” to future Supplement / Medigap policies. Guaranteed issue means that you have the right to buy a policy without medical underwriting, which can lead to denials of coverage or inflated prices based on age and health conditions. Another concern is that the new lower premiums, while attractive, are due to a temporary rate adjustment, and future costs may not remain low.

How might this affect you? Both our contracted outpatient services through OASIS and our Campus Home Health program accept Original Medicare but not Advantage Plans (HMOs or PPOs), with the exception of Home Health accepting UHC Community and UHC Dual Complete (AHCCCS). For example, if you are a retired teacher previously on the ASRS Senior Supplement Plan, you are now on a PPO Plan. You may have had physical therapy on campus as an outpatient, or through the campus Home Health service. Now, however, you will not be covered and will need to seek outpatient services off campus, and Home Health from an outside agency.

SHIP Medicare Counselors believe individuals can get better coverage at a better price by remaining on Original Medicare with a Supplement and Part D coverage. The new deadline to change your Medicare coverage from the new PPO to Original Medicare with a supplement is March 3rd, 2019.

If you are affected by this change, and wish to speak to a Medicare counselor about making a change, please let Josephine know no later than February 15th at x16117.

New Medicare Cards

Sun, January 6, 2019 Published by

Medicare has recently changed their health insurance cards.  If you have traditional Medicare, you will notice that previously your Social Security number was used as your medical identification number as well as your Medicare Number.  As we know, over the past several years there has been nationwide concerns with identity theft and this is one way Medicare is addressing the concerns to minimize the risk of future identity theft.

Most of you should have already received your new Medicare card in the mail.  If you have not, please contact the Social Security Administration to ensure your address is correct.  You may contact them at ssa.gov/myaccount or by calling 800-772-1213.

It is important that when you receive your new card that you destroy your old card and replace with the new one which has a unique combination of letters and numbers and provide a copy to all of your health care providers. Please see the example below.

In addition to replacing your card, we are requesting all residents/responsible parties to provide accounting with a copy of your new card.  You may take it personally to their office in Agelink or it can be sent in with your monthly payment so that the new information can be updated in your Electronic Record here on campus.  Accounting’s office is open from 7:30AM to 4:30PM Monday through Friday.

Having the most up-to-date information will assist with transition so that if you are sent to the hospital we can provide them with the most current and up to date information.  Additionally, it allows a smooth billing of Medicare if you are admitted to the Health Care Center for a short stay or need to utilize Home Health or Outpatient Therapy services on campus.

Please be advised that only health care professionals should be requesting your Medicare card.  The Centers for Medicare/Medicaid Services (CMS) also wants beneficiaries to beware of anyone who contacts you about your replacement Medicare card, as scammers have already targeted recipients with new ploys. CMS officials say they will never ask a beneficiary for personal or private information or for any money as a condition of getting a new Medicare number and card.

If you have any questions, please do not hesitate to contact me at x16111. *

Beware; You Need to Be Aware

Sun, July 29, 2018 Published by

For those of you with Medicare Part A and Part B insurance, the following may come as a surprise to you.  What I am referring to is, over the last few years, there had been an increase in the hospital admission practice of admitting patients under an outpatient “observation” status versus an “inpatient” status.  While we don’t see this happening as often, it is still something to be aware of and keep fresh in your mind.

Some Medicare patients have found that after being admitted into the hospital for a few nights, they were then discharged to a skilled nursing facility and that their stay was not going to be covered under their Medicare Part A benefits because when they were admitted to the hospital, they were admitted under an outpatient “observation” status.

The difference between an outpatient “observation” status and “inpatient” status according to Medicare.gov, is that an “inpatient” status means you are formally admitted to the hospital per a doctor’s order.  An “observation” status means a doctor has not written an order to admit you to the hospital.  This may be the case if you are getting emergency care, observation services, outpatient surgery, lab test, x-rays, etc. Medicare.gov also states, “The decision for inpatient hospital admission is a complex medical decision based on your doctor’s judgment and your need for medically necessary hospital care. An inpatient admission is generally appropriate when you’re expected to need two or more midnights of medically necessary hospital care, but your doctor must order such admission and the hospital must formally admit you in order for you to become an inpatient.”

What does all of this mean? If you have been admitted as an “inpatient”, Medicare Part A will cover your hospital services after you have met your deductible as well as will cover eligible drugs administered as part of your inpatient treatment during a covered stay.  Medicare Part A will also cover 100% for the first 20 days in an approved skilled nursing facility or rehab if the patient had spent at least three midnights in the hospital admitted as an “inpatient”.  If you were classified as “observation”, Part A will not cover the services.  Medicare Part B can cover your hospital services; however, a copay is required and varies depending on the service.   Additionally, prescription drug coverage during an outpatient “observation” stay is not covered by Part A or Part B potentially leading to more out of pocket expenses.   Medicare Part B may be used in skilled nursing facilities to cover the physician visits as well as the rehabilitative therapies prescribed.

What can you do to avoid this type of situation?  AARP offers the following tips:

  1. Ask about your admission status each day you are in the hospital as it may change.
  2. Ask the hospital doctor to reconsider your case if you were admitted under an “observation” status.
  3. Ask your own doctor whether “observation” status is justified. If not, ask him/her to call the hospital to speak with the hospital doctor for an explanation.

For more detailed information on how Medicare covers hospital services, including premiums, deductibles, copayments, or any other questions you have about Medicare, you may reach out to Josephine Levy, our Success Matters Resource Navigator who is also a Medicare State Health Insurance Program Counselor, at x16117.  You may also visit Medicare.gov/publications to view the “Medicare & You” handbook or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.*

Advocacy Action Alert: Save Medicaid

Mon, June 19, 2017 Published by

It is critical that Senators Flake and McCain hear from all of us! I ask that you share the information above and encourage them to oppose changing Medicaid to block grants or per capita caps when our senior population across the nation is rapidly growing. It is the wrong policy at the wrong time.

Hospice is About Living, Not Dying

Mon, March 13, 2017 Published by

Hospice is a word many people fear and think of in a negative manner. I have often heard that people fear Hospice because they believe it will hasten one’s death. When you learn about it, you realize that Hospice doesn’t shorten someone’s life, nor does it prolong someone’s life. Hospice of the Valley shares that “Hospice care is for people with a life-limiting illness who want to be cared for in the comfort of their home environment-surrounded by the people and things they know and love.” Hospice is a program that not only provides care from physicians, nurses and nursing aides, but also services including social workers, chaplains, volunteers and bereavement counselors if needed.

On Tuesday, March 21st, please join representatives from Hospice of the Valley at 3PM in the Life Center to hear how Hospice supports patients and their families in their homes. You will learn when Hospice care is appropriate and how Medicare and other insurance companies cover the cost of Hospice care.

Please come learn about a valuable program offered, what other services Hospice of the Valley offers and have all of your questions about Hospice answered. On behalf of the Health and Wellness Committee, we hope to see you Tuesday, March 21st at 3PM in the Life Center.

Medicare Benefits and YOU

Sat, September 24, 2016 Published by

1620218Late each year, beneficiaries are offered the opportunity to review their Medicare plans and make changes accordingly during the Medicare Open Enrollment Period. Understanding how your insurance selection impacts you is more important today than ever before. This is crucial since the Affordable Health Care Plans and Medicare are key Congressional discussion items.

To help educate and inform you on Medicare updates and available options, we have asked a third party insurance consultant, Ellen Dean from Dean and Associates, to come and discuss changes in Medicare on Monday, October 19th at 2:30pm in the Motion Studio at the Nelson Administration Center.  Mrs. Dean, an expert on senior health insurance since 1992, will inform you on the complexities of Medicare Insurance Coverage and Part D Prescription Drug Coverage.  Ellen’s partner, Katie Ponton, will also be available to specifically discuss changes directly related to the 2017 Part D Drug Plans.  Additionally, Ellen has agreed to meet individually with residents and their families to evaluate insurance coverage and re-enroll you into a different insurance plan if you so desire.  Medicare open enrollment is scheduled for October 15-December 7, 2016 with changes effective for a January 1, 2017 start date.  As a Certified© Financial Planner and Health Insurance Broker, Mrs. Dean and Katie work with many insurance companies and are not restricted to a limited few….their expertise is highly valued!

Like many health care providers, we are not contracted with many Medicare Advantage HMO Plans.  This is due, in large part, to the fact that many HMOs do not reimburse our Health Care Center at the rate that covers the cost of care provided.  Offering high-quality skilled nursing care services is important to us because we know these services are important to you and your family.  In addition, to add to our continuum of care, the services offered by Beatitudes Home Health are only reimbursed by Medicare at this time, as well as our outpatient therapy clinics which are contracted with Medicare and very few other insurance companies.

It is essential that you understand your current options and find a plan that works best for you in regards to costs and access to care.   Our experience has shown that residents who have Medicare with a traditional supplement have greater satisfaction with health care services.  These residents have more choices in providers and may see lower out-of-pocket costs in the event of a medical emergency, post-hospital skilled care event, or cancer treatments.

I hope you will join us on October 19th for this special informational session covering the 2017 Traditional Medicare vs. Medicare Advantage plan (HMO) Benefits. Additionally, you may set a private appointment with Mrs. Dean right here on Campus by calling 602-266-9200. *

Health Insurance Reminders

Fri, May 13, 2016 Published by

Just a few reminders to help you get the best use out of your Campus-provided Health Reimbursement Account (HRA) dollars each year ($2000 for employee only and $4000 for employee plus dependent(s)):

  • If you’re on the Cigna HIGH (open access) plan – the HRA dollars will automatically be applied to all of your doctor visits (no additional card needed).
  • If you’re on the Cigna MIDDLE (LocalPlus and CMG network) plan – you will need to use your black/purple Ameriflex Visa card for covered HRA expenses.  Note: if you seek treatment at a specialist or outpatient clinic, you will need to pay cash/card for your visit and seek reimbursement through Ameriflex.  Claim forms are available online, through their smart phone app, or in HR.
  • If you’re on the Cigna LOW (CMG network only) plan – you will need to use your black/purple Ameriflex Visa card for covered HRA expenses.  Note: if you seek treatment at a specialist or outpatient clinic, you will need to pay cash/card for your visit and seek reimbursement through Ameriflex. Claim forms are available online, through their smart phone app, or in HR.

**Keep in mind – you cannot use HRA dollars on ANY PLAN for Prescriptions ($20/$40/$60 copays), Urgent Care ($75 copay), or Emergency Room ($400 copay, waived if admitted).  You will need to pay cash/card for these copays.  This helps you save and protect your HRA dollars for serious medical injuries and illnesses.**

See HR anytime if you have additional questions about any of your benefits!

HRA Proper Usage 2015