Medicare Archives | Georgia Medicare Plans

Medicare Adds Telehealth Consults

Bob Vineyard · December 18, 2020 · Leave a Comment

Telehealth doctor phone consults covered by Medicare. Concern over the COVID-19 “pandemic” prompted Medicare to respond by allowing doctor “visits” by telephone.

Medicare covers telehealth and telemedicine services

What is Telehealth / Telemedicine?

Medicare telemedicine services include office visits, psychotherapy and other consultations. Real time two-way communication (video and audio) allows patient and doctor to have “FaceTime”.

With telemedicine you can receive medical advice anytime, anywhere, without leaving your home.

What if your doctor is unavailable when you have a medical crisis? The ability to use telehealth services is beneficial.

Telemedicine is Not New

Doctor/patient phone consults are not new. In home visits, especially in rural areas, are virtually impossible.

Telehealth services have existed since the 1950’s with the use of landlines. As phone technology improved cellular “smartphones” and computer tablets like iPads have expanded the ability to communicate.

New technology allow the doctor and patient to talk and see each other at the same time. This “Star Trek” approach to health care allows us to go where no one has gone before.

Insurance is not necessary to access services like GoodRx Care but it is nice to know that your red, white and blue Medicare card works for you.

Is Telehealth a Viable Business Model?

Telehealth is a two edged sword.

On one hand patients have access to REAL doctors who offer “FaceTime” type consults. Patients and doctors exchange information about overall health, aches, pains and concerns.

Consuling a real doctor with a medical degree is better than asking Dr. Google about symptoms.

Beyond the question of quality of care physicians will have to ask if this is a viable business model? Will telemedicine provide sufficient revenue to allow practices to survive?

Close to half of doctors are now using telehealth to treat patients as the COVID-19 pandemic changes practice patterns and how physicians deliver care.

That’s up from 18% of physicians using telemedicine two years ago, based on The Physicians Foundation’s “2018 Survey of America’s Physicians.” – Fierce Healthcare

So the good news is, more doctors are offering remote access consults. But the bad news?

Some medical practices are seeing a 60% dropoff in patient visits and a 55% reduction in revenue. Medical support staff is being laid off or having a reduction in hours.

Telemedicine is a short term solution to health care with a long term impact that is not workable.

A substantial minority of physicians (32%) said they plan to change practice settings, leave patient care roles, temporarily shut their practices or retire in response to COVID-19, the Merritt Hawkins survey found.

My Own Telemedicine Visit

A few weeks ago my family practitioner called to let me know they have temporarily suspended in office visits. My overall health is good. No chronic conditions but my doctor prefers to have 6 month follow up visits which include routine lab work.

They wanted to know if I would be willing to have a virtual office visit in place of the customary one.

I thought about it for a moment. No need to get dressed, no mask, no hand sanitizer routine. I won’t have to strip and put on a hospital gown. Won’t have to weigh in.

What’s the downside?

Let’s go for it.

The overall visit took about 20 minutes. My doctor was more chatty than normal. Even greeted me with “Hi Bob” like we were old friends.

She had questions for me, primarily about alcohol consumption during COVID-19 “lock in”. Also asked about what I was eating and how was my weight?

Normally I only drink on weekends, having a glass of wine or two with supper. Now I find myself having wine closer to 5 nights per week vs the usual two.

Is that a bad thing?

No, not really. Just don’t let it get away from you was her response. Same with your weight.

Because I had read about doctors losing money on virtual visits I wondered about the bill.

A month later I had my answer.

Normally these visits run around $450 (gross charges) including lab. After Medicare repricing the total comes in around $150 or so.

My televisit was $210 repriced to $86.

Saves me money but how about the medical practice? How long can they survive with 40% less revenue?

I suppose time will tell.

Medicare Hospital Bonus 2019

Bob Vineyard · June 28, 2020 · Leave a Comment

Do you know about the Medicare hospital bonus program? Hospitals can get cash for better results. The idea sounds good in theory, but there is a dangerous underbelly to this plan. (UPDATED 6/28/2020)

The Centers for Medicare and Medicaid Services said on Tuesday that 55%—more than 1,500 hospitals out of approximately 2,700 facilities participating in the program—got a slightly higher Medicare payment under the program. Overall there will be $1.9 billion in incentive payments for hospitals in federal fiscal year 2020, which runs from Oct. 1 until Sept. 30, the same amount as fiscal 2019.
“The highest performing hospital in FY 2020 will receive a net increase in payments of 2.93 percent, and the lowest-performing hospital will incur a net decrease in payments of [negative] 1.72 percent,” the agency said.
Fierce Healthcare

Quality of Care and Medicare Hospital Bonus

Quality of care bonuses. What could possibly go wrong?

So how does Medicare decide winners and losers?

Eight of the current 25 quality standards, Yahoo News reported, are based on patient satisfaction: communication with nurses; communication with doctors; responsiveness of hospital staff; pain management; communication about medicines; cleanliness and quietness of hospital environment; discharge information and overall rating of the hospital.
The rest are based on how often hospitals followed clinical standards of care, such as controlling heart surgery patients’ blood sugar levels and giving them beta blockers to lower their blood pressure.
Georgia Health News

All sounds so simple. If a hospital delivers better results, and you are a satisfied customer, they can get a Medicare hospital bonus.

Do you think hospitals might “cherry pick” the Medicare patients they take in and the type of services they will provide to Medicare patients? And does it matter if you have a Medicare Advantage plan or original Medicare and a Medicare supplement plan (where you can choose your doctor and hospital)?

The maximum amount any hospital could gain or lose was 1 percent of its regular Medicare payments.
For nearly two-thirds of the hospitals, the changes are less than a quarter of a percent, KHN said. Still, for hospitals with a high number of Medicare patients, hundreds of thousands of dollars are at stake.
The caps will rise to 2 percent over the next four years.

The maximum Medicare hospital bonus (or penalty) now is 1%, rising to 2%. But will it stop there or keep climbing?

If a hospital can game the system in hopes of qualifying for the maximum bonus, how many really sick patients with expected poor outcomes do they have to reject in order to earn the highest kickback from Medicare?

This is about more than money. It is about your health and quality of care. Georgia Medicare Plans is concerned about your health and the health of your wallet. Save money by comparing your existing Medigap rates with an instant GA Medigap quote.

How Do Georgia Hospitals Compare to Other States?

How does quality of care in Georgia stack up against other states?

Georgia Health News reveals

Some other Southern states had higher percentages of hospitals getting bonuses than did Georgia. In both North Carolina and South Carolina, 69 percent of hospitals are receiving the extra payments; Alabama, 64 percent; Florida, 57 percent; Kentucky, 53 percent.

Louisiana equaled Georgia’s 51 percent performance. Performing worse than Georgia were hospitals in Tennessee, at 40 percent, and Mississippi, at 39 percent.

Does this mean you can receive better care in other states?

Not necessarily, but these are figures that cannot be ignored.

Budgeting for Healthcare Costs

It is impossible for most retirees to cover the OOP (out of pocket) cost of health care without insurance.

Original Medicare pays 80% of your outpatient health care costs but the remaining 20% can be staggering.

Most retirees worry about paying hospital bills, but the MAJORITY of medical claims are OUTPATIENT.

Original Medicare does not cap your OOP health care costs. You pay until you get better, run out of money or die.

A cost effective Medicare supplement plan from Georgia Medicare Plans can give you piece of mind.

Shop and compare rates. Get your personalized Medigap rate report. Invest 10 minutes to call and ask us ANY Medicare question. Either you like what you hear or you don’t.

I will stay on the phone with you as long as you have questions. Never a sales pitch. No obligation to buy.

I call this my offer you can’t refuse.

Should Diabetics Take Cholesterol Medication?

Bob Vineyard · May 21, 2020 · Leave a Comment

Are you a diabetic with high cholesterol? Should you take a statin drug? Are you at risk for heart disease? How much should you expect to pay for your diabetic medications?

Georgia Medicare Plans feels that retirees on Medicare need good information to maintain their physical and financial health. Free Medicare Part D review, free instant Medicare supplement rates and access to our most popular report “Medicare and Social Security” are just a few of the valuable services we provide.

This report has been viewed and shared over 1,000 times in the last few months.

Diabetic and High Cholesterol

Many diabetics also battle high cholesterol, but are statins the treatment of choice?

New guidelines from the American Diabetes Association (ADA) call for giving the cholesterol-lowering drugs known as statins to all people with diabetes to help prevent heart disease.

Health Day

But are diabetics at any higher risk for heart disease than anyone else with high cholesterol?

According to Dr. Richard Grant, not necessarily.

“We agree that the decision to start a statin should be based on a patient’s risk,” said Dr. Richard Grant, a research scientist at Kaiser Permanente Division of Research and chairman of the ADA’s professional practice committee.
“It turns out that patients with diabetes have the same risk as people with heart disease, so all of our patients need to be on statins,” he said.

But are statins the only way, or even the best way to treat cholesterol?

According to Dr. Grant, some diabetics may not need statins. Younger, healthier patients and older patients with other medical conditions may not benefit from statins.

Heart disease is the No. 1 killer of people with diabetes, Grant said. People with diabetes are two to four times more likely to have a heart attack or stroke than people without diabetes, he said.
The increased risk of heart disease in people with diabetes is what was behind the rationale for this year’s recommendations on statins, blood pressure and exercise, according to Grant.

Many people can control their blood pressure and cholesterol with diet and exercise alone. But some people, such as my wife, have high cholesterol as part of their genetic make up. No matter how much she exercises or how closely she watches her diet, she cannot get her cholesterol below 240.

She does take Red Yeast Rice (a natural statin) and fish oil at the suggestion of her doctor. This seems to help but she can’t overcome the genetics.

Diabetic medications

Treating chronic illnesses can be very costly for retirees. Georgia Medicare Plans works closely with their clients to help them find ways to save money while treating their diabetic condition.

Many type II diabetics can fill their metformin prescription at no charge at select pharmacy’s. Some diabetic supplies (including insulin) are covered under Medicare Part B. A good Medigap plan combined with original Medicare can save you several hundred dollars per year in out of pocket costs.

Medigap carriers will issue coverage to most type II diabetics (as long as you do not have complications associated with the disease) and some type I diabetics. You may even qualify for standard rates.

Switching from brand name drugs can save you anywhere from a few hundred dollars a year to several thousand dollars.

One such example is Glucophage (brand) vs metformin (generic). Most drug plans will not cover a brand name drug if a generic alternative exists.

Glucophage was once available as a brand name drug only. Your cost was over $1,000 per year at retail. Now that is is generic a 30 day supply is $4 or less.

Actos is another popular diabetic medication. If you are taking Actos and pick a low cost ($15) drug plan your drug cost for a 30 day supply is over $300! Switching to the generic version ( Pioglitazone ) will drop your drug costs to $12 for a 30 day supply.

While these savings are significant, changing from Actos (brand) to pioglitazone (generic) will not only allow you to pick a lower premium drug plan ($15) but more importantly lowers your annual drug costs to a more respectable $150 per year.

Most agents are willing to help you find ways to save money on your Medicare supplement coverage but few are willing to explore savings on drug plans. We find that most of our clients who bought drug plans without any help are paying more than they need to both in premiums and out of pocket drug costs.

We save our clients $550 per year or more on their Medigap premiums but the savings exceeds $1000 per year on drug costs.

Recently we reviewed drug coverage for one of our clients. They were paying $115 per month for a drug plan and spending $13,000 per year for their medications. A 30 minute review showed them how to cut their premium in half and drop their drug costs to $6,000 per year.

You don’t have to be a diabetic to realize these kind of savings. Your path to saving money begins with a free Georgia Medicare Plan rate quote.

#diabetic #Medicare #cholesterol #MedicarePartD

Welcome to Medicare – What’s Covered?

Bob Vineyard · May 1, 2020 ·

Welcome to Medicare. What’s covered, what isn’t? In the exam room I notice a sign. “Lab work is not covered by Medicare“. You owe $289. Do not pass go. Do not collect $200.

Welcome to Medicare physical exam? Covered. Lab work? Not covered. Really? You turned 65 and signed up for Medicare. What happens next?

Here is a short introduction to Medicare. What’s covered, what isn’t, and what to expect

Medicare’s definition of preventive care has surprises
Lab work may not be covered
Medical necessity is the rule
Free exams aren’t always free

Whether you have original Medicare and a supplement or you enrolled in an Advantage plan, the underlying rules of what is covered and what isn’t are the same. The difference is in how you pay for it.

You might want to view our Medicare Exam video on YouTube

Turning 65 – Welcome to Medicare 2019 – What’s Covered?

By the time you reach 65 and enroll in Medicare, most people have a doctor (or doctors) they like and trust. They want to continue that relationship and are not interested in picking a doctor from a list provided by an insurance company.

Georgia Medicare Plans specialize in helping you keep your doctor(s) and finding a Medicare supplement plan that fits your needs and budget. We have rates and information on more than 230 different Medigap plans and will provide a FREE REPORT on all plans based on your age, gender and zip.

You can start your research by comparing rates and benefits for roughly 30 plans by getting an INSTANT GA Medigap quote.

I understand your confusion. Most people want information so they can understand what lies ahead. They want the time to read, make notes and ask questions.

Most of the insurance agents you will talk to are not old enough to enroll in Medicare and have not experienced it first hand. Bob Vineyard turned 65 in September, 2015 and enrolled in Medicare. In spite of 40 years in the health insurance business and over 400 Medicare clients, I am still learning things every day about how Medicare works.

Ask me anything. Others talk, we listen.

Welcome to Medicare Surprises

When I turned 65 and signed up for Medicare, one of the first things I did was schedule my Welcome to Medicare physical.

Because I chose original Medicare and a supplement plan, I was able to keep my doctor. My group insurance plan required me to have an annual exam and wellness interview so there should not have been any surprises with my Welcome to Medicare exam.

That was the wrong assumption.

While waiting in the exam room I saw a notice on the bulletin board.

Lab work is not covered by Medicare

Seriously? What’s that all about?

Preventive screenings are covered by Medicare in the following situations

Abdominal aortic aneurysm scan – Men only, if you smoked 100 cigarettes in your lifetime
Bone density – Mostly women, if you are estrogen deficient or have osteoporosis
Lab tests – Only if considered medically necessary by Medicare

What is considered medically necessary?

Medicare defines medically necessary as tests or treatment needed to diagnose or treat an illness, injury, condition, disease or symptoms that meet accepted standards of care.

Preventive lab work may not be covered by Medicare.

Congratulations! You are healthy. Your test is not covered!

I take no medications. For the last few years my doctor has run routine lab work to make sure my body is doing what it is supposed to. As much as it galls me to say, my Obamacare plan covered routine tests like CBC, Lipid Panel, CMP, etc. at no charge to me.

These tests were not free. The labs and technicians do not volunteer their time. The costs associated with the lab tests were absorbed by the health insurance carrier and baked into the premiums.

Not so with Medicare.

Those under age 65 pay nothing.

If you are 65 and older, there is no more free lunch.

When I asked about the sign on the wall. The one that said “Lab work is not covered by Medicare” her response took me aback.

Medicare generally doesn’t cover those tests if you are healthy. But if you were sick, they would pay for them.

Sign this ABN form. If Medicare denies the claim you will have to pay the cost of your lab work. You will owe $289.

So much for my “free” Welcome to Medicare exam.

Medicare physical exam.

Is it covered? Is it free? How much will I have to pay?

Original Medicare is quite good in most respects. No more doctor networks. Forget about balance billing (when you use Medicare providers that accept assignment). Huge bills for health care are a thing of the past.

So exactly what is covered, and what isn’t? Check out this free Guide to Medicare Preventive Services. And yes, it really is free. Click to download.

More ways to save money.

Most of the retirees we talk to are paying too much for their Medicare supplement plan. Many are facing rate increases. One large Mutual company has increased rates 10 times since 2012!

Medigap plan F will be retired in 2020. Switch now if you can. Plan G is popular with over 90% of our clients. Some have not had a rate increase in two years.

Get a free GA Medigap quote. FREE report listing rates for all plans based on your age, gender and zip code sent by email once we confirm your information.

You need to be informed. The more you know and understand the better it will be for your bank account.

#MedicareLab #WelcometoMedicare #GAMedicareExpert #GAMedigapRates