“Skinny Labeling” and Medicare
“Skinny labeling” is a practice by which follow-on drug manufacturers seek approval for some but not all indications for which branded drugs are approved. Medicare saved $1.5 billion between 2015 and 2020 as a result of competition between five biologic drugs and their skinny-label biosimilars. Recent judicial rulings are threatening these savings for Medicare and […]
What are Medicare Special Enrollment Periods?
Medicare Special Enrollment Periods (SEPs) allow you to make changes to your Medicare coverage outside of the annual Open Enrollment Period. SEPs are triggered by certain life events, such as: – Moving to a new area – Losing other health insurance coverage – Getting married or divorced – Turning 65 or becoming eligible for Medicare […]
How to buy a Medigap policy?
In Original Medicare, you generally pay some of the costs for approved services. Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private company that helps pay your share of costs. Step 1 – Decide which plan you want. Medigap policies are standardized, and in most states are named by letters, Plans […]
What is the Medicare Summary Notice ( MSN) ?
It’s not a bill. It’s a notice that people with Original Medicare get in the mail every 3 months for their Medicare Part A and Part B-covered services. The MSN shows: – All your services or supplies that providers and suppliers billed to Medicare during the 3-month period. – What Medicare paid. – The maximum […]
Medicare and Illegal Nursing Home Debt Collections
“Nursing homes that participate in Medicare and Medicaid are prohibited from forcing a resident’s family or friends to assume responsibility for the cost of care as a condition of admission or continued stay in the facility,” Rohit Chopra, CFPB Director, said in a press release. “ Under laws in place, family members and friends signing […]
Do Required Minimum Distributions (RMDs) increase Medicare premiums?
Yes, Required Minimum Distributions can increase your Medicare premiums. When you withdraw money from traditional IRAs and other retirement accounts, these RMDs count as taxable income. Higher income can trigger Income-Related Monthly Adjustment Amounts, known as IRMAA, which add surcharges to your Medicare Part B and Part D premiums. Medicare uses a two-year lookback period […]
What is the Tiered System of Copays in Medicare Part D Drug Coverage?
Medicare Part D drug plans use a tiered copay system to manage costs for both the plan and beneficiaries. This system charges lower copayments for less expensive drugs and higher copays for costlier medications, encouraging the use of generic and lower-cost alternatives. The typical structure includes four tiers. Tier 1 has the lowest copay and […]
How do I receive the Medicare giveback benefit?
The Medicare Giveback Benefit is a Part B premium reduction offered by some Medicare Part C (Medicare Advantage) plans. If you enroll in a Medicare Advantage plan with this benefit, the plan carrier will pay some or all of your Part B monthly premium. The summary of benefits (SB) or evidence of coverage (EOC) of […]
What is the Medicare reimbursement rate?
Medicare reimbursement rates vary depending on the type of service and provider. The Medicare Physician Fee Schedule (MPFS) determines how much Medicare pays healthcare providers for services rendered to beneficiaries. Generally, Medicare Part B reimburses approximately 80 percent of the Medicare-approved amount for covered services after the beneficiary meets their annual deductible of $283. Different […]
Does Medicare cover preventive care services?
Detecting diseases early and improving health is the purpose of preventive services. Medicare covers a wide range of preventive services, such as screenings for cancer, obesity, substance abuse, and chronic diseases. A majority of these services are recommended by the US Preventive Services Task Force and have no cost sharing under the Affordable Care Act. […]