Medicare fraud and abuse can happen anywhere.
The Centers for Medicare and Medicaid Services (CMS) – the Federal agency that administers the Medicare Program – defines fraud as “the intentional deception or misrepresentation that the individual knows to be false or does not believe to be true.” Common examples of suspected fraud or abuse include:

• A provider that knowingly prescribes excessive or unnecessary tests and services.

• A provider that charges Medicare twice for a service or item that you only got once.

• A person who steals your Medicare Number or card and uses it to submit fraudulent claims in your name.

• A company that offers you a drug plan that Medicare hasn’t approved.

It’s important to note that an insurance agent who is not above board or insists you enroll in one plan over another is not only unscrupulous, but also may be committing fraud.

Fraud is driving up the cost of health care.
Unfortunately, the rise in fraud and abuse is resulting in higher health care costs and taxes for everyone. Medicare and Medicaid fraud has been estimated to cost taxpayers over $100 billion dollars a year, while putting beneficiaries’ health at risk. CMS works with individuals, entities, and law enforcement agencies to detect and prevent fraud and abuse, but the losses are staggering. We recently heard about an MRI company operating in multiple states that submitted millions of dollars in claims for services they never provided. They were shut down, but Medicare has yet to recoup the funds.

Take steps to protect yourself or your loved ones from Medicare fraud.
STEP 1:
Understand your Medicare plans before you enroll. Make sure you know what is covered and what is not. An experienced Medicare agent will give you the guidance you need to make educated decisions about the type of coverage that’s right for you. With over 20 years of experience, Premier Benefit Services promises you an honest and eye-opening conversation about how Medicare works and what your choices are.

STEP 2:
Protect your Medicare number and other personal information.

• Don't share your Medicare card, Medicare Number, Social Security card, or Social Security Number with anyone except your healthcare providers or people you know need to have it.

• Never give out your Medicare Number in exchange for special offers like free medical care or equipment.

• Never let someone use your Medicare card and never use anyone else’s card.

As a licensed insurance provider, Premier Benefit Services is required to protect our client information, and we ensure that everything from our cell phones to computers meet strict security standards.

STEP 3:
Review your statements carefully. Record your appointments and services and save the receipts and statements from your providers. Then review your statements regularly to make sure the details correctly match your records.

STEP 4:
Report suspected fraud. Call 1-800-MEDICARE and have your Medicare card or Medicare Number and the claim on hand. You can also report suspected fraud anonymously by contacting the Office of the Inspector General (OIG) at tips.oig.hhs.gov or by calling 1-800-HHS-TIPS (1-800-447-8477). The OIG record systems collect no information that could trace the complaint to you.

Remember: You have the right to know everything about your medical care, including costs billed to Medicare. So don’t hesitate to ask questions if you aren't sure of something. To learn more about Medicare fraud, visit https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse.

New to Medicare? Find out how to get the coverage you need.
Contact Bruce today to schedule a complimentary consultation.

Simply put:

Part A (Hospital Insurance) helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

Part B (Medical Insurance) helps cover:

• Services from doctors and other health care providers

• Outpatient care

• Home health care

• Durable medical equipment like wheelchairs, walkers, hospital beds, etc.

• Many preventive services like screenings, vaccines, and yearly “wellness” visits

How does Medicare work?
Most people only need to sign up for Part A and Part B once. You can also choose which way you want to get your Medicare health coverage: either Original Medicare or a Medicare Managed Care Plan (also known as Medicare Advantage Plan). If you choose Original Medicare, you’ll also decide if you want prescription drug coverage (Part D) and a medical supplement plan.

Is Medicare free?
Contrary to what many people think, Medicare is not free. Part A is sometimes called “premium-free Part A” because the premium in $0 if you have been working for at least 40 quarters or 10 years, and paying your Medicare taxes.

However, there is a monthly premium for Part B. The amount is based on your income and it can change from year to year. For 2024, the premium is $174.70 each month (or higher depending on your income).

There are also Part A and Part B deductibles. You’ll usually pay 20% of the cost for each Medicare-covered service or item. However, Medicare Part A and Part B each have deductibles that must be met before this 20% co-pay kicks in.

When it comes to enrolling in Medicare, the earlier the better.
We advise clients to sign up for Medicare when they are first eligible in order to avoid a gap in coverage and/or late enrollment penalties. For most people, eligibility starts three months before they turn 65 and ends three months after they turn 65.

If you are celebrating your 65th birthday in the next few months, go to www.ssa.gov and sign up online for Medicare Parts A and B (you’ll need to create a secure “my Social Security” account if you don’t already have one.) Still working? Here are two things to note:

• If you have health insurance from an employer, you only need to sign up for Medicare Part A.

• However, if the company you work for has less that 20 employees, you must also enroll in Part B.

If you’re new to Medicare, learn how to get the coverage you need.
An experienced Medicare agent will give you the guidance you need to make educated decisions about the type of coverage that’s right for you. With over 20 years of experience, we promise you an honest and eye-opening conversation about how Medicare works and what your choices are. And we never charge for our services. Contact Bruce today to schedule a complimentary consultation.

Sign Up for Medicare Part A – No Matter What
It’s a good idea to enroll in Medicare Part A when you become eligible at age 65, even if you have employer coverage. If you have been working for at least 40 quarters or 10 years, and paying your Medicare taxes, Medicare Part A is free.

• If you work for a small business with fewer than 20 employees, you will most likely be required to sign up for Medicare Part A and Part B by your employer. While Part A is premium-free, the monthly premiums for Part B are $174.70 in 2024. Note that your income can affect what you pay for Part B and Part D (prescription drug coverage), and high earners often pay higher monthly premiums for both of these parts of Medicare.

• Those who work for companies with 20 or more full-time workers and have access to employer-based health insurance can choose to delay signing up for Medicare Part B while they are still working. That way, they don’t have to pay premiums for both Medicare and their employer coverage.

Keep in mind that you need to sign up for Medicare Parts A and B during your initial enrollment period (IEP), which begins three months before and ends three months after the month you turn 65. If you don’t, you could end up with gaps in coverage – and potentially costly penalties.

Be Aware of Your Options
Whether you are working or not working, it is important to fully explore your options in order to choose the health insurance coverage that’s best for you. For example, you (and your employer) may save a significant amount of money by opting out of your company’s plan and switching to Medicare.

We recently worked with a client who was turning 65, not ready to retire, and unsure what to do about health insurance for himself and his spouse. After comparing his premium for employer coverage (which he seldom used) with the cost for Medicare Part A and Part B plus a zero-premium Medicare Managed Care Plan (better known as Medicare Advantage Plans), it turned out he would be paying much less if he dropped his company’s coverage. And his employer would save money by no longer paying their part of his premium.

Lost in the Medicare Maze?
An experienced Medicare agent will give you the guidance you need to make educated decisions about the type of coverage you need. With over 20 years of experience, we promise you an honest and eye-opening conversation about how Medicare works and what your choices are. And we never charge for our services. Contact Bruce today to schedule a complimentary consultation.

Understanding COBRA Basics
This federal law generally requires that group health plans sponsored by employers with 20 or more employees offer workers and their families the opportunity for a temporary extension of health coverage – called “continuation coverage” – in specific instances where coverage under the plan would otherwise end.

Generally, your coverage under COBRA will be the same coverage you had while you were an employee. This is helpful if you want to continue to see your same doctors and receive the same health plan benefits. Your spouse, former spouse, and children are also eligible for continuation coverage, even if you decide not to sign up for coverage for yourself.

You have 60 days to choose whether or not to elect continuation coverage once your employer-sponsored benefits end. While COBRA is temporary, the law requires that continuation coverage extend for a limited period of 18 months (36 months in some cases) to allow you to explore other health insurance options.

Electing COBRA and Enrolling in Medicare
If you are 64 years old and get laid off, you may think you can elect COBRA coverage for the full 18 months and then sign up for Medicare once your COBRA coverage ends. While this is a reasonable assumption – one we have seen many clients make – it is not necessarily a wise choice. Here’s why:

• If you have COBRA and are eligible for Medicare, COBRA may only pay a small portion of your medical costs – leaving you to pay most of the costs yourself. To avoid unnecessary medical bills, you may need to enroll in Medicare Parts A and B right away.

• If you become eligible for Medicare after you’ve signed up for COBRA, your COBRA benefits will end when you turn 65, no matter how many months of continuation coverage you were offered.

Whether you choose COBRA or not, you have 8 months to sign up for Medicare Part B without a penalty. If you miss this period, you will have to wait until January 1 - March 31 of the following year to sign up, and your coverage will start July 1. This may cause a gap in your coverage, and you may have to pay a lifetime Part B late enrollment penalty.

Avoiding Coverage Gaps and Late Enrollment Penalties
Before making any decisions about your health insurance, speak with your employer about the specific COBRA rules and regulations that apply to you. For example, you may be able to elect continuation coverage for the number of months you will need insurance before turning 65.

It’s important to sign up for Medicare before — or soon after — your employment ends to protect yourself from coverage gaps and late enrollment penalties. For most people, Medicare eligibility starts three months before they turn 65 and ends three months after they turn 65.

New to Medicare?
You may find it challenging – if not downright overwhelming – to understand the options and get the coverage that’s right for you. An experienced Medicare agent will give you the guidance you need to make educated decisions about the type of coverage you want.

With over 20 years of experience, we promise you an honest and eye-opening conversation about how Medicare works and what your choices are. And we never charge for our services. Contact Bruce today to schedule a complimentary consultation.

Here are three things to know as you begin your Medicare journey.

1. Medicare is not free.
Many of our clients are surprised to learn that Medicare comes with many costs, including premiums, deductibles, and copays. Original Medicare consists of Part A (hospital coverage) and Part B (outpatient care). There is no cost for Part A as long as you have worked for 10 years or 40 quarters and paid into the system via payroll taxes. But Parts B and D (prescription drug coverage) have premiums that you will pay monthly.

• Medicare Part B’s 2024 standard monthly premium is $174.70 (some beneficiaries may pay more through income-adjusted surcharges.) If you collect Social Security, the premium is deducted from your monthly payment.

• Part D premiums, deductibles, and copays depend on the specifics of your coverage.

2. The sooner you sign up, the better.
When it comes to enrolling in Medicare, we advise people to sign up as soon as they are eligible in order to avoid a gap in coverage and/or late enrollment penalties.

For most people, Medicare eligibility starts three months before they turn 65 and ends three months after they turn 65. This 7-month window is called your Initial Enrollment Period (IEP). Coverage always starts on the first day of the month of your birthday unless you were born on the first. Then it starts the month before.

If you are celebrating your 65th birthday in 2024:

• Go to www.ssa.gov and sign up online for Medicare Parts A and B (you’ll need to create a secure “my Social Security” account if you don’t already have one.) You can also visit your local Social Security office.

• If you have health insurance from an employer, you only need to sign up for Medicare Part A. However, if your company has less that 20 employees, you must also enroll in Part B.

Keep in mind that it can take 4 to 6 weeks from the date you enroll to receive your Medicare card in the mail! This is another reason to avoid waiting until the last minute.

3. Don’t listen to your friends.
In addition to the different “parts” of Medicare, there are options such as supplemental insurance plans, Medicare Managed Care Plans (also known as Medicare Advantage Plans), and prescription drug plans. Some parts of Medicare are administered by the federal government, while others are managed by private insurance companies.

There are many factors to consider before choosing a plan (or opting not to) – from the costs involved to the specifics of your situation. Not only are the choices confusing, but what is right for your friend, colleague, or family member may not be the right thing for you.

An experienced Medicare agent will give you the guidance you need to make educated decisions about the type of coverage you want.
With over 20 years of experience, we promise you an honest and eye-opening conversation about how Medicare works and what your choices are. And there is never a fee. Once you have your Medicare card, contact Bruce to schedule a complimentary consultation.

Between now and then, it’s important to follow up with your physicians and/or your pharmacy.

• You should receive your new cards within two weeks of completing the applications. If you don’t receive them by mid-December, contact your insurance agent.

• Make sure your new Medicare Managed Care Plan (Medicare Advantage Plan) card lists the proper plan and your primary physician’s name.

• If you have a new prescription drug card, speak with your pharmacist about updating your records.

If you have received paperwork outlining your new benefits, check to make sure it’s accurate and keep it handy so you can refer to it if needed.

There is a second Open Enrollment Period just for those in Medicare Managed Care Plans (Medicare Advantage Plans).
From January 1 through March 31, 2024, current Medicare Managed Care Plan (Medicare Advantage Plan) members can make a one-time change that will remain effective through the end of the year. You may also choose to discontinue your Managed Care Plan and switch to a medical supplement plan and a stand-alone prescription drug plan (Medicare Part D). Again, this only applies to those already enrolled in a Medicare Managed Care Plan – not those looking to switch to one from original Medicare.

Turning 65 soon? Now may be the time to sign up for Medicare.
When it comes to enrolling in Medicare, the earlier the better. We advise people to sign up for Medicare when they are first eligible in order to avoid a gap in coverage and/or late enrollment penalties.

For most people, Medicare eligibility starts three months before they turn 65 and ends three months after they turn 65. This 7-month window is called your Initial Enrollment Period (IEP), and it’s the first Medicare enrollment period for people as they become eligible.

So, if you are celebrating your 65th birthday in the next few months, go to www.ssa.gov and sign up online for Medicare Parts A and B (you’ll need to create a secure “my Social Security” account if you don’t already have one.) Still working? Here are two things to note:

• If you have health insurance from an employer, you only need to sign up for Medicare Part A.

• However, if the company you work for has less that 20 employees, you must also enroll in Part B.

If you don’t sign up for Medicare when you are first eligible, you will most likely have to wait until the General Enrollment Period of the following year (January 1 - March 31). You might also have to pay a late enrollment penalty.

Do you want get the best benefits possible (and save money?)
The 2023 Annual Enrollment Period may have ended, but that doesn’t mean you will stop being bombarded with mail and TV commercials promoting all the great Medicare benefits you can get. And unfortunately, most of what they promise is not accurate – and not available in many states.

If you want the real facts about Medicare, please give us a call. With over 20 years of experience, we promise you an honest and eye-opening conversation about how Medicare works and what your choices are. Then you can make an educated decision on what type of Medicare coverage you want. And there is never a fee. Contact Bruce today to schedule a complimentary consultation.

Medicare Managed Care Plans (Medicare Advantage Plans)

• Major carriers including Aetna, Braven/Horizon Blue Cross and WellCare have terminated certain plans. This means you will have to cross over into a different plan – or find and enroll in a new one.

• Many of our clients are concerned about increases or decreases in co-pays and deductibles. Others have discovered that their doctors are no longer in their plan’s network.

• If you have moved to another state – or even a different county – you may find that your old plan is not offered.

• More plans are offering or expanding ancillary benefits, so you may want to explore dental, hearing, and vision coverage, or wellness options like gym memberships.

Stand-Alone Prescription Drug Plans (Medicare Part D)
Have your medications changed this year? Were you taking a generic drug that is now branded? Did you switch pharmacies?

These are all good reasons to review your stand-alone prescription drug coverage plan. But the biggest reason to consider making a switch is that premiums on stand-alone drug plans have increased across the board for 2024.

Choosing a new prescription plan can be complicated, so review your Annual Notice of Changes and speak with a licensed agent about your options. Be sure to gather all of the information related to your current coverage, including:

• Cards for your plan and effective dates

• Home address including zip code

• An up-to-date list of medications, including dosage and frequency

Purchasing Additional Coverage
Keep in mind that during the Medicare Annual Enrollment Period, those currently enrolled in original Medicare (Parts A and B) can purchase additional coverage for the 20% of costs that traditional Medicare does not cover. This can be either a medical supplement plan and a stand-alone prescription drug plan or a Medicare Managed Care Plan (Medicare Advantage Plan) that may include prescription drug coverage.

Don’t wait – the Medicare Annual Enrollment Period ends December 7!

Need help comparing coverage options? With over 20 years of experience helping clients navigate the Medicare maze, Premier Benefit Services can help you choose the plan or plans that will give you the best bang for your buck. Contact Bruce today for a complimentary consultation.

From October 15 through December 7, those currently enrolled in Medicare have the opportunity to change their current Medicare Managed Care Plan (better known as Medicare Advantage Plans) or stand-alone prescription drug coverage to better meet their current healthcare needs and/or budget.

Now is the time to review your options for 2024 and make sure you understand what changes in coverage you can make.

When can you make changes to your Medicare plans ?

• The Medicare Annual Enrollment Period starts October 15, 2023 and ends on December 7, 2023.

• Changes you make during the 2023 enrollment period will go into effect on January 1, 2024.

What changes can you make during the Annual Enrollment Period?

• If you are currently enrolled in original Medicare (Parts A and B), you can purchase additional coverage for the 20% of costs that traditional Medicare does not cover. This can be either a medical supplement plan and a stand-alone prescription drug plan or a Medicare Managed Care Plan (Medicare Advantage Plan) that may include prescription drug coverage as well as additional bells and whistles.

• You can also switch from one Medicare Managed Care Plan (Medicare Advantage Plan) to another.

• You may elect to change your stand-alone prescription drug plan coverage (Medicare Part D).

• All changes are effective January 1, 2024.

What do you need to consider when reviewing your plans? First and foremost, we encourage our clients to do their homework! All Medicare beneficiaries will receive an Annual Notice of Changes that summarizes the changes in costs and benefits from 2023 to 2024. Reviewing the first few pages is a must-do, especially if your medical needs, medications and/or doctors have changed over the last year.

When reviewing your Annual Notice of Changes, pay close attention to the following:

• Premiums: Has there been a change to the monthly premium for your Medicare health plans or prescription drug coverage from 2023 to 2024? It may wise to consider another plan.

• Copayments: Compare your plan’s copays for your primary care doctors and specialists to see if they have gone up or down. Also check to see if there are any changes in the ancillary benefits available to you in your plan, such as dental, hearing, and vision.

• Prescription Drug Coverage: There are numerous changes being made to stand-alone prescription drug coverage plans for 2024, so it is important to review your Annual Notice of Changes carefully – especially if your medications have changed.

If you are not satisfied with upcoming changes to your healthcare or prescription drug coverage, now is the time to explore alternatives. With over 20 years of experience, we understand that navigating the Medicare maze on your own can often be confusing and frustrating. Let us help you choose an option or options that fit your needs going forward. Contact Bruce today for a complimentary consultation.