Federal officials are allowing the private insurance plans to use “step therapy” for drugs administered by doctors. In step therapy, patients must first use cheaper drugs to see if they work before receiving more expensive options.
Beneficiarios de Medicare pueden conseguir medicamentos más baratos si pagan en efectivo… pero por reglas mordaza el farmacéutico no puede decirlo.
Sometimes a drug plan’s copayment is higher than the cash price, and under a little-known federal rule, pharmacists have to tell Medicare beneficiaries that — but only if they ask.
Under new federal rules unveiled this week, these privately run alternatives to traditional Medicare might provide air conditioners, rides to medical appointments and home-delivered meals.
Los Centros para Servicios de Medicare y Medicaid ampliaron la forma en que definen los beneficios “relacionados directamente con la salud”, que las aseguradoras pueden incluir en sus pólizas.
Last month’s budget deal means Medicare beneficiaries are eligible for physical and occupational therapy indefinitely. Plus, prescription drug costs will fall for more seniors.
Agencies sometimes turn away Medicare beneficiaries with chronic health problems by incorrectly claiming Medicare won’t pay for their services, say patient advocates.
Most beneficiaries have from Oct. 15 to Dec. 7 to decide on drug coverage and whether to switch from traditional Medicare to a Medicare Advantage plan.
Sept. 30 marks the end of Medicare’s temporary offer to waive penalties for certain late Medicare enrollees with Affordable Care Act insurance coverage.
Tighter Medicaid budgets could jeopardize states’ home-based services that help older adults and disabled people live in their homes instead of more expensive nursing homes.
People who were using marketplace plans instead of Medicare may qualify for the reprieve. They have until Sept. 30 to apply.
Ombudsman’s offices represent long-term care residents on issues such as admissions and discharges, food, physical environment and abuse.
Not being officially admitted — a status known as observation care — can have financial consequences for beneficiaries, and patients had often complained they were not informed.
Many seniors are denied coverage because therapists mistakenly believe that they must be making improvements to qualify for coverage.
According to a settlement four years ago, Medicare was supposed to make clear to therapists that their services are covered even if beneficiaries are not improving. But that is not yet widely accepted.
Federal officials release names of insurers who ranked poorly in a recent review of their online directories’ accuracy.
People in these facilities are now guaranteed more flexibility on food and roommate choices, as well as improved procedures for grievances and discharges.
Thousands of people mistakenly think that if they have insurance, they can wait to sign up for Medicare Part B. Generally, insurance other than that provided by a current employer will not exempt them from Medicare’s strict enrollment requirements.
Some insurers have been allowed to move customers on the health law’s marketplaces into their Medicare Advantage plans when they become eligible for Medicare, but seniors complain they didn’t always know it was happening.
The government is sending emails and letters to some seniors to warn them that if they are eligible for Medicare and stay on the health law’s exchange, they will have to repay any subsidies they receive and if they miss their Medicare enrollment opportunity, they will face a life-long penalty.