What does balance billing mean?

Medicare and Balance Billing

What does the term balance billing mean with regard to Medicare bills?  Suppose you get a lot of testing done for outpatient services.  The first place the claim goes is to Medicare for approval.  If Medicare approves the expense, it then goes to your insurance company.  Any balance remaining after Medicare and the insurance company pay is called a "balance bill".  Under Ohio law, this cannot be passed on to the Medicare consumer. 


Whether or not balance billing can do done is controlled by state.  For example, the state of Florida allows balance billing and Ohio does not.  That means that if you get sick in Florida and don't have a medical plan in place that covers balance billing, you could end up with a bill for Florida services.


The plan choice you make can have financial consequences if you have not considered the concept of balance billing in your choice.  For more information, you can contact Alta Vista Benefits at 614-889-0934.

Medicare changing approved expenses

Medicare is changing what expenses they deem to be "Medicare approved".  I have been getting frequent calls about Medicare denying charges for services normally approved

and paid by Medicare.  What is interesting is that there have not been any publications or changes to medicare.gov that indicate a policy change has been made on covered expenses.

The way to correct this is to file an appeal with Medicare.  They can take up to 90 days to process the appeal. 

If you have a question about bills you are getting and you don't understand why things are not getting paid, you can contact Alta Vista Benefits for help at 614-889-0934.

When you can change your Medicare Supplement

When you can change your Medicare Supplement


Most Medicare recipients are familiar with Annual Enrollment each year, which begins October 15 and ends December 7.  This is the time of the year where you can make changes to a Medicare Advantage or Part D (Prescription Drug Plan) for the following calendar year. 


What many people don't know is that Medicare Supplements can be changed all year long.  Changes are not restricted to Annual Enrollment. 


If you have a Medicare Supplement and would like to change it, you must answer all underwriting questions in order to be approved.  If you have health issues, the trick is to find an insurance company that is more lenient on underwriting.


If you have questions about this process and would like to explore changing your Medicare Supplement, call the expert at 614-889-0934.  We are your advocate and will help you review your options.

How to pick a Medicare Supplement

How to pick a Medicare Supplement

 

Many people are confused about how to pick a Medicare Supplement.  So here are a couple of hints about your choices.

 

1. Medicare Supplements are not network based plans, meaning you can go to any doctor or hospital that accepts Medicare.  This is an advantage for anyone who travels and is in contrast to Medicare Advantage Plans. 
2. All Medicare Supplements are standardized plans.  That means that any plan you choose is going to be the same regardless of the company you choose. The only thing that varies is the cost with each insurance company and the list of the plans they offer. Not all companies offer all of the available plan designs.
3. Some Medicare Supplements offer a gym membership with them.  This does raise the cost of the plans that offer it. 
4. Medicare plans have premium increases over time. So, it important to choose an insurance company that has stable rates over time.  Only an agent who works with Medicare consistently knows this type of company history and can help you with your choice.

If you want a Medicare Expert to help you select a Medicare Supplement plan, call Lucy Grosz at 614-889-0934 or visit  http://www.altavistaben.com.

Parts of Medicare

The Parts of Medicare

 

There are four parts of Medicare:

1. Part A which pays for hospital care.
2. Part B which pays for medical care, like doctor visits.
3. Part C which is also called the Medicare Advantage program. 
4. Part D which covers prescription medications. 

Part A and Part B of Medicare are administered by the Federal government.  Together they are called "Original Medicare".


You can buy Part C/Medicare Advantage coverage from private companies. Medicare Advantage plans combine Part A and Part B and may offer prescription drug coverage.  The plans can also include additional benefits like eye care, hearing, wellness services and a nurse hotline.


Medicare Advantage plans are area specific, meaning you must live in the plan's service area.  To apply for these plans, you must be enrolled in Part A and Part B.


Part D helps pay for prescription drugs.  It is only offered through private insurance companies.  Part D plans can be standalone or be part of a Medicare Advantage plan. To apply for a standalone plan, you must be enrolled in Part A and/or Part B.


If you are confused about the coverage options with Medicare and when you can make changes, give us a call at 614-889-0934.

Medicare Annual Enrollment - What you need to know

Every year between October 15th and December 7th, Medicare beneficiaries can evaluate their current coverage and change plans for the following January.  Finding a plan that has the lowest premium and the lowest cost for prescriptions can be a confusing and overwhelming process.

We are Medicare experts, represent many carriers, and we are your advocate. We offer a free service to help guide you through this process.  Here are the reasons why it is important for you to evaluate your coverage each year:

Reasons to check your drug coverage:

1.   Medicare’s formulary can change;
2.  Your plan’s formulary can change;
3.  Your own drug list can change;
4.   Pharmacies change their pricing;
5.   Pharmacy networks change;
6.  Insurance carrier plans and pricing changes.

Reasons to check your Medicare Advantage coverage:

1. The plan's network of doctors and hospitals can change;
2. The plan itself can change for the following year;
3. The out of pocket maximum may be higher;
4. New plans may be available in your area;
5. Your drug list may have changed during the year;
6. The plan's formulary may have changed;
7. Some of your drugs may not be covered under your current plan next year.

We will also review your Medicare Supplement coverage to see if you need to change it. 

You can contact us at 614-889-0934.  Call today.