September Medicare Must-Knows

RetireMEDiQ strives to keep individuals informed about the latest Medicare news. Each month, we recap the top information consumers need to know about recent developments in the Medicare industry and how it may affect you.

Medicare Reminds Beneficiaries to get Pneumonia Vaccine

According to Medicare.gov, more than than one million Americans are admitted to the hospital every year with pneumonia. This year – more than ever before – the Centers for Disease Control (CDC) urges beneficiaries to take advantage of the Part B coverage of pneumonia vaccines. According to a recent blog and video posted on the website, only 67 percent of adults over 65 have ever received the vaccine, despite being a higher-risk population. You may be at a higher risk for pneumonia if you:

  • Are 65 or older.
  • Have a chronic illness (like asthma, diabetes, or lung, heart, liver or kidney disease).
  • Have a condition that weakens your immune system (like HIV, AIDS or cancer).
  • Live in a nursing home or other long-term care facility.
  • Have cochlear implants or cerebrospinal fluid (CSF) leaks.
  • Smoke tobacco.

The CDC encourages all seniors and vulnerable populations to receive both the flu and pneumonia vaccines this season in particular, as all vulnerable populations face added risks and exposures in the midst of the COVID-19 pandemic.

Rural Health Care Takes Center Stage

The Centers for Medicare and Medicaid Services (CMS) announced an initiative called The Community Health Access and Rural Transformation (CHART) Model which “aims to ensure individuals in rural America have access to high-quality, affordable health care,” according to CMS. Under the CHART Model, providers can support rural healthcare in two ways. The first, called the Community Transformation Track, aims to fund money to rural health care providers to reform how they offer care to rural residents, including seniors, provide more predictable payment structures, and offer more flexibility in terms of operations and regulations when it benefits patients. Such changes might include expanding telemedicine opportunities, waiving certain Medicare hospital conditions of participation and enabling providers to waive cost-sharing for certain Part B services. The second option, called the Accountable Care Organizations (ACO) Transformation Track offers upfront investments in rural providers who agree to participate in a two-sided risk arrangement as part of the Medicare Shared Savings Program. Both tracks aim to expand coverage and access to health care to rural Americans across the country.

Planning a Surgery? More Choices, Lower Out-of-Pocket Costs Could be Heading Your Way

August was a busy month for the Centers for Medicare and Medicaid Services (CMS). In addition to supporting expansion for rural health, CMS proposed several policies that would offer Medicare beneficiaries more choices in where they seek care for surgeries and lower their out-of-pocket costs for certain medications. In what’s called a “proposed rule,” CMS outlined several changes to existing regulations. For instance, hospitals and ambulatory surgical centers would be able to operate with more flexibility in terms of what services they could offer to Medicare beneficiaries. Currently, many health care facilities are limited in what they can offer because of the “Inpatient Only List,” which is a predetermined list of surgeries and procedures that Medicare will cover for patients under “inpatient” status at hospitals. Many hospital patients are labeled as outpatient or “under observation” before meeting thresholds for achieving inpatient status based on Medicare’s requirements. If a patient needs a particular procedure while listed under observation, Medicare is not required to cover that procedure if it is on the “Inpatient Only List.” Eliminating that list expands coverage for Medicare beneficiaries while simultaneously expanding the list of ‘approved’ centers to receive such operations. In its proposed rules, CMS also passes certain discounts to Medicare beneficiaries who receive prescription medications from hospitals who purchased the drugs through the discount program called 340B, which offers steep discounts on certain outpatient drugs. To learn more about these programs and savings, visit the Centers for Medicare and Medicaid Services website.

Annual Enrollment is Approaching

This year’s Medicare Annual Enrollment Period runs from Thursday, Oct. 15, through Monday, Dec. 7, 2020. We’re here to help you prepare for your enrollment if you’re new to Medicare. It’s never too soon to reach out to us! You can reach our team of expert advisors today at 1-855-981-8611. If you’re a RetireMEDiQ client and have questions about your current plan or the Annual Enrollment Period, connect with our client advisors at 1-877-222-1942.

We’d Love to Hear from You!

If you have questions about anything covered in this post, please comment below, call our team of client advisors at 1-877-222-1942 or email us at client@retiremediq.com.

If you are not yet a RetireMEDiQ client and have questions about what this may mean for you as you approach retirement, contact our team of expert advisors at 1-855-981-8611.

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