Choosing the right combination of services through Medicare can be a daunting task. Sadly, it was recently revealed in a study, published by the University of Pittsburgh, that only a little over 5 percent of seniors selected the most cost-effective prescription drug plan. The remainder overspent by an average of more than $365 for their Medicare Part D coverage each year.
“People need assistance in choosing the least expensive plan for their medical needs,” said lead author Chao Zhou, Ph.D., a post-doctoral associate at Pitt Public Health. “Educational programs that help people navigate the dozens of plans available would make it easier to select plans that best meet their health care needs without overspending.”
Part D coverage was introduced in 2006 and cost the federal government $65.8 billion in 2011, according to the Congressional Budget Office.
This Pitt study investigated the difference in a patient’s total spending (premiums plus out-of-pocket costs) between the plan the patient selected and the least expensive option in that geographical area that would satisfy the patient’s medication needs.
The study looked at data for 412,712 people, with an average age of 75. Participants tend to overprotect themselves by purchasing plans with more generous features, such as generic drug coverage in the coverage gap.
If you think you are spending too much for Medicare Part D prescription drug coverage, you may want to visit this site: www.medicare.gov/find-a-plan/questions/home.aspx now, since you can switch to a Medicare Prescription Drug Plan that has 5 stars for its overall plan rating once during the period from Dec. 8, 2012 through Nov. 30, 2013.
Continuing on Medicare, there was a great article in the Wall Street Journal recently by Anne Tergeson on steps you can take if you have a Medicare claim rejected.
It seems that Medicare denies millions of claims every year (107 million in 2010); leaving beneficiaries with billions of dollars in medical bills that they thought Medicare would pay for.
While the appeals process can be complicated and time-consuming, those who press their cases enjoy relatively high success rates.
“Folks don’t appeal as much as they should,” said Doug Goggin-Callahan, director of education at the nonprofit Medicare Rights Center in New York and Washington, D.C. “If you and your doctor feel you should be entitled to a service, you should go through the process.”
If you are considering filing an appeal for a denial of a Medicare claim, these agencies can help:
• The Center for Medicare Advocacy (medicareadvocacy.com). This group publishes helpful informational packets on how to appeal denials of skilled nursing and home health care services, along with other material.
• Centers for Medicare and Medicaid Services (medicare.gov). The agency that administers Medicare has a “claims and appeals” tab on its website and also publishes a “Medicare Appeals” brochure.
• The Medicare Rights Center (medicareinteractive.org) furnishes in-depth information regarding the Medicare claims process and the group also provides free counseling help to callers (800-333-4114).
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Greg Roberts is a certified financial planner with 35 years of financial and estate planning experience.