Diabetes is a serious and pervasive disease in the United States. With around 9% of the population suffering from this disease, it is among one of the most common chronic diseases faced in our country -- especially among the elderly. According to National Diabetes Statistics Report, 2017, the percentage of adults 65 and older living with diabetes has increased to 25.2% (U.S. Centers for Disease Control and Prevention, National Diabetes Statistics Report, 2017).
In this three-part series, we are taking a closer look at this disease and its effects on Americans. In this second installment, we will be examining the way that diabetes affects the elderly, especially those on Medicare.
Diabetes Prevention and Medicare
The increased emphasis on offering preventative health services through Medicare has meant that there are now more resources available to help those who are at risk of developing diabetes. Medicare beneficiaries can now be diagnosed and receive medical advice that may help prevent the disease from fully developing.
Diabetes and Original Medicare
When it comes to diabetes care, Medicare Part B is probably the most relevant portion of what is traditionally considered Original Medicare (Part A and Part B). Part B covers many important outpatient services, medication, and supplies for diabetes care. Some (but not all) examples of what is included:
· Blood Glucose Strips
· Lancet devices
· Glucose Control Solutions
· Insulin Pumps and Pump Supplies
· Obesity Screening
While Original Medicare does cover a wide range of diabetes medical treatments, you will be required to pay a monthly premium. You will still be responsible for a deductible on many of your medical expenses. Typically, that deductible will be 20% of the Medicare-approved cost. Medicare Supplement insurance may cover those gaps in which Original Medicare does not cover.
Diabetes and Medicare Part D
Part D is an important plan to consider if you suffer from diabetes. That is because Part D allows you to choose a prescription drug program. While Original Medicare generally only covers insulin that is used in a pump, Part D allows you more flexibility. In addition, you could have more access to other drugs that can be helpful in combating diabetes.
Medicare Part D will cost an additional premium and requires a copay or deductible depending on the specific plan you choose. Additionally, you will need to pay attention to the coverage gap. This temporarily increases the copay on prescriptions after a certain amount has been spent (this “amount” is not enough to qualify for emergency coverage, though).
Medicare may be very beneficial for people with diabetes. Still, you will need to carefully weigh the benefits of different Medicare plans to find what is right for you.
In the third portion of this series we will examine the way that diabetes can affect life insurance.
Medicare is one of the most popular government run programs in the nation. Every day, 10,000 Americans enroll in Medicare and around 37 million rely on Medicare for their preventative health services like flu shots and cancer screenings.
According to the Kaiser Family Foundation, 6 in 10 Americans report that the program is working well. That number climbs when you look at seniors, 8 out of 10 of whom believe Medicare works well for them. But working well and working perfectly are two separate things.
A major flaw in the Medicare program is the risk for both fraud and abuse. Fortunately, there are ways for concerned seniors to help combat both, thanks to the Senior Medicare Patrol.
What Is the Senior Medicare Patrol (SMP)?
The SMP is a network of specially trained volunteers who seek out evidence that abuse or fraud has occurred and report it to the proper authorities. In doing this, the SMP helps to prevent undue burden on the Medicare system that could potentially cause a rise in the price of senior health care.
Who Are the Volunteers?
The vast majority of the roughly 5,000 nationwide volunteers are civic-minded Americans who are retired and on Medicare. Like a neighborhood watch, these volunteers are among the first defense against the sort of fraud that could have devastating effects on the Medicare system.
What Do SMP Volunteers Do?
SMP volunteers are responsible for a number of services geared towards improving the life of Medicare beneficiaries and their families. Among the most common tasks are:
Whether you are looking for a way to help combat the issues of insurance fraud and abuse, or you are looking for a way to find out if you yourself might be at risk, SMP offers a number of services and opportunities that might interest you. To learn more about this important program, visit the official website.
This concludes our three-part series on Medicare fraud and abuse. Knowing what to watch out for can make a real difference in your risk of being taken advantage of.
If you have any additional questions, give us a call at Bankers Fidelity at (866) 458-7500.
The Commonwealth Fund, "Medicare's Numbers Game," April 2015
The Henry J. Kaiser Family Foundation, "The Public's Health Care Agenda for the 113th Congress," January 2013
Senior Medicare Patrol, "Become a Volunteer"
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The number of people enrolling in Medicare is rising from 39.7 million in 2013 to 55.7 million in 2015. In fact, according to the CommonWealth Fund, there are projected to be 81 million enrollees by 2030.
The second part of this Medicare fraud and abuse series is designed to examine some of the most common ways that Medicare fraud and abuse manifest themselves.
This is a common abuse perpetrated on Medicare patients. This is when a medical facility bills you or the government for a service, treatment, or medication you never received. The guilty party can be your doctor padding your claims to increase their profit or it can be the result of identity theft.
No Medical Necessity Fraud
No Medical Necessity Fraud can be one of the most difficult to identify. In a typical case, a medical provider will submit a claim for medications, ambulatory services, or medical devices that the patient did not actually need. In extreme cases, victims can even be subjected to dangerous surgeries with little to no possible benefit. While it helps unscrupulous providers pad their pockets, it puts patients at risk and places extra costs on the Medicare system. Since most patients are inclined to trust their doctor's opinion, it can be difficult to know whether a given medical procedure is actually necessary.
Many important surgeries are made up of a number of essential steps, but each step is considered part of the larger procedure -- they are bundled. But many times, a doctor can receive a greater amount of money by billing for each individual step separately. By doing this, the doctor can increase their own profits, leaving you and the Medicare system will be facing an undue burden.
Pharmaceutical companies have huge profit margins on many of their basic products, despite the availability of less expensive generic options. That is because the pharmaceutical reps often provide incentives for doctors to prescribe their medications, including financial benefits, among other things. At its worst, doctors will prescribe medication that offers no real benefit for a patient in order to fulfill their part of the agreement made with the pharmaceutical companies.
There are a number of different ways Medicare and Medicare Advantage patients may be defrauded. While the fraud might seem harmless to some, certain kinds may have life threatening results for the patient. But don't worry, in the next blog of this series, we will look into what you can do to prevent health care fraud.
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Medicare open enrollment season, which runs between October 15 – December 7, 2017, is fast approaching. During this time thousands of Americans will be applying for benefits. While Medicare and Medicare Advantage offer benefits to millions of people, fraud and abuse are two issues that adversely affect Medicare and the people who depend on it. In fact, a 2015 report found that as much as $60 billion was lost through Medicare fraud in 2014.
In this three-part post, we will take a close look at health insurance fraud and abuse, how they happen, and what you can do to prevent them. In this first post, we will explain what Medicare fraud and abuse are and, more importantly, why they matter.
What Is Medicare Fraud?
To put it simply, one type of Medicare fraud occurs when someone knowingly makes a false claim for services and procedures that never happened. That means your doctor or another party is charging the Medicare system for services never rendered. Because health care providers are reimbursed by the government for treating Medicare patients, it is a potentially lucrative form of fraud that costs taxpayers billions every month. We will dive deeper into the types of Medicare fraud in post two.
What Is Medicare Abuse?
Medicare abuse is a little different. One example is when a doctor administers treatments or procedures that do not truly benefit a patient. These procedures can range from unneeded but harmless prescriptions to potentially deadly surgeries. In this case, work is being performed by the doctor, but the work was not necessary. Medicare abuse exposes patients to unnecessary risk.
Why Should Anyone Care?
People seem to care more about Medicare abuse because it can have a negative impact on a person's life, even resulting in death. But fewer people seem worried about Medicare fraud. All too often, it's seen as a victimless crime. That simply isn't true. As tax payers, it's your money being stolen and wasted.
Plus, every unnecessary cost to Medicare results in an undue burden on the Medicare system as a whole, which then results in higher premiums and health care costs for everyone who relies on the program.
That's why Medicare fraud should be a concern for every American, whether they pay for private insurance or are on Medicare. In the next post, we will examine the most common methods of Medicare fraud and abuse.
ABC News, "Medicare Funds Totaling $60 Billion Improperly Paid, Report Finds," July 2015
Medicare Consumer Guide, "Preventing Medicare Fraud"
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A new study published in the New England Journal of Medicine concluded that air pollution kills thousands of Americans every year. The study used data from millions of Americans on Medicare to determine the consequences of air pollution on older Americans.
The study was among the most comprehensive to date on the effects of air pollution. Led by Francesca Dominici, a Harvard T.H. Chan School of Public Health biostatistics professor, the study required researchers to synthesize data from federal air monitoring stations and satellites to create a map of air pollution. The map was so detailed that it could determine pollution for individual zip codes.
The pollution map was then cross referenced with data from 60 million Americans on Medicare from 2000-2013. The conclusion drawn was that even low levels of air pollution are lethal, killing around 12,000 Americans per year.
"We are now providing bullet-proof evidence that we are breathing harmful air," Dominici said in an interview with NPR. "Our air is contaminated."
But what can Americans do with this information? There are several concrete steps you can take to protect yourself.
1. Check Your Daily Pollution Forecast
The American Lung Association has an app that you can download that will let you know how much pollution to expect in your area on any given day. If the forecast is high, limit the amount of time you spend outdoors.
2. Avoid Exercising in Areas of Heavy Traffic
Cars create pollution. Even if you are going for a short walk down the road, the pollution has the ability to build up over time. State parks and gyms are a great alternative for a safer place to exercise.
3. Get Regular Check Ups
Air pollution can cause a number of diseases, including lung cancer. That is why it is important that you take full advantage of the preventative care options that your insurance offers. That way, you can catch any diseases early.
4. Stop Smoking
This one should be self-explanatory, but if you are worried about air pollution then you need to make a concerted effort to cut down on the amount of cigarette smoke you are exposed to. While smoking habits have decreased, 8.4% of the population still smoked in 2014, according to the State of Aging and Health in America.
5. Consider Medicare Supplement Insurance Options (Medigap)
If you live in an area of high pollution, you may decide to invest in a Medigap plan that can offer you more protection should the worst happen.
Air pollution is a serious problem for all Americans, but for seniors, it can have a more pronounced effect. Taking precautions can prevent you from experiencing the worst of the consequences.
Disclaimer: Neither Bankers Fidelity Life Insurance Company® nor its Medicare Supplement policies are affiliated with or endorsed by the U.S. Government, the federal Medicare program, or the Centers for Medicare and Medicaid Services. This is a solicitation of Medicare Supplement insurance and an independent agent may call on you.
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Understanding Medicare Supplement
Neither Bankers Fidelity Life Insurance Company® nor its Medicare Supplement policies are affiliated with or endorsed by the U.S. Government, the federal Medicare program, or the Centers for Medicare and Medicaid Services. This is a solicitation of Medicare Supplement insurance and an independent agent may call on you. The Medicare Supplement products issued by the Company are insurance policies. Policy form series B 21092 is issued by Bankers Fidelity Life Insurance Company®, Atlanta, GA; policy form series B 21492 is issued by Bankers Fidelity Assurance CompanyTM, Atlanta, GA. Limitations and exclusions apply; actual policy provisions control. Rates subject to change on a class basis. Individually underwritten; application to determine eligibility required.
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