Articles written by Sean Mcphilamy


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  • Making health care decisions in advance

    Sean McPhilamy, Alaska Medicare Information Office|Jun 1, 2024

    This month’s article begins with a recommendation to prepare documentation of your personal desires as related to your medical situation and future health care needs. These can help convey your intentions should you not be able to voice them yourself. Next, a reminder that Medicare only provides coverage for services and equipment deemed medically necessary – you might find yourself in need of additional help with activities in your daily life. Finally, a mention regarding how hospice care pro...

  • Medicare and federal employee benefits

    Sean McPhilamy, Alaska Medicare Information Office|May 1, 2024

    This month’s article will focus on how Medicare may work with health benefits for federal employees, retirees and annuitants. Employees and retired employees of the federal government are eligible for Federal Employee Health Benefits (FEHB) coverage, subject to those positions that are excluded by law or regulation. Currently this includes employees of the U.S. Postal Service. The Office of Personnel Management administers the FEHB program. When someone becomes eligible for Medicare, most c...

  • Understanding the phases of Part D coverage

    Sean McPhilamy, Alaska Medicare Information Office|Apr 1, 2024

    Prescription Drug Plan coverage is a valued element within Medicare. Known more commonly as Part D of Medicare, these policies are offered by privately managed insurance companies, and regulated both by the State of Alaska’s Division of Insurance along with the national Centers for Medicare and Medicaid Services (CMS). The cost of your Medicare Part D-covered drugs may change throughout the year. If you notice that your drug prices have changed, it may be because you are in a different phase of...

  • Medicare and your right to appeal a discharge

    Sean McPhilamy, Alaska Medicare Information Office|Mar 1, 2024

    If you or a loved one are receiving in-patient medical care, there comes a time when that care will end. Hopefully, this is because the patient is ready for discharge, but sometimes, the patient is notified that care will be discontinued, possibly due to a notice from Medicare. You have a right to appeal this decision. What if my medical care ends too soon? If you are receiving care in a hospital or non-hospital setting and you learn that your care is going to end, you have the right to a fast,...

  • What's new in Medicare benefits for 2024?

    Sean McPhilamy, Alaska Medicare Information Office|Feb 1, 2024

    Medicare coverage and costs change each year, so it’s important to understand and review your benefits. Here’s an overview of what’s new in 2024. Medicare Part A and Part B costs in 2024 Medicare Part A covers inpatient hospital services, skilled nursing facility services, home health care, and hospice. Most people don’t owe a premium for Part A, but if neither you nor your spouse have 10 years of Social Security work credits, you may owe a monthly premium. If you’re admitted to the hospital...

  • Denied Medicare Part D coverage? You can appeal

    Sean McPhilamy, Alaska Medicare Information Office|Jan 1, 2024

    While I am writing this month’s article, we are in the last few days of the annual Open Enrollment Period, when you may sign up to change your enrollment in a Medicare Part D Prescription Drug Plan. This period occurs annually from Oct. 15 through Dec. 7; changing your plan at other times of the year may require you to be eligible for a Special Enrollment Period. But what if you don’t meet this requirement, and your prescription drug cost share (the amount you pay when you pick up the prescripti...

  • Medicare: Choosing doctors and other providers

    Sean McPhilamy, Alaska Medicare Information Office|Dec 1, 2023

    Choosing a medical provider can be both challenging and overwhelming for many patients. Here in the Great Land, Alaskans often travel significant distances to obtain healthcare. Medicare can help, when searching for and finding a provider. You can also save money by choosing providers who accept Medicare assignment. This last term, “assignment,” is an important one to remember, especially if you are newly enrolled in Medicare. First, a brief introduction to finding health care providers, fro...

  • Marketing can be intense for Medicare drug plans

    Sean McPhilamy, Alaska Medicare Information Office|Nov 1, 2023

    During Medicare’s Open Enrollment Period, you will likely experience more marketing from private Medicare insurance providers, such as Part D prescription drug plans. Companies try to reach consumers in various ways, like television commercials, radio ads, events, mailings, phone calls and texts. The government has rules, though, to protect you from forceful or misleading marketing. Knowing the rules and red flags can help you make the best choices for yourself during Open Enrollment. M...

  • Time to review your Medicare Prescription Drug Plan

    Sean McPhilamy, Alaska Medicare Information Office|Oct 1, 2023

    From Oct. 15 through Dec. 7, I encourage you to review and, if needed, change your Prescription Drug Plan under Part D coverage. Changes you elect will become effective on Jan. 1. Certified Medicare counselors across Alaska can help you as part of the Medicare Information Office’s network of program Ambassadors, including through your local Aging and Disability Resource Center (ADRC). Give us a call, we would be glad to answer your questions, guide you through the process, and even complete the...

  • Medigap policies help cover out-of-pocket costs

    Sean McPhilamy, Alaska Medicare Information Office|Sep 1, 2023

    As you may know, Original Medicare (Parts A and B) covers approximately 80 percent of the cost of most services. But what about the remaining 20 percent, or even the other out-of-pocket costs like deductibles or inpatient copayments? You may want to obtain a Medicare Supplement Insurance (also known as Medigap) policy as a companion to your Medicare coverage. But how to know which one? My first recommendation is to obtain a copy of the Consumer Guide to Medicare Supplement Insurance (Medigap),...

  • Medicare coverage for health-related transportation

    Sean McPhilamy, Alaska Medicare Information Office|Aug 1, 2023

    Ambulances are a critical resource in transporting patients to and from medical facilities, like hospitals. Ambulances are medically equipped and staffed by professionals like paramedics and Emergency Medical Technicians (EMTs). Emergency transportation Medicare Part B covers emergency ambulance services. Medicare considers an emergency to be any situation when your health is in serious danger, and you cannot be transported safely in another way. There are certain requirements you must meet for...

  • Your Medicare Part D prescription benefits

    Sean McPhilamy, Alaska Medicare Information Office|Jul 1, 2023

    Medicare includes Part D, the prescription drug benefit, offered through private health insurance companies. Each prescription drug plan meets federal requirements as managed by the Centers for Medicare & Medicaid Services (CMS). Insurance companies enter into agreements with both drug manufacturers and drug distribution networks. Some of the costs associated with Part D drug coverage are: Premium: The monthly amount that you pay to your Part D plan for coverage. Premiums vary by plan, and the...

  • Medicare coverage for mental health

    Sean McPhilamy, Alaska Medicare Information Office|Jun 1, 2023

    Mental health care can diagnose and treat mental illnesses or mental health conditions. A mental illness or mental health condition may affect your thinking, feeling or mood. Examples of mental health conditions include depression, anxiety and schizophrenia. Some also consider addiction, like opioid use disorder and alcoholism, to be mental health conditions. Mental health conditions are typically not the result of any single event or circumstance. Rather, they are complicated conditions involvi...

  • Medicare and making the most of your doctor visits

    Sean McPhilamy, Alaska Medicare Information Office|May 1, 2023

    Obtaining the best health care involves good communication between you and your doctor. Today I will help explain how you can build an effective relationship with your doctor and make the most of your visits. Communicate well with your health care provider Communication is very important when building relationships with your health care providers and getting the best possible care. To help you communicate with your providers, take the following steps: Be prepared. Arrive at your doctor’s o...

  • Medicare coverage for home health care

    Sean McPhilamy, Alaska Medicare Information Office|Apr 1, 2023

    Receiving home health care can be available for some Medicare recipients. To be eligible for Medicare coverage of home health services, you must be homebound. In other words, it must be difficult for you to leave your home and doing so requires a lot of effort. Medicare considers you homebound if you need help to leave your home. The help you need can be from another person or from medical equipment such as crutches, a walker or a wheelchair. You are also considered homebound if your doctor...

  • When is the correct time to enroll in Medicare?

    Sean McPhilamy, Alaska Medicare Information Office|Mar 1, 2023

    Enrollment into Medicare or choosing different Medicare coverage may only happen during specific times of the year. This month we will learn about these enrollment periods, so you can make the most of them. As a reminder, initial Medicare enrollment is processed through the Social Security Administration, whether in-person during an appointment, over the telephone, or by going online through Social Security’s website. Know when to sign up for Medicare for the first time You may be a...

  • Here is what's new in Medicare for 2023

    Sean McPhilamy, Alaska Medicare Information Office|Feb 1, 2023

    Medicare coverage and costs normally change each year, so it is important to understand and review your benefits. Here is an overview of what’s new in 2023. Part A Medicare Part A covers inpatient hospital services, skilled nursing facility services, home health care, and hospice. Most people do not owe a premium for Part A, but if neither you nor your spouse have 10 years of Social Security work credits, you may owe a monthly premium. If you are admitted to the hospital as an inpatient, you w...

  • Don't confuse Marketplace insurance with Medicare

    Sean McPhilamy, Alaska Medicare Information Office|Jan 1, 2023

    Medicare and Marketplace health insurance can easily be confused, but the two are different federal benefit programs. The Health Insurance Marketplaces were created by the Affordable Care Act. These Marketplaces allow people to buy insurance who do not have (or do not have enough) health insurance. You can access the Marketplace online at www.healthcare.gov or by calling 800-318-2596. Plans sold through Marketplaces are also known as Qualified Health Plans. Many people who have a Marketplace...

  • Medicare offers benefits to military veterans

    Sean McPhilamy, Alaska Medicare Information Office|Dec 1, 2022

    As a military veteran, this month’s topic resonates with me. Medicare can work with military-related healthcare, whether you are a military veteran or a military retiree. As a reminder, Original Medicare (available to the majority of eligible Alaskans) consists of Part A (hospitalization insurance) and/or Part B (medical service providers insurance). Part D is Medicare’s prescription drug plan benefit offered through third-party insurers who are approved both by Medicare and the State of Ala...

  • Review and update your Medicare Part D plan

    Sean McPhilamy, Alaska Medicare Information Office|Nov 1, 2022

    Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies as a standalone prescription drug plan (PDP) for those enrolled in Original Medicare. Sometimes a Part D plan's costs change or the plan no longer covers your medications. Today I will discuss how you can review your current plan, or choose to enroll in a new Part D plan. The goal is to ensure you have the lowest cost coverage that...

  • Medicare Open Enrollment presents options

    Sean McPhilamy, Alaska Medicare Information Office|Oct 1, 2022

    Another autumn is upon us, and one thing that means is that Medicare's Open Enrollment Period (OEP) will be happening soon. Each year from Oct. 15 through Dec. 7, you can make changes to your Medicare sponsored Prescription Drug (also known as Part D) coverage in order to meet your needs for calendar year 2023. As long as you make your decision and request any coverage changes by Dec. 7, then that insurance coverage will be effective, Jan. 1. You may be able to receive better drug coverage at a...

  • Medicare Open Enrollment season is approaching

    Sean McPhilamy, Alaska Medicare Information Office|Sep 1, 2022

    You may make changes to your Medicare Part D prescription drug plan coverage each year during Medicare’s Open Enrollment Period, which runs Oct. 15 to Dec. 7. Beginning in September, you may receive notices with information about possible changes to your coverage for the coming year. Please read these notices, as these can help you decide if you should make changes to your coverage during Medicare’s Open Enrollment Period. If you are currently enrolled in Medicare, watch for the “Medicare & You...

  • Services that Medicare does not cover

    Sean McPhilamy, For Senior Voice|Aug 1, 2022

    Our Medicare benefits were established under the Social Security Amendment of 1965, reflecting the restrictions and limitations of most health insurance at that time. This law excluded coverage for certain things, like dental care and routine vision services. Long-term care is also excluded because these services do not meet the definition of health care services in the law. Just because something is not covered by Medicare, though, does not mean that it isn’t needed. As I discuss some types o...

  • Identifying and fighting Medicare fraud

    Sean McPhilamy, For Senior Voice|Jun 1, 2022

    This June, we acknowledge 25 years of progress helping each other in preventing Medicare fraud. We appreciate your efforts, both for yourself, your fellow Alaskans, and all who benefit from Medicare. As your local Senior Medicare Patrol (SMP), we are ready to provide you with the information to protect yourself from Medicare fraud, errors and abuse. If you have any questions or concerns, please call the State of Alaska’s Medicare Information Office (MIO) to speak with any of our certified c...

  • Filing Medicare grievances and complaints

    Sean McPhilamy, For Senior Voice|May 1, 2022

    Things don’t always go according to plan. When unforeseen challenges or mistakes occur, you may wish to know to whom you may voice your concerns and who can help resolve your concerns. For an appeal regarding a denied claim, be sure to review your Medicare Summary Notice (MSN) to submit the appeal in writing. You are also encouraged to call the Medicare Information Office to speak with any of our certified counselors if you need assistance with the appeals process. Quality concerns If you h...

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