Senior Voice -

By Rita Hatch
Senior Voice Correspondent 

Reviewing the Affordable Care Act, new Medicare rules

 


I would like to reiterate, for all the Affordable Care (ACA) skeptics, the many benefits of ACA:

1. Health care plans now must allow parents to keep their children who are under the age of 26 on their family health coverage.

(The exception in Alaska is because our governor has decided that the Alaska Care Retiree Health plan is not subject to that provision.)

2. The new 80/20 law means that insurance companies cannot spend more than 20 percent on administrative costs and must spend at least 80 percent of your premium on health care and quality improvements and not on the salaries of CEOs. If they don’t do this they must pay you a rebate or reduce your premiums.

3. The Affordable Care Act increases the funding available to community health centers. The 178 Community Health Care Centers in Alaska, which provide preventive and primary care services to 91,020 people, have received $48.7 million under the Affordable Care Act.

4. Insurance companies can no longer drop your coverage if you get sick.

5. Starting in 2014, no one can be denied health insurance because of a pre-existing condition.

6. You no longer have to pay some of the out-of –pocket expenses for preventive care. This includes immunizations, mammograms and other screenings for certain cancers and diabetes.

7. Starting in 2014, insurance companies can no longer place lifetime or annual dollar limits on your health coverage.

National mail-order program for diabetic testing supplies

I wrote about the new Medicare rule in my last column and Judith Bendersky of the state Medicare office has a column in this month's Senior Voice further explaining the new rules.

This program is designed so you can continue getting quality supplies while saving money. You will need to use a Medicare national mail-order contract supplier for Medicare to pay for diabetic testing supplies that are delivered to your home.

If you do not want these supplies delivered to you, you can go to any pharmacy that is enrolled with Medicare and buy them there. You should check that the store accepts assignment, which means that they accept the Medicare-approved amount as payment in full.

My experience is in trying to find a solution for Tier 1 retired state employees who are facing the loss of using Costco Mail Order to get their diabetic testing supplies. I found out that most of the state employees at Retirement and Benefits and AlaskaCare did not even know there was a new regulation, which starts July 1, 2013.

What I have found out that applies to retired state employees is that you can no longer get your diabetic supplies through Costco mail order if you want Medicare to pay for them. You will have to pick out one of the suppliers on an approved list and have your doctor send them a new prescription with the brand of glucometer that you are now using (or you can change to any brand you want to try out). The company you choose (a Medicare supplier) will then bill Medicare, and Medicare will bill Health Smart, our current insurer. Contact me and I will mail or e-mail you the list of approved providers.

Anyone can go to a local pharmacy that accepts Medicare and get the diabetic supplies that they use and Medicare will pay for it. However Medicare will not pay for any company that delivers it to you in any way (mail, parcel post, FedEx, pony express, dogsled, etc.) if they are not one of the companies that opted into this program.

If you are traveling outside of Alaska and need diabetic supplies or oxygen you will have to arrange with your current supplier, whom you have a contract with, to give you the name of a supplier in the area you are going to arrange to get more oxygen.

Alaska is not in a competitive bidding area. In order to find a competitive bidding area, you will either have to go to the Internet at http://www.cms.gov/DMEPOSCompetitiveBid or call Medicare at 1-800-Medicare (1-800-633-4227) for help in finding a contract supplier.

You may also call me and I will provide you with the list.

If this sounds crazy to you, the reason this is happening is to stop the instances of Medicare fraud and to ensure that the prices you pay for the diabetic supplies are not exorbitant. Congress decided that Medicare saved money in the first round of these changes to Durable Medical Equipment (DME) and it would include the rest of the country in these changes.

Editor's note: The Alaska Dept. of Health and Social Services has information about this topic here: http://dhss.alaska.gov/News/Documents/press/2013/MedicareMailDeliveryDiabeticSuppliesPR_061413.pdf

Beware medical equipment “freebies”

Do not respond to telephone offers for free diabetic supplies or if you get items in the mail that you did not order. If either of these things happen, you should protect your Medicare number or any other personal information to anyone who calls you. Don’t accept items that you did not order. If you suspect fraud, call the fraud hotline at 1-800-447-8477. Or call 1-800-633-4227 (1-800-MEDICARE).

As always, if you have questions about anything I have written, please call me and I will discuss them with you.

Rita Hatch volunteers for Older Persons Action Group’s Medicare Counseling and Assistance program. Call her at 276-1059 in Anchorage or 1-800-478-1059 toll-free statewide. Her e-mail address is ritaopag@gci.net.

 
 

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