Medicare Advantage Plans and Telemedicine

On Friday, April 5, 2019, the Centers for Medicare and Medicaid Services (CMS) finalized a proposal to expand the Medicare Advantage Plan (MAP) telemedicine benefits for seniors and people with disabilities by creating a new category of benefits eligible for additional telemedicine services. The new benefits, which will be available in 2018, fall under the Health Insurance Portability and Accountability Act (HIPAA) of 2010.

Medicare Advantage plans have long been able to cover the list of Medicare telemedicine services mentioned above, but in recent years Congress and CMS have expanded their ability to provide telemedicine services based on telemedicine for Medicare FFS and Medicare Advantage. Telemedicine, which must be provided as primary care, is usually limited to services covered by Medicare Part B and provided by a physician or others. The recipient is referred to as the provider, not the patient or his doctor.

Currently, MA plans have the option of offering other telemedicine services as an additional benefit, financed by additional premiums paid by students. The MA’s plan foresees that certain additional telemedicine services will be offered as primary and not as complementary services. Starting in 2020, under President Barack Obama’s Affordable Care Act (ACA) and President George W. Bush’s 2010 Health and Human Services Act (H.R. 2121), the federal government will unveil new “test services” that certain Medicare Advantage plans can offer, including expanded telemedical health care, marking the beginning of a new era of Medicare telemedicine coverage for Medicare.

In April, the Centers for Medicare and Medicaid Services passed a directive allowing Medicare Advantage to offer additional telemedicine services in 2020. Starting in calendar year 2020, participating Medicare benefit plans will be able to offer tele-health services as part of a plan that continues to cover face-to-face appointments on the same topics. The Centers of Medicare & Medicaid Services (CMS) is implementing the program on a basis that aims to move beneficiaries to more convenient and cost-effective – effective telemedical options for their health needs.

In a press release, CMS administrator Seema Verma called the move “an important step in bringing innovative technology to Medicare beneficiaries. The news is encouraging for Medicare Advantage plans, the 34 percent of Medicare recipients who participate in a plan, a figure that is expected to rise 11.5 percent this year.

Telemedicine can also improve the outcome of an organization and provides an alternative for elderly patients without transportation, such as people with disabilities or those in nursing homes.

The MA will now be able to offer telemedicine services to patients in urban and rural areas for a wider range of services than before. Medicare beneficiaries covered by a private insurer through Medicare Advantage have better access to tele-health services in their own homes. In addition, patients will be entitled to telemedical services in several places, namely at home. Patients no longer have to travel to a CMS – qualified telemedicine service center, and they also have the option of obtaining telemedicine services in another location – the patient’s home.

Compare Medicare Advantage plans for coverage of additional telemedicine services as a basic service, rather than a supplemental service, means that Medicare plans pay for services provided through capitalized payments. This coverage of basic rather than supplemental benefits will encourage Medicare benefit plans to expand tele-health coverage. These services are offered as part of the basic care, which means that MA students can access additional services such as telemedicine services in addition to the standard services at a lower cost.

This amendment will give the MA more flexibility in determining whether its telemedicine offerings will reduce its overall costs and will allow them to determine whether or not their telemedicine offerings will reduce overall costs.

Today’s announcement builds on the Medicare Advantage plan released earlier this week that provides Advantage Medicare access to telemedicine services for chronically ill patients with chronic diseases. We plan to offer complementary services to chronically ill patients that are not necessarily health-related, but can take into account social determinants of health.

With the new telemedicine supplemental benefit, Medicare Advantage plans will have the flexibility to offer beneficiaries a range of historic services. With increasing technological innovation and an increase in the number of beneficiaries eligible for telemedicine services, the Agency is pushing ahead with plans to broaden the range of beneficiaries – eligible telemedicine beneficiaries. The plans will be able to compete for patients based on the quality of their medical care and access to the best medical services available to them.

The new rules, which will take effect in 2020, will allow Medicare Advantage to offer telemedicine services to give patients more opportunities to receive health care from anywhere in their home.

CMS coverage of telemedicine services has historically been limited to Medicare Advantage plans in the United States and other health insurance plans. Recipients living in a geographical area can access telemedical services from home or office, but not from a hospital.

Your Dynamic Retirement

You can deduct your Part B premiums from your monthly benefits that you deduct while you’re receiving Social Security benefits. If you take out Medicare Part G or another type of health insurance, you may owe a monthly premium, depending on the plan you choose.

You pay a lump sum, known as a deductible, and Medicare starts paying for your care. Medicare covers most of the health care costs, such as prescription drugs, hospital visits and doctor’s fees. Both Part A and Part B of the original Medicare insurance have annual deductibles, but Medicare Part G and other health insurance plans also have deductibles.

Starting January 1, 2020, Medigap plans sold to new people through Medicare will not be allowed to cover Part B deductibles. Plans C and F are not eligible for Medigap Plan G, but they will still be available to you as of January 2, 2019. If you are eligible for Medicare but are not yet enrolled, you may be able to buy Plan C or Plan F.

If you take out a Medigap policy and wait until your COBRA insurance ends, you may have to behave yourself, including paying your union insurance before you pay for Medicare, or wait until your plan ends.

If you buy a Medigap policy sold by an insurance company outside your state, you may also need to conduct yourself.

Federal law does not require insurance companies to sell Medigap policies to people under 65. However, some states require Medigap insurance to sell you a Medigap policy even if you are older than 65, and you may be able to purchase any desired Medigap policy as long as you purchased it before the age of 65 and did not turn 65 at least two years before the policy’s term began.

According to CNBC, “While Medigap policies are standardized regardless of which insurance company sells them and where you live, the premiums can vary from insurer to insurer and among locations. And, experts say, this makes it important to understand the differences you may see when evaluating your options”.

“You’d want to know a carrier’s premium rating system, its claims history and how good its customer service department is,” said Elizabeth Gavino, founder of Lewin & Gavino in New York and an independent broker and general agent for Medicare plans.

Employer plans often offer coverage similar to Medigap, but you don’t need a Medicaid policy. If you have group health insurance through your employer or a union that you or your spouse currently work for, you may want to wait until you enroll in Part B of an employer plan. Employers are not obliged to provide pension coverage, and they can change benefits and premiums, or even cancel coverage. You can control your insurance coverage if you cover retirees through an employer’s union.

Get a copy of your plan’s benefits brochure, call your employer’s benefits manager and look for a summary of the plan description provided by your employer or union. Your employer and your union can offer options to limit pension protection for you or your spouse, limit the amount of contributions or limit the number of years you are paid.

Federal COBRA rules protect you if your former employer goes bankrupt or goes out of business and other companies in the same organization still offer a health plan to the group.

If you have a Medicare Advantage plan and plan to return to the original Medicare, you can apply for a Medigap policy at the end of your COBRA period. When you leave your plan, your Medigap insurer will sell you a plan with no deductibles, no co-pays and no outside costs, leaving you with $1,000 a month in annual and deductible payments and $2,500 a year at the end – up. You have the right to purchase the Medigap policy even if you cannot or cannot obtain COBRA continuation insurance, as there is no longer an open enrollment period under the ACA.

If you are already enrolled in Medicare Part B, you will not receive a Medigap Open enrollment period when you turn 65. So, because you are insured on an ongoing basis, you ask for a new policy that takes effect when your Medicare Advantage enrollment ends.

You are likely to have a wider choice of Medigap policies and receive a lower premium over time. However, these policies are likely to cost you more than the average premium for a Medigap policy sold to people under 65. If your insurer decides to sell you a Medicaid policy for people over 65, you can use your medical insurance as the basis for the policy even if you don’t live in the state.

Even if you have occupational insurance, your employer can designate Medicare as primary health insurance at age 65, depending on your employer’s size.

If your occupational insurance is considered secondary coverage, you and other private insurers will pay for your medical claims, while Medicare pays its share. If your jobs – related insurance will be secondary coverage, then it’s important to sign up for Medicare. However, when your employers designate Medicare as your primary health insurance at age 65, Medicare becomes your secondary insurance, just as if it were your primary health insurance.

You will receive a letter from your employer’s insurance company informing you that you have a Medicare Part D plan that provides drug coverage for prescription drugs and other health services. You can sign up for part of the plan and have the memorandum of understanding made available to Medicare. If you lose your drug coverage, you are responsible for paying a portion of the penalty if you behave in one of the following ways: (1) underpaid, (2) out-of-pocket, or (3) over-the-counter.