UNITED STATES— Hello Toni, in May, my retiree benefits will be changing, and my husband and I will no longer be covered because we both will be 65. I am afraid that my husband and I will not be medically taken care of since we were forced to make this change and enroll in the retirement plan’s Medicare Advantage plan.
Can you please explain a few rumors I have heard? Many doctors are not accepting Medicare due to low Medicare reimbursements and that if you are over 75 and need care for cancer, that it will be denied. Please tell me what is true and what is a rumor? Thanks, Anne from Atlanta, Georgia.
Hello Anne, never have I seen the Medicare community as concerned about their retirement Medicare benefits as they are now since corporations have let their retirees go to search for a Medicare option with no direction regarding how to personalize your plan.
One thing that Healthcare Reform affected is how your Medicare dollars are being spent.
Below are some of the rumors that are circling around in the forms of bogus emails and scams that we all are receiving.
• Doctors will not be accepting Medicare because of the amount of reimbursement and the overwhelming paperwork. This is NOT a rumor. Many of your “smaller” family clinics that do not specialize in the 65 or older community, are not processing Medicare claims and thus not accepting Medicare assignment, but there are plenty of primary care physicians or PCPs that are still accepting Medicare patients. Larger clinics are generally still accepting Medicare as well as Medicare Advantage plans. For those turning 65, make sure to establish a relationship with a primary care physician as well as a specialist prior to turning 65. Do not wait past 65 to start going to the doctor because it may be hard to find one that is accepting “NEW” patients. Many doctors are accepting current patients for Medicare with no problems but have what is called a “closed panel” for new patients.
• If you are over 75 and on Medicare, you will be denied cancer treatment! This is a rumor. Medicare does not distinguish what age you are as to what treatment you will receive. If it is “medically necessary” then Medicare will pay for it. Medicare does not ration care because of age. Last week, I wrote about Medicare clinical trials which is vital when one has a serious illness.
• A patient must be admitted in the hospital by their primary care physician not an ER doctor for Medicare to pay: Big Rumor. Medicare will pay, but the claim must be classified as “formally admitted” for Medicare Part A, in-patient hospital care, to pay; not file as “under observation” which is under Medicare Part B, outpatient care. Generally, your ER doctor will not follow your care, but turn it over to a hospitalist.
Toni Says®: Many retirees are losing retiree benefits and the companies are using Medicare Advantage plans as an option. Always check with your doctor when this happens and discover which Medicare Advantage plans that specific office accepts. Email the Toni Says® Medicare team us at firstname.lastname@example.org for your specific situation.
Is the maze of Medicare confusing you? Visit www.abbs4u.com and attend ABBS (American Baby Boomer Society) Medicare courses for more Medicare education.
If you are still confused and would like to discuss your specific Medicare circumstances either email email@example.com and the Toni Says® team can help you.
Toni King, author of the Medicare Survival Guide® is giving a $5 discount on the Medicare Survival Guide® Advanced book and bundle packages for the Toni Says® newspaper article readers at www.tonisays.com.