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Medicare 2016 Costs


The Medicare 2016 costs are out! We’ve updated our Medicare fact sheet to reflect the new numbers, and we invite you to download it and share (link below).

Medicare 2016 Costs

This is a breakdown of the Medicare 2016 costs, and the related comparison costs for 2015:

Part A premium Most people don’t pay a monthly premium for Part A because they have enough eligible quarters of employment. If you don’t, you’ll pay up to $411 in 2016 ($407 in 2015).
Part A hospital inpatient deductible and coinsurance  You pay:

  • $1,288 deductible for each benefit period ($1,260 in 2015)
  • Days 1-60: $0 coinsurance for each benefit period
  • Days 61-90: $322 coinsurance per day ($315 in 2015)
  • Days 91 and beyond: $644 coinsurance ($630 in 2015) per each “lifetime reserve day” (up to 60 days in a lifetime) after day 90 for each benefit period
  • Beyond lifetime reserve days: all costs
Part B premium Most people (current beneficiaries who receive SS and are not subject to the income adjustments) pay $104.90 each month (unchanged from 2015).*
Part B deductible and coinsurance $166 per year ($147 in 2015). After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and medical equipment.
Part C (Medicare Advantage) premium These costs vary by plan.
Part D premium Premiums and coverage vary by plan. Higher income individuals pay more.

*If you were not previously enrolled in Medicare Part B, do not receive Social Security or are dual-eligible for Medicare and Medicaid, the standard benefit for 2016 is $121.80 (dual-eligibles’ costs are picked up by the state’s Medicaid program, however). Higher income individuals ($85,000 for individuals, $170,000 for couples, based on your tax return from two years ago) pay an adjusted amount, up to $335.70.

When eligible for Part A Skilled Nursing Facility coverage following a qualifying hospital stay, the co-pays are as follows:

  • Days 1–20: $0 for each benefit period.
  • Days 21–100: $161 coinsurance per day of each benefit period ($157.50 in 2016).

To read more about Medicare costs 2016 and get a concise overview of Medicare’s parts and coverage, download our free 2016 Medicare fact sheet.

Contact our healthcare advocates at 727-447-5845 for personalized Medicare advice today! Time’s running out for the open enrollment period to analyze how you might save money on Medicare costs in 2016 and make change.

We’re here to help you and your family age wisely and well.

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News Update: Possible Relief on 2016 Medicare Premium Increase


2016 Medicare news update

As we shared in our recent post, some Medicare beneficiaries could be facing a steep hike in their 2016 Medicare premiums. Part B premium increases are tied to Social Security COLA (Cost of Living Adjustment), and since there will be no COLA in 2016 (announced October 15th) most (about 70%) of Medicare recipients fall under the “hold harmless” protection and will not pay more. However, the remaining 30% (those not receiving Social Security, new Medicare enrollees, and high income individuals) could be facing a base rate increase of 52% (from $104.90 to $159.30) on their 2016 Medicare B premium. The premium scales higher based on 2014 income (up to $509.80).

The potentially good news is that a bipartisan budget proposal which recently passed in the House of Representatives would offer relief for these 30% of Medicare recipients*. Under this budget, the 2016 Medicare premium increase would be reduced to about a 14% increase. In this proposal, the costs for Part B would be covered by a treasury loan, gradually paid back by incremental Medicare premium increases.

There are some other provisions in this budget that might affect you or your loved ones. First, on a positive note, it addresses potential cuts to Social Security disability payments, by reallocating some of the payroll taxes to this program. On a less positive note, some households may be losing Social Security benefits (those receiving benefits under a spouse, ex-spouse or parent’s work record…if that person has suspended his/her benefits).

Get all your 2016 Medicare News!

We will keep you updated on the progress of this bill and other 2016 Medicare news. We invite you to sign up to be one of the first to receive our 2016 Medicare fact sheet, as well as our monthly insider tips.

You may want to read our article about Medicare 2016 open enrollment as well.

*Update: The bill was passed in the Senate.

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Medicare Facts and Figures for 2015


On October 9th, Secretary of Health and Human Services Sylvia Burwell announced the Medicare costs for 2015.

The great news is that the Medicare B premium ($104.90) and deductible ($147) will remain at the same levels for the coming year! Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and more. Since 2007, higher income individuals ( above $85,000/year for individuals, $107,000 for joint tax returns) pay higher Part B premiums, up to $335.70 (see above article for the chart detailing the different levels).

Most Americans do not pay a premium for Part A services (hospital coverage: pays for inpatient hospitalization, skilled nursing and some home healthcare) because they have sufficient quarters of employment (40+) to qualify for Part A premium-free. For those who have 30-39 quarters of employment, the Part A premium in 2015 is $224 (down $10 from this year) and for those with 0-39 qualifying quarters, the cost is $407 (down $19).

When a Medicare recipient is admitted to the hospital, there is a Part A deductible (costs for up to a 60 day stay), which will be $1260 in 2015 (an increase of $44 over 2014). For longer stays, beneficiaries pay an additional $315 per day for days 61 through 90 in 2015, and $630 per day for hospital stays beyond the 90th day (up to 60 additional “lifetime reserve days” available; then recipient pays all costs).

Medicare Part A also covers limited skilled nursing/inpatient rehabilitation coverage*. If recipients qualify for coverage, they will owe a co-pay for days 21-100, which is $157.50 in 2015 (up from $152). For many Medicare recipients, this co-pay is covered via supplemental insurance.

*Skilled nursing facility coverage is based on meeting criteria (medical necessity for skilled inpatient rehabilitation/care and services are reasonable and necessary for your condition/prognosis). You do not automatically get a full 100 days and for many conditions; less time is very likely. The SNF coverage is also dependent upon a qualifying 3-day hospital stay (observation time does not count; see link above about hospital admissions) for the related condition. 

For the full breakdown of 2015 Medicare costs, see our Medicare 2015 Fact Sheet. We also offer these in printed form for your office/clients. For information or individualized assistance with Medicare, contact us at 727-447-5845.

Don’t forget to review your Medicare D plan for 2015! Open enrollment is from October 15th-December 7th and our patient advocates are standing by to help you ensure you save money and get the best possible coverage (without the sales pitches!).


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2015 Medicare Open Enrollment: What You Need to Know


Medicare prescription drug coverage

2015 Medicare Part D open enrollment is available from October 15, 2014-December 7, 2014 for current Medicare beneficiaries.

Why should everyone review their Medicare drug plan during open enrollment?

A Florida study done a couple years ago found the great majority of their sample were not in the best (most affordable) plan for them. A plan switch can sometimes save the client thousands of dollars over the year. Sometimes your current plan is still the best, but you won’t know without comparing. And, if your plan made changes or you had medical changes, another plan may be much better for you next year.

What information do you need to compare Medicare drug plans?

  1. Medicare # and effective date for Part A (see Medicare card)
  2. List of current medications (with dosages/frequency)
  3. Preferred pharmacy(ies), if applicable

Additionally, you may want to be prepared with some information on how Medicare works and your options for receiving coverage. If you plan to stick with traditional Medicare and simple review your drug plan choices, that will be pretty straightforward. But, if you are on a Medicare Advantage Plan and want to consider switching back to traditional Medicare (or vice versa), or have other coverage (VA, retiree health insurance, etc.) and may be making changes, you should have a basic understanding of the pros and cons with different options, costs, etc. (or enlist help from one of our patient advocates). The Medicare website offers a good overview and the Center for Medicare Advocacy also provides a range of educational materials.

Medicare Part D #s for 2015

The standard Part D deductible and out-of-pocket limit will increase in 2015, while donut hole (gap) coverage will increase. Looking ahead to 2015, here are some of the changes in the standard benefit as set by CMS (Center for Medicare and Medicaid Services):

  • Initial Deductible:
    will be increased by $10 to $320 in 2015
  • Initial Coverage Limit:
    will increase from $2,850 in 2014 to $2,960 in 2015
  • Out-of-Pocket Threshold:
    will increase from $4,550 in 2014 to $4,700 in 2015
  • Coverage Gap (donut hole):
    begins once you reach your Medicare Part D plan’s initial coverage limit ($2,960 in 2015) and ends when you spend a total of $4,700 in 2015. In 2015, Part D enrollees will receive a 55% discount on the total cost of their brand-name drugs purchased while in the donut hole. The 50% discount paid by the brand-name drug manufacturer will still apply to getting out of the donut hole, however the additional 5% paid by your Medicare Part D plan will not count. Enrollees will pay a maximum of 65% co-pay on generic drugs purchased while in the coverage gap.

 Contact Aging Wisely’s patient advocacy team to learn more about how we can help with your Medicare choices!

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Preparing for Medicare Open Enrollment 2015


medicare annual open enrollment

Facts about Medicare Open Enrollment for 2015

Each year, Medicare recipients have the opportunity to change Medicare plans for the coming year. The period of time allocated for making changes is the annual open enrollment period or annual coordinated election period. For the past couple years, this period has been October 15th-December 7th.

Almost 90% of Medicare’s nearly 50 million beneficiaries have some form of prescription drug coverage, with more than 17 million enrolled in private drug plans through the prescription drug program (Part D). Of those 17 million, 14 million are in the top 10 plans. Though plans must have basic key features, covered drugs and costs vary widely. You cannot necessarily just look at the monthly premium to determine what is best for you so it’s important to take the opportunity to look at your choices.

Here are a few key Medicare facts and dates:

  • New Medicare recipients (those who turn 65 or become eligible for Medicare, such as via a disability) have an initial 7 month enrollment period (to avoid late enrollment penalties): the 3 months prior to the month of eligibility, the month of eligibility and the 3 months following. Coverage begins the first day of your eligibility month (or the first day of the month you enroll if you don’t enroll until after your eligibility month).
  • Each year, current recipients can make changes to their Part D plan from October 15th to December 7th. The new plan will begin on January 1st of the following year. Everyone should do a review since both the plan options and your personal situation may have changed.
  • From January 1st-February 14th there is also a Medicare Advantage Disenrollment Period. During this time, those who are enrolled in a Medicare Advantage plan can disenroll, switch back to regular Medicare and pick a Part D plan.
  • There are Special Enrollment Periods (SEPs) for those in certain circumstances. These include moving in or out of a skilled nursing facility.
  • **You may hear information about enrollment periods or other details about the new healthcare plans under “Obamacare” (for example, the open enrollment period was originally set to correspond with the yearly Medicare period, but has been delayed). Do not get this information confused with Medicare. Also, beware of scammers who may try to take advantage of confusion around Obamacare and convince you that your Medicare plan is affected and you need to provide personal data.

All this seem a bit confusing? Check out our 2014 Medicare fact sheet (we will have a 2015 version as soon as those numbers become available) or contact us about our Medicare Analysis services.

Our expert care managers can save you money and reduce your hassle! Trust our patient advocates…they do not sell insurance but instead offer expert guidance based on years helping patients navigate the healthcare system.

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Florida Medicaid: The Big Switch to Managed Care


Florida Medicaid advocacy

Medicaid reform legislation that was proposed in Florida in 2011 was designed to move management of Medicaid benefits to private, for-profit managed care companies. In the time since, there have been many meetings and debates, various changes, pilot programs and challenges to overcome in getting this concept implemented. However, the time is now here…and Florida Medicaid recipients will soon be receiving letters asking them to enroll in a particular plan (if they have not already). The state is rolling these changes out on different dates in the various counties. The roll out date for Pinellas, Pasco and Hillsborough counties is February 1, 2014.

What does this mean for Florida seniors?

If you are receiving Medicaid benefits or you have applied, this change affects you…and means you will have some decisions to make. If you care for an aging parent in Florida and/or serve as a decision maker (for example as guardian, P.O.A., healthcare surrogate) for a Florida elder or other person receiving Medicaid benefits , you should understand these changes so that you can assist and understand what choices need to be made. Essentially, all Medicaid beneficiaries will now be receiving benefits through a managed care company. So, they will have to choose which plan they wish to enroll in to manage their benefits. If a senior does not make a choice, Florida will choose a plan for that person. Enrollment is mandatory. The plan will oversee your benefits and care plan for determining how much/which benefits and services you receive. Once enrolled in a plan, a representative will meet with you and develop a care plan (you are entitled to have an advocate with you at this meeting and to have input in developing your care plan). If you have problems with your plan or the care being provided, there are specific processes for complaints and changes (the consumer guide below provides information on this; it is important to note that you have limited time frames for making changes and filing complaints).

What do I need to do?

You will have some decisions to make and it is very important to clearly understand these decisions and how they may affect your care. There have also been numerous program glitches that could cause issues for you. If you work with an Aging Wisely care manager currently, your care manager can help you through this process and provide resources to help at various stages. Our team has been studying the changes and getting training from some of the top experts, so we can be best prepared to help you. As always, we also work collaboratively with expert providers so we can refer you for help in specific areas.

Consumers can get some excellent information on these Florida Medicaid changes on the website Foundation for LTC Solutions. This group of Florida elder advocates has created resources like a decision tree and guide for the enrollment decisions. If you want to understand more about the program and decisions involved (as well as some of the pitfalls and important tips), you can download their Florida Medicaid Managed Care Consumer Guide. The guide is divided up in to sections based on your situation (answer a couple simple questions to be guided in to the correct section), so that while there is a lot of information you should only need to review the section that is applicable to your (or your loved one’s) situation.

Because Medicaid benefits will now be managed by the specific plan in which you enroll, the decisions can have a big impact on the care you receive. For example, if you are currently receiving home health benefits or care at assisted living, you may have to switch providers or move if your new plan is not contracted with these providers. We want to draw your attention to the importance of this major change, while not panicking you. Advocates have worked hard to spot the difficulties with the process and fight for protections. There are some safeguards built in and options if you encounter problems. Having a good care team is essential for each elder… you need strong advocates and resources to help (whether dealing with issues related to Medicaid managed care or just eldercare in general).

If you are working with Aging Wisely, your care manager will be reaching out to you about these changes as they apply to you and offering assistance. The resources above offer great insight for Medicaid recipients and their loved ones/decision makers to get an overview and answers to key questions.

If we can help with any questions or resources about Florida Medicaid, Medicare or other patient advocacy issues, please contact us at 727-447-5845.

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