Just when you thought things had settled down…..
Medicare Open Enrollment begins October 7 and runs through December 7, 2026.
Until then, what items should you be considering?
Create an account at Medicare.gov if you haven’t already. This is a separate logon from the one you use for Social Security (ssa.gov). Here you can see your Medicare Summary Notices (MSN) for services you received that have been submitted by your provider on your behalf. You should also watch here to see if there are charges that don’t belong to you. As many layers of security as have been added, Medicare numbers can still be ‘hacked’ and charges made that are not your responsibility.
If you are already enrolled in Medicare, how has your plan been working for you? Have you received notice of a premium increase for your Medicare supplement? You may apply to a different company that has a lower premium, understanding that the insurance company will ask you questions regarding your health (this is called underwriting). This doesn’t mean you shouldn’t apply. Each company has its own underwriting criteria and what health conditions work for one may not for another. At a minimum, you should talk with an insurance consultant (broker) to see what your options are.
What do you do if Medicare denies payment of a service? If you have Original Medicare, yes, you have the right to appeal. You can see what has been paid by viewing your MSN either online or if you have received it by mail. First, contact your doctor’s office and make sure there was not a billing error (wrong code). If the code they submitted is correct, start your appeal by following the appeal instructions on the MSN or Redetermination Request Form. This must be submitted to the Medicare Contractor (MAC) within 120 days of the date on MSN. (MAC contact info is on the form). The MAC should decide within 60 days. If your appeal is successful, your service or item will be covered. If your appeal is denied, you can move on by appealing to the Qualified Independent Contractor (QIC) within 180 days of the date of the MAC denial letter. The QIC information is listed on the denial letter, and they will also provide a decision within 60 days.
What’s going on with GLP-1 you ask? Starting July 2026, Centers for Medicare & Medicaid (CMS) will start a short-term model to allow certain Medicare beneficiaries access to GLP-1 meds for $50 per month. The program, called Medicare GLP-1 Bridge, will run July 1, 2026, through December 31, 2027. At this time, an eligible GLP-1 drug is any of the following products when used to reduce excess body weight and maintain weight reductions: Foundayo, Wegovy (injection & tablets) and Zepbound (KwikPen). Certain criteria must be met with regard to age, BMI, and certain health conditions. For more information www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge#overview
I am available to help navigate any of these or if you just have a question.
If there are topics of interest to you, let me know by sending a note through my website.
Mary Hansen is a licensed insurance consultant (broker) with American Republic Insurance Services. She looks forward to answering your questions. You can submit them to her website: maryhansenmedicare.com Phone: 630.286.9160 You can also find her on Facebook: https://www.facebook.com/foxvalleymedicarehelp/ Look for her daily posts!
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