APA Fights On

On the latest in the medical world, Nada Stotland, MD, MPH and President APA said that the American Psychiatric Association will continue its struggle for legislation to stop the unfairness of the system which discriminates against Medicare patients who are in genuine need of mental health care.

 This comment was made by Dr. Stotland after the chance to debate on the Bill was lost on Thursday as they were six votes shorter than the necessary requirement of sixty votes.

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Missed Your Optimal Enrollment Period for Medicare Part B? When to Sign Up

If you are eligible for automatic enrollment in Medicare Part A, you will start getting it the first day of the month you turn 65, or, if you are disabled and under 65, after you have been receiving disability benefits from Social Security or Railroad Retirement Board for 24 months. If you are not eligible for automatic enrollment, you should sign up when you’re close to 65.  However, if you miss your initial enrollment period, there are some other times when you may be able to enroll.

Starting January 1^st and running until March 31^st each year, the General Enrollment Period is the next best thing.  When you sign up during the General Enrollment Period, your coverage will start on July 1^st. The drawback for waiting until the General Enrollment Period, of course, is that you may be responsible for paying a late-enrollment penalty.  Unfortunately, you might need to pay the late-enrollment penalty for as long as you have the plan. 

Another time you might be able to enroll is during a Special Enrollment Period.  You may be eligible for a Special Enrollment Period if your or your spouse have a group health plan based on your current work.  You can then sign up for Part B at any point during your workplace coverage or in the eight-month period that starts when the employment (or group health plan coverage) ends.  Finally, if you didn’t enroll in Medicare Part B during your initial enrollment period because you were volunteering in a foreign country and already had health insurance for that reason, you may qualify for a Special Enrollment Period For International Volunteers.  Usually, when you are enrolling during a Special Enrollment Period, you won’t need to worry about a late-enrollment penalty.

While there are, then, ways for you to enroll in Medicare Part B outside of your initial enrollment period, the optimal time is, of course, when you are first eligible.

Eligibility and Enrollment in Medicare for End-Stage Renal Disease

Most people know that Medicare is health insurance designed for people 65 and over, or under 65 with certain disabilities.  What a number of people don’t realize is that Medicare also covers individuals at any age who have End-Stage Renal disease, or ESRD (permanent kidney failure requiring dialysis or a kidney transplant).

In order to receive Medicare coverage for ESRD, if you need regular dialysis or have had a kidney transplant, you must be enrolled in Medicare Parts A and B.  To be eligible to receive Medicare Part A, you or your spouse (or your parent, if you are a dependent child) need to have worked the required time under Social Security, the Railroad Retirement Board, or as a government employee, or you need to be getting or eligible for Social Security, Office of Personnel Management, or Railroad Retirement benefits. You are eligible for Part B if you get Part A.    

To enroll in Medicare due to ESRD, visit your local Social Security office or call them at 1-800-772-1213.  Remember, you must sign up for Medicare Parts A and B in order to receive ESRD coverage.  It’s a good idea to apply for Part B at the same time as Part A to avoid any late penalties. 

Low-Income Subsidy Designed to Help Qualifying Seniors Pay for Prescription Drugs

If you qualify for Medicare and have limited resources, you may also qualify for the low-income subsidy available to people who need extra help. This subsidy is intended to help individuals pay for their Medicare drug plan’s monthly premium, yearly deductible, and coinsurance/copayments.  It can also limit any coverage gaps.

 To qualify for extra help, you need to have limited income and limited resources available to you.   This year, you might qualify if you alone make below $15,315 and have resources under $11,710.  If you are married and living with your spouse (with no other dependents), you must make below $20,353 per year and have resources under $23,410. 

A number of people automatically qualify for this extra help. For instance, if you have full Medicaid benefits, are receiving help from your State Medicaid program, or are receiving SSI without Medicaid, you will most likely automatically qualify for the low-income subsidy.  If you do, you will receive a letter from Medicare to inform you of your status.  After qualifying, you need to choose a Medicare drug plan in order to reap the benefits of your extra help. Research your available plans and select one that covers the medication you require.  If you don’t select a plan, Medicare will select one for you.

Even if you don’t automatically qualify for extra help, you may be able qualify by applying.  To apply, contact Social Security at 1-800-772-1213 or visit them online at www.socialsecurity.gov.