Do Medicare Advantage Plans Frequently Deny Care That Would Be Covered by Original Medicare? Two Enrollment Periods, One Critical Decision — Don’t Make the Wrong One As the Original Medicare Open Enrollment (October 15 – December 7) period winds down for the year, you may still be contemplating whether to switch from Original Medicare […]
What Are the Differences Between the Medicare Supplement Plans — and Should You Switch from Plan F to Plan G?
If you have Original Medicare and want help covering the out-of-pocket costs that Original Medicare doesn’t pay — such as deductibles, coinsurance, and co-payments — you probably already have Medicare Supplement Insurance, also called Med Supp and Medigap coverage. These plans are sold by private insurance companies but are standardized by the federal government. […]
Key Changes Coming to Medicare in 2026
What Are the Three Key Changes Coming to Medicare in 2026 — and How Could They Affect You? As Medicare’s 2026 plan year approaches, seniors are facing more moving parts than usual. This year’s open enrollment period — running through December 7 — is especially important because several cost and coverage changes are […]
Nearly Half of QMBs Are Wrongly Billed — Are You One of Them?
How QMB Beneficiaries Are Still Getting Charged for Services They Shouldn’t Have to Pay For If you or someone you love is enrolled in the Qualified Medicare Beneficiary (QMB) program, here’s something you should know — you are legally protected from paying any out-of‑pocket costs for Medicare Part A or Part B services: no deductibles, […]
Virginia’s New Medicare Supplement Birthday Rule: No Health Questions Once a Year!
Virginia’s New Medicare Supplement Birthday Rule: No Health Questions Once a Year! Virginia’s New “Birthday Rule” for Medigap Policies — A Game-Changer, But Not a Federal Law A new law taking effect in Virginia on July 1, 2025, gives Medicare Supplement (Medigap) policyholders a valuable opportunity: the right to switch plans every year around their […]
What’s in a Name? “Rehab” vs. “Subacute Care” in Virginia, Maryland, and DC
When a loved one is hospitalized and begins to recover, doctors and discharge planners will often recommend transfer to another facility for ongoing care. But depending on whether you’re in Virginia, Maryland, or the District of Columbia, the terminology used to describe this next level of care may sound very different — even when the […]
$1.3 Billion is Being Spent for Medicare Advantage Health Plans that Provide No Care to Veterans
This week, we observed Veterans’ Day, honoring Veterans for their incredible strength, resilience, and commitment to our country. As we are also in the midst of Medicare Open Enrollment (October 15 – December 7), now is an important time to ensure that our nation’s veterans are receiving the healthcare they require, whether it be from […]
Medicare Open Enrollment Updates for 2025
For those enrolled in Medicare, you will soon have the opportunity to make changes to your health and prescription drug coverage. Medicare’s Fall Open Enrollment begins on October 15 and lasts through December 7, 2024. During this time, those with Medicare can make changes to their Medicare coverage which will go into effect on January […]
One-Stop Resource for Medicare Offerings
Dear Angel, I recently signed up for Medicare. What is the best place to go to find out about all of the offerings, including preventative care and chronic care management? Thanks for your help! Juan Stopp — Dear Juan, Coverage to Care initiative created by the Centers for Medicare & Medicaid Services (CMS) to help […]
Should You Ever Prepay a Hospital Bill?
A week before she was due to have knee replacement surgery, Jennifer got a call from the surgeon’s office. She was told that she had not met her annual deductible, so she would owe $700 up-front. Jennifer paid because she thought she had to. Later, when she got an explanation of benefits statement from her […]
Happy Birthday Medicare!
Dear Kiwi and Mango, I understand that July 30 marks the 59th birthday of Medicare. I will be 65 early next year. What should I do and what resources can I count on for more information before I sign up? Thanks for your help! Cella Brate — Dear Cella, You are correct! Next month marks […]
Should I Enroll in Medicare if I have Federal Retiree Coverage?
Q. In your latest article, you discuss how elder care lawyers help seniors with planning in advance for the financial and health concerns that occur as we age. I really appreciate the assistance and advice your elder law firm provides. I am a retired federal employee who will be 65 next year. I was wondering […]
What Does Medicare’s New Rule Mean for Prior Authorization?
Q. My wife and I are currently on Medicare. Something problematic that we have experienced is that when we go to a doctor’s appointment and need a referral, we cannot go to a specialist or get some much-needed medications without prior approval. It may take days, weeks, or even months for a necessary test or […]
The Darker Side of Medicare Advantage Plans
Q. Last year, during the Medicare Open Enrollment Period, my wife and I saw a commercial on television for a Medicare Advantage (MA) plan that sounded almost too good to be true. The company seemed reputable, so we took the claims for better prices and a wider range of services at face value and quickly […]
Why Medicare Advantage Ads Look So Different This Fall
Q. I heard somewhere that Medicare Advantage companies are being held to a higher standard this year when it comes to their advertisements, many of which were misleading to consumers in the past. My mother fell for one of the ads last year and enrolled in a plan where she couldn’t see her choice of […]
Part 2: When Artificial Intelligence and Health Don’t Mix
This is part two of a two-part series. In part one, “Is CMS’s Latest Effort Enough to Hold Medicare Advantage Companies Accountable?” I described how CMS plans to hold Medicare Advantage (MA) companies to higher standards for America’s seniors. This includes cracking down on misleading marketing tactics for Medicare Advantage plans, as well as […]
Part 1: Is CMS’s Latest Effort Enough to Hold Medicare Advantage Companies Accountable?
This is part one of a two-part series. The first part describes the recent rule to “strengthen Medicare Advantage (MA) and hold health insurance companies to higher standards for America’s seniors and people with disabilities by cracking down on misleading marketing schemes by MA plans.” Part 2 will describe how MA insurance companies have been […]
What the New Enhanced Auditing of Medicare Advantage Means for You
Q. I remember reading in one of your articles this past fall that some of the largest Medicare Advantage insurers are submitting inflated bills and that it’s one of the reasons everything is so much more expensive for plan enrollees. I also heard that the way Medicare Advantage plans are currently audited is a big […]
Customers Are Being Misled by Marketers into Signing Up for Certain Private Medicare Advantage Plans
Medicare Advantage plans now enroll nearly half of all Medicare beneficiaries, but some consumers are being misled because of the aggressive marketing campaigns by certain Medicare Advantage plans, and because of the fact that the federal government calls these types of plans “advantage plans,” leading consumers to believe that they provide some kind of advantage, […]
Now This Is SCARY! Medicare Advantage Is Submitting Inflated Bills to Make More Money, Totaling in the BILLIONS!
Q. I heard recently that most of the largest Medicare Advantage insurers are submitting inflated bills. Is this why everything has gotten so expensive for seniors enrolling in these plans? Also, what is being done about this? Thanks for your help! A. The New York Times recently published an article about how some Medicare Advantage […]
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