COVID-19 ACCELERATES USE OF VIRTUAL HEALTHCARE: WILL THIS GENIE EVER GO BACK IN THE BOTTLE?

Until now, virtual healthcare could still be described as something of a novelty utilized by “early adopters” like those consumers that traditionally are the first to use a new technology.

I bet, until now, if you asked a healthcare expert about when virtual healthcare would become truly a customary part of our national health landscape, most would have predicted a gradual increase in use and a general market acceptance over roughly the next 10 to 20 years.

Boy, with the emergence of the Coronavirus, it sure makes me think those expectations are quickly changing.

As a consequence of the Coronavirus Pandemic and the Stay-At-Home orders and other emergency responses to the pandemic that we have been living out around the country, virtual healthcare is emerging as a significant part of our health care delivery system.

Many patients and their providers who have experienced the convenience of virtual healthcare might not want to go back to a traditional in-person archetype of care that’s been the age-old norm.  At least as it relates to the blocking and tackling of our common, everyday healthcare needs.

Virtual visits have been cropping up as a covered service in many group health plans and even some Medicare Advantage plans recently.  It sure seems now, though, that as a result of this pandemic the door has been kicked wide-open for greater utilization of virtual healthcare services across our healthcare system.

Lots of employers who largely didn’t give virtual health a whole lot of thought before the Corona crisis are paying more attention and even started touting virtual office visits as an important employee benefit.  Many plans are now covering virtual visits and the like with no copays or out-of-pocket cost to employees and their dependents.  (However, please check with your specific plan regarding cost.)

And, even Medicare is making great accommodations for expanding virtual healthcare as a Medicare benefit, at least temporarily until the pandemic situation runs its course.

WILL THIS GENIE EVER GO BACK IN THE BOTTLE?

I doubt it.

How to Enroll in Medicare During the Corona Virus Emergency

Here are the latest Medicare Enrollment postings to the Social Security & Coronavirus Disease (COVID-19) website:

Can I enroll in Medicare?

Date: April 14, 2020

If you already have Medicare Part A and wish to sign up for Medicare Part B under the Special Enrollment Period (SEP), please complete form CMS 40-B, Application for Enrollment in Medicare – Part B (Medical Insurance) along with the CMS L564-Request for Employment Information and proof of employment, Group Health Plan (GHP), or Large Group Health Plan (LGHP). Return the completed forms to your Social Security office by mail or by fax to 1-833-914-2016.

Note When completing the CMS L564

• State on the form “I want Part B coverage to begin (MM/YY)”
• If possible, your employer should complete Section B.
• If your employer is unable to complete Section B, please complete that portion on behalf of your employer without your employers signature and submit one of the following forms of secondary evidence:
  • income tax form that shows health insurance premiums paid;
  • W-2s reflecting pre-tax medical contributions;
  • pay stubs that reflect health insurance premium deductions;
  • health insurance cards with a policy effective date;
  • explanations of benefits paid by the GHP or LGHP; or
  • statements or receipts that reflect payment of health insurance premiums.

Can SSA help me by phone?

Date: April 14, 2020

During the COVID-19 pandemic, we are asking the public to first try to use our online services before calling us.

If you cannot use these online services, although our offices are closed to the public, employees from those offices are assisting people by telephone. You can find the phone number for your local office by using our Field Office Locator and looking under Additional Office Information. (Note, if you already had a scheduled appointment with your local office, an employee from that office will attempt to call you at your scheduled appointment time.)

If you cannot use our online services or reach your local office, you may call our National 800 Number, where you may be able to take care of your business by using one of our automated telephone services without having to wait for a telephone agent. If you need to speak with an agent, be aware that wait times are longer than usual. You may have to wait 90 minutes or longer, which is why we encourage you to try our online services or call your local office first.

Main Nationwide Phone Number — 1-800-772-1213

To Find Your Local Office Phone Number Go To Local Field Office Locator , enter your zip code and then look for the phone number at the bottom of the page.

For more information you can go here – https://www.ssa.gov/coronavirus/

Medicare and Employer-based Coverage

When you have both Medicare and employer-based coverage, Medicare will either pay primary or secondary for your medical costs. When Medicare is primary insurance, Medicare pays for your medical bills first.  When Medicare is the secondary insurance, Medicare pays after the employer-based coverage pays . Usually, secondary insurance pays some or all of the costs left after your primary insurance has paid (for example, deductibles and copays).

This month’s Medicare Minute (courtesy of the Medicare Rights Center) addresses these and other questions:

How does Medicare work with job-based insurance?

What are the differences between primary and secondary insurance?

How does Medicare work with retiree insurance and COBRA coverage?

To read or download it, click here — Medicare and Employer-based Coverage.

UNEXPECTED MEDICARE PENALTIES AND INCOME-RELATED ADJUSTMENTS: CAN YOU APPEAL? HOW?

Medicare can be confusing and lead to unexpected costs. This is especially true if you’re not informed on the front end when you first become eligible for Medicare; or, if you delay enrollment, when you enroll that first time. The three most common surprise-cost culprits sprung on those new to Medicare include:

1.)   Medicare Income-Related Monthly Adjustment Amount (IRMAA)

• IRMAA is an amount you may pay in addition to your Part B and/or Part D premium if your income is above a certain level.  We wrote about IRMAA in this recent post 2020 Medicare Part B Monthly Premium and Income-Related Monthly Adjustment Amounts

2.)  Part B late enrollment penalty (LEP)

• For each 12-month period you delay enrollment in Medicare Part B, you may have to pay a 10% Part B premium penalty, UNLESS you have other credible coverage that is compliant with Medicare rules (such as insurance based on your or your spouse’s job-based insurance).

3.)  Part D late enrollment penalty (LEP)

• For each month you delay enrollment in Medicare Part D (Prescription Drug Plan), you may to pay a Part D late enrollment penalty unless you have creditable coverage that is as good or better than the basic Part D benefit or get “extra help” (Low Income Subsidy).

The good news, if you want to call it that, is if you get dinged for income adjustments or penalties – Yes, you can appeal.

In cases of IRMAA adjustments you can request a new initial determination right out of the chute if you have experienced a life-changing event that caused an income decrease, or if you think the income information Social Security used in making the initial determination is incorrect. If you don’t agree, you can also file for reconsideration or file an appeal.

You can also appeal your Part B and/or your Part D Late Enrollment Penalties (LEP) though the processes for doing so are different for Part B and Part D.

For Part B LEP, just follow the instructions on the notice that you received informing you of the penalty. You will need to prove that you were enrolled either in Part B or in coverage through current employment during the period of time for which you are being penalized.

For Part D LEP, you can appeal the penalty if you think you were continuously covered or if you think the amount of the penalty was calculated incorrectly. This appeal must be filed with Medicare’s contractor (MAXIMUS Federal Services) for handling appeals.

For more information on adjustments, penalties and how to file an appeal refer to this month’s Medicare Minute Newsletter courtesy of The Medicare Rights Center.

And go to:

Medicare Part B Premium Appeals | HHS.gov

Medicare IRMAA Life Changing Event Form

Late Enrollment Penalty (LEP) Appeals

If you have questions, we are happy to help:
Email: 65Plus@bbginc.net
Phone: 866-845-8600; Ext 130