Senior Health Services - Bill Wolfe Owner/Agent

09/02/2024

Are you confused about how and when to sign up for Medicare?

Are you confused about all the different plans and choices?

Well, we can help you understand and navigate the system.

Call for your no-cost evaluation, there is never a fee for my service.

Call now to connect with business.

10/13/2021

We represent many carriers for Medicare including:

Priority Health
BC/BS
AARP
Aetna
Humana
and many more.

We can also help guide you through the ever-changing Medicare system.

10/13/2021

It's Medicare open enrollment time again!
call for your no obligation review.

10/17/2015

About 30 percent of Medicare beneficiaries, or roughly 7 million Americans, are about to pay 52 percent more for their Medicare Part B premium.

10/27/2013

News for Priority Health Medicare members

Free in-home health checks
Our partner, CenseoHealth, will be conducting free in-home health assessments again this year for many Priority Health Medicare Advantage members. Last year, thousands of our members took advantage of this opportunity to learn about ways they could improve their health and the care they receive.

If you get a call inviting you to participate, please say yes. This will help us provide all of the services that are available to you through your Medicare plan.

Free dental coverage
We've added dental coverage to most of our Medicare Advantage plans, including PriorityMedicare ValueSM, PriorityMedicareSM and PriorityMedicare SelectSM. (Sorry, dental coverage isn't part of Medicare Advantage plans provided through employers.)

To check whether your dentist participates in this plan, you can visit deltadentalmi.com to use a searchable dental directory. Or call Delta Dental's toll-free number, 1-800-524-0149, for an automated system that lists names of participating dentists near you. If you have additional questions or wish to speak to someone directly, you can exit the system at anytime to speak with a Delta Dental Customer Service associate during their normal business hours, Monday through Friday, 8:30 a.m. to 8:00 p.m. (Eastern Time).


Free fitness membership
We've included a no-cost Silver & Fit® fitness membership in many of our Medicare Advantage plans: PriorityMedicare ValueSM, PriorityMedicareSM and PriorityMedicare SelectSM, so you can stay in shape at any age. If you prefer, you can choose to have home fitness kits delivered right to your doorstep. (Sorry, fitness memberships are not included in Medicare Advantage coverage through an employer.)

Getting started is easy.

Find a participating fitness facility near you by visiting prioritymedicare.com or silverandfit.com or by calling toll-free 1-877-427-4788 (TTY/TDD 1-877-710-2746), Monday – Friday, 8 a.m. to 8 p.m. Then either:
Register on the Silver & Fit® website, silverandfit.com, OR
Go directly to a participating fitness facility to sign up for your Silver & Fit® membership Customized-for-you directory

Our partner, CenseoHealth, will be conducting free in-home health assessments again this year for many Priority Health Medicare Advantage members. Last year, thousands of our members took advantage of this opportunity to learn about ways they could improve their health and the care they receive.

10/11/2013

Faster Assistance for Medicare Patients
By JUDITH GRAHAM

Just over a year ago, Medicare quality improvement organizations (Q.I.O.’s) across the country began a practice known as “immediate advocacy.”

These government-financed organizations have long helped older adults who appealed discharges from hospitals and other facilities or who had serious complaints about the quality of medical care. But these complaints often took months to investigate and resolve.

Now, for issues that don’t require a review of medical records, staff at a state Q.I.O. will listen to a senior’s concerns, get in touch with the health care provider, and try to work out a solution within a matter of hours or days. That can be a godsend for older adults or caregivers who get the brush-off when they try to get a provider to respond to a problem. When the Q.I.O. calls, action usually follows. (There are Q.I.O.’s across the country.)

Dr. Adrienne Mims, president of the American Health Quality Association, which represents Q.I.O.’s, and medical director of Alliant GMCF, the Q.I.O. in Georgia, recalled the case of a woman in her late 60s who needed physical therapy for a back injury she suffered during a car accident. She didn’t have a car and could only get a ride to the physical therapist’s practice in the morning, Dr. Mims said. But office staff refused to give her an appointment before noon; they said that time was reserved for people with private insurance.

“This woman called us, and our nurse reached out to the provider,” Dr. Mims remembered. “She asked, ‘Are you discriminating against a certain portion of the population?’ And that question was enough. They made arrangements to see her in the morning after that.”

Q.I.O.’s don’t have legal authority to require medical providers to comply with their recommendations. But “we serve as a convener, and we do have the authority to have these conversations,” said Patricia Merryweather, executive director of Telligen, the Q.I.O. in Illinois and Iowa. If a provider refuses to engage in discussions, “it moves to the complaint phase.”

Complaints require that a hospital, doctor and other provider make available medical records, which are reviewed by an independent expert. If the allegations in a complaint are confirmed, the Q.I.O. will contact the provider and propose a quality improvement plan.

For instance, a hospital may be asked to examine why wrong medications were ordered for a patient and to put in place a system that will prevent it from happening again. Or a nursing home may be asked to conduct extra training for aides if the Q.I.O. finds that patients with bed sores aren’t being turned and repositioned every few hours, contrary to recommended best practices.

“What we won’t do is take an institution’s license away or try to shut down a facility or help someone who intends to sue” over a medical problem, said Nancy Borgstadt, director of review services for CFMC, Colorado’s Q.I.O. In other words, the problem you experienced may lead to improved care for other patients who come after you, but it may not make things right for you. If that’s your goal, you may want to pursue other alternatives to the Q.I.O. complaint process.

The most recent annual report for IPRO, in New York, gives a sense of the kinds of concerns these organizations handle. Of 879 complaints brought to the organization between Aug. 2011 and July 2012, the largest number, 219, had to do with a failure to develop appropriate treatment plans for patients, while 69 dealt with the failure to deliver accurate diagnoses or medical assessments.

Altogether, 31 percent of complaints were substantiated by independent reviewers. Of that group, the failure to document in the medical record items affecting patient care was the most common substantiated complaint (79 percent), followed by the failure to coordinate care across disciplines (57 percent) and the failure to appropriately assess or act on laboratory or imaging results (53 percent).

10/08/2013

Medicare open enrollment: Prescription drug basics
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(MoneyWatch) Now's the time to review your Medicare prescription drug coverage, so you can be ready to make changes during Medicare's open enrollment period that runs from Oct. 15 to Dec. 7. Your goal? To minimize total out-of-pocket spending for prescription drugs, including the premiums you pay, plus your copayments and deductibles. This post provides some basic information about prescription drugs under Medicare, while my next post offers some ideas for managing your total out-of-pocket costs.

How to pick the right Medicare plan
Save lots of money by managing prescription drug costs
Medicare Part D donut hole: How to close it yourself
Medicare prescription drug basics

The cost of prescription drugs isn't covered by Medicare Parts A and B (which covers hospital and outpatient services) or by Medigap plans that supplement Medicare. In fact, there is no automatic coverage for prescription drugs under Medicare -- instead, you'll need to make a conscious choice about how to obtain prescription drug coverage. If you don't make any choice, there's a good chance you won't be covered for prescription drugs.

There are two ways to obtain prescription drug coverage under Medicare:

You can buy a stand-alone Medicare Prescription Drug Plan (PDP) under Medicare Part D. These plans add drug coverage to traditional Medicare and Medigap plans. If you choose to be covered under a traditional Medicare plan and purchase a Medigap plan to cover the costs that Medicare doesn't cover, you'll still have to buy a PDP to get prescription drug coverage. Monthly premiums in 2014 for PDPs are estimated to average $31.

You can enroll in a Medicare Advantage (MA) plan that also covers prescription drugs. (See my prior post for some background on MA plans.) MA plans cover some costs not covered by Medicare, but you usually have to use providers in the MA network. Not all MA plans cover prescription drugs, so you'll need to look closely at the terms of your MA plan to see if it does. If your MA plan doesn't cover the cost of prescription drugs, you'll need to buy a PDP as explained above.
There's actually a third way to be covered for prescription drugs, but it's not that common. If you're one of the lucky few who's covered by your former employer's retiree medical plan, these plans will often cover the cost of prescription drugs for no additional premium other than the premium you're already paying for medical coverage. In this case, you'd be throwing money down the drain if you bought a separate PDP or MA.

To determine your possible out-of-pocket costs, you should know about two concepts -- the standard Part D deductible and copayment schedule, and your plan's tier classification for reimbursing drug costs.

Learn about your plan's deductibles and copayments

Medicare has several requirements for a standard Part D prescription drug coverage; a PDP or MA plan may offer more generous terms than the standard plan, but any plan has to offer benefits at least as generous as the standard plan. For 2014, here are the deductible and copayment features for the standard plan:

The initial deductible is $310; you'll pay 100 percent of the costs of prescription drugs up to this amount.

Once your drug costs exceed $310, you'll pay 25 percent of the total cost of drugs that range from $310 to $2,970.

If the total cost of your drugs exceeds $2,970, you'll fall into the hated "donut hole," and under the standard plan, you'll pay 100 percent of any drug costs from $2,970 to $4,550.

Once your total drug costs exceed $4,550, you'll be eligible for catastrophic coverage, and you'll only pay for 5 percent of drug costs over this amount.
About one in four Medicare Part D enrollees falls into the donut hole each year. If you do fall into the hole, you may be eligible for discounts on generic drugs and certain brand name drugs. In some instances, subsidies for low-income beneficiaries may also reduce out-of-pocket expenses for prescription drugs.

Learn which exact drugs are covered

You'll also want to understand your plan's list of covered drugs, called a formulary. Many Medicare drugs plans place drugs into different tiers, and drugs in each tier may have a different cost. The lowest tiers typically cover generic drugs with the lowest co-payment, and the highest tiers typically cover specialty or brand name drugs with the highest co-payment. Insurance companies often change the tier classification for certain drugs and must disclose these changes during open enrollment; don't throw these notices away -- read them carefully to see how they impact you.

Two good places to learn more about prescription drugs and what's covered include Medicare's website and the website of 65 Incorporated, a Medicare educational and consulting firm that isn't affiliated with any insurance companies or the government.

Stay tuned for my next post that shares ideas for managing your total drug costs.

09/24/2013

Please read the following announcement from Medicare. Keep in mind, open enrollment is just around the corner and I'm happy to answer any questions you might have. Call or email anytime.

“MEDICARE & YOU” WITHOUT THE PAPER

Love your red, white, and blue “Medicare & You” handbook but love the convenience of getting information on your computer, tablet, or phone even more?

You can get all of the same information in your printed handbook online at Medicare.gov. Learn what’s new, get Medicare costs, and find out what Medicare covers. Even better, the handbook information on the web is updated regularly, so you can instantly find the most up-to-date Medicare information.

On Medicare.gov, you can also do a lot of things on your own like replace your Medicare card, change your address, sign up or make changes to your Medicare coverage, and find out important dates. All this in time for October 15 – the start of open enrollment.

Take advantage of some other great features to get just what you need:

Search quickly for what you want and print only the pages you need, while getting the latest, up-to-date official Medicare information, including the most recent list of available plans
Get “Medicare & You” in different formats like large print, eBook or audio
Subscribe to get an e-mail when information is updated
Access personalized information
And, if you’d like to trade in your printed copy for a paperless version, we’ve got you covered. You can choose to get your next “Medicare & You” handbook electronically by using the “go paperless” option. In a few simple steps, you’ll be all set. Sign up today and we’ll send you an e-mail including a link to the new online Medicare & You. It’s instant, current, and convenient.