In a previous Senior Scene article, we demonstrated how your current level of income results in increased premiums for Medicare Part B. The following information demonstrates how the same higher income ranges may result in an increase in prescription drug plan (Part D) monthly premiums. As of Jan. 1, 2011, individuals with certain incomes have been required by law to pay what is known as Part D-IRMAA in addition to their monthly plan Part D premium. IRMAA stands for Income Related Monthly Adjustment Amount. Most individuals pay their Part D-IRMAA via deduction of their Social Security benefit. Some individuals are directly billed their Part D-IRMAA by CMS or the Railroad Retirement Board (RRB).
CMS began disenrolling individuals for failure to pay Part D-IRMAA on April 1. Nationally, a total of 1,105 individuals were disenrolled on April 1 for their failure to pay Part D-IRMAA to either CMS or RRB. Once the disenrollment policy takes effect, individuals are automatically disenrolled at the end of the three-month grace period for which full payment of Part D-IRMAA is not made. Plans are required to notify the beneficiary of the disenrollment in writing. See chart A, which explains the additional Part D premium costs based on income. At the time of this printing, there are no North Dakotans involved in disenrollment due to failure to pay higher rates. This will be evaluated on a monthly basis.
The disenrollments effective on April 1 means these individuals will no longer be enrolled in the plan that contains their Part D coverage as of that date. This may include individuals in Medicare Advantage plans with Part D coverage and some employer plans. All disenrolled individuals will retain Medicare; they will receive their Medicare health benefits through Original Medicare. They will not have Part D or prescription drug coverage.
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David Zimmerman
Individuals who are disenrolled may subsequently enroll in another Part D plan (including an MA plan with Part D coverage) at their next valid election period. This may be the fall annual enrollment period (coverage starting Jan. 1 of the following year) or a special enrollment period (SEP), such as 5-star SEP or other established SEPs based on the individual's circumstance.
Individuals who are disenrolled for failure to pay Part D-IRMAA may ask CMS to reconsider the decision. Call 1-800-MEDICARE within 60 days of disenrollment to request such an action. CMS has a policy to allow for reinstatement if the individual was unable to make timely payment due to an unusual and unexpected circumstance over which they had no control and that is not likely to happen again. Individuals who receive favorable determinations must pay all owed amounts within three months of disenrollment in order to get their coverage back.
Chart A (top right) shows the estimated prescription drug plan monthly premium based on income. If your income is above a certain limit, you will pay an income-related monthly adjustment amount in addition to your plan premium.
2013 approved drug plan
The information in Chart B (middle right, released April 2, is considered final and will apply to next year's prescription drug plans. These changes apply both to stand alone PDPs and to Medicare Advantage Plans that include Part D (MA-PD).
LIS changes
The following income and resource information (see Chart C (bottom right) for both Low Income Subsidy (data represents Partial Help maximum) and the Medicare Savings Program has been finalized for 2012.
Diabetes services
How does Medicare cover services related to diabetes?
According to MedicareRights.org, Medicare Part B covers most care related to diabetes, including doctor's office visits, screening tests and diabetes self-management training and diabetes supplies. Medicare Part B pays 80 percent of the cost of a doctor's office visit after you meet the Part B deductible. In addition to regular doctor's visits related to diabetes, Medicare also covers certain special services to help screen for or treat diabetes.
If you don't have diabetes, Medicare pays 100 percent of the cost of diabetes screenings every year if you see a provider who accepts assignment, which means the provider accepts Medicare's approved amount as full payment for a service. You won't even have to pay a deductible for the screening if you're at high risk for diabetes. If you're pre-diabetic, Medicare will cover two diabetes screening tests per calendar year without co-pays or deductibles. Having pre-diabetes means you have blood glucose (sugar) levels that are higher than normal, but you aren't yet diabetic. These preventive diabetes screenings include fasting glucose tests and/or post-glucose challenge tests.
If you already have diabetes, Medicare covers 80 percent of the cost of diabetes self-management training after you meet the Part B deductible. Self-management services are covered if you're at risk of complications from diabetes, or you have recently been diagnosed with diabetes.
Although Medicare doesn't normally cover foot care, it will cover foot care every six months for diabetics with diabetes-related nerve damage.
Medicare Part B also covers 80 percent of the cost of certain diabetic supplies after you meet the Part B deductible. This includes glucose monitors, blood test strips, insulin if you use an insulin pump and therapeutic shoes in certain cases. If you inject your insulin, Medicare prescription drug coverage may help pay for your insulin and supplies.
Medicare will also pay 100 percent of the cost of medical nutrition therapy, and the Part B deductible doesn't apply. Medical nutrition therapy helps you learn to eat right so you can better manage your illness. In order to have Medicare cover medical nutrition therapy, your doctor or other health care provider must refer you for these services and you must get them from a registered dietitian or other qualified nutrition professional. Talk to your doctor if you think you qualify for this benefit. If you're in a Medicare Advantage plan, your plan must cover the free preventive services (medical nutrition therapy and diabetes screenings) the same way Original Medicare does as long as you see a provider who is in your plan's network.
If you have questions about any of these or other Medicare-related issues, call the North Dakota Insurance Department at 1-800-247-0560.
David Zimmerman is consumer assistance division director at the North Dakota Insurance Department.