Newsletter: from Theresa Cangemi @ Medicare Made Simple, LLC

The Medicare Lady™

Celebrating 14 years as a Medicare Specialist, October 2022

📧 tcangemi@MyMedicareMadeSimple.com

📱 Cell: 315.727.4933

Hello Theresa,

MEDICARE - MEDICAID: YOUR BENEFITS MAY CHANGE THIS YEAR! - Will You Re-Qualify for Medicaid?

HEALTH SECTION - FRUIT JUICE vs REAL FRUIT

ANNOUNCEMENT: NOW LICENSED in NY and Florida.

If you are moving and relocating to Florida, I can help you find a new Medicare plan. Please give me a call; and referrals to friends and family are always welcomed and appreciated!

I will be known in Florida as “Boomer Health Plans Made Simple, LLC”

(Florida would not let me keep the word “Medicare” in my business name).

Keep reading!

Theresa Cangemi CSA, CLTC

"The Medicare Lady™"

MEDICARE SECTION

It has come to my attention that there will be changes with MEDICAID BENEFITS you are currently receiving. Some may lose benefits. Medicaid and state funding is now going through an “unwinding or redetermination period.” According to CMS (Centers for Medicare and Medicaid) and the FFCRA provision, COVID-19 officially ended March 2023.

Contents of this article are taken in-part from the online article:

10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision - https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/

At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a provision that Medicaid programs keep people continuously enrolled through the end of the COVID-19 public health emergency (PHE), in exchange for enhanced federal funding.

The FFCRA provision requires states to provide continuous coverage for Medicaid enrollees in order to receive enhanced federal funding. By preventing states from disenrolling people from coverage, the continuous enrollment provision has helped to preserve coverage during the pandemic. It also increased state spending for Medicaid. The continuous enrollment provision for Medicaid/CHIP began February 2020 and ended March 2023. This requirement was issued by the Centers for Medicare and Medicaid Services (CMS) that lays out rules states must follow during the Unwinding Period, also called the Redetermination Period for Medicaid benefits.

Efforts are in place to conduct outreach, education and provide enrollment assistance can help ensure that those who remain eligible for Medicaid are able to retain coverage and those who are no longer eligible can transition to other sources of coverage.

But, as states resume disenrollments following the end of the continuous enrollment provision, millions of people could lose coverage and that could reverse recent gains in coverage. States can resume disenrollments beginning in April 2023 but must meet certain requirements to be eligible for enhanced federal funding during the unwinding. This Redetermination Period or Unwinding could last up to 12 months.

Eligible Medicaid individuals are at risk for losing coverage if they do not receive or understand notices or forms requesting additional information to verify eligibility or do not respond to requests within required timeframes.

All states indicated they had taken steps to update enrollee contact information during the past year and nearly three-quarters of states (37) were planning to follow up with enrollees before terminating coverage. As of March 13, 2023, 26 states had posted their renewal redistribution plan, which had to be submitted to CMS (Centers for Medicare and Medicaid) by February 15, 2023 for most states.

States completing renewals by checking electronic data sources to verify ongoing eligibility reduces the burden on enrollees to maintain continuous coverage. However, when states do need to follow up with enrollees to obtain additional information to confirm ongoing eligibility, they can facilitate receipt of that information by allowing enrollees to submit information by mail, in person, over the phone, and online.

CMS (Centers for Medicare and Medicaid) guidance provides a roadmap for states to streamline processes and implement other strategies to reduce the number of people who lose coverage even though they remain eligible. However, there will also be current enrollees who are determined to be no longer be eligible for Medicaid, but who may be eligible for ACA marketplace or other coverage (under the age of 65).

COVID-19 Federal Health Emergency ending soon: How will this impact you?

On May 11, 2023, the COVID-19 Federal Health Emergency will end. When the emergency declaration ends, it will mean changes to certain policies established during the pandemic (early 2020) that gave the federal government flexibility to waive or modify certain requirements in a range of areas.

Starting May 12, 2023, out-of-pocket expenses for certain COVID-19 benefits may change, depending on an individual’s health care coverage.

COVID-19 lab tests: The plan cost share will apply.

COVID-19 treatment: The plan cost share will apply.

COVID-19 over-the-counter (OTC) tests: Will now only be covered if the plan includes an OTC benefit.

COVID-19 vaccines, including boosters: Any pharmaceutical treatment doses (e.g. Paxlovid) purchased by the federal government are still free to all, regardless of insurance coverage. This is based on the availability of the federal supply and is not affected by the end of the public health emergency.

Here are some TERMS being used for this new provision and the definitions:

Definition: “D-SNP” (Dual Special Need Plans) – are Medicare Advantage plans for those eligible for Medicare and Medicaid benefits.

WHAT YOU SHOULD KNOW:

DURING “RETRO WINDOW” (retro active window) - - DSNP (Dual Special Need) PROVIDERS CAN'T CHARGE MORE THAN WHAT MEDICAID WOULD HAVE PAID (IN MOST STATES)
PROVIDERS CAN RESUBMIT – TO GET REIMBURSED
AS LONG AS A DSNP (Dual Special Need) MEMBER MAINTAINS MEDICAID THEN COST SHARING IS PROTECTED, GENERALLY, AND WON’T EXPERIENCE OUT OF POCKET EXPENSES
DURING “RETRO WINDOW” OR RENEWAL WINDOW- IF MEMBER REGAINS MEDICAID THEN REINSTATED BACK TO TERMINATION DATE LIKE THEY NEVER LOST MEDICAID
ANY OUT OF POCKET SPENT, MEMBER CAN SUBMIT AND GET REIMBURSED
ANY CLAIMS CAN GET REPROCESSED, IF MEMBER LOSES MEDICAID AND THEN REQUALIFIES
SOME STATES WON’T ALLOW DSNP (Dual Special Need) PROVIDERS TO COLLECT MORE THAN WHAT MEDICAID WOULD HAVE PAID
SOME RISK: AFTER “RETRO WINDOW“ IF HAVE GAP IN COVERAGE OR LOST PROTECTION, MEMBER RESPONSIBLE FOR ALL COST SHARE UNTIL REGAIN ELIGIBILITY. COST SHARE COULD BE A COPAY OR 20% CO-INSURANCE COST SHARE MEMBER WILL BE RESPONSIBLE FOR.
DSNP (Dual Special Need) MEMBER HAS TO RESPOND TO STATES REQUEST TO PROVIDE ADDITIONAL INFORMATION, TO STAY COVERED
DURING “RETRO WINDOW” IT IS BETTER TO STAY WITH THE MEDICARE PLAN AND COMPLETE RENEWAL PAPERWORK.

IN NY: FOR MEDICAID MANAGED CARE ORGANIZATION (MMCO) MEMBERS WILL BE RESPONSIBLE FOR THEIR COST SHARE DURING “RETRO WINDOW“ ACTIVITY PERIOD FOR ALL MEDICAID POPULATIONS (NY IS THE HYBRID STATE).

CARRIERS (insurance companies) WILL BE MAKING PROACTIVE CALLS –

IN MAY – TYPICALLY 3 PHONE CALL ATTEMPTS AND FOLLOW UP LETTERS.

Please pay attention to the phone calls and letters you may be receiving. These calls and letters are notices and may request updated information from you to determine if you are still eligible for Medicaid benefits.

I am sure that there may be some “phony baloneys” trying to piggy-back on this Redetermination or Unwinding period. Be careful to screen who is calling you asking for your information. Verify who is calling and let them give YOU the verification (your name, your address, Medicaid ID#, Medicare #) to verify who they are. They called you!!!!

Also, you can look for the logo and address of the state or federal government agency on the letter mailed to you, like: Social Security logo, Medicare, or Medicaid. Also, look to see if the letter is signed, has the name of a person you can call back and a phone number. Verify the phone number is correct to the government agency and not a phony call center.

FOR SOLICITATIONS: Look for the small print on any notice /letter / flyer you receive that might say, in small print:

“This mailing is NOT from the Federal Government, nor Medicare, and is from an agent or agency.”

This type of notice on any mailing would be a solicitation and you can THROW AWAY this flyer or letter.

REMEMBER: IF YOU RECEIVE MEDICAID BENEFITS, EVERYONE WILL BE GOING THROUGH THE PROCESS TO SEE IF YOU STILL QUALIFY FOR BENEFITS. Please pay attention to notices you may receive to verify and update your information. You can call Social Security, Medicare, or Medicaid directly to update a change of address and/or income. AND, pay attention to letters, phone calls, and deadline dates.

Hope this information was helpful.

Be well!😊

HEALTH SECTION

Real Fruit (not fruit juice)...from Yuka.io

Drinking fruit juice is not the same thing as eating fruit!

Fruit juice does not contain any fiber. And fiber is what slows down the speed at which the sugar in fruit is digested. That explains why the glycemic index is higher for fruit juice than for fruit. For example, the glycemic index for an orange is about 35, whereas the glycemic index for orange juice is around 45.

Furthermore, eating whole fruit encourages chewing and promotes satiety, which does not happen with fruit juice. Lastly, fruit juice contains fewer vitamins than the fruit itself.

So, go for fruits rather than fruit juices — even homemade versions and guaranteed 100% pure juice!

* This article is for information purposes only. I don’t recommend, support, or diagnose any featured writer or article. I am not a doctor. Your health is one of a kind. What works for one person may not for another, so the information in these articles should not take the place of an expert opinion. Before making significant lifestyle or diet changes, please consult your primary care physician or nutritionist. You and your doctor will know your own health best.

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