Latest news with #MedicareBeneficiaries
Forbes
4 days ago
- Health
- Forbes
Why People Leave Medicare Advantage Plans And Why It Matters To You
Over half of Medicare beneficiaries opted for Medicare Advantage plans in 2024, and the percentage is expected to climb to 60% by 2030, according to the Kaiser Family Foundation. Medicare beneficiaries can choose between Medicare Advantage plans (also known as Part C) and original Medicare. Original Medicare is coverage under Parts A and B of Medicare. Beneficiaries in original Medicare are encouraged to also have Medicare supplement (Medigap) insurance policies and Part D prescription drug policies. Medicare Advantage plans essentially bundle all that coverage into one plan and typically add benefits such as vision, dental, and hearing care. Medicare Advantage plans increased in popularity partly because of the additional benefits. Relatively healthy members of Advantage plans also tend to have lower out-of-pocket costs because they aren't paying premiums for Medigap and Part D policies. But about half of beneficiaries left their Advantage plans within five years, according to data from 2011-2020 published in the JAMA Health Forum. Some opt for a new Advantage plan while others switch to original Medicare. Before deciding to sign up for a Medicare Advantage plan, it's a good idea to know why people leave their Advantage plans. Some analysts believe the high turnover among Advantage plan members can influence how the plans are operated. If an Advantage plan's managers know most enrollees won't stick around for the long term, the plan might have less incentive to address long-term or chronic conditions of beneficiaries. The quality of an Advantage plan seems to have a significant effect on turnover. Plans that had five-star ratings lost only 23% of members after five years. While plans with four-star ratings lost over 41% of members after five years, and lower-rated plans had even higher turnover rates. Another study concluded cost wasn't a major factor in decisions to leave Advantage plans. Beneficiaries were more likely to be concerned about difficulties in accessing and receiving high-quality medical care. Another difference between original Medicare and Advantage plans is that an Advantage plan only covers care by a provider in the plan's network. In addition, some care must be approved by the plan before it will be covered. In original Medicare, the beneficiary can choose any provider who accepts Medicare and rarely needs approval from Medicare before receiving a treatment or care. Limits on the medical providers included in a plan's network as well as required approvals for treatments and care cause dissatisfaction among Advantage plan beneficiaries. The study found that beneficiaries in poor health were more likely to switch plans because of dissatisfaction about limits on providers and the need for approval of care. That finding is consistent with anecdotal reports I've heard from Medicare insurance agents over the years. They find that in the early years of retirement when people are relatively healthy, Medicare beneficiaries are happy with Medicare Advantage plans. The plans cost them less, and they don't need to visit doctors often. But when serious health conditions arise or more frequent care is needed later in retirement, people are likely to want to switch from an Advantage plan to original Medicare. Once the need for medical care increases, the limits on providers and approval requirements become more important. Generally, you can switch from an Advantage plan to original Medicare each year during open enrollment. But there's a catch. During a person's initial enrollment period for Medicare, insurers offering Medicare supplement policies are required to sell the policies without regard to a person's health history. But after the initial enrollment period, insurers generally can review an applicant's medical history and use it to decline coverage or charge higher premiums. Though a person legally can switch from an Advantage plan to original Medicare, the absence of guaranteed issue for a Medigap policy after the initial enrollment period might make the change impractical.
Yahoo
13-07-2025
- Health
- Yahoo
Medicare data breach exposes 100,000 Americans' info
Healthcare data continues to be a top target for cybercriminals. In June alone, two major breaches compromised over 13 million patient records. Now, a newly confirmed Medicare data breach has affected more than 100,000 Americans. The Centers for Medicare & Medicaid Services (CMS) sent letters this week to those affected, confirming that hackers accessed sensitive data linked to accounts. Sign up for my FREE CyberGuy ReportGet my best tech tips, urgent security alerts and exclusive deals delivered straight to your inbox. Plus, you'll get instant access to my Ultimate Scam Survival Guide — free when you join my Over 8M Patient Records Leaked In Healthcare Data Breach The breach traces back to suspicious activity starting in late 2023. According to CMS, cybercriminals used stolen personal data from external sources to fraudulently create accounts. That information included: Read On The Fox News App Full names Dates of birth ZIP codes Medicare Beneficiary Identifiers (MBIs) Medicare coverage details CMS began receiving alerts in May 2025 when people reported receiving account confirmation letters for accounts they had not created. This triggered an internal investigation. Hackers not only created unauthorized accounts but, in some cases, accessed additional sensitive data such as: Home addresses Provider and diagnosis codes Services received Plan premium details CMS has deactivated all affected accounts and is mailing new Medicare cards to the estimated 103,000 individuals affected. The agency says no confirmed identity theft cases have been reported yet. CMS stressed the action is being taken out of "an abundance of caution," but the breach raises questions about federal cybersecurity safeguards. If you're one of the people affected by the Medicare data breach: Watch your mailbox for a replacement Medicare card Monitor your account for suspicious activity Report unauthorized services or charges immediately CMS is still investigating how the attackers obtained such accurate personal data and whether more individuals may be at risk. What Is Artificial Intelligence (Ai)? So far, CMS has not identified the attackers. However, the use of valid personal information suggests that the hackers may have obtained data from prior breaches or leaks on other platforms. This breach reveals a troubling vulnerability in the federal healthcare system, where hackers can exploit existing data to create legitimate-looking accounts and access deeply personal medical information. Here are five important steps you can take right now to protect your Medicare information and reduce your risk of identity theft after the breach. Regularly check your Medicare and healthcare accounts for changes you did not make. Be cautious of unfamiliar services, charges or communications from providers you don't recognize. In light of the Medicare data breach, where bad actors used valid personal details to create fake accounts, enrolling in a trusted identity theft protection service can offer an extra layer of defense. These services monitor your Social Security number, email, phone number and other sensitive data to alert you if it's being sold on the dark web or used to open fraudulent accounts. Many top-rated services also help you freeze your credit and bank accounts and offer expert support if your identity is compromised. My top pick includes up to $1 million in identity theft insurance to cover stolen funds and legal fees, plus access to a U.S.-based fraud resolution team that helps you recover faster. See my tips and best picks on how to protect yourself from identity theft at Never share your Medicare number or card details with anyone over the phone or email, unless you initiated the contact and trust the source. Treat it like a credit card. If you believe your information is being misused, remove it from the internet. A personal data removal service can help you remove all this personal information from the internet. It has a very clean interface and will scan 195 websites for your information and remove it and keep it removed. Check out my top picks for data removal services and get a free scan to find out if your personal information is already out on the web by visiting a free scan to find out if your personal information is already out on the web: If you notice suspicious activity, report it directly by calling 1-800-MEDICARE (1-800-633-4227) to report Medicare fraud. Also, file a report at to create a recovery plan with the Federal Trade Commission (FTC). This not only helps you recover faster but also contributes to broader investigations that protect others. This Medicare breach may not have resulted in confirmed cases of identity theft so far, but that does not mean the situation should be taken lightly or dismissed as low risk. It took malicious actors less than two years to create over 100,000 fake Medicare accounts using valid personal information, which suggests a significant weakness in how sensitive data is being protected and monitored at the federal level. Do you think healthcare organizations are doing enough to protect your data? Let us know by writing us at Sign up for my FREE CyberGuy ReportGet my best tech tips, urgent security alerts and exclusive deals delivered straight to your inbox. Plus, you'll get instant access to my Ultimate Scam Survival Guide — free when you join my Copyright 2025 All rights article source: Medicare data breach exposes 100,000 Americans' info
Health Line
30-06-2025
- Health
- Health Line
Medicare Annual Wellness Appointment: A Guide
Medicare beneficiaries who have had coverage for longer than 12 months are eligible for an annual wellness visit. This is designed to develop or update a personalized plan to help prevent disease and disability based on your current health and risk factors. It is important to remember that an annual wellness visit (AWV) is not the same as a routine physical exam. Some people may use the terms interchangeably, but they are different types of appointments. When making this appointment with your healthcare professional, be sure to specify it is for your Medicare AWV so it is billed and covered correctly. Glossary of common Medicare terms Out-of-pocket cost: This is the amount you pay for care when Medicare doesn't pay the full cost or offer coverage. It includes premiums, deductibles, coinsurance, and copayments. Premium: This is the monthly amount you pay for Medicare coverage. Deductible: This is the annual amount you must spend out of pocket before Medicare begins to cover services and treatments. Coinsurance: This is the percentage of treatment costs you're responsible for paying out of pocket. With Medicare Part B, you typically pay 20%. Copayment: This is a fixed dollar amount you pay when receiving certain treatments or services. With Medicare, this often applies to prescription medications. What is a Medicare annual wellness visit? Medicare adopted AWVs in 2011 to encourage both beneficiaries and clinicians to utilize preventive services. This AWV is an appointment with your primary care physician (PCP) to create or update your personalized prevention plan. This plan may help prevent certain illnesses or disabilities based on your overall health and risk factors. These visits are not head-to-toe physicals. »Learn more: Medicare preventive services Who is eligible for an annual wellness visit? Anyone with Medicare is eligible for an AWV. Medicare Part B will cover the visit if: you have had Part B for longer than 12 months you have not had an AWV in the past 12 months You also cannot have an AWV in the same year as your 'Welcome to Medicare' preventive visit. What does an annual wellness visit cover? AWVs typically include routine measurements, health advice, a review of your medical history and prescriptions, and more. First annual wellness visit Your first AWV will generally involve the following: completing a health risk assessment (HRA), which helps you and your doctor develop a personalized prevention plan establishing your medical and family history establishing a list of your current providers and suppliers, which are any professionals who provide medical and mental health care. taking routine measurements, such as: height weight blood pressure body mass index (BMI) checking for any cognitive (thinking ability) impairments reviewing your potential risk for depression reviewing your functional ability and safety establishing a screening schedule establishing a list of your current risk factors and conditions providing personalized health advice and necessary referrals to preventive counseling services or health education programs completing a social determinants of health (SDOH) risk assessment reviewing any current opioid prescriptions and screening for substance use disorders providing advance care planning services if desired Subsequent visits Subsequent AWVs will typically involve: reviewing and updating your HRA and SDOH risk assessment updating your medical and family history updating your list of providers and suppliers taking your routine measurements checking your cognitive abilities updating your screen schedule updating your list of conditions and risk factors updating any health advice and referrals giving advance care planning services if desired »Learn more: Medicare end-of-life planning What is the cost of an annual wellness visit? Medicare AWVs are covered at no cost to you as long as your healthcare professional accepts assignment. This means they agree to accept the Medicare-approved amount as payment and not bill you for anything more. The Medicare Part B deductible does not apply to wellness visits. However, you may have to pay your deductible or coinsurance for any additional tests, services, or treatments your healthcare professional decides may be necessary based on your wellness visit. Medicare will also only fully cover your AWV if it has been more than 12 months since your Welcome to Medicare visit. Your AWVs must also be spread out so that you do not have more than one in a 12-month period. A note on Medicare Advantage Medicare Advantage (Part C) plans are required to offer AWVs without charging a deductible, copayment, or coinsurance as long as you see an in-network provider and you meet all other eligibility requirements for the service. Routine physical exams generally entail: an updated health history checking vital signs, such as blood pressure and heart rate a visual exam where the doctor examines your appearance for signs of potential conditions checking your eyes, nose, and throat checking your skin and nails testing your motor function and reflexes laboratory tests, such as blood panels and urine tests While a routine physical exam may be similar to a wellness visit, it is a separate appointment. Medicare doesn't cover routine physical exams. The only time Medicare covers exams like this is if they are in relation to a specific diagnosis or treatment of an illness, injury, or symptom. Otherwise, you are responsible for 100% of the cost. Annual wellness visit vs. Welcome to Medicare visit A Welcome to Medicare visit is similar to an AWV. This appointment entails many of the same aspects. However, this is an initial preventive visit within the first 12 months of being covered by Medicare Part B. For your Welcome to Medicare visit, you need to bring the following with you: family health history medical records, including immunization records a list of any prescription drugs, over-the-counter medications, vitamins, and supplements you are currently taking »Learn more: Welcome to Medicare visit The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Health Line
02-06-2025
- General
- Health Line
What Is the Medicare Beneficiary Ombudsman?
The Medicare beneficiary ombudsman (MBO) is a representative who works on behalf of Medicare enrollees to resolve Medicare-related complaints, ensure access to information, and improve the program. An ombudsman is a person who reviews how an organization operates, investigates complaints, and helps resolve those complaints. They typically work as a client advocate within an organization or business. The MBO serves this function within the Medicare program. Learn more about the services the MBO provides and how to connect. What is the role of a Medicare beneficiary ombudsman? Congress formed the MBO role in 2003. The person in this role assists Medicare enrollees in various areas, including handling complaints, appeals, and requests for information. The general duties of the MBO, as outlined in section 1808 of the Social Security Act, are to: receive and help resolve complaints and inquiries that Medicare beneficiaries and other stakeholders make work with representatives of health insurance counseling programs to provide information and resources to beneficiaries report to Congress on ways to improve the administration of Medicare In addition to addressing complaints, some of the specific issues enrollees may have to address with an MBO include: Appeals: If you disagree with a Medicare payment or coverage determination, you can file an appeal. The MBO can assist you with this process. Enrollment concerns: If you have issues when leaving a Medicare Advantage (Part C) plan or joining a new plan, the MBO can assist you. Claims: If you need to file a Medicare claim, the MBO can help you through the process or troubleshoot issues that arise. What are a beneficiary's rights under Medicare? As a Medicare beneficiary, you have various clearly outlined rights and protections. The MBO exists to help preserve those rights and ensure fair treatment of all Medicare beneficiaries. It can be helpful for Medicare enrollees to periodically review their rights to understand what types of treatment and services they can expect. A Medicare beneficiary's rights include: fair and courteous treatment privacy of personal and health information access to appropriate healthcare professionals for medically necessary services clear, understandable information access regarding coverage, plan options, costs, and more Medicare designs its protections to keep beneficiaries up to date on coverage status and prevent unexpected costs. They come into play when Medicare may not cover a service, or you reach the end of Medicare coverage. A beneficiary's protections include: receiving an Advance Beneficiary Notice (ABN) of Noncoverage for any services that Medicare doesn't cover getting a Notice of Medicare Noncoverage at least 2 days before covered home health services end acquiring a Hospital-Issued Notice of Noncoverage (HINN) for inpatient services that Medicare Part A doesn't cover If you've experienced violations of your rights or protections or have an issue with Medicare noncoverage, you can contact the MBO for assistance. How to contact a Medicare beneficiary ombudsman Not all Medicare-related questions should go directly to the MBO. Other contact points may be more suitable based on your coverage and the nature of your question or concern. If you're a Medicare Advantage or Part D enrollee, contact your insurance carrier with any questions or complaints about your plan. You can generally find contact information for the plan on the back of your insurance card. If you have questions about Original Medicare or need help with issues that a private insurance carrier can't address, you can contact Medicare by phone at 800-633-4227. If you have general questions or would like free, unbiased Medicare counseling, you can contact your local State Health Insurance Assistance Program (SHIP). Finally, if you have questions that the channels above can't resolve, you can direct your query to the MBO. You can do so by contacting Medicare by phone at 800-633-4227 and requesting your case's submission to the MBO. Summary The MBO has a role within the Medicare program to provide customer service and advocacy. The MBO can assist Medicare beneficiaries with resolving complaints and accessing important information. They also work to improve Medicare's administration by submitting an annual report to Congress on its operation. If you have a concern requiring the MBO's attention, you can contact Medicare by phone and explain the situation.
Health Line
19-05-2025
- Health
- Health Line
Qualifying Individuals (QI) Medicare Savings Program
The QI program is a Medicare savings program (MSP) that helps pay your Part B premiums. Your individual or joint income and resources must meet certain criteria to qualify. The Medicare Qualifying Individuals (QI) program helps Medicare beneficiaries cover their Part B premium. Your premium is the monthly fee you pay for your Part B outpatient medical coverage. The QI program is one of four Medicare savings programs. These programs help individuals with limited incomes cover their healthcare costs. To qualify, you need to meet the QI program's income requirements. You must reapply every year to keep your coverage. What is the QI Medicare savings program? The Medicare QI program is one of several Medicare savings programs to help people with limited income and resources pay their Medicare costs. Assistance comes from each state and is based on your income and resources. In 2025, the four Medicare savings programs are: The QI program is for people who have Medicare Part A (inpatient hospital insurance) and Part B (outpatient medical insurance), which together make up Original Medicare. The program covers the cost of the Part B premium for people who qualify. How does QI work with Medicare? The QI program is for Medicare enrollees with Part A and Part B, and it's intended to cover your Part B premiums. In 2025, the standard Part B monthly premium is $185. The QI program will pay this cost if you qualify. The QI program won't change your Part A costs — and most people don't pay a premium for Part A. So, if you have Original Medicare with premium-free Part A and you qualify for the QI program, your total monthly premium would be $0. The QI program applies only to Original Medicare. That means it won't affect any Medicare Advantage (Part C) or Medicare supplement (Medigap) plan you choose to buy. Enrollees who qualify for the QI program will, however, automatically qualify for help with Medicare Part D prescription coverage) through the Medicare Extra Help program. QI eligibility Your eligibility for the Medicare QI program is based on your income. In 2025, the income limits for the QI program are $1,715 per month for individuals or $2,320 for married couples. The income limits are slightly higher in Alaska and Hawaii: Alaska: Individual: $2,220 Married couples: $2,994 Hawaii: Individual: $1,819 Married couples: $2,452 You'll also need to be at or below the resource limit. In 2025, that meant you'd need less than $9,660 in resources as an individual or $14,470 as a married couple. Resources include bank accounts and stocks. Medicare doesn't consider high value items like your car or home to be resources. Additionally, some income and resources specific to American Indian and Alaska Native communities do not count toward Medicare limits. The income limits can change each year and are based on the federal poverty level (FPL). The FPL is calculated using data like the cost of living and the average salary in each state. Various programs use the FPL as a benchmark to qualify for programs like Medicare QI. You aren't eligible for QI benefits if you also qualify for Medicaid. However, you can still apply for the program through your state Medicaid office. The office will determine which programs, if any, you qualify for. Tips for finding help paying for Medicare Medicare was created to offer healthcare services for people ages 65 years and over as well as individuals with certain health conditions. But out-of-pocket costs like premiums, copayments, and deductibles can add up. If you're having trouble paying for your share of Medicare costs, you can take several actions or look into programs that can help: Dual eligibility: If you have a significant need or disability, you may qualify for both Medicare and Medicaid. This is called dual eligibility, and it could offer you additional health coverage and services. Extra Help: This program offers savings on prescription medication costs, but you have to be enrolled in a Medicare Part D prescription plan to participate. If you qualify for the QI program, you'll also qualify for the Extra Help program. Medicare Advantage (Part C) plans: Medicare parts A and B cover inpatient and outpatient care, respectively. Medicare Part D is an optional program that covers prescription medications. Medicare Part C, also called Medicare Advantage, allows you to tailor a Medicare plan that best suits your healthcare and financial needs. Bundling Medicare services through an Advantage plan may help you save money. Medicare savings programs: These programs — including the QI program — help cover a share of your Medicare costs. Participation is limited to particular needs and income limits. Sign up on time and plan ahead: A variety of penalties may be applied to your share of Medicare costs. Sign up for initial coverage on time. Add additional services you think you might need within designated time frames to avoid late fees and penalties. Update your income: A number of Medicare programs use income to determine eligibility. If your income drops, be sure to update Medicare. How to enroll in Medicare QI programs Ensure eligibility: Make sure you're eligible for Medicare and enrolled in Part A. Contact your local office: Contact your state Medicare savings program office. They will have the application you need and can also provide instructions and assistance. Apply: Medicare encourages anyone who thinks they might be eligible for the QI program to apply. Medicare beneficiaries whose income is close to the qualifying line — and even if it goes slightly over — should apply, as there is no application cost. Reenroll each year: You'll need to reenroll in the QI program each year. Applications for the QI program are approved on a first-come, first-served basis, so you'll want to apply as early as possible. Priority is given to people who were enrolled in the QI program the previous year. The takeaway The Medicare QI program is one of four Medicare savings programs. It helps Medicare beneficiaries with limited incomes pay their Part B premiums. You'll need to apply through your state and meet the income requirements to qualify. If you qualify for the QI program, you'll also qualify for Part D Extra Help.
