Dear Medicare Beneficiaries

Dear Medicare Beneficiaries,

As we all know, the Annual Enrollment Period (AEP) began yesterday October 15 th. Please be aware that there are 80 million seniors turning 65 over the next 15+ years so call waiting times will be long. Have patience with us, either Medicare, Social Security or your health plan provider. We are doing our best to accommodate and address the concerns you have with your current or prospective health plan. To expedite any inquiry please be prepared with your Medicare card, your health plan card, member ID and a list of any prescriptions you are taking. This will assist us in efficiently answering your concerns.
Also, please be aware that the AEP ends on Dec 7th so if you need any information mailed to you regarding your current or new plan please call at least two weeks before the AEP deadline. By doing this you will have plenty of time to review the information and call back to ask any questions or concerns you may have.
Medicare beneficiaries, I speak to you from the trenches of Medicare warfare. I am on the front lines and deal with seniors and their frustrations everyday. I am providing you with little secrets that will get you the answers you seek in a timely fashion. Take heed however, not everything you hear is gospel. You want to make sure you always confirm the information you receive from another source. If that means calling back then do so. Trust me when I tell you this…” You want to make absolutely sure that the terms and conditions of care provided by your health care provider are what you were expecting.” If it is NOT, then you must contact Medicare because you may have been mislead and this type of Medicare fraud can cost you dearly, both emotionally and financially.


Can Doctors and Patients Choose Wisely?

I applaud the society of medical professionals for trying to accomplish cohesion and efficiency within an industry that is having a significant effect on our country’s economy. Health care costs are rising and severely affecting the financial stability of current or prospective seniors aging into Medicare.

The Choosing Wisely Campaign is a project of the ABIM Foundation, medical specialty societies and Consumer Reports. At the heart of the campaign are a series of lists of tests and procedures to question – developed by the societies. Each society came up with a list within their domain of practice.

These ‘lists’ are comprised of overused tests and treatments, that for the beneficiary can be devastatingly expensive and in many cases unnecessary. Do doctors really care and want the best for their patients? I would like to think that they do, and this initiative is doing wonders in restoring my trust. Here’s the problem however…. The medical field’s mantra, if you will, is to provide the best possible care for patients both ethically and professionally. If that’s the case then why are doctors ordering multiple tests or treatments for a patient that when looking at the evidence, doesn’t really help them or provide any new information regarding their illness? I understand they want to do all that they possible can for the patient, but at what cost? It does not cost doctors anything. For the patient however, they are now starring down a barrel made of bills (expenses for providing care) that most cannot afford. So again, I ask, “how does going the extra mile help?”

In a lot of cases, getting a second or third opinion has saved millions of lives. (Not to mention, subsequently either adding or subtracting to the ever increasing cost of providing health care in this country). But many of those second and third opinions have also provided nothing that benefits the patient. The only thing new here is the fact that a patient now has to pay for a procedure or test/treatment they could have done without. The key to solving this conundrum is to find an effective way to develop and execute combined decision making. Doctors and patients must find a better way to communicate their concerns, albeit procedural or financial. This common understanding is truly necessary in order to get past this complication, and increase efficiency without decreasing the quality of care provided.

An interesting point is addressed by this article concerning viewers’ interpretation of this initiative as a means to decrease access to quality health care. For the record IT IS NOT. Choose Wisely’s mission however, is to use communication as a means to determining whether certain or often used tests/treatments are relevant and necessary for the patient. If the medical industry as a whole can reduce health care costs without affecting quality of care provided, it is a win win for both the patient (less medical expenses) and doctors (less paper work and hassle to get insurance companies to cover said treatments provided). Decreasing the cost of health care provided as a nation could potentially save this country billions.

That being said, this potentially new surplus of funds could be used to increase reimbursement rates for social insurances like Medicare or Medicaid, which eventually would increase the quality of care delivered across the country. Doctors would no longer resist the urge to turn away new patients if they have government funded insurance because the reimbursement rates for services rendered would be acceptable. As of right now, they are not, and Medicare beneficiaries are paying the price for it.

A Country,…..Lost.

I saw the other day on CBS Channel 3 news a senior resident is facing eviction from her high rise apartment for flying small American flags from her balcony for Memorial Day. The Phillipsburg Housing Authority says that they are not “Anti-American” but that its a hazard issue to have anything hanging off balconies. They are trying to enforce lease adherence due to federal laws and safety rules.
“Really, are you serious right now?”
What has this country come to in this day and age? That a senior citizen who has survived a world war, the great depression and a cold war threat can’t show pride for their country. I’m sad to say but this, to me, validates every reason why seniors ARE and SHOULD BE upset at their country. The significance of law and corporate greed have surpassed patriotism. Our seniors today have seen a country once dedicated to its citizens mutate into an egotistical superpower obsessed with nepotism. Needless to say, this leads me to my point.
Seniors and baby boomers today have experienced a time when our country valued its relationship with its citizens. They were this country’s backbone; our present and future successes have been predicated on their devotion and love for America. Today…..sadly to say, but we are considering cutting the funding for Social Security and Medicare: Two major social insurances established for administering the health of these same seniors. Now, to me, this sort of approach seems a bit callus and cold. Actually, let me re-phrase that…. Really callous and cold. How can we as a nation turn our backs on the same individuals that helped create the land we call “The Home of the Free and the Brave?”
I understand that we as a country are facing a major crisis right now with regards to this country’s economic situation but to reduce health care funding for 80 million seniors turning 65 over the next 20 years is quite drastic; and will it really change anything?… I’m not so sure. That sort of approach is only solving one problem and creating another. We need to find a more systematic approach to addressing the major concerns of this country and I believe the Affordable Care Act is step in the right direction. Don’t get me wrong, it certainly has its flaws but it DOES keep those responsible for this country’s success at the forefront of their solution exploration. That being said, any wrinkles can be ironed out over time. Nothing is ever perfect the first time around, but it is a bit refreshing to now that the current “Powers that Be” have the moral aptitude to keep our seniors in mind.

A Plee, to all Health Care Professionals

As a Quality Development Specialist at a health insurance consulting firm I have begun to notice a disturbing trend…not just from the agents that I monitor and critique but from the insurance industry as a whole. A lack of patience is really wearing thin on seniors and they are fed up with it.

Listen, I get that subsequent generations after the “Baby-boomers” are more tech savy and computer literate but that is NO excuse to assume or expect (for that matter) that ALL seniors enrolled or aging into Medicare can just look online to get the answers they need. Medicare and Social Security are struggling to handle the volume of beneficiaries affected social insurance and so we as health care professionals NEED to understand this.

Take the time and effort to fully explain the benefits and responsibilities that Medicare beneficiaries will encounter. If we all do our part, we can significantly reduce the red tape tying up the system.

Are You A Part of the Growing Trend?

Senior health care management is a growing concern among the 80 million baby boomers turning 65 and facing retirement over the next 20 years, and for many is a daunting task to tackle. If you handle your own administration then you may have noticed the developing trend of seniors taking responsibility to understand and educate themselves about Medicare.

“ Do you know what type of Medicare plan you currently have, and how it coordinates benefits?”

For most, it’s like buying a lottery ticket and hoping to win. Seniors have better odds of winning the lottery than they would the chance of NOT having any claims disputes with insurance providers about coverage. “What’s the correlation?” I’m glad you asked. The probability of skating through the world of insurance without any hassles is slim to none. However, if you empower yourself by learning about what your beneficiary rights and entitlements are, you’ll be less likely to be taken advantage of.

You would be surprised to know that many seniors are uninformed, so you shouldn’t feel alone. But one does beg to question, if you were to educate yourself about Medicare and health insurance, what resources do you have? Well…. there’s Medicare, Social Security and CMS. Have you tried contacting these “so-­‐called” resources? If you haven’t, by all means give it a try and let me know how you make out; just be prepared to spend at least 30-­‐45 minutes on hold before a representative will be available to help you. Don’t get me wrong, these resources ARE Valuable and Viable options, but they are incapable of handling the growing volume of seniors seeking assistance to concerns regarding understanding their health care possibilities.

So….. what viable “options” are there for seniors to use as a resource to educate themselves more about Medicare and their health care management? Well, reading this article is a good start, but here are a few more tangible possibilities seniors can take advantage of. Educational resources for seniors include the Internet, (highly recommended but not necessarily user friendly to those unfamiliar with how to navigate a computer), Local Community Senior Centers and Local Corporations for the Aging.


This is probably the best educational resource guide available to seniors. The entire world is at your fingertips. You can access Medicare, CMS and Social Security’s website archives for all the new changes made and the history of social insurance. You could also use the Internet to follow the leaders in health care whether it is through publications, blogs or chat rooms. The Internet has the capability to provide seniors with the ability to educate themselves on their own time and at their own pace.


Community Centers are a great place for seniors to go to educate themselves. You have access to the Center’s resources, for example weekly/monthly lectures by community professionals, but more importantly, it’s a place where people get together to show each other that they are not alone. Everyone can share his or her Medicare experiences with someone who cares and understands. It’s that personal connection that frees them from any inhibition towards embarrassment for not comprehending how a health plan really works. “It’s a struggle we all share,” a prospect once told me.

It shouldn’t have to be.


Corporations for the aging are fantastic educational resources for seniors because they can provide information about senior services, programs, and local senior communities in the area. They are the voice for the elderly; their advocate. They want to ensure that the quality of life for future generations of seniors continues to improve.

” Simplify Your Healthcare Management.”

Medicare. How many seniors that are enrolled understand its benefits? ….. Not as many as you think. For a program established by this government FOR its seniors, they sure don’t make it easy for them to understand how to make the most of their healthcare options. The government and independent providers refer beneficiaries to Medicare to inquire about coordination of benefits between health plans and retiree benefit programs. Questions such as: “Who pays for which services first?” and “How much will I pay?” This referral system would work except for one, lousy problem…… Beneficiaries are left to remain on hold until they decide to hang up.

For what it’s worth, I think it’s important to understand, and applaud Medicare and Social Security for trying to be efficient in streamlining the customer service aspect of their business. By implementing automated systems beneficiaries can opt out of waiting for a live agent and just follow the prompts to get the desired answers to their questions. Initially that sounds great, but what if the beneficiary has a special circumstance? As in most instances when beneficiaries reach out, their questions require a full and thorough explanation, therefore making the computer-generated system ineffective. So where are the beneficiaries left to seek advice from now? Social workers at Retirement Communities, Skilled Nursing Facilities (SNF), and Human Resources departments of Employer Retiree Plans are all viable resources. They are educated enough to answer these questions. Unfortunately, however, those resources end up spending the majority of their time filing claims forms for the beneficiary. So who is left making sure the individuals understand how their Medicare options work and how Medicare coordinates benefits with their current or prospective health, employer or retiree plans? Anybody???

Would it be callous to associate this frustration to a rat trapped in a maze? I understand that may seem a bit cold, but it is really quite accurate. The answers for seniors are available but only after exhausting every avenue, which has their own fair share of obstacles and hurdles, making the process akin to the rat lost in a maze. This only frustrates beneficiaries, confusing them even more and overall makes matters worse.

What good is a system if its own beneficiaries cannot access it efficiently?

Herein, lies the problem. Many may say the responsibility of maintaining one’s own healthcare management falls upon oneself. Agreed. Individuals should not have to rely on others to make their important healthcare decisions due to the inaccessibility of designated resources. Beneficiaries want to be aware and cognizant of the options available to them and how to make the most of their choices so they can meet their individual healthcare needs. The “Designated Resources,” used to handle the inquiries about Medicare health plans, both Medicare and Social Security, respectively, are incapable of handling the demands of 80 million seniors. And so, millions go without ever fully understanding how Medicare, an integral part of their healthcare that contributes to their well being, truly works. This lack of direction, with regards to healthcare management, can be very dangerous.

Millions of beneficiaries enroll into healthcare plans without completely understanding how it affects their financial responsibility. They enroll into plans expecting a level of coverage that is different than what the insurance company will provide. Or worse yet, the beneficiaries’ projected Out-of-Pocket-Expenses for the year are far greater than forecasted. Where will the additional income come from? One begs to question where the lack of communication occurred….

The 21st century consumer market place demands delivery upon receipt. If you pay for something, you expect to get something else in return; that particular mindset is warranted. In insurance, for example, those things can be customer service, specific coverage and to pay when they, the insurance company, say they will (claims).

As a consumer, one would like to place blame on one faction versus the other, but a lack of communication could very well have stemmed from both the insurance company and the consumer. The insurance provider can make a contract so confusing, that the consumer doesn’t bother to read it all. And, well,…. just that. The consumer fails to read the ENTIRE contract or Summary of Benefits, (SOB), for those of us in the insurance industry. Therefore beneficiaries are confused as to their responsibility upholding a contract they do not understand. Hence, misunderstandings occur leaving beneficiaries confused and frustrated.

Misconceptions and misinterpretations of shared responsibility plans can lead to unwarranted claims as well. This is a major contributor to what ties up the claims departments. Claims that shouldn’t be filed are, and the one’s that should take precedence are held up, slowing down the efficiency of distributing claim payouts where they need to go. As I’m sure we can all infer, unfortunately now the individuals that are in dire need of that payout have to wait.

The insurance industry is a business, and therefore beneficiaries should approach the task of choosing a viable health plan based on their needs in the same manner, analytically and cost-effectively. By gaining a better understanding of how cost-sharing plans actually work, beneficiaries can more effectively forecast their annual Out-of-Pocket-Expenses and budget accordingly. If they are cognizant of what Medicare covers versus what they don’t cover, they are now aware, or at least in a better position to make the necessary adjustments to bear the financial responsibility, (in theory).

So then what’s the solution? Good question. What seniors need is for someone to provide an ACCESSIBLE resource within establishments and communities that will allow them easy access to the answers for their healthcare management questions. Managed Care Consultants is “THAT” resource.

Managed Care Consultants provides many different forms of educational services to the retirement community of your establishment. Through seminars, consultations, blogs and emails retirees of your institution will have 24-hour access to the answers they seek. Qualified health professionals are committed to consulting with beneficiaries about the different scenarios they may encounter when dealing with coordinating benefits between Medicare, Healthcare providers and Retiree and/or Employer plans.