This month . . .

Is squishy better than hard? (We are talking about food . . .)

How long do I have to stay in jail before I can change my drug plan?

Are you paying a “membership fee” to see your doctor?

What is prior authorization and how does that impact me?

Is this an offer I should refuse? WARNING, deadline approaching.

Once ripe, you have a narrow window of time — generally a few days — before the fruit starts to spoil (1Trusted Source).

You may wonder how to determine when an avocado is rotten and no longer good to eat.

Here are 5 signs that an avocado has gone bad.

https://www.healthline.com/nutrition/when-is-an-avocado-bad

During the fall Annual Enrollment Period is when most folks change their plan. However, there are a number of situations 

I moved to a new address that's still in my plan's service area, but I have new plan options in my new location.

I just moved into, currently live in, or just moved out of an institution (like a skilled nursing facility or long-term care hospital).

I have or am enrolling in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage).

Medicare takes an official action (called a "sanction") because of a problem with the plan that affects me.

I'm released from jail.

Follow this link for more options . . .

https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan/special-enrollment-periods

Medicare won’t cover your membership fee for a direct primary care arrangement (similar to concierge services).

Many DPC providers don’t accept Medicare or any other insurance for services. For Medicare, this is called “opting out.” Medicare won’t reimburse you for any services from a provider who opts out unless it’s an emergency.

https://www.nasdaq.com/articles/direct-primary-care-offers-more-access-but-medicare-wont-pay

In my specialty of cancer medicine, however, it isn’t simply a matter of cost or preferring a generic brand of medication to a brand name. These are too often life-and-death situations where time is of the essence.

One thing stands out when I reflect on the hundreds of “peer-to-peer” appeal calls I’ve made over the past decade. I have never failed to overturn the denial.

It is beyond egregious that the insurance companies have been allowed to get away with this for so long. The companies don’t see the consequences of their denials or what the appeals cost us.

For physicians, appeals cost time and energy. It takes us away from other patients, who suffer the stress and inconvenience of extra waiting. And the gaslighting of our medical expertise contributes to the ongoing epidemic of physician burnout via moral injury.

For the patients who receive an initial denial, even when the appeal is successful, it causes the harm and suffering of being told their care might not be covered and wondering how they will pay for treatments necessary to save their lives. Will they face such impossible choices as selling their home and going bankrupt to afford their cancer treatment? Choosing between food or medicine? It forces them to confront the reality that our medical system doesn’t consider them inherently “worthy” of care. Even after we win the appeal, these mental harms cannot be undone.

https://www.kevinmd.com/2023/04/the-insurance-denial-process-one-oncologists-fight-against-a-broken-system.html

Medicare scam alert! Unsolicited callers are pitching seniors about alleged new Medicare benefits in Georgia. "Keep your drug plan while eliminating the premium. PLUS free dental and vision! Hurry, this offer expires May 11,2023."     Why May 23? CMS declared medical emergency ends and you can use an SEP to enroll in a Medicare Advantage plan. They never tell you what you are giving up, only what you will gain. Don't fall for this bait and switch.

When you wake up at midnight and realize you are being watched . . .

Miss a newsletter? Follow this link to the archives

http://gamedicarenews.com/

Summer is almost here. Have fun & be safe!

Call or email if you have Medicare questions. Pass this along to your friends.

Bob