As a kid growing up in Cleveland, each day for years, I very avidly consumed everything published in the sports section of the local morning newspaper. Remember those? That morning newspaper, known to most of us back then simply as “The PD”, has persevered and lives on to this day. A favorite column back then, penned quasi-regularly by a legendary local sportswriter, was simply titled Notes-Off-The-Cuff. It contained a potpourri of brief but always interesting slices of information from across the Cleveland sports world.
As a tip of the cap to that old column and the recollection of the joy I always found in reading it, I introduce our humble Medicare version of “Notes-Of-The-Cuff.” We plan to publish it in this space “quasi-regularly” with the goal of providing you with brief but useful bytes of information pertaining to your Medicare coverage.
Medicare Coverage Of The New Weight-loss Prescription Drugs…..
Right out of the chute, new weight-loss prescription drugs with names like Ozempic, Wegovy (semaglutide), and Mounjaro (tirzepatide) are showing promise as highly effective weight loss agents. They’re garnering lots of interest both from those in the medical community as well as those that struggle with obesity and weight loss. Currently, these drugs, which are quite expensive (e.g., Wegovy starts at an estimated annual rate of $13,600), are not covered by Medicare. This mostly stems from a 2006 law that bans Medicare from covering drugs prescribed for weight loss. Congress would need to amend the law for weight-loss drugs in order for these new entrants to be covered under Medicare. However, some measure of limited coverage could potentially be extended through an administrative action and/or by the Center for Medicare and Medicaid Services (CMS) establishing demonstration projects and innovation models. As one might imagine, the makers of these types of weight-loss drugs are aggressively lobbying for enactment of broad Medicare coverage. However, until something changes, access to these relatively costly medications will continue to be limited to those folks willing and able to pay entirely out-of-pocket for them…………. (Note: Some of these drugs are currently covered by Medicare for the treatment of diabetes but not for weight loss.)
What I’m Hearing About The Cost of Medicare Part B in 2024?
Earlier this year, experts were projecting about a $10 per month increase from $164.90 to $174.80. Just today, however, I heard we should expect the Part B premium to now rise by about $15 a month in 2024 to $179.80 per month. The new projection comes on the heels of the recent approval for coverage of the new Alzheimer’s drug, Leqembi, which now costs about $26,000 a year and is slated to be covered under Part B. We’ll know for sure in the next month or so………..
How Medicare Covers Ambulance Rides
Medically necessary emergency and non-emergency ground and air ambulance services are covered under Medicare Part B. What you are expected to pay depends on the type of coverage you have (e.g., supplement plan, Medicare Advantage plan). You may pay a copay (e.g., $250), coinsurance (e.g., 20%), or as in the case of supplement plans, you may not have any out-of-pocket costs at all if you have met the annual Part B deductible ($226 in 2023). Medicare Part B also covers air ambulance service if a ground ambulance cannot get to where you are, or there is a great distance to travel or some other obstacle involved in getting you to the nearest appropriate facility. Different requirements for people in rural areas may apply if the health care provider determines an air ambulance is necessary due to time, location, and other geography-related factors………….
AND FINALLY —- Are You Paying an Income-Related Monthly Adjustment Amount (IRMAA) And Your Income Has Gone Down? Here’s What To Do…..
I regularly get asked about this. And, yes, there is definitely something you can do. If your income has gone down and you think the change could make a difference in the income-related adjustment amount you have to pay Medicare each month, contact Social Security. Communicate as soon as possible that you have new information for them showing your income level has changed (decreased) and you’d like to request an IRMAA reconsideration (reduction). In addition to information documenting the new income level, they’ll want documentation verifying the reason or event for the reduction in your income. The documentation should relate to the change in income and may include such things as a death certificate, a letter from your employer about your retirement or a significant one-time payment, or something similar. If Social Security finds in your favor, no matter how long the reconsideration takes, they’ll make the adjustment retroactive to the date you first requested it. If you think this situation may apply to you, try it. It’s worth a shot.
If there are specific topics you’d like us to address in future issues please drop us a line at 65plus@bbginc.net with your suggestions.