Area Agency on Aging for Southwest Florida

Most Medicare drug plans have a coverage gap (also called the donut hole). This means theres a temporary limit on what the drug plan will cover for drugs. You enter the coverage gap when your total drug costsincluding what you and your plan have paid for your drugsreaches a certain limit.In 2024, that limit is $5,030. While in the coverage gap, you are responsible for 25% of the cost of your drugs.A SHIP (SHINE) counselor can answer your Medicare questions and help you understand coverage and options!To reach SHINE, call the Helpline at 866-413-5337.

What is preventive care?Preventive care is the care you receive to prevent illness, detect medical conditions, and keep you healthy. During this Medicare Minute, well look at Medicares coverage of preventive services and review the screening, vaccines, and counseling that can help you stay on top of your health. A quick reference handout is available for download that will include everything covered in this blog post and more.Medicare Part B covers many preventive services with no cost-sharing, as long as you meet the eligibility requirements and follow the guidelines below.Is it covered by Medicare?Preventive services recommended by the U.S. Preventive Services Task Force are covered with zero cost-sharing, so you will not owe any deductible or coinsurance when you receive them. You can find a list of those services on Medicare.govs page on Preventive & Screening Services. You can also call 1-800-MEDICARE or read your Medicare & You handbook for a full list.Do I meet the coverage criteria?For many of the covered preventive services, you have to meet certain criteria based on your age, sex, or certain risk factors. Your health care provider should be able to tell if you qualify.Am I seeing the right kind of provider?Original Medicare: To get preventive services with no cost-sharing, you should see a provider that accepts assignment, also known as a Medicare-participating provider. Many providers accept assignment, but you should ask your provider in advance if they accept assignment. If you see a non-participating or opt-out provider, you may be responsible for part or all of the cost of your service.Medicare Advantage: It is usually best to receive services from an in-network provider. Contact your provider to learn if they are in-network for your plan, or contact the plan to learn which providers are in-network. If you go out-of-network, you might be responsible for part or all of the cost of your preventive service.What will happen during my annual wellness visit?The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider to create or update a personalized prevention plan. Medicare Part B covers the AWV if you have had Part B for over 12 months and you have not received an AWV or your Welcome to Medicare Visit in the last 12 months.At your Annual Wellness Visit, your doctor may:Check your height, weight, blood pressure, and other routine measurementsGive you a health risk assessment, which might include a questionnaire that you complete before or during the visitReview your functional ability and level of safetyLearn about your medical and family historyMake a list of your current providers, durable medical equipment (DME) suppliers, and medicationsCreate a 5-10 year screening schedule or check-listIdentify risk factors and current medical and mental health conditions along with related current or recommended treatmentsScreen for cognitive impairment, including diseases such as Alzheimers and other forms of dementiaScreen for depressionProvide health advice and referrals to health education and/or preventive counseling services aimed at reducing risk factors and promoting wellnessWhat the annual wellness is not:It is not a head-to-toe physicalAlthough Medicare Part B covers the Annual Wellness Visit with no cost-sharing, depending on your visit, you may be responsible for paying a facility fee and/ or cost-sharing on any diagnostic services you receiveWhat is genetic testing fraud and abuse?Genetic testing fraud or abuse can occur when Medicare is billed for genetic screenings or tests that are not medically necessary and were not ordered by the beneficiarys treating physician. We often see scammers offering cheek swab tests to obtain a beneficiarys Medicare information, which the scammers can then use for fraudulent billing or medical identity theft. Genetic testing is often advertised as one of the following:Cardio/cardiac genetic screening/testDNA screening/testHereditary cancer screening/testDementia screening/testParkinsons screening/testPharmacogenetics (medication metabolization)Look for these red flags to avoid genetic testing fraud and abuse:A company offers you free testing without your treating physicians orderA company uses telemedicine to offer you testing over the phone and arrange for an unrelated physician or teledoc to order the testsMedicare is billed (often thousands of dollars) for a broad range of genetic tests that you do not request or possibly even receiveA company requests your Medicare number at a health fair, senior center, assisted living facility, mall, farmers market, or church-sponsored wellness eventTo prevent genetic testing fraud and abuse, make sure to work with your trusted health care provider on your preventive health. Protect your personal information and Medicare number. Always read your Medicare statements for any suspicious charges. And finally, if you received a cheek swab or genetic screening/test that was not medically necessary, report your concerns to your local Senior Medicare Patrol (SMP).Who to contact for more information:Your doctor: If you would like to schedule preventive care (such as an Annual Wellness Visit or Welcome to Medicare visit) contact your doctor or health care provider.State Health Insurance Assistance Program (SHIP): Contact your SHIP if you would like to learn more about how Medicare covers preventive services or if you are confused why a provider is charging you for preventive care. SHIP counselors are trained and trusted to provide unbiased Medicare counseling. In Florida the program is referred to as SHINE (Serving Health Insurance Needs of Elders). In Southwest Florida, call toll-free: 866-413-5337 or email shineinfo@aaaswfl.org.Senior Medicare Patrol (SMP): Contact your SMP if you believe a provider is fraudulently billing you for preventive services or if you have experienced genetic testing fraud. SMPs empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report potential health care fraud. In Southwest Florida, call toll-free: 866-413-5337 or email shineinfo@aaaswfl.org.The Medicare Rights Center is the author of portions of the content in these materials but is not responsible for any content not authored by the Medicare Rights Center. This document is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2,534,081 with 100 percent funding by ACL/HHS.  The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.

Medicares Open Enrollment runs October 15 through December 7 and is the time of year when you can make certain changes to your Medicare coverage. The last change you make will take effect on January 1. Take action during Medicares Open Enrollment to make sure your coverage will meet your needs in 2025.What changes can you make during Medicares Open Enrollment?Joining a new Medicare Advantage Plan or Part D prescription drug planSwitching from Original Medicare to Medicare AdvantageSwitching from Medicare Advantage to Original Medicare (with or without a Part D plan)Call 1-800-MEDICARE (633-4227) or visit www.Medicare.gov to make changes.Review your coverage for 2025Medicare Advantage and Part D plans usually change each year. Make sure that your drugs will be covered next year and that your providers and pharmacies will still be in the plans network.Original Medicare: Visit www.Medicare.gov or read the 2025 Medicare & You handbook to learn about Medicares benefits for the upcoming year.Medicare Advantage or Part D plan: Read your plans Annual Notice of Change (ANOC) and Evidence of Coverage (EOC).What to consider when choosing a new plan:Ask yourself the following questions before choosing a Part D drug plan:Does the plan cover all the medications I take?Does the plan have restrictions on my drugs?How much will I pay for monthly premiums and the annual deductible?How much will I pay at the pharmacy (copay/coinsurance) for each drug I take?Is my pharmacy in the plans preferred network? Can I fill my prescription by mail order?What is the plans star rating?If I have other drug coverage, will the Medicare drug plan work with this coverage?For a full checklist of questions to ask before choosing a Medicare Advantage Plan, where to find Medicares Plan Finder tool, and tips on protecting yourself from marketing violations and misleading marketing, download SHIPs full handout here.Where can I go for more help?State Health Insurance Assistance Program (SHIP): Contact your SHIP if you have questions about any notices you receive or have experienced a potential marketing violation. SHIP counselors can help you review your options and pick a plan that meets your needs. SHIP counselors provide trusted, unbiased, and individualized Medicare counseling. Contact information for your local SHIP is below. Senior Medicare Patrol (SMP): Contact your local SMP if you believe you have experienced a potential marketing violation. SMP team members can help you to prevent, detect, and report potential Medicare fraud, errors, or abuse.In Southwest Florida, SHIP/SMP are also known as SHINE (Serving Health Insurance Needs of Elders), to contact your local SHINE Medicare Counselors, call toll-free 866-413-5337 or visit floridashine.org.The Medicare Rights Center is the author of portions of the content in these materials but is not responsible for any content not authored by the Medicare Rights Center. This document was supported, in part, by grant numbers 90SATC0002 and 90MPRC0002 from the Administration for Community Living (ACL), Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy. [September 2024]

You dont have to be a U.S. citizen to be eligible for Medicare. If you are not a U.S. citizen, but are lawfully present, you may be able to get Medicare coverage, depending on your situation.  There are two ways non-citizens can be eligible for Medicare. Lets learn how.Do you qualify for Federal Disability or Retirement benefits?You will qualify for Medicare if you qualify to receive or currently receive:Social Security retirement benefitsRailroad Retirement Benefits (RRB)Social Security Disability Insurance (SSDI)Regardless of your citizenship or how long you have lived in the U.S., if you qualify for these benefits, you qualify for Medicare.These benefits are tied to your U.S. work history, or the work history of a spouse or sometimes family member. Even if you have not been in the U.S. long or have not worked long enough, you may still qualify based on your spouses work history or benefits.If you arent sure if you qualify for these benefits or have enough work history, contact the Social Security Administration (SSA).*If youre eligible and ready to enroll, or have questions about Medicare eligibility and enrollment, you should contact SSA. You can call the national helpline (800-772-1213), go to www.ssa.gov, or visit your local branch to enroll.Are you a lawful permanent resident who has lived in the U.S. for 5+ years?If you meet both of these requirementsyou are a lawful permanent resident and have been in theU.S. for 5 years prior to enrolling in Medicareyou are eligible for Medicare:Lawful Permanent Residents (LPRs)  LPRs are non-citizens who are allowed to live in the U.S. indefinitely. To get LPR status and a green card, you must apply with the U.S. Citizenship and Immigration Services.Five-Year Residency Requirement  The five years begins the day someone arrives in the U.S. with the intention of establishing a home, not just visiting. You can still leave the U.S. temporarily, meaning for no more than six months.*Use the National Immigration Legal Services Directory to find immigration service providers in your area. You can find the directory at www.immigrationadvocates.org/legaldirectory/.Be aware of people trying to steal your Medicare numberMedical identity theft happens when someone steals your personal information and uses it to get medical treatment or equipment and bills your insurance for it. Healthcare companies can try to reach people in various ways, like television commercials, radio ads, events, mailings, phone calls, and text messages. Some of them may be legitimate, but some could potentially be scammers trying to steal your personal and/or medical identity information.Protect your Medicare and/or health ID number and only share it with your health care provider or trusted person. Protect your Medicare card like you would a credit card. Scammers have various ways of stealing someones Medicare number and other personal information.Detect medical identity theft by reading your Medicare statements often. If you see services or prescriptions that you didnt know about or receive, your Medicare and/or health ID number could be considered compromised.Report potential medical identity theft to your local SMP. It can affect your medical and health insurance records, and your ability to receive services or equipment in the future when it is medically needed. It can also lead to incorrect costs for both you and the Medicare program. Reasons to report:You gave out your Medicare and/or health ID number:Over the phone or internet to someone offering additional benefits, durable medical equipment, genetic testing, COVID-19 testing/supplies, back braces, etc.At a fair or other gathering as a check-in or to receive free servicesIn response to a television or radio commercial, Facebook ad, postcard, or print ad requesting a Medicare numberYou are contacted by a debt collection company for a provider bill  you do not oweYou received boxes of bracers, testing kits, or other medical supplies in the mail that you did not requestA Medicare and/or a Medicare Advantage plan denies or limits your coverage or benefit because of a medical condition you do not haveDownload the full handout with local SHIP/SMP contact information to resources and directories (pdf).For more information call 866-413-5337 or email shineinfo@aaaswfl.org for assistance in Southwest Florida.The Medicare Rights Center is the author of portions of the content in these materials but is not responsible for any content not authored by the Medicare Rights Center. This document was supported, in part, by grant numbers 90SATC0002 and 90MPRC0002 from the Administration for Community Living (ACL), Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.

The Adult Protective Services Program, a division of the Florida Department of Children and Families, is dedicated to preventing further harm to vulnerable adults who are victims of abuse, neglect, exploitation, or self-neglect, as outlined in Chapter 415, Florida Statutes.The Florida Abuse Hotline plays an important role in this process by screening allegations of adult abuse or neglect. It assesses whether the information meets the criteria for an abuse report. If the criteria are met, a protective investigation is initiated to determine if there is evidence of abuse, neglect, or exploitation; to assess immediate or long-term risks to the victim; and to identify any additional services needed to ensure the victims well-being.If you see or suspect anyone one of being abused or neglected. Please reach out via the Abuse Hotline 1-800-962-2873 or via this link: https://reportabuse.myflfamilies.com/s/Elder Abuse Prevention TrainingThe AAASWFL provides complimentary training on Elder Abuse Prevention for both professionals and community members. Participants will receive a certificate of completion upon finishing the training. For more information or to schedule a training session, please contact Gloria Lappost at (239) 652-6914 or via email at Clorivel.Lappost@AAASWFL.org.