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Palmetto_rgb_webMental health conditions, such as depression or anxiety, can come at any age and can happen to anyone. They are nothing to be ashamed of. While they can occur at any time, stressful holidays and the let-down after the holidays often make these conditions worse.
With that in mind, it’s important to know that Railroad Medicare covers many mental health services (Medicare pays 80 percent while the patient pays 20 percent) after your annual deductible is met and when the service is provided by: a psychiatrist or other doctor, a physician assistant, a nurse practitioner, a clinical psychologist, a clinical social worker or a clinical nurse specialist.
Some of the covered services are

  • Annual screening for depression;
  • Individual and group psychotherapy with doctors, or certain other licensed professionals who are allowed by the state to offer these services;
  • Family counseling (if the main purpose is to help with your treatment);
  • Testing to find determine if you’re getting the services you need and/or if your current treatment is helping you;
  • Psychiatric evaluation;
  • Medication management;
  • Occupational therapy that’s part of your mental health treatment;
  • Individual patient training and education about your condition;
  • Diagnostic tests.

Talk to your doctor or health care provider if you feel you may be depressed or have any of these following symptoms (this is not an all-inclusive list):

  • Sad, empty, or hopeless feelings;
  • A lack of energy;
  • Trouble concentrating;
  • Difficulty sleeping or sleeping too much;
  • Little interest in things you used to enjoy;
  • Suicidal thoughts.

If you have questions about your Railroad Medicare coverage, you can call their toll-free Customer Service Line at (800) 833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET. For the hearing impaired, call TTY/TDD at (877) 566-3572. This line is for the hearing impaired with the appropriate dial-up service and is available during the same hours Customer Service Representatives are available.
Visit Railroad Medicare’s Facebook page at https://www.facebook.com/myrrmedicare. Join Railroad Medicare’s listserv/e-mail updates. Just select the ‘E-Mail Updates’ in the ‘Stay Connected’ section on the lower left-hand side of our main webpage at www.PalmettoGBA.com/RR/Me.

RRB_seal_150pxThe standard Medicare Part B monthly premium will be $104.90 in 2015, the same amount as in 2014.

Some beneficiaries will continue to pay higher premiums based on their modified adjusted gross income, but these amounts are also remaining the same as in 2014. The monthly premiums that include income-related adjustments for 2015 will be $146.90, $209.80, $272.70, or $335.70, depending on the extent to which an individual beneficiary’s modified adjusted gross income exceeds $85,000 (or $170,000 for a married couple). The highest premium rate applies to beneficiaries whose incomes exceed $214,000 (or $428,000 for a married couple). The Centers for Medicare and Medicaid Services estimates that less than five percent of Medicare beneficiaries pay the larger income-adjusted premiums.

Beneficiaries in Medicare Part D prescription drug coverage plans pay premiums that vary from plan to plan. Beginning in 2011, the Affordable Care Act required Part D beneficiaries whose modified adjusted gross income exceeds the same income thresholds that apply to Part B premiums to also pay a monthly adjustment amount. In 2015, the adjustment amount ranges from $12.30 to $70.80.

The Railroad Retirement Board withholds Part B premiums from benefit payments it processes. The agency can also withhold Part C and D premiums from benefit payments if an individual submits a request to his or her Part C or D insurance plan. The RRB will also begin withholding Part D income-related adjustment amounts from benefit payments in January 2015.

The following tables (click here) show the income-related Part B premium adjustments for 2015. The Social Security Administration is responsible for all income-related monthly adjustment amount determinations. To make the determinations, SSA uses the most recent tax return information available from the Internal Revenue Service. For 2015, that will usually be the beneficiary’s 2013 tax return information. If that information is not available, SSA will use information from the 2012 tax return.

Those railroad retirement and social security Medicare beneficiaries affected by the 2015 Part B and D income-related premiums will receive a notice from SSA by December 2014. The notice will include an explanation of the circumstances where a beneficiary may request a new determination. Persons who have questions or would like to request a new determination should contact SSA after receiving their notice.

Additional information about Medicare coverage, including specific benefits and deductibles, can be found at www.medicare.gov.

Palmetto GBA is reminding railroad retirees that Railroad Medicare Part B provides coverage for services such as doctors’ visits, ambulance transports, lab tests and some supplies. Benefits are the same for eligible individuals, whether eligibility is through Railroad Retirement or Social Security.

Railroad Medicare is funded by a portion of Railroad Retirement Tier I and Social Security payroll taxes paid by employees and employers. Monthly premiums are also applied to the program.

There are times when Medicare-participating providers and suppliers don’t understand that if they accept Medicare Part B, this includes Railroad Medicare too.

The Centers for Medicare and Medicaid (CMS) has incorporated information about Railroad Medicare in its online manual publications pertaining to Medicare Policy and Regulation. The CMS manual states:

“Carrier jurisdiction claims for individuals who are QRRBs (Qualified Railroad Retirement Beneficiaries), including those who are entitled to both Social Security and Railroad Retirement benefits, are handled by the Palmetto Government Benefits Administrators (GBA) L.L.C., a subsidiary of Blue Cross and Blue Shield of South Carolina.”

The CMS also includes information about Railroad Medicare in its annual Medicare & You booklet mailed to Medicare patients every year.

When Palmetto GBA conducts educational events or speaks one-on-one with providers and suppliers, they always explain what Railroad Medicare is and confirm that Medicare Part B benefits are standard nationwide.

If a provider or supplier you want to work with participates in Medicare, but states “not Railroad Medicare,” Palmetto GBA recommends that they call Palmetto’s Provider Contact Center at (888) 355-9165. Palmetto’s staff is trained to discuss these matters with all Part B providers and suppliers. They also recommend providers or suppliers visit Palmetto’s website at www.PalmettoGBA.com/RR.

If you have questions about your Part B coverage, call Palmetto’s Beneficiary Contact Center at (800) 833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET.

Palmetto also encourages beneficiaries to visit their website at www.PalmettoGBA.com/RR/Me and sign up for email updates. To do so, select “Email Updates” on the lower left-hand side of the web page under “Stay Connected.”

 

Would you accept a job paying $1 million to count out $2 billion in $1 bills?

Think again, because working a 40-hour week and counting out $1 per second, you would require 266 years to count out the $2 billion total.

Now that you have an idea how much $2 billion is, consider that in the 12 months ending Sept. 30, 2010, the federal government, through the Department of Justice, recovered $2.6 billion in Medicare health care fraud judgments and settlements from 726 separate defendants.

This $2.6 billion total has exploded from $490 million in 1999, meaning that Medicare health care fraud is on the rise, according to PalmettoGBA, which administers Railroad Medicare.

As we struggle to preserve Medicare – and keep a lid on what we, as current and future retirees must pay for its coverage — it is necessary to do all we can to keep a lid on Medicare inflation.

We can help keep those costs down and help preserve Medicare by recognizing, reacting to and reporting Medicare health care fraud.

Here is what you can do:

  • Examine carefully your Medicare Summary Notices (MSNs).
  • Be alert for charges for services you didn’t receive, double billings for the same service, and procedures or services not ordered by your physician.
  • Keep your Medicare card in a safe place. If it becomes lost or stolen, notify your Medicare provider immediately.

If you see a charge or a date of service that is incorrect, first call your provider and ask about it. If the billing is not corrected, or if you suspect a pattern of improper billing, call the Department of Health and Human Services Medicare fraud hotline at (800) 447-8477, which will initiate an investigation and keep your identity confidential.

For more information on Medicare fraud, visit www.PalmettoGBA.com/rr/me

If we don’t take the initiative to help keep Medicare costs down, we place the future of Medicare – and our own health care futures – in jeopardy.

Many physicians and medical practitioners are choosing to withdraw from participation in Medicare. This has a direct financial impact on all UTU members who are retired or intend to retire in the near future.

If you are eligible for Medicare, and your physician or medical practitioner withdraws from participation in Medicare, you are faced with a choice of signing a binding contract for continued medical services or choosing a physician who does participate with Medicare.

While Palmetto GBA, which administers Railroad Medicare, provided the following information, this alert also affects airline and bus members covered by Medicare.

If you are covered by Medicare, and your physician or medical practitioner has withdrawn or withdraws from participation in Medicare, the physician or medical practitioner will ask you to sign a contract for future services that would have been covered by Medicare prior to the physician or medical practitioner withdrawing from Medicare participation.

Once you sign the contract, Medicare will not pay for any services provided by that physician or medical practitioner. Additionally, no Medicare payment may be made to you for items or services provided directly by a physician or practitioner who has opted out of Medicare.

The contract you will be asked to sign is a binding agreement that you give up Medicare payment for services furnished by the physician or medical practitioner and that you agree to pay from your own pocket the physician or medical practitioner without regard to any limits that would otherwise apply to what they charge.

The only exception is in an emergency or urgent care situation.

Even if you sign such a contract with your physician, you may still receive services from other physicians and practitioners who are participating with Medicare.

“Physician” means doctors of medicine, doctors of osteopathy, doctors of dental surgery, doctors of dental medicine, doctors of podiatric medicine and doctors of optometry.

“Medical practitioner” means physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse midwife, clinical psychologist, clinical social worker, registered dietitian and nutrition professional.

Not affected are chiropractors, physical therapists and occupational therapists. They are not permitted to withdraw from Medicare participation.

If you are asked to sign a contract with a physician or medical practitioner who withdraws from Medicare participation, the contract must:

  • Be in writing and in print large enough so you can read it.
  • State whether the physician or medical practitioner is excluded from Medicare.
  • State that you or your legal representative accept full responsibility for payment of charges for all services provided by the physician/practitioner.
  • State that the you or your legal representative understand that Medicare limits do not apply to what the physician/practitioner may charge for items or services provided by the physician/practitioner.
  • State that you or your legal representative agree not to submit a claim to Medicare or to ask the physician or medical practitioner to submit a claim to Medicare.
  • State that you or your legal representative understand that Medicare payments will not be made for any items or services furnished by the physician or medical practitioner that would have otherwise been covered by Medicare if there was no contract and a proper Medicare claim had been submitted.
  • State that you or your legal representative are entering into the contract with the knowledge that you have the right to obtain Medicare-covered items and services from physicians and practitioners who have not opted out of Medicare.
  • State that you are not compelled to enter into contracts that apply to other Medicare-covered services provided by other physicians or practitioners who have not withdrawn from Medicare participation.
  • State the expected or known effective date and expected or known expiration date of the withdrawal period.
  • State that you or your legal representative understand that Medigap plans do not — and that other supplemental plans may elect not — to make payments for items and services not paid for by Medicare.
  • Be signed by you or your legal representative and by the physician or medical practitioner.
  • Not be entered into by you or your legal representative during a time when you require emergency care services or urgent care services.
  • Be provided to you (photo copy is acceptable) or to your legal representative before items or services are furnished to you under the terms of the contract; and be made available to the Centers for Medicare and Medicaid upon request.

Staying with, or going to, a physician who does not participate in Medicare is a difficult choice.

Retirees covered by Railroad Medicare may call the Railroad Beneficiary Contact Center at (800) 833-4455 or TTY at (877) 566-3572 to obtain names of physicians and medical practitioners in their area who participate in Medicare.

Those not covered by Railroad Medicare should contact their Medicare provider.

For more information on Railroad Medicare, sign up for email updates at :

www.palmettogba.com/medicare

Select “e-mail updates” under the “Stay Connected” section. You also may receive updates through Railroad Medicare’s Twitter or Facebook page by going to:

www.facebook.com/#!/myrrmedicare