Page 48 - June 2023 Issue.indd

important to know that not all Medicare by allowing licensed professional
Prescription Drug plans are covering all counselors, including marriage and
insulins in 2023, and many of the plans family therapists, to offer services
Spot cover on their formularies. Folks may their Medicare approved Health Care
under the general supervision of
Senior are limiting which insulins they do
practitioner. Your general provider
have to discuss changing their insulin
with their doctor to ensure coverage will need to be part of the equation to
Senior Moments that guarantees that low rate. Please establish and document your medically
by Mary Moran take advantage of this one opportunity necessary behavioral health situation.
to enroll in a plan that guarantees
410-479-2535, or 410-490-3078
coverage of your insulin and all your This makes sense since Medication
Good news for diabetics! Th rough the meds for 2023. Assisted Treatment (MAT) combines

end of 2023, all beneficiaries who use behavioral therapy and medications to
When you change plans, your True Out treat mental health and substance abuse
a covered insulin product may drop
of Pocket (Troop) costs carry over from disorders. Your Health Care provider
and change their part D coverage one
time for the remainder of the year! your existing plan to the next one. Th is needs to be in the loop about any new
means the amount of money you have meds being suggested or prescribed by
You do not have to be in any particular
already spent toward your prescription a mental health therapist. As with all
Medicare Savings Program, Extra Help,
or SPDAP to facilitate this change. CMS drug deductible follows you to the next Medicare claims, the Behavioral Health

is granting a Special Enrollment Period plan. You will not have to start over to Services must be identified as medically
reach the annual deductible. necessary to be Medicare approved.
(SEP) for Exceptional Circumstances
to all who use diabetic insulin. This
To utilize this SEP, benefi ciaries must Medicare will cover an individual’s
SEP is due to the Prescription Drug call 800-Medicare so a customer service outpatient screening using diagnostic
plans having submitted their bids and
representative can assist with the testing, such as for Depression and
formulary cost projections of insulin
change of plans. Brokers, Agents, and Anxiety, provided by a doctor.
products to CMS for posting on the unfortunately, SHIP, cannot assist with Additionally, approval for Telemedicine
Medicare Plan Finder Before President
the plan change. Beneficiaries must call to provide internet-based video talk

Biden’s August 2022 signing of the
1-800- Medicare for assistance with therapy may have to be prescribed
Inflation Reduction Act (IRA). This making this prescription drug plan by your health provider and proven
year, the IRA limits the members’ cost
change over to a plan that covers your medically necessary. For optimum
sharing on covered insulin to $35 for a
diabetic insulin. health, it makes sense to have both
one-month supply. Members receiving
one’s mental and physical health care
Low Income Subsidies (Extra Help) CMS is also expanding its Behavioral providers communicating with one
will continue to pay the statutory CMS Health Strategy! Medicare benefi ciaries another!
maximum. will have easier access to Behavioral
Health services, including mental FYI, Federal Parity regs created
Remember pump users: $35. Insulin health and substance abuse disorders, six different categories of benefits
Pump coverage starts July 1st. It is
for Behavioral Health. Inpatient
TURNING 65? in-network, inpatient out of network,
outpatient in network, outpatient
out of network, emergency care, and
Confused about all the Medicare Terms & Options? prescription drugs.
Let Me Help You!
A clinically accepted Standard of Care
treatment plan, established by the
Anthony Insurance Services mental health provider for a patient’s
care, must be submitted to Medicare
Ann M. Anthony based on the Diagnostic and Statistical
Manual of Mental Disorders V (DSM).
DSM V is the most recent version of
Specializing in Medicare Supplemental Plans, the guide to be used by professionals
Medicare Advantage Plans, Medicare Part-D Plans, to identify and diagnose behavioral
health conditions. DSM-IV was in use
Dental and Vision, Long Term Care, and Life Insurance
Call Ann Today for an Appointment 410-708-0899 • anthonyins17@gmail.com from 1994-2013, and many laws and
22850 Fleming Road, Denton, MD 21629 regulations still refer to that earlier
version. However, in order to be
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