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A MESSAGE FROM SPECTRUM GENERATIONS CEO, GERARD QUEALLY

A MESSAGE FROM SPECTRUM GENERATIONS CEO, GERARD QUEALLY

This time of year brings much change to our environment.  The leaves change color; sportsmen get ready for hunting season; and shorts and sandals get replaced with sweaters and boots.  It is also a critical time of year for Maine’s older population.  The Medicare Open Enrollment Period is from October 15^th through to December 7^thand Spectrum Generations is here to help older adults of central Maine stay informed and answer their questions about Medicare, Medicare Advantage, and MaineCare, Medigap and other programs and benefits that supplement Medicare.

Each year Medicare health and drug plans can make changes to things like premium cost, coverage and which providers and pharmacies are in their networks.  People in a Medicare health or prescription drug plan should always review the materials their plans send them, like the “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC) and if their plans are changing, they should make sure their plans will still meet their needs for 2016.

This can be a daunting task; especially to older persons who are new to Medicare or were recently diagnosed with an illness and need to make decisions about future treatment and costs.  A slight change in a drug coverage plan can potentially cost thousands of dollars to the Medicare recipient.  Spectrum Generations’ Aging and Disability Resource Councilors (ADRC) and our volunteers are trained in State Health Insurance Program (SHIP) protocols and are ready to assist older adults in this important task of choosing a new or remaining with their current Medicare coverage.  Our counselors can be reached during normal working hours at 1-800-639-1553 to schedule an appointment.  

 Once an older person has Medicare coverage, another critical ally is the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).  The BFCC-QIO for Maine is a company called Livanta (www.bfccqioarea1.com). They handle all Medicare beneficiary complaints, quality care reviews, medically necessary reviews and discharge appeals from hospitals, skilled nursing facilities, home health and hospice providers, and rehabilitation facilities. 

Medicare beneficiaries have certain rights and protections.  Beneficiaries, their family members, or advocates can request a review of certain decisions about a Medicare beneficiary’s care and cost of treatment.  The first step to file an appeal or initiate a complaint is to contact Livanta’s BFCC-QIO day or night, including weekends, at 1-866-815-5440.  Even if you get their voice message, they will get back to you in 12-24 hours.

Peace of mind about your Medicare coverage is a critical aspect of staying healthy and living an enjoyable life in your community as you age.  Spectrum Generations stands ready to help through the Medicare Open Enrollment Period and throughout the year.