Your Guide to Open Enrollment

Your Guide to Open Enrollment

Open enrollment season is a period of time when people may elect or change the benefit options in health insurance and Medicare. The dates are October 15 through December 7. Current Medicare users can choose to re-evaluate part of their Medicare coverage and compare it against other plans in the health insurance market. After re-evaluating you can either add, drop, or switch Medicare Advantage or Part D plan. The Medicare Advantage plan is also known as the “Part C” plan. You cannot use Open Enrollment for Part A and/or Part B for the first time.

Medicare Plans:

Medicare is made up of several primary components or parts.

  • Part A: this plan is often called the hospital insurance plan because it pays for your care while you are in a hospital. It also pays some of the costs you stay in a skilled nursing facility or if you get health care at home. Lastly, it covers hospice care for people who are terminally ill.
  • Part B: this plan pays for doctor services, outpatient hospital care, and home healthcare that is not covered by in Part A.
  • Part C: this covers hospital services, doctor office visits, prescription drugs, and includes benefits such as dental, vision, and hearing coverage.
  • Part D: to join this plan it must be run by an insurance company or other private company approved by the Medicare. Each plan can vary in cost and the drugs covered. This plan covers your prescription drugs. If you take drugs now or if you do not and your health changes or you need more medicine, this plan will help pay and protect you from high drug costs.

Why consider re-evaluating your current Medicare Plan?

Choosing health insurance is no longer a one-time decision for most Medicare beneficiaries. Each year, insurance companies can make changes to Medicare Plans that can impact you personally and financially. It can impact monthly premiums, deductibles, drug costs, and provider or pharmacy “networks”. A network is a list of doctors, hospitals, or pharmacies that negotiate prices. There are three benefits to re-evaluating your current or new Medicare plan:

  1. You can switch to a better prescription drug coverage. Open enrollment even allows you to add a new drug coverage for the first time. This can help if you have crucial medications that you need and you can get them for a better price. It can also ensure that your drug plan still covers the drugs you need.
  2. You can save money and keep the doctor you already go to. Switching Medicare plans can potentially save you hundreds of dollars a year, especially if your current plan has out-of-pocket costs. Remember to check your doctors, hospitals, and pharmacies are still in the “network” you are a part of. If your insurance company has changed your plan’s provider or pharmacy network for the next year, you can use open enrollment to switch to a plan that will cover your current doctors, hospital, and pharmacies in the “network”.
  3. You can find a higher quality plan. You can check the quality of your plan during the open enrollment to make sure that you are getting the benefits and low costs you need.

At Gonzaba Medical Group in San Antonio, we accept Medicare plans. It is important to be educated on the open enrollment to make sure you can get everything you need. At Gonzaba, we offer primary, specialty, and chiropractic care. We also have a complete radiology center and a physical therapy and rehabilitation program. We have everything you need to treat your health care needs and can provide you all of the diagnostic and laboratory services. If you are interested in coming to us, visit our website to learn more or give us a call at 210-921-3800. Our mission is to provide an innovative system of medical care that delivers with integrity every day.

How Strong 65 Can Impact Your Health

How Strong 65 Can Impact Your Health

senior health san antonio

STRONG65, through Gonzaba Medical Group, is a free senior health care program designed by Dr. Bill Gonzaba that promotes healthy lifestyles and fitness to seniors all over the San Antonio area. Those who sign up for the program can participate in events and activities such as:

  • Farmers Markets
  • Giveaways
  • Dances
  • Karaoke
  • Chair Yoga
  • Bingos

The program also provides a VIP (Very Important Partner) cards! The VIP card gives seniors exclusive access to events and giveaways throughout the program. The only requirement is you must be at least 62 years old.

Strong 65 can impact your health by influencing you to stay active and eat healthy. Here are the key messages the program promotes:

  • Stay strong through age-appropriate exercise: line dancing and chair yoga, are a few of the activities that will help keep you active and moving.
  • Eat healthy: enjoy access to nutrition tips, advice, and recipe collections.
  • Take care by making your health a priority: choose the right medical team partner, visit your physician regularly, and take the medication that is prescribed to you.
  • Engage with life: live with conviction and purpose. Staying active in your community and engaging with your peers is what defines a thriving senior. Go to the events and continue to take opportunities to socialize.

Senior health care is a priority at Gonzaba Medical Group. The STRONG65 program with Gonzaba can help. To sign up to or learn more about STRONG65, please visit http://strong65.com/.

6 Tips to Manage Stress

Every year in April we observe Stress Awareness Month. A month that is dedicated to revealing the complications that are associated with stress and healthy ways to manage it. There are times when our lives become stressful- it is something that is unavoidable, and it feels as though a huge weight is on your chest. During these times the body can provide many different signs that it is under a great amount of stress. You can become irritable, suffer from stiff muscles and joints, have frequent headaches and stomach pains, and experience insomnia. Living a stress filled life can also have more serious complications to our health, including depression, anxiety, high blood pressure, and heart disease. This month, we want to provide you with a few tips that may help you manage the stress in your life.

Tip 1: Assess the Situation. Look at what exactly is causing your stress. Is it something that is out of your control? If so, try taking a step back and letting go of the stress. It is part of the human condition to worry about items and topics that are utterly unchangeable. Are you stressed by traffic in the morning? Are you worried or concerned that your favorite sports team will not enter the playoffs? Besides leaving a little early to beat traffic, you can’t control certain outcomes.

Tip 2: Distract Yourself. There are times when working on a project or dealing with a situation can seem completely unmanageable. Our instincts tell us we need to fix something right away and then spend countless hours worrying about the situation. Instead, try to find something that will distract you. Indulge in a hobby, read a book, or go for a run. Choose an enjoyable activity that will help relieve your stress.

Tip 3: Create a Schedule. Stress can often be linked to feeling as though there are many tasks that need to be accomplished but not knowing where to start or not having enough time to complete them all. Creating a schedule can help manage your time and reduce stress. It is also good to include “me” time in your schedule. Taking the time to care about oneself and participate in tasks that bring joy is key to fighting stress. It can be a small item done first thing in the morning, on a lunch break, or before going to sleep.

Tip 4: Healthy Life. Maintaining a healthy lifestyle by sleeping well, eating well-balanced meals and exercising regularly are great ways to fight stress. Proper sleep ensures that the mind and body are properly rested and ready for the day. If you eat meals that are healthy and full of nutrients, it will keep the body healthy, even when facing stress. Exercising releases endorphins which are excellent at combating the feeling of stress.

Tip 5: Relationships. Nurturing and creating lasting relationships is essential to managing stress. Having a friend, family member, or significant other to talk when stressed is sometimes all that is needed to feel relief. Stress can even cloud judgment at times and have someone that offers insight and advice can relieve the tension that stress causes.

Tip 6: Your Doctor. A certain amount of anxiety and stress is normal, but if you find yourself stressed out constantly you may need to consult your primary care physician. Please, talk to your doctor about anything you feel is impacting your physical and mental health. If needed, your physician may refer you to another doctor who can help you get back to living your life without overwhelming anxiety and stress.

Keep these tips in mind the next time you are feeling stressed out. It is important to manage stress in a constructive way so that it does not impact your health. The next time you feel tense, try removing yourself from the situation and indulging in a healthy pleasurable activity like drawing, reading, or talking to a friend. If you are concerned that the stress might be affecting your health or the health or a loved one, Gonzaba Medical Group can help. Our dedicated doctors and staff members are here to help everyone that walks through our doors and we would be delighted to assist you.

How Medicare Helps Senior Citizens

Medicare Providers San Antonio

Every day thousands of people enroll in Medicare. This government-backed medical insurance program helps millions every year to cover some or all of their medical expenses and is continuously growing. Just a decade ago, nearly 15 percent of the U.S. population — approximately 44 million people — were covered under the program. The number has grown to over 57 million people or about 18 percent of the U.S. population. It’s understandable why so many people take advantage of Medicare coverage — Medicare offers a variety of benefits for seniors who qualify. But it’s important to understand the essentials that the coverage providers and how to find Medicare providers to take care of their issues. Here are a few aspects to consider.

What Is Medicare?

Medicare is a medical insurance program provided by the federal government for American citizens and other qualifying U.S. residents who are over the age of 65. The Social Security Administration funds the program under the Federal Insurance Contributions Act (FICA) — the 1.45 percent that taxpayers pay out of their total annual wages. The plan also covers those with disabilities, too. There are different parts to Medicare, including Medicare Parts A, B, C (Medicare Advantage) and D plans. These plans cover different parts of medical expenses. For example, Medicare Part A primarily covers hospitalization costs, while Medicare Part B covers preventative services, such as glaucoma screening and diabetes testing. Medicare Part B also takes care of outpatient costs, such as doctors visits, physical therapy, and medically necessary equipment. Medicare Part D offers prescription coverage. Medicare Advantage (also known as Medicare Part C) is an alternative to Medicare Part A and B plans except that it expands coverage and is provided through private insurance companies. Medicare coverage also can be supplemented with Medigap insurance for aspects not covered by Medicare Part A and B, such as copayments or deductibles.

The Advantages of Medicare

Having a Medicare plan offers several advantages. The primary benefit of these federally backed insurance plans is that they often cover a substantial amount of medical expenses for the elderly population. Seniors who take advantage of these plans also can leverage preventative care services and keep up to date on annual doctor visits. This is an especially important as Medicare policyholders get older. The body naturally deteriorates as it ages, and an annual doctor visit can provide policyholders with a chance to discover ailments that may not be visible or that trained medical professionals can easily spot. Medicare patients can also leverage coordinated care, including the help of caseworkers in some instances, to manage care. Another advantage is that there are several medical facilities and providers that take Medicare coverage.

Understanding Medicare Coverage

It’s important to understand that Medicare covers most costs but not every medical expense. That’s why some individuals opt for additional coverage called Medigap policies. Keep in mind that Medigap policies do not pay out if the patient already has an existing Medicare Advantage plan. Moreover, there may be restrictions how many types of prescriptions drugs covered. For example, Medicare plans often provide more coverage to generic prescriptions drugs over brand drugs. That means that patients who opt for a brand drug may pay more out-of-pocket costs to cover the expense. Thus, it’s vital for Medicare policyholders to gain a thorough understanding of the plan they have.

Finding a Medicare Provider in San Antonio

Finding a provider who accepts Medicare insurance is simple when you use the right tool and put best practices in place. Patients should start finding a Medicare provider by checking with their insurance provider. Keep in mind that calling to verify the doctor still accepts the insurance is also ideal, as doctors drop and add insurance plans frequently. Also, consider using the Physician Compare tool on the official Medicare. Gov website to search for Medicare providers. This tool is provided by the Centers for Medicare and Medicaid Services and patients can use it to find the Medicare-accepting doctors and medical professionals they need based on location, group, specialty, condition, and body part. For example, patients can search for a Medicare providers in San Antonio by searching by location. It’s also a good idea to research the doctor that’s being considered. Check out reviews, verify if the medical professional is board-certified, and watch out for any red flags, such as disciplinary action or malpractice suits. These conditions may play an important role in whether or not the patient experience is enhanced or hampered.

Get Healthy With Gonzaba Medical Group

Whether searching for a primary care doctor in San Antonio who accepts Medicare or a professional staff who understands the essentials of Medicare, it’s important to find a team that is reliable. San Antonio is home to Medicare providers who have the expertise and experience with working with Medicare, such as Gonzaba Medical Group. The Gonzaba Medical Group helps patients get the medical care they need and has eight offices in the San Antonio area that accept Medicare and other Gonzaba insurance policies. Contact the Gonzaba Medical Group to schedule an appointment today and take care of getting and staying healthy now.

What Does Medicare Part B Cover?

For those who are seeking more insurance information, Medicare is the federal health insurance program created specifically for seniors, 65 years of age and older, as well as certain younger people with disabilities and those suffering from End-Stage Renal Disease. Given the sensitive nature of the patients the plan covers, it is of the utmost importance to always ensure this coverage is sufficient and that it covers all necessities for the elderly and ill individuals who subscribe to this plan. Although there are four distinct types of coverage under the Medicare banner (Medicare Part A-Medicare Part D), the purpose of this post is to go over the coverage information for Medicare Part B.

Medicare Costs

Before we delve into what Medicare Part B covers, we must first understand that Medicare also carries its share of costs. Firstly, the monthly premium is $134. Although this is considered fairly inexpensive, one must also keep in mind that patients are often on fixed/ limited incomes. Moreover, despite this being the official cost, this is not what the average beneficiary is responsible for paying. In fact, given that the vast majority of Medicare recipients are elderly (70 percent), most premiums are paid directly from the patient’s Social Security benefits. Furthermore, given a specific rule addressing the correlation between Medicare premiums with Social Security cost-of-living adjustments, premiums for this demographic tend to go up more slowly than the others. That said, on average, they are paying $109 monthly.

On the flip side, overall, the remaining 30 percent pay the entire $134 monthly premium. This percentage includes those who are new to Medicare beneficiaries as well as those who have not yet filed for Social Security. Furthermore, being impoverished or unemployed is not the only way in which your income can affect your eligibility and/or premiums. Those who make too much are also expected to pay higher premiums. Based on the patient’s modified adjusted gross income from two years ago, as well as your tax filing status. Those who make over $85,000 have to pay an increased premium.

Medicare Part B Coverage

Now that we’ve gone over the costs of Medicare, let’s look into what it covers. As mentioned, Medicare Part B supplies medical insurance to the elderly as well as a variety of others. Covering a variety of medical supplies and necessities, Medicare part B covers outpatient visits to doctor’s offices, clinics, hospitals, as well as an array of other medical facilities. Furthermore, Medicare part B also covers an array of preventative services as a means of preventing illness and/or early detection. Although there are now four distinct categories of Medicare, Medicare Part A and B are considered Original Medicare.

Medicare Part B covers the following:

Doctor visits- Visit your doctor’s office for things such as physical exams, regular check-ups, for referrals, and other necessary medical actions. Your Medicare plan will cover the majority of the services needed as well as subsequent materials such as medications and other paraphernalia. For instance, the Gonzaba Medical Group offers quality healthcare to elderly patients in the San Antonio area.

Laboratory tests and X-rays- In addition, doctor’s visits are but one aspect of maintaining one’s physical health. Laboratory testing is commonly recommended for the elderly as well as those with various health issues as their health is already considered to be compromised in some way, having X-rays and other laboratory testing options can be some of the best methods of preventing illnesses and/or detecting them early.

Emergency ambulance services- Although this is highly uncommon, the costs associated with one ride in an ambulance can be astronomical and unfortunately, if you are in need of an ambulance ride, you probably are not in the position to negotiate prices. Fortunately, Medicare part B will cover the vast majority of these costs.

Mental health services – Although it is thought to be separate from physical health, mental health is an intricate part of your overall well-being. Moreover, given that the elderly are especially prone to Alzheimer’s, dementia and other types of mental health issues, offering patients mental health services is a vital element of Medicare.

Durable medical equipment – Depending on which types of illnesses or ailments a patient may have; medical equipment is a term that can refer to an array of materials. For instance, those who suffer from diabetes may need a steady supply of needles to test their glucose levels. On the flip side, those with mobility issues may need equipment such as canes, wheelchairs, scooters and the like.

Preventive services (Pap tests, flu shots, and screenings) – Moreover, as we age, preventative medicine begins to take center stage. Rather than waiting for a problem to emerge, healthcare professionals will recommend an array of test and other procedures to prevent their health from drastically deteriorating.

Rehabilitative services (physical therapy, occupational therapy, and speech-language pathology services) – Lastly, in the unfortunate event that a patient experiences a serious medical issue, rehabilitation services are provided to help them regain their health as well as their sense of autonomy. Major accidents, strokes, and seizures, as well as other conditions, often act as the catalyst for a poor bill of health. Fortunately, rehabilitation services are offered under Medicare part B.

Although it provides high-quality coverage, it is still up to every patient to find a service provider they can trust. For seniors seeking high-quality medical care in San Antonio, the Gonzaba Medical Group is a great practice to receive sound medical care and advice.

What Does Medicare Part A Cover?

Open enrollment for Medicare brings about several questions, including what costs and services each part covers. Seniors who are considering Medicare enrollment should understand what each section covers, including the costs associated with Medicare Part A.

Medicare Part A is the primary coverage that Medicare recipients receive, and it covers a variety of services, including skilled nursing facility care, hospice, home health services, nursing home care and hospital care. It works like an insurance for hospital care and services. But Medicare Part A does not cover every hospital-related cost. Here are a few factors to consider:

Hospital Care

When it comes to hospital care, Medicare Part A primarily covers the costs associated with hospital care. Hospital care under Medicare Part A includes long-term care hospitals, inpatient hospital care, and skilled nursing facility care.

  • Long-Term Care Hospitals. When patients have multiple serious conditions, long-term care hospitals serve as a key component of providing patients with specialized care. If a Medicare policyholder receives care while staying in a long-term care hospital, they can have peace of mind that it is covered. However, Medicare policyholders are still required to pay a deductible during the benefit period — the period the patient is admitted in the hospital and receiving inpatient care until 60 days following the time the patient no longer receives inpatient care. This deductible only needs to be paid once during the benefit period.
  • Inpatient Hospital Care. Medicare Part A covers hospital services and amenities, including meals, semi-private rooms, and inpatient treatment medications. This care also covers inpatient mental health care and inpatient care even when Medicare policyholders are taking part in a qualified clinical research. The care that Medicare policyholders receive at long-term care hospitals, psychiatric hospital, inpatient rehabilitation facilities, critical access hospitals and acute care hospitals are covered under Medicare Part A. But keep in mind that inpatient hospital care does not cover amenities, such as a phone or TV, in the room if these amenities are not inclusive of the charge. It also does not cover personal care items, such as shaving cream or razors. Other services that are not included are private-duty nursing and private rooms that are not medically necessary. Inpatient hospital care also requires Medicare policyholders to pay deductibles and make coinsurance payments depending on the length of stay in the hospital. For instance, patients do not have to pay a coinsurance payment for inpatient care that does not last longer than 60 days. However, a $335 coinsurance payment is required in 2018 for patients who receive inpatient care and services between days 61 and 90.
  • Skilled Nursing Facility Care. When Medicare policyholders require skilled nursing care, they can take advantage of the coverage benefits received under Medicare Part A. This hospital insurance also covers this specialized care when patients receive it at a skilled nursing facility. For instance, Medicare policyholders can receive coverage for services, such as dietary counseling, medications, skilled nursing care, a semi-private room, and required occupational or physical therapy, when these services are provided in a skilled nursing facility. However, there are limitations to this benefit. For example, patients who break their skilled nursing facility care for more than 30 days must receive three days of inpatient care before they can receive extra skilled nursing facility care coverage. No coinsurance is required for 20 days, but starting on day 21, patients can expect a coinsurance payment of $167.50 in 2018, and any service or cost beyond the 100th day must be paid by the patient.

Nursing Home Care

If nursing home care is medically necessary, Medicare Part A may cover nursing home care services. Some services that may be covered under this benefit may include, such as changing sterile dressings. However, if it only covers custodial care, such as getting dressed or bathing, these services are not covered by Medicare.

Home Health Services

Home health services, such as speech-language pathology services, skilled nursing care that is intermittent and physical therapy, are covered by Medicare Part A. Under Original Medicare, these services are covered at no cost to the patient, with the exception of durable medical equipment, which patients will have to pay a partial cost. Other home health care services may include part-time home health aide services and medical supplies intended for use at home. However, home health services under Medicare Part A do not cover personal care, home-delivered meals, round-the-clock home care or homemaker services, such as cleaning and shopping.

Hospice

Seniors who qualify for hospice care can expect a variety of services and amenities covered under Medicare Part A, such as grief and loss counseling, social work services, dietary counseling, doctor services, and prescription drugs for pain relief. Hospice care is completely covered under Medicare Part A. However, policyholders are expected to pay a $5 copayment per medication for pain relief or a similar prescription drug. What is not covered under Medicare Part A includes room and board at the patient’s residence or a nursing home where the patient lives if these places are where hospice care services will be rendered.

Final Thoughts

Understanding the fundamentals of what Medicare Part A covers is important for deciding which healthcare policy best meets senior healthcare needs. It’s also key to use providers who accept Medicare coverage to effectively leverage benefits. Consider using healthcare professionals who understand Medicare and who can help with a variety of healthcare options that seniors can leverage, such as Gonzaba. Take advantage of Medicare benefits, and schedule an appointment with Gonzaba for vital senior healthcare services.