Original Medicare covers you in the United States of America, including the District of Columbia, Guam, U.S. Virgins Islands, Puerto Rico, Northern Mariana Islands, and America Samoa. If you are going outside of these lands and/or overseas, for a majority of the time Medicare will not pay for the health services or supplies. There are some rare occasions where Medicare will cover your service or supplies.  An example of the rare occasions where Medicare will cover your service or supplies is as the following: If your emergency happens in the United States of America but nearest hospital to treat you is in Canada or Mexico.

According to Medicare.gov “In some cases, Medicare may cover medically necessary health care services you get on board a ship within the territorial waters adjoining the land areas of the U.S. Medicare won’t pay for health care services you get when a ship is more than 6 hours away from a U.S. port. “  As you can see, understanding the boundaries, the loop holes and the safety net created by Medicare is best left to an expert to fully understand.

Many experts advise their clients to invest in travel insurance as a “just to get home” safety net. when you have travel insurance you will have coverage for things that aren’t an emergency. It’s reasonably priced, and a great asset to have to in your back pocket if you are a frequent traveler, particularly an international traveler. If you have an emergency under $50,000, Medigap is a great option for you. With Medigap you can go anywhere in the U.S. that accepts Medicare . Also most Medigap plans include foreign travel emergency coverage up to  $50,000- but this coverage is meant to be reimbursed. For example, if you were hurt abroad, depending on the procedure needed you would either Medivac to the United States or receive treatment abroad. Either way, it would be your responsibility to pay for that procedure out of pocket, and then the insurance company will reimburse the claim. The Medigap covers 80% up to 50k, so you could still end up with a big bill.

So before setting sail, or boarding the plane, make sure you speak to your Medicare advisor and ask many questions. No one plans to have a medical emergency while on vacay, but it’s better to be proactive rather than reactive.

Part D may feel difficult to understand, but it is a very important element to grasp an full understanding of.  The very first thing to understand is that having a yearly review considering your Part  D plan is vital. It is vital because your Part D plan can change on a yearly basis.  Your medication, dosage, provider’s location, and cost may change on the since last year.

Medication has tiers ranging from big name brands to generic brands. The cost, and tier requirements may change in which you may benefit or pay extra for the same drugs.   When speaking to our experts at Senior Health Medicare, we will not only review your current Part D plan, but we will put together a plan that will give you the same coverage with the best prices. 9 times out of 10 you and your spouse do not share the exact medication, to combat that our experts will create an individual plan for you and your spouse.

Call us now- before October 15^th to get an appointment with our advisers. Enter your medications into our Part D Analysis form on the website. We will do a FREE drug plan comparison and recommend the plan with lowest out of pocket cost based on your medications.

Part D Analysis form: https://seniorhealthmedicare.com/health-ins-form2.php

1 Medicare doesn’t have a family plan

Medicare plans are only individual coverage, not family. This means that spouses each need to have their own Medicare coverage. Additionally, no dependents receive coverage. In the event that your spouse is younger than you, when you enroll in Medicare they can seek employer coverage or individual coverage through the marketplace (healthcare.gov — the Affordable Care Act website). Note, that if you and your spouse are entering Medicare around the same time, you may be recommended different plans from different companies if they are a better individual fit for you. Some companies to offer household discounts for enrolling with the same company, but other than that it is unique to the individual.

2 There is no cap on out-of-pocket costs in Original Medicare

Most employer plans have annual limits on your out-of-pocket health expenses. Medicare pays 80% of approved medical expenses, then the beneficiary is responsible for the remaining 20%, without a cap. For example, if you have an $100K surgery, you will have to pay $20K, which is why people buy Medicare Supplement plans or Medigap plans to fill this gap.

3 Make a plan for any pending procedures

If your employer plan offers you better benefits than Medicare or costs less, then you may want to have the elective surgery sooner than later. Or wait until you are enrolled in the Medicare system. Surprisingly, the first year for a Medicare beneficiary usually has the highest number of claims because people wait for elective surgery until they are covered on the system.

4 Observation VS  Inpatient 

Medicare pays different rates according to status. Even if the patient is admitted in a hospital for one week, if they are under “observation” they are considered as out-patients.  Medicare requires a three-day hospital inpatient stay minimum before the covering of cost. When a patient is admitted under “observation” , the time frame is not counted toward the Medicare’s requirement regardless of the length.

5 Research can mean more money in your pockets

In the employer health insurance world, you are stuck with the benefits designed for the group. With Medicare, it should be custom to you and your individual needs. Finding an educational resource to learn more about Medicare and how it works, will only help you make smarter decisions when it comes to health insurance. It can also mean saving money in the process.

6 When you enroll into a Medicare Advantage plan, you are disenrolling from Original Medicare

Medicare Advantage plans were introduced in the early 2000’s as an alternative to Original Medicare parts A and B. The way they are marketed is that they offer the same benefits as Original Medicare, but it’s a little more complex than that. While Original Medicare and Medicare Supplement plans are programs regulated by the government, Medicare Advantage plans are controlled by the insurance companies. It literally takes an act of Congress to change Original Medicare, whereas Medicare Advantage plans are  in the company’s hands. You essentially give up your Medicare to work with a network provider. Learn more about the difference between Medicare Advantage and Original Medicare with a Supplement here.

7 You can change your Medicare Supplement coverage whenever you want

You don’t have to wait for AEP to change your Medicare Supplement coverage. You can change your Medigap plan anytime during the year, as long as you can pass medical underwriting. The programs that must wait for changes until AEP are Part D Prescription plans and Medicare Advantage plans.

Leave a comment, let us know which tip is the most useful.

If you have more questions, speak with one of our agents at http://www.omegabenefit.org/

Your initial enrollment period starts 3 months before your 65th birthday month and ends 3 months after. It lasts a total of 7 months. During that time you can switch to any plan you want to!

The annual enrollment period for medicare is between October 15th and December 7th each year.
During this time you’re going to be able to do a few special things.

• Change your Medicare Part D Plan.
• Change from and to medicare advantage programs.
• Change from a medicare advantage program to a medicare supplement.

This a time where medicare is crazy busy and agents are very active.

Keep in mind, if you have a medicare supplement you are going to be able to change your medicare at any day and time.

If you have any questions, ask an agent at http://www.omegabenefit.org/