Tips for Navigating Medicare Open Enrollment

Open enrollment for Medicare runs now through December 7th, with changes taking effect on January 1st, 2021. If no action is taken, 2020 coverage continues next year. However, now is the time to verify whether there’s a more cost-effective option to suit your circumstances. The annual fall enrollment period is for adding or changing coverage related to an Advantage Plan (Medicare Part C) and prescription drugs (Part D), meaning you can switch, add, or drop those parts.

About 62.7 million people are enrolled in Medicare; most are 65 or older. A third of beneficiaries are enrolled in Advantage Plans, and the remainder are enrolled in Part A (in-patient coverage) and Part B (outpatient care) plans. Part D, a standalone/supplemental plan, is also offered by private insurance companies.

By September 30th, Advantage Plans or prescription drug plans should alert beneficiaries about whether their coverage is changing for the upcoming year. Specific options vary significantly from year-to-year despite being federally regulated. Check your notice to see whether any changes will be taking place. Prescription coverage, deductible costs, and in-network doctors are some examples of adjustments that could change.

If you wanted to drop your Advantage Plan instead of switching to another, you’d be left with original Medicare (Parts A and B) and would need to get a standalone Part D prescription drug plan if you wanted that coverage. Medigap (supplemental Medicare policies) help cover cost-sharing aspects of original Medicare, which is Part A and Part B outpatient coverage, including copays and insurance.

When initially enrolling for Plan B to purchase Medigap, beneficiaries receive a six-month window without having to answer health questions and be penalized for pre-existing conditions. One exception is that if the beneficiary had an Advantage Plan for less than a year or it is their initial enrollment. In that case, a unique enrollment window of 12 months is allotted for a Medigap policy.  

For further reading, check out the original article. For Medicare questions or concerns, contact the experts at Senior Health Medicare who are available to guide you through the process of open enrollment.

Senior Health Medicare is a superior resource for Medicare guidance, information, and ongoing client support. Selecting a Medicare plan is not a flippant decision. It requires annual revisiting and re-evaluating in order for the client to stay in the most cost-effective coverage. Senior Health Medicare is here to serve as your resource through all the years to come. Contact us today at 888-404-5049 or visit us on the web at www.seniorhealthmedicare.com.

Written by the digital marketing staff at Creative Programs & Systems: www.cpsmi.com.

Difference Between Medicare and Medicaid

Sharing the same prefix makes Medicare and Medicaid easily interchangeable, but in reality, they are entirely different. To add to the confusion, both are structured by the government to assist people with healthcare costs. Beyond sharing prefixes and the healthcare realm, the two programs have nothing else in common.

Medicare: an insurance program paid from trust funds which those covered have paid into.

  • For seniors 65+ or those with a qualifying disability
  • Federal government sets standard benefits and costs
  • Private plans might provide additional (varying) coverage and costs
  • Parts A and B provided by the government; Parts C and D provided by insurance companies

Medicaid: an insurance assistance program serving low-income people.

  • For individuals, families, and children with limited income and resources
  • State sets Medicaid programs based on federal guidelines
  • Different programs exist for specific populations
  • Both mandatory and optional benefits available

Both Medicare and Medicaid include premiums, deductibles, copays, and insurance costs. Specific Medicaid groups are exempt from out-of-pocket expenses, and there are four different Medicare savings programs available. Some people can have both Medicare and Medicaid; these people are called “dual eligible.”

To enroll for Medicare, enroll with either Social Security directly (Parts A and B) or a private insurance company (Parts C and D) to choose the coverage you need. To enroll for Medicaid in Michigan, visit their website.

Both Medicare and Medicaid are two very different healthcare programs. It is imperative to understand the differences. If you are dual-eligible, learn how they can work together for your benefit.

For more information about the differences between Medicare and Medicaid, visit the U.S. Department of Health and Human Services website. To enroll in Medicare Parts C and D, contact Senior Health Medicare today.

Senior Health Medicare is a superior resource for Medicare guidance, information, and ongoing client support. Selecting a plan is not a flippant decision. It requires annual revisiting and re-evaluating in order for the client to stay in the most cost-effective coverage. Senior Health Medicare is here to serve as your resource through all the years to come. Contact us today at 888-404-5049 or visit us on the web at www.seniorhealthmedicare.com.

Written by the digital marketing staff at Creative Programs & Systems: www.cpsmi.com.

COVID-19 Sparks Regulatory Changes to Medicare

In response to the global COVID-19 pandemic, Congress and the Trump administration implemented a record number of legislative, regulatory, and sub-regulatory changes to the Medicare program. These alterations allow for unprecedented flexibility to healthcare providers, Medicare Advantage Plans, and Part D plans. Some of the changes waived Medicare participation conditions, allowing patients to be treated in alternative care settings. Other changes allow for telemedicine services to be eligible for Medicare reimbursement to physicians and other healthcare providers.

Significant COVID-19 changes that include telecommunication reimbursement include telephone visits, physician supervision services, urban and rural areas, and new sites (including patient homes). Hospitals can now provide alternative services at locations, including other healthcare facilities, expansion sites (hotels or community facilities), and specific services at patients’ homes. Moreover, licensed providers can provisionally offer services outside of their enrollment state. 

Both the benefits and unintended consequences of these policy actions should be carefully analyzed by policymakers and stakeholders to provide patients access to healthcare, and so providers can offer high-quality care. As the COVID-19 pandemic continues, stakeholder input and analyses should inform the regular rulemaking process to guarantee any permanent governing adaptations improve the Medicare program. The effects of these policies should be meticulously studied to determine the most efficient way to prepare for future public health emergencies.

Want to know more about the new regulations or need some assistance navigating through Medicare terminology, plans, policies, etc.? Look no further; Senior Health Medicare is here to help you find your path through the Medicare world. Click here to read more information about regulatory changes. 

Senior Health Medicare is a superior resource for Medicare guidance, information, and ongoing client support. Selecting a Medicare plan is not a flippant decision. It requires annual revisiting and re-evaluating for the client to stay in the most cost-effective coverage. Senior Health Medicare is here to serve as your resource through all the years to come. Contact us today at 888-404-5049 or visit us on the web at www.seniorhealthmedicare.com.

Written by the digital marketing staff at Creative Programs & Systems: www.cpsmi.com.

7 Costly Medicare Mistakes Seniors Should Avoid Making

There are many parts to Medicare, and with that comes confusion and a good chance at missing something. It is essential for everyone approaching age 65 to get informed on Medicare and sign up for the right plan at the right time. Neglecting the chance to act at making the best Medicare decisions could cost you. Here’s how to avoid these seven common mistakes so you can get the right coverage without overpaying on premiums and deductibles, experiencing gaps in coverage, or getting hit with high penalty fees.

  1. Deciding without fully understanding each Medicare plan.

Medicare has many plan options making it very confusing and hard to decide which plan is best. It is essential for new enrollees to do their homework on Medicare before their enrollment period, so they know precisely the action they need to take. It’s necessary to become familiar with the differences between Original Medicare with a Medicare Supplement or “Medigap” plan, and Medicare Advantage plans, also known as “Part C.” Not knowing what your final choice has to offer could leave you with a plan that doesn’t fully cover your specific healthcare needs.  

  1. Going out of your plan’s network.

It is essential to realize when you sign up for Medicare, not every health provider will accept your specific plan and that this could change every year. Most places accept original Medicare and therefore, any Medicare supplement plan, but if you have a Medicare Advantage plan, you might not be covered if the provider is out of network. Always make sure to check if the doctor or hospital you are going to is in your network or it could mean an expensive bill. One more thing to be wary of here is that doctors and hospitals can stop taking Medicare Advantage plans ANY TIME, even though you have to wait until fall to change your plan. We see doctors jumping out mid-year, and that puts people at a crossroads: either I see my current doctor and pay for visits/procedures out of pocket, or, I find a new doctor who is in my network (for now). One more thing – if you think that your plan covers emergencies out-of-network, we want to kindly remind you that the insurance companies dictate what is considered an “emergency.” What you find emergency room-worthy actually isn’t up to you.

  1. Missing your enrollment periods.

There are enrollment periods that vary from person to person, depending on when an individual turns 65 or when they decide to leave their current job that provides them with healthcare benefits. When turning 65, eligibility to sign up for Medicare begins three months before your birthday month and continues for three months after. If you turn 65 and still have healthcare coverage through your job, you may want to delay your Part B enrollment until you seek full benefits from Medicare. This depends on the situation, size of the company, and the cost comparison, so you definitely want to discuss this with an expert to be sure you make the right moves. The Annual Enrollment Period (AEP) is the same for everyone, every year, which begins October 15th and goes until December 7th. This is the only time frame for current Medicare beneficiaries to change Part D prescription plans or Medicare Advantage plans. You can change a Medicare Supplement plan any time you want, however. It’s important to become familiar with these time frames, so you aren’t left without coverage at any time or hit with late-enrollment fees or penalties.

  1. Ignoring your Annual Notice of Change (ANOC).

The Annual Notice of Change (ANOC) is sent out to all Medicare beneficiaries before the Annual Enrollment Period stating any changes to plans and costs that will take place the following January. If you don’t read your NAOC, you might not know if your plan details or costs have changed, and it could leave you without coverage in certain areas and/or more expensive bills. You might learn it is in your best interest to keep the plan you have, but ignoring this critical update from your insurance company could result in getting stuck in a plan that costs way too much or doesn’t take care of your needs.

  1. Improperly signing up for Medicare Part B.

Once you turn 65, you are automatically enrolled in Medicare Part A (which covers your facility costs at the hospital) because you worked more than 40 quarters (10 years) and it does NOT come with a premium. Medicare Part B, however, not only comes with a premium (income-based, starting at $135.50 per month for 2019) but also comes with huge penalties and expenses if you enroll or delay enrollment improperly. If you are still working and you plan to continue working after your 65th birthday, you will need to find out the answers to a few critical questions. First off, is your company larger than 20 employees? If so, they MUST offer you health coverage while you are still employed. However, this does not mean you have to or should take this. It’s best at that point to compare your predicted costs with your employer plan versus your options under Medicare. About 50% of the time, it makes sense to leave your employer plan for Medicare. Definitely something you want to discuss with an expert. Okay, here is another common situation, let’s say you decide not to take Medicare Part B, and your employer is found to be less than 20 employees, otherwise known as not-credible coverage. If your plan is found to be not-credible coverage then when you go to take Medicare Part B, Medicare charges you a 10% penalty of the premium (about $13.50 per month at the lowest income bracket) for the rest of your life. That penalty can really add up. Lastly, let’s say that you take your Medicare Part B while you are still working and your employer has over 20 employees, so you stay on this insurance, too. The problem people run into with this is that when you take your Medicare Part B, not only are you paying a premium for coverage you aren’t using, but you run the risk of lapsing your Open Enrollment window. This is the time that lasts for six months (three months before and three months after your 65th birthday) in which you can choose any Medicare Supplement plan you want, with no medical questions asked. When you lapse this window while it’s sitting as your secondary insurance to employer coverage, when you retire, you will have to be reasonably healthy to get supplemental coverage.

  1. Missing your opportunity to switch plans.

There are many reasons a beneficiary might want to change Medicare plans, but it is easy to miss the chance to do so when it comes to prescription and Medicare Advantage plans. Just like enrollment, there are only specific periods where switching is possible. You can make changes to your prescription and Medicare Advantage plans during AEP. With Medicare Advantage plans, you have a 1-year trial period from the first date active, which allows you to switch to Original Medicare anytime within that timeframe if necessary. There are other unique opportunities to change, including life events like moving to a new area where your current plan doesn’t exist. The most common reason to switch plans is to save money, so make sure you understand your enrollment windows.

  1. Signing up for the same plan as your spouse.

When you get health insurance through an employer, often you can choose a plan that covers you and your spouse. With Medicare, you each need an individual plan, and it isn’t always the best option to go with the same insurance company, let alone plan. As you age, the chances of having different healthcare needs than your spouse become higher, so it is significant for beneficiaries to pick a plan that is specific to you and your personal needs. Often, healthy couples can and should take the same plan, because some insurance companies offer household discounts. Comparing companies and rates is the best way to decide what’s most cost-effective for you and your spouse.

Medicare is confusing, and finding a helpful resource isn’t always easy. Here at Senior Health Medicare, we aim to be that helping hand that you can rely on so you can avoid making these mistakes and navigate Medicare with ease. If you have any further questions about this blog or anything Medicare-related, please feel free to comment on this post or contact one of our helpful experts by phone.

 

How You Can Help Prevent Medicare Fraud

Medicare fraud is happening all the time, which results in higher taxes and healthcare costs for everyone. People and companies who get access can steal your Medicare number and personal information to scam the system for illegitimate products and services. It is important for beneficiaries to understand how to spot and protect from fraud to keep costs from rising even higher in the future. Not to mention, keeping your confidential information safe.

Doing Your Part

  • Keep your Medicare card, Medicare number, and Social Security number safe as you would protect a credit card. Only give this information to doctors, Medicare providers or someone you know should have it.
  • Keep records of all doctor’s visits and services provided. Always check your Medicare statements to ensure every detail is accurate.
  • Be sure to check you were given the right medications before leaving the pharmacy.
  • Never accept special offers on free or discounted Medicare.
  • Ask any questions about your Medicare or billing costs. It is your right to know.
  • Be aware of providers who claim they know how to bill Medicare even though they don’t usually offer that particular service.
  • Always report suspected incidences of Medicare fraud.
  • Never accept anything from a door-to-door salesperson claiming they are from Medicare. Medicare never sends representatives to your home.
  • Don’t let the media influence you about your health because they don’t always have your best interest in mind.

How to Spot & Report

If you have any suspicions whatsoever never hesitate to call Medicare. If you think a charge on your statement isn’t correct, call your provider and ask them about it. Always review your Medicare claims for any errors to stop fraud from happening early on. View your claims as soon as they are processed by logging into MyMedicare.gov or give them a call. When reporting Medicare fraud, make sure you have any records indicating possible existing errors and documents providing proof of services. To report any suspicious activity, you can call 1-800-MEDICARE (1-800-633-4227), report online at the Office of Inspector General or call them at 1 800 447 8477.

Medicare can be confusing for enrollees, which makes it easy for criminals to take advantage. If you have any questions or would like more general knowledge on Medicare, leave a comment, or give us a call. Here at Senior Health Medicare, we strive to educate beneficiaries on Medicare so that you and your loved ones stay protected and feel confident in your Medicare decisions.

Everything Enrollees Should Know About This Year’s Changes in Medicare

Since there are changes in Medicare all the time, it is essential for all beneficiaries to stay informed regardless of how minor the changes from the previous year might be. 2019 has brought in many variations including an early close in the Donut Hole, expansion in Medicare Advantage, and changes in premiums and deductibles. Also, Medicare is eliminating all “Cadillac” Medicare Supplement plans (including F and C) as a way to save money as the baby boomers come into the Medicare system at a rate of 10,000 every day.

High Volume of Enrollees

In 2020 it is expected that the Medicare costs will double due to the amount of retiring baby boomers. At this point, there will be more people on Medicare than paying in. For Medicare to save money in the future, it must make changes in Plans or rule them out for new beneficiaries. Medicare taxes and the Trust Fund continue to cover less since health care costs are rising faster than economic growth.

Plans F and C

2019 marks the last year for Plans F and C. On January 1, 2020; these plans will no longer be available to new enrollees. In 2015 the Medicare Access and CHIP Reauthorization Act (MACRA) was passed to prohibit the sale of Medigap plans that pay for Part B deductibles. If a beneficiary already has Plan C or F you can continue to purchase these plans after the New Year. People that already have these plans are “grandfathered” in, but we have found that when plans close to new enrollees, the likely outcome is rate increases on the premium at a faster volume and rate than open plans.

Part B

In 2018 the standard premium for Medicare Part B was $134 a month and had gone up to $135.50. Some Enrollees will pay less because their premium amount depends on their Social Security Cost of Living Adjustment, which may not cover the increase.

Previously, the highest income bracket for Part B enrollees was $160k and above. This year a new bracket of $500k and above was added with a premium of $460.50 a month.

The deductible has increased from $183 to $185 per year, and once you meet this, then you are responsible for 20% of the Medicare-approved amount for services. This exposure has no cap- if you go in for major surgery, you will pay 20% unless you have a Medicare Supplement or Advantage plan to ease the burden.

Medigap plans that cover the Part B deductible can be sold in 2019 but can no longer be purchased starting 2020. Those who already have these programs can keep Plans C and F, but no new enrollees can buy plans that cover the Part B deductible.

Medicare Advantage

Test drives

Once enrolled in the Medicare Advantage plan, beneficiaries will now be able to try it out for three months, and if they aren’t satisfied, they can switch plans.

Open Enrollment

Starting this year from January 1st to March 31st anyone enrolled in a Medicare Advantage plan can switch plans. New beneficiaries with both Medicare Part A and B plans have a three-month Medicare Advantage Enrollment period.

Broader Span of Coverage

Additional services are available within Medicare Advantage plans including coverage on meal deliveries and transportation services.

The Donut Hole

The Donut Hole is gradually closing due to the Affordable Care Act (ACA). In the past, Medicare beneficiaries experienced higher costs on medications at a certain point in the year due to a gap in coverage. At one point it was 100%. Since the beginning of 2019, the Medicare donut hole only affects generic medications. Beneficiaries will now save money by just paying 37% of those costs while in the donut hole.

Part A

Premiums for people whose work history (or spouses) isn’t 40 quarters are required to pay dividends for Part A coverage (hospitalization costs). Premiums for 30-40 quarters of work history have gone from $232 a month to $240. For less than 30 quarters it was $422 and is now $437. For all enrollees, every benefit period, Part A deductibles increase, though most beneficiaries have coverage that pays for all or part of it.

Every year there are changes in premiums and deductibles, but Medicare is striving to make changes for the better. Some parts that have improved the system include the removal of the therapy cap, an updated handbook, and a broadening of telehealth programs. For any questions about these topics or an expansion on changes in the donut hole, Part B, Part A or Medicare advantage, please leave a comment or give our Medicare Experts a call. We aim to be your educational Medicare resource!

Travel smart with Medicare

Before going on any trip, creating a checklist is always recommended. While you are updating your passport, checking the weather to prepare to pack, you should also make sure to check on your health coverage while traveling. Medicare can be great for travelers if the proper decisions are made.

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.

10 Healthy eating tips for seniors.

As we all know, when we increase in age our metabolism decreases. As a result, our food intake has a higher level of importance compared to when we were in our 20’s or 30’s.  Here are some quick and easy tips to eating healthier and living a longer life.

 

  1. Eat a variety of foods

Some of us stick to our favorite foods, and aren’t open to trying anything new. To ensure that we are getting all of the necessary vitamins needed, we must have a well-balanced diet. According to the National Council on Aging, our meals need to consist of fruits, whole grains, vegetables, low-fat dairy, and lean meats. Not only will this meal make your body feel amazing, but it will look more amazing, too.

  1. Minimize the salt

As we age, our sense of taste becomes weaker and we try to compensate for that by using extra salt. According to many studies, salt has a direct connection to high blood pressure. We know that stress, lack of physical activity, some medications, and a whole list of other factors can lead to hypertension. To combat this, exchange some of the salt for fresh herbs and spices.  Herbs and spices like basil, cardamom, garlic and ginger are known to lower blood pressure. These ingredients also add a punch of bright flavor where you might normally add salt.

  1. Drink more water

We all need water to survive. Our muscles are about 70% water, our brains are about 85% water, and our blood is about 80% water. Not only do these percentages show we obviously need water, but our body gives physical signs when it is lacking water.  Drinking fresh juice and some sugary drinks are okay once in a while, but water needs to the main source of hydration in our diets. You may be surprised how much better you feel just by upping your daily water intake!

  1. Read the labels

Sometimes we can fall into the habit of buying the same things.  We should question ourselves and ask “How often do I read the nutrition label?” Those labels are not there to take up space, they actually hold real value. Some of the numbers on the labels may shock you. The next time you’re shopping, take a peak at the nutrition labels and see what you find.

  1. Consider supplements

Some of us are taking a lot of pills, medications, and other things already, and the thought of adding another thing to the list is overwhelming.  Fruits and vegetables are great sources for vitamins, but in some cases they’re just not enough. For example, people over the age of 50  do not get enough vitamin B12 according to the Academy of Nutrition and Dietetics.  Talk to your doctor and see what they supplements they recommend for you.

  1. Reduce sugar

Reducing the sugar in our diets is something many dietitians and nutritionists agree on throughout the world of nutrition.  We should aim to exchange some of our sugary snacks and treats with fresh fruits. According to the Academy of Nutrition and Dietetics, strawberries are great for eyes and contain plenty of vitamin C. Vitamin C is an antioxidant that can help lower your risk of cataracts.

  1. Eat more Kale, if you can

Kale is an amazing source of lutein and zeaxanthin, both are needed for healthy eyes and retina protection. Kale can help protect our eyes from sun damage, lower the risk of cataracts, and it can help protect our eye from macular degeneration. Even though this amazing leafy-green can help many, some of us who are taking blood thinners like Coumadin, and others who have a cruciferous vegetable allergy should speak to their doctors before eating kale.

  1. Try Green Tea

According to many studies, green tea has been considered to help reduce our risk of cancer, neurodegenerative diseases, and more. The studies referenced here focus on breast, prostate, and colorectal cancer.  Not only does green tea help with lowering our risk of cancer, it can also help lower our risk of Alzheimer’s and Parkinson’s. Both diseases are classified as neurodegenerative, and studies show that the compounds in green tea can have various protective effects on neurons.

  1. Not all fats are bad

Omega-3 fatty acids are essential for good brain health.  Studies shows that is can help with improving healthy memory function. Seafood and fatty fish is an amazing source of omega-3 fatty acids.  Not everyone likes fish, for those of us who doesn’t , plant sources like nuts and seed also contain omega-3 fatty acid.

  1. Enjoy your food

Eating is not only necessary for living, it can add the spice life that we all need. So have fun, make revisions to old recipes, and share your knowledge of food to the younger generations.

Leave a comment and tell us which tip are you most excited about trying.

Understanding Part D

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 15th 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

7 Medicare Tips for New Enrollees

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.