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Medicare Plans

Reinstating the Medicare Advantage “Open Enrollment Period”

by Jagger Esch
written by Jagger Esch

If you or a loved one receives Medicare coverage, you know how complicated and confusing enrollment periods can be. Enrollment periods are only confusing because the term “Open Enrollment Period” is used correctly and incorrectly to describe times when a plan change is possible

Reinstating “Open Enrollment Period”

The Medicare Advantage Open Enrollment Period was discontinued in 2010. In 2019, the OEP will make a return.

From 2011-2018 Medicare beneficiaries were given only the Medicare Advantage Disenrollment Period (MADP), during this time beneficiaries could disenroll from their Medicare Advantage plan and switch only to Original Medicare. Now all that is changing.

The Medicare OEP will begin on January 1st and end on March 31st. During this time Medicare beneficiaries can disenroll from a Medicare Advantage plan and enroll into another Medicare Advantage plan. You also have the option of switching back to Original Medicare, with or without Part D coverage.

It’s important for beneficiaries to know that they won’t be able to switch Part D prescription drug plans. If you are currently enrolled in a stand-alone Prescription Drug Plan you will need to change your policy during the Annual Enrollment Period from October 15 through December 7.

Medicare Supplement Open Enrollment Period

New terminology needs to be set up to make things easier for Medicare beneficiaries. It doesn’t need to be complicated, and it should be simplified.

The Medicare Supplement Open Enrollment Period is for Medicare beneficiaries that are new to Medicare Part B. This period lasts 6 months and begins on the first day of the month that you turn 65 or older and enrolled in Medicare Part B.

So, if you turn 65 on April 8 and don’t join Medicare until May 20, your Medicare Supplement Open Enrollment will start on June 1, which is the first day of the month in which you are both 65 and Enrolled in Medicare Part B.

Incorrectly Called “Open Enrollment Period”

The Annual Enrollment Period (AEP) happens every year from October 15 through December 7, this enrollment period is commonly called the Open Enrollment Period. It’s incorrect to refer to the AEP as the OEP, but people do.

When a Medicare beneficiary turns 65, they become eligible for the Initial Enrollment Period (IEP), this gives beneficiaries 7 months to enroll in a Medicare Advantage plan. IEP is commonly mistaken for an Open Enrollment Period. It’s clear that they are confusing the IEP with the Medicare Supplement Open Enrollment Period, while they are similar, they aren’t the same.

Other Coverage Changes in Medicare 2019

April of 2018, Medicare recipients will start to receive new Medicare ID cards that no longer have a Social Security number displayed on them. This is to help prevent fraud and identity theft among seniors. As required by the Medicare Access and CHIP Reauthorization Act (MACRA) all beneficiaries will have a new Medicare ID card by April 2019. The new cards will display a random ID number and you can shred the old card.

Then the Bipartisan Budget Act of 2018 (BBA 2018) will help close the donut hole one for brand-name drugs. This means that beneficiaries will only pay 25% of the cost of brand-name drugs. The cost of closing the donut hole for brand-name prescriptions is being shifted to the drug manufactures instead of insurance companies or beneficiaries.

So many good things are happening in 2019, it only makes sense that there is some less than desirable news. A new premium bracket for the highest-income Part B and Part D enrollees with go into effect. Under the BBA 2018 enrollees with an income of $500,000 or more ($750,000 for married couples) will pay a higher premium for Part B and Part D coverage.

Annually by September 30th, Medicare Advantage recipients will receive an Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) from their existing insurance carrier for their Medicare Advantage and Medicare Prescription drug plan providers.

CMS shares plan changes for the following year in October, several months before the new year. Medicare.gov is an awesome resource for Medicare beneficiaries, you can use it to compare plans, look up information and learn more about Medicare.

 

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Medicare Plans

Alternatives to 1st Dollar Coverage Plans

by Jagger Esch
written by Jagger Esch

We’ve lived our lives planning for our future and the future is now. Unfortunately, gone are 1stdollar coverage plans. Instead of paying a monthly premium that allowed us to close our wallet after writing that check we can expect to do a little more searching to find just the right plan. It’s back to the licensed insurance agent to review your needs and benefits against costs and risk.

If you aren’t familiar with 1stdollar coverage, we are referring to Medicare Supplement Plans F and C. Medicare Supplement Plans are sometimes referred to as Medigap Plans. Plan F covered everything not covered by Original Medicare. Plan C covered everything not covered by Original Medicare, except excess charges.

What Now

Nonetheless, there are great coverage options available to you. The most comprehensive Medigap Plans available for the 2020 year will be Plans G and N. Previously, these two plans were overlooked by many in favor of paying a higher premium and nothing more. Medicare Supplement Plans G and N will now be the sought-after coverage options.

Plan G

In 2019, the Medicare Part B deductible will be $185. For beneficiaries enrolled in a Medicare Supplement Plan G, that $185 deductible will be all they pay for covered services. Between Original Medicare and Medicare Supplement Plan G, everything else is paid for you.

This plan is like Medicare Supplement Plan F in that you can minimize your out of pocket risk. But by assuming the $185 deductible, you will save much more than $185 on an annual basis. Currently, the Plan G is the most popular plan.

The reason is that in most cases a Medicare Beneficiary will save considerably more every year by paying their Medicare Part B deductible out of pocket. In many cases, a Beneficiary can save $300 or more over the cost of the year, and that is even after the deductible is met. To Savy seniors, this plan has been the choice for several years now.

Plan G does cover any excess changes that could be imposed by a hospital or physician’s office. So, you are not giving up any peace of mind to save several hundred dollars. The protection is in this plan. You can find Medicare Plan G reviews here.

Plan N

Medicare Beneficiaries that want cost-effective coverage and are willing to use facilities and physicians that accepts Medicare assignment should consider Medicare Supplement Plan N. Plan N does not offer does not cover the $185 (2019) deductible or excess charges.

In addition, Plan N has small co-pays when seeing the doctor or going to the emergency room. The co-pay for a doctor visit, primary or specialist, is up to $20. The emergency room co-pay is up to $50.

The Plan N caters to seniors that do not go to the doctor often. Many times, the cost savings from the Plan N to the Plan G are significant as well. The only real gap in the Plan N is that it does not cover excess charges.

Most doctors do not charge them, but you will frequently see a cancer specialist, and specialty hospitals charging those charges. A Cancer policy can always be purchased, roughly $1 per day for about $10,000 in coverage, to help cover these charges if you were to be diagnosed with cancer. You can find Medicare Plan N reviews here.

Why the Sudden Change

The end of first dollar coverage plans has been several years in the making. Congress created the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and signed it into legislation on April 16, 2015.

There are several reasons for the birth of MACRA. People agree the single most important reason is to keep doctors on the Medicare program. Medicare Beneficiaries need a large pool of doctors from which to select the one that best fits their needs and personality.

It is important to mention that someone who is already enrolled in one of the plans being retired can keep it. It is even permitted to change to another carrier’s Plan F or C, depending on which plan they have currently. Provided they can medically qualify, up until 2020.

The last plan that was retired was the Plan J. The difference is when Plan J was retired, Medicare Beneficiaries were allowed a special enrollment period to change to the Plan F with no medical underwriting. This is not the case this time around.

If you want to know more about the elimination of Plans F or C, click here.

History has shown that members that elect to stay on retired plans will be subject to larger than usual rate increases. It may not occur right away but as people that are healthy leave those plans to more cost-effective alternatives and people that cannot medically change pass on, there are less people in the pool of that plan. In order to keep up with the increased claims of sicker people, the prices must increase more dramatically to cover the claims.

 

 

 

 

 

 

 

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Why COBRA is Not Creditable Coverage
Health InsuranceMedicare

Why COBRA is Not Creditable Coverage

by Jagger Esch
written by Jagger Esch

What is COBRA?

COBRA, which is short for the Consolidated Omnibus Budget Reconciliation Act of 1985, is a federal law that requires any employer that has twenty or more employees and offers health coverage, must give the option to continue that coverage if the employee were to be in a situation in which they would lose the coverage; termination, reduction of hours, retirement, or certain other events. Why COBRA is Not Creditable Coverage
You should always check your local state laws for variations where different COBRA-like laws could apply.

What is covered by COBRA?

  • Coverages that you receive from an employer are generally covered by COBRA
  • Dental Coverage
  • Hearing Coverage
  • Health Care Coverage
  • Prescription Drug Coverage
  • Mental Health Coverage
  • Alcohol and Substance Abuse Coverage
  • Medical Spending Accounts
  • Vision Coverage

What is not covered by COBRA?

  • Retirement Plans
  • Disability Insurance
  • Vacation Plans
  • Life Insurance

How do I get COBRA?

Listed below are examples of qualifying events that would trigger COBRA

  • Reduction of hours of employment, (example: Going from full time to part time)
  • An employee’s death
  • Active Military Duty when you do not voluntarily have health coverage
  • Divorce or legal separation of a spouse that is covered from an employee
  • Aging into Medicare
  • Not returning to work at the end of FMLA(Family and Medical Leave) when coverage was in effect when the leave began and was lost while on leave
  • The employer going bankrupt
  • Termination of employment, voluntary or involuntary, unless it is for gross misconduct (COBRA does not define misconduct)

If COBRA is an extension of my employer coverage, why is it not creditable?

Creditable coverageis defined as health insurance, prescription drug, or other health benefit plan that meets a minimum set of qualifications. Group health plans, individual health plans, student health plans, as well as a variety of government-sponsored or government-provided plans are all types of creditable coverage plans.
One would think if the coverage is virtually the same as the coverage they had through the employer, it would be considered creditable. This statement makes sense but unfortunately it is not the case. Medicare does not consider COBRA creditable coveragewhen it comes to enrolling in Part B.
When you lose or leave your group coverage to go on Medicare you get a 8 month enrollment window to pick up Medicare Part B. You can elect COBRA if you are offered it, but you need to pick up Medicare Part B or you will be subject to a penalty.
The penalty for not picking up Part B when you have an enrollment period to do so is 10% for each consecutive 12 months you do not have coverage. The penalty stays with you for life and never goes away.

Can I pick up Medicare Part B at anytime if I miss my allotted time period?

If you do not pick up your Medicare Part B when you have the enrollment period available to you, you’ll have to wait until the General Enrollment Period (GEP). The General Enrollment Period starts on January 1stand continues until March 31stof every year.
When enrolling into Medicare Part B using the General Enrollment Period does not mean your Medicare Part B will start right away. When you use the GEP to sign up, your Part B will not start until July 1stof that same year.
This unfortunately happens to many seniors every year because they simply do not know.

But I just found this out now and my COBRA is ending?

Unfortunately if this happens to you there are not many options. You can see if there is an Affordable Care Act plan in your area to help you until you can get on your Medicare Part B. When this unfortunate case happens there are not many options, however you could consider a Hospital Indemnity, and a Critical Illness plan to help give some protection.
A Hospital Indemnity Plan, is a reimbursement coverage plan that will pay you for each day you are in the hospital, they can also pay you for doctor visits. You decide on a dollar amount you want or need in the event you must to go to the Hospital or doctor’s office and you pay the insurance company a monthly premium.
A Critical Illness plan is similar. These plans pay you out a lump sum tax free amount if you are diagnosed with a critical illness such as cancer, heart attack, or a stoke. The benefit amounts vary from as little as a $5000 benefit, up to $50,000 with most providers offering this coverage.
Regardless, if you fall into the situation of not having your Medicare Part B on time, these are important coverages to consider.
Nowadays half of all men and one third of all women are getting some form of cancer. The good news; we are living through it longer. The benefit payment amount does not have to be spent on medical expenses. You can use it for whatever you choose. Want to go to the best cancerspecialist? Then use it for travel and airfare. Want to see Rome? Enjoy your time abroad.

Why COBRA is Not Creditable Coverage

Why COBRA is Not Creditable Coverage Why COBRA is Not Creditable Coverage Why COBRA is Not Creditable Coverage Why COBRA is Not Creditable Coverage Why COBRA is Not Creditable Coverage

Why COBRA is Not Creditable Coverage

Why COBRA is Not Creditable Coverage Why COBRA is Not Creditable Coverage Why COBRA is Not Creditable Coverage Why COBRA is Not Creditable Coverage Why COBRA is Not Creditable Coverage Why COBRA is Not Creditable Coverage Why COBRA is Not Creditable Coverage Why COBRA is Not Creditable Coverage Why COBRA is Not Creditable Coverage Why COBRA is Not Creditable Coverage Why COBRA is Not Creditable Coverage

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Why Medicare is Primary for Small Employers
MedicareMedicare Plans

Why Medicare is Primary for Small Employers

by Jagger Esch
written by Jagger Esch

Turning 65 But Still Working; What To Do?

In this day and age more eligible Medicare Beneficiaries are choosing to continue working and they are confused about what they should do when reaching age 65. Why Medicare is Primary for Small Employers
In some cases, Medicare Beneficiaries can postpone their Medicare Part B and continue on their group coverage. Other times, these individuals will need to go ahead and pick up their Medicare Part B to stay on their employer’s group plan.
If you find yourself in this situation, take heed, there are a few things you need to know in order to be certain you are making the right decision for yourself, and not subjecting yourself to a potential penalty.

Should You Enroll in Part B or Delay it?

The number of employees your company has in their workforce will be the determining factor. If your employer along with all of their subsidiaries (if any), has more than twenty employees then your employer’s group health plan will be primary and Medicare secondary.
Naturally, in this case you will not be required to start your Medicare Part B and you will not incur a penalty for delaying enrollment. You should, however, check with your employer’s benefits administrator before you elect to delaying your Medicare Part B enrollment.
You will want to ensure that your employer coverage is considered creditable for Medicare Part B and/or Part D. If it is not you will need to pick up Medicare Part B and/or Part D to avoid a penalty.
If your employer and any subsidiaries has 20 employees or less, Medicare Parts A and B will be your primary coverage. What this means for you is that if you delay enrollment into Medicare Part B you will receive a Part B penalty of up to 10 percent for every consecutive 12 month period you do not have creditable coverage.

Medicare is Primary Means What?

When Medicare is primary it means Medicare is the first to pay and your employer coverage will pay after Medicare pays its portion. You will be responsible for any amount not covered after Medicare pays their portion and your employer’s group plans pays their portion.
Just as an example, when you go to the doctor you will be subject to Medicare’s deductible and the 20% left over. Your employer plan make pay all or part of those costs.
Keep in mind the employer coverage you have after turning age 65 may not be the same coverage that you had prior to being 65. Check with the benefits administrator from your employer to discuss what changes will be occurring to your current employer sponsored health coverage.

Which is Better, Employer or Medicare Coverage?

One of the biggest concerns when investigating policy benefits should be prescription drug coverage. Normally, employer plans do not have a gap in prescription drug coverage.
However, nearly all Medicare Advantage Plans that contain prescription drug coverage and all Medicare Prescription Drug Plans include a coverage gap. You may have heard the term “donut hole” used to describe the prescription drug coverage gap that impacts Medicare Beneficiaries.
Due to the new Bipartisan Budget Act of 2018, the coverage gap is closing in 2019, for brand name drugs. Nevertheless, the cost of prescriptions drugs during what was previously known as the coverage gap, will still increase just not as drastic as before.
Before making a decision, review your medical and prescription drug options and evaluate the benefits and risks of each choice. This determination will require you to ponder and decide for yourself.
Everyone’s situation is a bit different, needs and budget will vary from person to person. Comparing employer coverage versus Medicare as primary, it is not possible to say one is better than the other.
The way Medicare Plans are rated in your state should be another factor in your deliberations. You’re in an “issue age” state in you’re a resident of Florida. The closer you are to age 65 when enrolling in a Medicare plan will ensure a lesser price on your supplement plan for the lifetime of that coverage. Most states are not “issue “age”.
It does not matter what age rating is used in your state of residency, chances are you will still receive annual rate increases.

What About My Situation?

If you work for a small company that has a group health plan, and your employer has less than 20 employees, Medicare will usually pay first. However, Medicare would usually pay second if both of these apply to your situation:

  • Your employer joins with other employers or employee organizations (like unions) to sponsor a group health plan(called a multi-employer plan)
  • Any of the other employers have 20 or more employees

Your employer’s group health plan could ask for an exception. Even if your employer has less than 20 employees, you’ll need to check with the employer’s benefits administrator to find out if Medicare pays first or second.

If the employer has more than 20 employees, the employer sponsored group health plan will usually pay first. Always confirm with the benefits administrator.

Employers that have 20 or more employees are required to offer current employees that are 65 and older the same health benefits that they were entitled to when they were under 65, with the same conditions.
If the group health plan offered coverage to significant others, they must offer the same coverage to significant others aged 65 and older that they offer to significant others under the age of 65.

What About Claims?

If the employer sponsored group health plandidn’t pay the full cost of your bill, your doctor or health care providershould forward the bill to Medicare for an additional (secondary) payment.
Medicare will pay based on what the group health plan paid already, and what the doctor or health care provider charged. You’ll be responsible for any additional costs not covered by Medicare or your employer sponsored group health plan.
Why Medicare is Primary for Small Employers Why Medicare is Primary for Small Employers Why Medicare is Primary for Small Employers Why Medicare is Primary for Small Employers Why Medicare is Primary for Small Employers Why Medicare is Primary for Small Employers Why Medicare is Primary for Small Employers Why Medicare is Primary for Small Employers Why Medicare is Primary for Small Employers

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How do the Medicare Deductibles work? One of the most common misconceptions that Medicare Beneficiaries have relates to their deductible. Most people that are going into Medicare for the first time are accustomed to having group coverage, and they may incorrectly be under the impression that once they take Medicare they don’t have to pay anything. Do Not Pay Your Part B Deductible at Doctor Appointments All of us wish this was the way things work, unfortunately it is not. When starting Medicare it is important to know what costs you are responsible for are and how you pay those expenses. Medicare Part A (Hospital) With Medicare Part A, in 2018, you must meet a deductible of $1,340 for each occurrence into the hospital, once that is met the benefit period last 90 days. In other words if you go back to the hospital within 90 days for the same thing you will not have to pay the $1,340 again, but if you go in for another reason you could have to pay it again. If you are in the hospital for more than 90 days additional costs will occur. It is also worth a mention that when in the hospital certain services could be covered under Medicare Part B instead of A. This means you could have additional costs beyond the $1,340 for the stay. Medicare Part B (Doctors) Medicare Part B has a annual deductible of $183in 2018. Once you have satisfied that deductible you will then be responsible for 20 percent of all costs, and potentially excess charges in most states. What is an excess charge? When you go to a doctor that accepts Medicare, there are two designations that come up. A doctor that accepts Medicare assignment, and A doctor that accepts Medicare but does not accept Medicare assignment. When a doctor accepts Medicare assignment it means they agree to accept what Medicare pays as full payment; if a doctor does not accept Medicare assignment it means they are allowed to charge up to 15% more than the Medicare approved amounts. That 15% is called an excess charge. How do I know if my doctor imposes excess charges? One of the easiest ways to find this out is simply ask, “Do you accept Medicare assignment?”, or “Do you charge excess charges?” Your doctor’s office will disclose to you if they do or do not accept Medicare assignment. You can also go to Medicare.gov and use the Physician lookup to look up your doctor and find out if they take Medicare assignment. Should I pay my deductible when I go to the doctor? This is a reoccurring question for Medicare Beneficiaries. It is a very important question to get the correct answer to, and here is how it works. When you go to the doctor you should show your Medicare card, if you have additional insurance like a Medicare Supplement you should show it as well. Upon conclusion of the doctor visit, the office staff will send the bill to Medicare. Once Medicare receives the bill they will determine if your deductible(s) has been met. If not, you will be sent a bill up to the amount of the deductible. If the bill is greater than the deductible, you may receive additional bills. Those bills will be for your 20% or excess charges. If you have secondary coverage such as a Medicare Supplement, some or all of those costs could be paid for by your supplement plan leaving you with little or nothing to pay out of pocket. If you have a Medicare Advantage Plan, the process will work a little differently and you have other concerns. A Medicare Advantage Plan essentially replaces your Original Medicare with a network based plan. When covered by a Medicare Advantage Plan it is common that you would have to pay at the doctors office prior to being seen. Some have out of network benefits. If your Medicare Advantage Plan has out of network benefits, it will also have a separate own set of co-pays, deductibles, and out of pocket costs. Most of the time your out of network responsibility will be double your in network amounts. What if I paid my doctor up front already? If you paid your doctor already for your deductible, it is possible Medicare will send you a bill for the deductible amount. It happens when Medicare receives an invoice from your doctor, Medicare automatically sends you a notice requesting payment for your deductible. If this happens you will need to pay that deductible to Medicare, and go back to your doctor and try to straighten it out with their billing department. Most medical provider billing departments know that with Medicare Beneficiaries they should not collect the deductible or any funds up front. This can be a hassle. If you have a doctors office that tried to make you pay your Medicare deductible up front, you may want to consider if that doctor has your best interest in mind. What about the hospital deductible? When it comes to the hospital deductible, it should work the same way. Upon being discharged, the hospital should bill Medicare. After Medicare applies their billing process you will receive bills for your portion, whether it be just the deductible or additional amounts. Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments
MedicareMedicare Plans

Do Not Pay Your Part B Deductible at Doctor Appointments

by Jagger Esch
written by Jagger Esch

How do the Medicare Deductibles work?

One of the most common misconceptions that Medicare Beneficiaries have relates to their deductible. Most people that are going into Medicare for the first time are accustomed to having group coverage, and they may incorrectly be under the impression that once they take Medicare they don’t have to pay anything. Do Not Pay Your Part B Deductible at Doctor Appointments
All of us wish this was the way things work, unfortunately it is not. When starting Medicare it is important to know what costs you are responsible for are and how you pay those expenses.

Medicare Part A (Hospital)

With Medicare Part A, in 2018, you must meet a deductible of $1,340 for each occurrence into the hospital, once that is met the benefit period last 90 days.
In other words if you go back to the hospital within 90 days for the same thing you will not have to pay the $1,340 again, but if you go in for another reason you could have to pay it again.
If you are in the hospital for more than 90 days additional costs will occur.
It is also worth a mention that when in the hospital certain services could be covered under Medicare Part B instead of A. This means you could have additional costs beyond the $1,340 for the stay.

Medicare Part B (Doctors)

Medicare Part B has a annual deductible of $183in 2018. Once you have satisfied that deductible you will then be responsible for 20 percent of all costs, and potentially excess charges in most states.

What is an excess charge?

When you go to a doctor that accepts Medicare, there are two designations that come up. A doctor that accepts Medicare assignment, and A doctor that accepts Medicare but does not accept Medicare assignment.
When a doctor accepts Medicare assignment it means they agree to accept what Medicare pays as full payment; if a doctor does not accept Medicare assignment it means they are allowed to charge up to 15% more than the Medicare approved amounts. That 15% is called an excess charge.

How do I know if my doctor imposes excess charges?

One of the easiest ways to find this out is simply ask, “Do you accept Medicare assignment?”, or “Do you charge excess charges?” Your doctor’s office will disclose to you if they do or do not accept Medicare assignment. You can also go to Medicare.gov and use the Physician lookup to look up your doctor and find out if they take Medicare assignment.

Should I pay my deductible when I go to the doctor?

This is a reoccurring question for Medicare Beneficiaries. It is a very important question to get the correct answer to, and here is how it works. When you go to the doctor you should show your Medicare card, if you have additional insurance like a Medicare Supplement you should show it as well.
Upon conclusion of the doctor visit, the office staff will send the bill to Medicare. Once Medicare receives the bill they will determine if your deductible(s) has been met. If not, you will be sent a bill up to the amount of the deductible. If the bill is greater than the deductible, you may receive additional bills. Those bills will be for your 20% or excess charges.
If you have secondary coverage such as a Medicare Supplement, some or all of those costs could be paid for by your supplement plan leaving you with little or nothing to pay out of pocket.
If you have a Medicare Advantage Plan, the process will work a little differently and you have other concerns. A Medicare Advantage Plan essentially replaces your Original Medicare with a network based plan. When covered by a Medicare Advantage Plan it is common that you would have to pay at the doctors office prior to being seen.
Some have out of network benefits. If your Medicare Advantage Plan has out of network benefits, it will also have a separate own set of co-pays, deductibles, and out of pocket costs. Most of the time your out of network responsibility will be double your in network amounts.

What if I paid my doctor up front already?

If you paid your doctor already for your deductible, it is possible Medicare will send you a bill for the deductible amount. It happens when Medicare receives an invoice from your doctor, Medicare automatically sends you a notice requesting payment for your deductible.
If this happens you will need to pay that deductible to Medicare, and go back to your doctor and try to straighten it out with their billing department. Most medical provider billing departments know that with Medicare Beneficiaries they should not collect the deductible or any funds up front.
This can be a hassle. If you have a doctors office that tried to make you pay your Medicare deductible up front, you may want to consider if that doctor has your best interest in mind.

What about the hospital deductible?

When it comes to the hospital deductible, it should work the same way. Upon being discharged, the hospital should bill Medicare. After Medicare applies their billing process you will receive bills for your portion, whether it be just the deductible or additional amounts.

Do Not Pay Your Part B Deductible at Doctor Appointments

Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments

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What you Need to Know about Open Enrollment fo Medicare
Medicare Plans

What you Need to Know about Open Enrollment fo Medicare

by Jagger Esch
written by Jagger Esch

The Medicare Annual Election Period (AEP) begins October 15th and runs through December 7th each year. It’s also known as Medicare’s open enrollment. A time when Medicare Beneficiaries can re-evaluate their coverage and make changes. It’s also a good time for those who didn’t sign up for a Medicare plan when first eligible to go ahead and enroll. What you Need to Know about Open Enrollment fo Medicare
Depending on the type of plan you have, you can make changes to your Medicare coverage during this time. Only under special circumstances that qualify as a Special Election Period, can Medicare Beneficiaries make changes outside the Annual Enrollment Period. That’s why it’s imperative that you understand when you can make changes.
For example, with Medicare Advantage Plans (also known as Medicare Part C) the Annual Election Period is when you can sign up, change or disenroll from the plan. The AEP allows Medicare Beneficiaries with Medicare Parts A & B to switch to a Part C plan.
In addition, Medicare Beneficiaries that are currently enrolled in a Medicare Advantage Plan (Part C) can disenroll in the Advantage Plan and enroll in a Medigap Plan, also known as a Medicare Supplement Plan.
The effective date for coverage elected during the Annual Enrollment Period will be January 1st of the following year.

Provider Networks

Are you willing to change doctors to save money? If you are enrolling in a Medicare Advantage Plan, this will a topic on the table when you review your options. If you have any doctors that you are not willing to change, have that information handy.
It will help your agent research your options, and make sure the doctor you’d like to keep are in the preferred network of any Medicare Advantage Plan you are going to consider.

Prescription Drugs

Your pharmacy can provide you with a list of the drugs and doses you are currently prescribed. This list is convenient when reviewing your Part D, Prescription Drug coverage options. Whether you are enrolling in a Medicare Advantage Plan or a Medicare Supplement/ Medigap plan, you will need to know if you are getting enough prescription coverage.
Prescription drugs are categorized into different tiers, with copayments/ coinsurance depending on the tier they fall under. The same prescription may have different costs, depending on the Prescription Plan you purchase.
Your agent will ask you for a list of your prescription so they can review those options available and advise which one will best suit your needs.

How to evaluate your options

Confirm your eligibility to enroll

To sign up for a Medicare Advantage Plan or a Medicare Part D Prescription Drug Plan, you must be enrolled in Medicare Part A and Part B and live in the service area of the Medicare Advantage Plan.
If you have end stage renal disease (ESRD), there are a few exceptions, but typically you cannot enroll in a Medicare Advantage Plan. You should contact Medicare for resources and options available.

Review changes to your situation and decide if your current coverage still meets your needs

Before the Medicare Annual Election Periodbegins, review the coverage you have in place. Consider the health benefits your current policy offers and weigh it against the benefits you’ve utilized over the previous 12 months.
You will receive an Evidence of Coverage from your current insurance carrier every fall. Use this document to review against your expected needs for the upcoming calendar year. Of course, nothing takes the place of a licensed insurance agent that can help you review the many options available to minimize your medical expenses.
Verify that your Medicare Part D, Prescription Drug Coverage is considered creditable. That means the coverage is expect to pay at least as much as the standard Medicare Prescription Drug Plan. If you go for 63 or more consecutive days without creditable drug coverage, you may incur a Medicare Part D late enrollment penalty. That penalty never goes away.
If you already have a Medicare Advantage Plan (Part C) in place, you should check to see if your current plan offers dental and /or vision coverage. Usually, these ancillary benefits require a separate enrollment.
For most people, changes occur and our health coverage needs are no exception. It’s worth the time invested to make sure you have the coverage needed before it’s too late.

Be conscious of how enrolling in a Medicare plan may affect other insurance coverage

Coverage such as Tricare for Life or a Federal Employee benefits plan could be impacted if you choose to enroll in other Medicare Coverage. Before making any changes, be certain to speak to your licensed agent or benefits administrator to find out how your insurance works with Medicare.
There are some plans that require you to have Medicare to maintain eligibility, while others will cause you to irreversibly lose your coverage if you enroll into a Medicare Advantage or Prescription Drug Plan.
We should really stress that if you have a retiree benefit plan, please contact your benefits administrator to be sure you understand your obligations in maintaining that coverage. Most plans that are offered to retirees just can’t be beat, so exercise caution if or when you choose to review other options that may be available.

Consider the cost of your coverage

With Medicare Advantage Plans, your insurance company reviews the plan benefits and premiums they charge, every year. Adjustments are made as needed to keep the premium/ loss ratio within the regulatory requirements.
Just as the insurance companies review the policies every year, your licensed agent can shop around and help you compare prices for the best coverage that will meet your anticipated needs and budget for the upcoming year. It has nothing to do with loyalty and is strictly dollar driven. Take advantage of the knowledge agents have to offer. Remember, the agent works for you.
Be cognizant of total cost sharing expenses. A lower premium doesn’t necessarily mean you’ll save money if it’s offset by high deductibles or copayments.
Medigap Plan benefits do not change. Medigap or Medicare Supplement Plans are regulated by Medicare and the benefits do not change. These are the plans that are differentiated by letters, such as Medicare Supplement Plan F or G. It is of interest to note, there are at least ten different Medigap plans currently available.
Any rate increases must be submitted and approved by Medicare. With a Medigap plan, the coverage is the same for a Plan F no matter who underwrites the policy. Medigap Plans cost a little more in premium than an Advantage Plan, but leave the insured person with less out of pocket expenses when seeking medical treatment.

What Can You Do

Working through the intricacies of Medicare can be like navigating through murky water. Frankly, you never really know what’s below the surface. You need a trust licensed insurance agent. The agent works for you, as a matter of fact, the agent has a fiduciary responsibility to help you find the best plan to meet your needs and budget.
Contact your pharmacy and ask them to provide you a list of your medications and doses. Then make a list of the doctor’s you want to be in your network. Determine what benefits are “deal breakers” when you start looking over your coverage options this fall.
Gather your receipts from copayments and coinsurance that you’ve paid for the current 2017 year. Then seek out your agent to help you review the data and make an informed decision as to which coverages will best suit your needs in 2019.

What you Need to Know about Open Enrollment fo Medicare

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What to do with the elimination of Medigap Plans C & F
Medigap

What to do with the elimination of Medigap Plans C & F

by Jagger Esch
written by Jagger Esch

For decades Medicare Supplement Plan F has been a top seller; it covers all the gaps in Medicare and leave beneficiaries with a $0 bill. With predictable healthcare costs, financial planning is easier. What to do with the elimination of Medigap Plans C & F
Plan C, like Plan F, is a very comprehensive plan. The only thing it doesn’t cover is the Part B Excess Charges. Plan C is not the same as Part C. Plan C is a Medicare Supplement plan and does not cover prescription drugs.

Why Plan C & F are Being Eliminated

Congress, wanting to cut spending, decided that by no longer allowing companies to cover the part B deductible, medical overuse could be prevented. Plan C & F are the only plans that cover the part B deductible. For 2018, the annual part B deductible is $183.
Cutting spending is not the only reason these plans are being phased out. The big issue Congress has been trying to avoid was, how to get doctors better paid for their Medicare services in the next few years. If the deductible is paid by the beneficiaries instead of the insurance companies, the doctors can be better paid.
Doctors that are not adequately paid are not going to want to work in the Medicare program, as you can imagine. Many health care providers made threats to quit the Medicare program if they were paid any less.
Congress created the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and signed it into legislation on April 16, 2015.
This bipartisan legislation created the Quality Payment Program which does several things:

  • Repeals the Sustainable Growth Rate
  • Changes how Medicare rewards clinicians for value instead of volume.
  • Arranges quality programs under the Merit Based Incentive Payments System.
  • Gives bonus’ for use of eligible alternative payment models.
  • MACRA is also requiring CMS to remove Social Security Numbers from all Medicare cards by April 2019.
  • Medicare Premiums for higher income individuals will also be increasing.

If you are going to be impacted by these changes, you have plenty of time to plan now to minimize any financial impact ahead.
This new legislation enacted by Congress should get doctors the fair payment they want for their Medicare services. The only difference is Plan F and C will be phased out and new enrollees will be responsible for the Part B deductible on Plan D or G.
Plan G is one of the top plans available to Medicare Beneficiaries. The savings usually makes it the most affordable plan for enrollees, depending on the state and enrollment type. The annual part B deductible is only $183, and sometimes a Plan F premium will be $200 more than a Plan G. Making plan G the more sensible plan anyways.
I don’t know if this is really going to cut the annual expenditure of Medicare, arguments on both sides of the spectrum have been given. nce 2020 comes we can all discover the real outcome.
If the beneficiaries are not experiencing higher than usual costs and doctors are paid fair compensation, then Congress found a great quid pro quo solution. If it doesn’t work in raising the pay for doctors, hopefully we will see more creative solutions.

MACRA and How It Impacts Providers

MACRA implements values-based initiatives aimed at improving care and access for Medicare and CHIP beneficiaries. The Quality Payment Program aims to transition the healthcare industry from fee-for-service to value-based care.
This means Medicare physicians, physician assistants, and nurses must participate in either a Merit-based Incentive Payment System (MIPs) or in Alternative Payment Models (APMs). The clinicians’ performance score will determine payment adjustment in later years. CMS will determine a positive, neutral or negative payment threshold.

Current Medicare Beneficiaries

If you are already enrolled in a Medicare Plan F or Plan C you should be “grandfathered” in to your plan and can keep your plan if you would like.
Some people are worried that the rates for Plan F and C will increase substantially, like in 2010 when plans H, I, and J were discontinued. The discontinuation of Plan F will be different in each state, some beneficiaries will still be able to change to other Plan F carriers in the future.
The states that follow the birthday rule or similar rule which lets them change Medicare Supplement companies during certain times of the year without going through any underwriting. This is the regulation in California, Connecticut, Missouri, New York and Oregon.
Only one Idaho has enacted legislation to be sure premium increases won’t affect Plan F beneficiaries specifically. The Idaho Department of insurance received misleading information from agents, telling people to switch plans now to avoid potential rate increases. Idaho Rule 18.01.54 protects Plan F policy holders from seeing a higher premium increase than other letter plan policy holders.

New to Medicare Enrollees

Congress believes that by implementing a mandatory deductible should make people think twice about visiting a doctor for a minor issue. Ideally this will mean fewer doctor visits, and lower Medicare spending.
Critics argue that by eliminating Plan F some people may choose to forego care altogether, resulting in even higher expenses later. If health conditions are not diagnosed early enough, Medicare could end up paying the price later.
The good news for Medicare beneficiaries is that the Part B deductible is not one of the biggest health care costs under Medicare. The Part B deductible for 2018 is only $183 for the year.
The Part A deductible is more than seven times the amount of the Part B deductible. In 2018 the Part A deductible costs $1,340 for each benefit period. Almost all standardized Medicare Supplement plans available in many of the states still cover at least 50% of the Medicare Part A deductible. Medicare Supplement Plan A is the exception, it does not cover the Part A deductible
For those new to Medicare, there are plans that are comprehensive and affordable; Plan G is one of them. You will be able to enroll in a plan G when you first become eligible for Medicare Part A and Part B.
Plan G covers everything Plan F covers, except for the Part B deductible. The doctor flexibility and $0 copayments give beneficiaries on this plan excellent coverage.
Plan N is another good option that is not getting discontinued. It is recommended that Medicare beneficiaries talk with an insurance agent about the plan that will be best suited for your individual healthcare and financial needs.

Things to Consider

The opponents of the legislation pointed out one brilliant thing; If someone has the money to purchase high-dollar coverage, they should be able to have that coverage. In theory, requiring beneficiaries to pay the Part B deductible should deter people from going to the doctor for minor problems.
Congress makes changes to the regulations on Medicare plans every so often. In 1990 they first made insurance companies standardized plan options for Medicare beneficiaries.
Then, in 2010 they removed some of the plan options like E, H I and J. The plans H, I and J were including prescription drug coverage; by eliminating that coverage option, congress was able to cut Medicare spending.
Congress can’t solve the Medicare-financing problem by borrowing funds. Debt in the Government is just a promise to raise taxes in the future. Younger workers will face massive tax increases if Congress does not cut Medicare spending.
With millions of people being affected by this change, at least Congress has given Medicare beneficiaries plenty of time to prepare. Legislation will always be changing and 2020 is still a few years away. What to do with the elimination of Medigap Plans C & F

What to do with the elimination of Medigap Plans C & F

What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F

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Understanding Special Enrollment Periods on Medicare
Health Insurance

Understanding Special Enrollment Periods on Medicare

by Jagger Esch
written by Jagger Esch

Special Enrollment Periods for Medicare are known as SEPs. There are a variety of reasons why a Medicare enrollee would be eligible for a SEP. Having the information needed to utilize a SEP when necessary will save you problems getting Medicare coverage when you need it. please email your resume to Christina Dailey at CDailey@senior.com. She can also be reached 949-454-2418. Understanding Special Enrollment Periods on Medicare
Navigating the Medicare system does not have to be complicated. If you have with the right information and resources, you will avoid the complications of missing your SEP and being without coverage, which could be devastating for you and your family. Understanding Special Enrollment Periods on Medicare

Who Qualifies and When?

The qualifications for a SEP are as follows:
If you are:

  • 65 or older
  • still employed or your spouse is still on the job
  • you have health insurance through your – or your spouse’s – employer
  • eligible for Medicare because of a disability

You can qualify for a SEP:

  • while you still have an employer or employment union health plan
  • eight months following the last month of employer or union group health coverage, or when you or your spouse no longer work, whichever comes first.

If your group coverage, provided by your employer, ends and you neglect to sign up for Medicare Part B during the SEP, you then must wait until the General Enrollment Period (GEP) to sign up for your Medicare plan. You may pay a penalty of a higher Part B premium because of late enrollment.

What About if You Relocate?

Relocation is a fact of life for many on Medicare. Moving to be near family, for financial reasons, for a change of scenery or other circumstances happens all the time. You won’t lose your Medicare coverage, but there are issues to manage:

  • If you live in the United States or its territories, you can keep your Original Medicare Part A and Part B coverage.
  • Make sure to have your medical records transferred from your previous doctors to the doctors you find in your new hometown.
  • If you are covered by a Medicare Advantage plan or a Medicare Part D Prescription Drug Plan, moving to a new state may qualify you for a Special Election Period (SEP).
  • During your SEP, you can enroll in a plan offered in your new service area.
  • If you have a Medicare Supplement plan (also known as Medigap) and relocate to a new state, it’s likely you will be able to keep that coverage, because the plans are the same in most states (Minnesota, Massachusetts and Wisconsin have their own Supplement programs).
  • Keep in mind that costs may vary from state to state, since Medigap plans are provided by private insurers.

What if You’re Incarcerated?

If you are incarcerated after enrolling in Medicare, it’s best to maintain your coverage for Parts A & B, if you can. Medicare does not cover your treatment while in prison, but keeping your coverage will ensure that when you are released, you will maintain your Medicare insurance coverage and not have to pay penalties, which can be permanent.

What if You Qualify for Extra Help for Prescription Coverage?

If your financial status qualifies you for aid with prescription drug expenses, you are eligible to enroll anytime for Medicare Prescription Part D. There is no SEP in this case.

What if Your Medicaid Status Changes?

If your Medicaid status changes, there are some scenarios that may apply to you, including:

  • You may be eligible for a two-month SEP during which you can assess your needs. If you wait longer than that, you may be assigned coverage without your input.
  • If you are covered by PACE, the Program of All-inclusive Care for the elderly, you may need different coverage.
  • If your coverage is dropped from a Special Needs Plan (SNP), you may need coverage.

These situations can be difficult to navigate within the Medicare system, so it’s best to find out how the facts apply to you. Don’t hesitate to reach out to a Medicare specialist if you are overwhelmed by the details.

How to Find Out if You Qualify for a Medicare Part B SEP

Eligibility for a Part B SEP can be determined by filling out these forms, available through the Social Security Administration office:

  • CMS 40B
  • CMS L564

After you have enrolled in Medicare Part B, it’s important to look into a Medigap or Medicare Supplement Plan. Medicare only covers 80% of your medical care, which means you will be paying the remaining 20% as well as deductibles, coinsurance, and copayments. A Medigap plan can cover those expenses.

Understanding Special Enrollment Periods on Medicare

Understanding Special Enrollment Periods on Medicare Understanding Special Enrollment Periods on Medicare Understanding Special Enrollment Periods on Medicare Understanding Special Enrollment Periods on Medicare Understanding Special Enrollment Periods on Medicare Understanding Special Enrollment Periods on Medicare Understanding Special Enrollment Periods on Medicare Understanding Special Enrollment Periods on Medicare Understanding Special Enrollment Periods on Medicare Understanding Special Enrollment Periods on Medicare Understanding Special Enrollment Periods on Medicare
 
 
 
 
 
 

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Health Insurance

Industry Experts Explain What Medicare Actually Covers

by Jagger Esch
written by Jagger Esch

Industry Experts Weigh in on Medical Services that Beneficiaries thought Medicare Paid for that Don’t

New Medicare beneficiaries tend to assume they’re fully covered by Original Medicare benefits. Unaware of the gaps in coverage, they end up finding out the hard way when they receive a medical bill in the mail. Industry Experts Explain What Medicare Actually Covers
Medicare Parts A & B only covers 80% of your medical costs. It has no out of pocket maximum and no prescription drug coverage. If you, or someone you know, only has Original Medicare, then this article pertains to you. Below, you’ll learn from industry experts as they explain what Medicare covers.

Medicare Does Not Cover it all

“We hear from many people who assume that long term care is covered by Medicare. Most are caught by surprise by that fact that Medicare does not cover long term care, only short-term rehab. This usually comes up when a loved one is no longer able to return home after a hospital stay and the shocking reality of paying privately for a care option is upon them. Another area we hear about Medicare not covering is scooters and walk-in tubs. These items are rarely covered by Medicare and once again, people are surprised by this harsh reality.” Amie Clark – Co-Founder of TheSeniorlist.com

  • Medicare does not cover Long-term care or support for your personal care needs. Most long-term care is not medical care, it is help with activities of daily living or personal tasks of everyday life. Medicare does suggest visiting LongTermCare.gov for information and resources to help you plan your long-term care needs. Medicare does cover care in a long-term care hospital, skilled nursing care in a skilled nursing facility, eligible home health services, hospice and respite care. Medicare will help cover durable medical equipment (DME) like scooters, walkers and wheelchairs if you have a medical need and qualify.

“People often assume that long term care, such as that provided by a nursing home, or a home health aide, is covered by Medicare. Unfortunately, that is not the case. Medicare will only pay for some short-term services after a hospitalization. Long term care can become a massive financial burden for much of the elderly population in the United States.” – Rebecca Gilbert, MD, PhD, APDA Vice President, Chief Scientific Officer.

  • Long term care not being covered can be a burden on beneficiaries and their families. I would recommend getting long-term care insurance before it is needed or too late. Many people are uninsured or underinsured, talking to an Insurance Agent to get questions answered and find the right plan for you is the best thing you can do.

“Patients and physicians are frequently confused about personal care services covered under Medicare benefits. They do not understand the difference between skilled and non-skilled home care services. For example, Medicare benefits cover a home health CNA when there is a skilled need and the patient meets home health criteria, including homebound status. Receiving this home health CNA service is temporary and can only be offered while nursing and/or therapy services are being provided, and at a low frequency (e.g. 1-2 visits per week). Non-skilled personal care services are not covered by insurance at this time and are paid privately or through special waivers. There is no time limit or guidelines as to who can receive personal care services since they are paid privately. Furthermore, DME supplies, such as transfer benches, adaptive feeding equipment and braces, are thought to be covered by Medicare, but are not. This is needed for safety in the home and should be covered to reduce further decline.” Sarah Deal – Interim Healthcare Inc

  • Having affordable DME supplies is vital for the elderly and disabled. While there are some DME supplies covered by Medicare, there are strict standards and both the doctor and the DME supplier need to accept Medicare assignment.

“There are several medical services that are not covered by Medicare that can cause a problem for seniors and their families. Many people have the preconceived misconception that Medicare pays for everything. On the contrary, there are Medicare deductibles, coinsurance and copays that has spawned a whole industry of supplemental plans to fill in the Medicare “gaps”. One of the areas that is not covered by Medicare is long-term care. We see this as a surprise to people on Medicare and their families because it is an area of care that so many seniors rely on later in life. However, Medicare itself does not cover nursing homes or custodial care. Now, there are insurance plans that you can purchase to cover that type of care, but these would, ideally, need to be purchased well before those benefits are needed. Another medical service that is not covered by “original” Medicare is prescription drugs. Prescription drug coverage for Medicare beneficiaries is provided through Medicare Part D. This is always a separate plan, sold through a private company, and it must be signed up for separately (you are not automatically enrolled in prescription drug coverage in most situations). Also, if you delay enrollment into prescription drug Part D coverage, you may face higher premiums due to Medicare’s Part D late enrollment penalty. Other medical care that is non-covered by Medicare are services for routine hearing, vision and dental care. There are some related aspects of these services that are covered, such as cataract surgery for example. But overall, routine care is not covered for hearing, vision or dental – this includes hearing aids, eyeglasses, and fillings, extractions, crowns, etc. You can purchase insurance to cover these things, but Medicare itself does not cover them.” Garrett Ball – Medicare Specialist at Senior.com

  • Medicare is not the most comprehensive coverage available. It does not cover many services. It is important for the Medicare beneficiary to purchase additional coverage. Some plans will include routine hearing, vision, and dental care. Part D Prescriptions Drug plans will need to be purchased through a private insurance company and you can be penalized if you are not enrolled in one when your part B goes into effect. Medicare is not the only insurance you want when something goes wrong with your health, you need to purchase additional coverage.

What you Can do to Prevent being Underinsured

Medicare does not cover everything; especially not long-term (custodial) care, routine dental, vision, hearing or prescription drugs. Working with an Insurance Agent or Counselor will help you get the coverage you need so you will be properly insured. Choose a plan that allows you to have the most consistent and reliable coverage year after year.

Looking for affordable DME products? Senior.com is a leader in the industry with affordable pricing and great customer service.
dustry Experts Explain What Medicare Actually Covers
Industry Experts Explain What Medicare Actually Covers Industry Experts Explain What Medicare Actually Covers Industry Experts Explain What Medicare Actually Covers Industry Experts Explain What Medicare Actually Covers Industry Experts Explain What Medicare Actually Covers Industry Experts Explain What Medicare Actually Covers Industry Experts Explain What Medicare Actually Covers Industry Experts Explain What Medicare Actually Covers Industry Experts Explain What Medicare Actually Covers Industry Experts Explain What Medicare Actually Covers Industry Experts Explain What Medicare Actually Covers

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