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What are the different types of Medicare supplement plans?

by Kylie Johnson
written by Kylie Johnson

All Medicare supplement policies

Medicare supplement insurance, also known as Medigap, is designed to cover some or all of the costs a patient is responsible for before Medicare Parts A and B will pay anything, copays required by Medicare Parts A and B and amounts over the maximum that Medicare Parts A and B will cover. The different Medigap plans are standardized between companies, meaning consumers will receive the same coverage for Plan A (or whichever plan they select) regardless of which company they buy it from. There are 11 plans, each designated by a different letter, and each one covers different things. (Medigap plans are not labeled with letters in Massachusetts, Minnesota and Wisconsin, so-called waiver states.)

Plan A

Plan A covers additional days in the hospital after Medicare benefits are exceeded, copayments and coinsurance, hospice care and up to three pints of blood.

Plan B

Plan B covers everything that Plan A does and also covers the deductible required by Medicare Part A.

Plan C

Plan C covers everything that Plan B covers as well as the deductible required by Medicare Part B, 80 percent of medical care costs occurred when traveling abroad and the coinsurance for stays in skilled nursing facilities.

Plan D

Plan D is the same as Plan C, but it does not cover medical care costs occurred when traveling abroad.

Plan F

Plan F covers everything covered by Plan C and also covers any excess fees charged by a doctor or hospital that Medicare does not cover.

Plan F—High Deductible

The high deductible version of Plan F has the same coverage as the standard Plan F, but individuals must pay a high deductible, often over $2000, before the policy covers anything.

Plan G

Plan G covers everything the standard Plan F covers except that it does not cover the Medicare Part B deductible.

Plan K

Plan K covers additional days in the hospital after Medicare benefits are exceeded and 50 percent of the following: Part B coinsurance, up to three pints of blood, hospice care, coinsurance for skilled nursing facilities and the deductible for Part A.

Plan L

Plan L covers the same things as Plan K, but it pays 75 percent on the services where Plan K pays 50 percent.

Plan M

Plan M covers additional days in the hospital after Medicare benefits are exceeded, copayments and coinsurance, hospice care, skilled nursing facility coinsurance and up to three pints of blood. It also covers 50 percent of the Part A deductible and 80 percent of charges while traveling abroad.

Plan N

Plan N is identical to Plan M, except it fully covers the deductible for Part A and requires a small copay for office visits and trips to the emergency room.

Medicare SELECT

A type of Medigap policy which typically charges lower premiums so long as the policyholders uses approved networks of hospitals and doctors.

Who should consider purchasing Medicare Supplement Insurance?

Retirees

Anyone reaching retirement age should begin researching health insurance options for those 65 and over. Deciding on a plan before turning 65 may allow some consumers to get special discounts.

Seniors

Older seniors may wish to purchase Medicare supplement insurance if they’re concerned about paying for an unexpected medical need.

People with qualifying disabilities

Individuals with qualifying disabilities, usually those that make them eligible for social security disability, may be allowed to purchase Medicare supplement insurance before they turn 65.

Affinity Group Members

Affinity groups like AARP may offer members advantages if they buy Medigap through the organization.

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Switching Medicare Supplement (Medigap) Plans
Medicare Plans

Switching Medicare Supplement (Medigap) Plans

by Garrett Ball
written by Garrett Ball

If you need to drop, change or enroll in a Medicare Supplement (Medigap) plan, you can do it at any time of the year. But before you make any changes, you need to consider whether you should make any changes or stay with whatever plan you currently have. Although you might be very satisfied with your Medicare Supplement plan now, it might not be suitable any longer because of your present needs or because of changes to the cost of your plan. As life events may have arisen, your current coverage could fall short of providing you with adequate coverage or may not meet all your needs for the duration of your life. You should consider very carefully the decision to change to another Medigap plan and/or company. Switching Medicare Supplement (Medigap) Plans
Some common reasons why you should consider switching Medigap plans, or switching from a Medicare Advantage plan to a Medigap plan are described below.

  • You are unhappy with your current Medigap policy because
  • the customer service being provided is substandard
  • your premiums have sky rocketed and you can no longer afford the increases
  • you want to change your level of coverage (i.e. Plan F to Plan G)
  • You have a Medicare Advantage Plan, but you are not happy with it because
  • the customer service being provided is substandard
  • your doctors are not in the Advantage plan network
  • you feel you just don’t have enough coverage and buying a Medigap policy would cover your healthcare more adequately
  • you fear that if you do acquire a major illness, you might be declined if you decide to switch at some time in the future, and you would rather change now.

What to consider when switching plans

When making that change to a Medigap plan, you should do a comparison of plans, i.e. which plans are available in your area and what benefits they offer (Plans F, G, N, etc). Medicare Supplement plans are standardized, however, they may vary widely in cost. You must get the same level of coverage no matter which company you buy your supplement from. In other words, one Medigap Plan G is the exact same as another Medigap Plan G. Your main goal is to find the best company at the lowest premium. Switching Medicare Supplement (Medigap) Plans
Note: If you are not satisfied with your Medicare Advantage plan, you have certain rights by federal law to buy a Medicare Supplement plan. You are entitled to these rights provided it is within 12 months of signing up for Original Medicare.

You cannot have both Medicare Advantage and Medigap, so you must be disenrolled from your Medicare Part C (Advantage) plan at the time a Medigap plan takes effect. You will need to contact your current plan and let them know that you want to go back to Original Medicare. Or you can disenroll from Medicare Advantage by signing up for a standalone Part D plan. For Medicare Advantage, the disenrollment process can only be done during certain times of the year or under special circumstances:

  • Annual Election Period (only for Part C and Part D): October 7 to December 15 each year. The change will take place the following January 1st. What changes can you make during the annual election period?
  • Annual Disenrollment Period (only for Part C and Part D): January 1 to February 14 each year. The change takes effect the 1st of the month following your request.

If you had a Medigap policy before you enrolled in a Medicare Advantage plan, you may be able to get the same policy back if it is still sold by that company. Otherwise you can buy another Medigap policy. Please note, that some states may provide additional special rights.

When is the best time to enroll in a Medigap Plan?

The best time for you to enroll in a Medigap plan is:

  • when you first turn 65. However, for you to be eligible, you must have already signed up for Medicare Part B. This is called the “Open Enrollment Period”. It is the 6-month period, which begins the 1st day of the month that you turn 65 and are in Medicare Part B. During this time, you have guaranteed issue rights. This means you cannot be declined in a Medicare Supplement plan because of your health. Even if you have health issues or pre-existing conditions, you are waived from answering any health questions, and must be offered the best available rate as anyone else who is in good health.
  • You are not limited to purchase a Medigap plan only during the open enrollment period or guaranteed issue rights. You are permitted to change it at any time since Medicare Supplement plans are not subject to the same guidelines as Medicare Advantage plans are. That said, you will, in most cases, have to undergo medical underwriting.

Whatever Medicare Supplement plan you switch to, make sure that you contact your current insurance company after you get approved by your new plan’s insurance company. This will prevent any duplication of coverage or any gap in coverage. You cannot have two Medigap plans at the same time. Switching Medicare Supplement (Medigap) Plans

Switching Medicare Supplement (Medigap) Plans

Switching Medicare Supplement (Medigap) Plans Switching Medicare Supplement (Medigap) Plans Switching Medicare Supplement (Medigap) Plans Switching Medicare Supplement (Medigap) Plans Switching Medicare Supplement (Medigap) Plans Switching Medicare Supplement (Medigap) Plans

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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 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 Happens to Medicare Coverage When You Move
Medicare Plans

What Happens to Medicare Coverage When You Move

by Garrett Ball
written by Garrett Ball

 
When you change your residence, whether it be in the same city you are living, a different city or out of state, and you are on Medicare, you need to do the following: What Happens to Medicare Coverage When You Move

  • The Social Security Administration handles Medicare enrollment. If you receive Social Security benefits, you can change your address online at ssa.gov, or by phone at 1-800-772-1213.
  • If you have you Original Medicare, changing your address as noted above is all you need to do. However, if you have a Medicare Advantage Plan or Part D Prescription Drug Plan, or if you have a Medigap policy, there are additional steps you need to take. What Happens to Medicare Coverage When You Move

Medigap Plans:

If you are enrolled in a Medicare supplement plan (Medigap), the first thing you need to do is change your address with your current Medigap plan company. It is suggested that as soon as you know what your new address is, you should contact them. You can still keep your same Medigap plan as the plans are standardized in most states. It is important that you are aware that your new plan rate might be higher (or lower) in your new state. Also, you might have to answer additional health questions if you do try to change plans or companies.
When moving out of your plan’s service area, in the case of Medicare SELECT plans, which may require you to use in-network providers:

  • You will be eligible to enroll in a standardized Medigap policy from your current policy company which has equal or lesser benefits compared with your current Medicare SELECT policy.
  • You may enroll in any Medigap Plan A, B, C, F, K or L that is available in your service area.
  • If you have had your Medicare SELECT policy for longer than six months, you will not have to go through medical underwriting. What Happens to Medicare Coverage When You Move

Medicare Advantage Plans:

There is a “Special Enrollment Period” for those who change their residence address outside of their service area. You have the choice of either:

  • You will be disenrolled by your Medicare Advantage plan if you move out of the service area. You will then have Original Medicare. but will keep your Medicare Part A and Part B. It is important you understand that if you do not enroll in a new Medicare Advantage plan during your Special Enrollment Period, the next chance you have will not be until the next SEP, from October 15-December 7;
  • if your current plan is offered in your new service area, you can stay with that plan;
  • if new plan options are offered in your new location, you may choose to enroll in one of these;

The Special Enrollment time frame is as follows:

  • If you let your plan know before your move, your window of opportunity to change plans will begin the month prior to your move, and will continue after your move for two full months.
  • If you do not notify your plan until after your move, you will only have the month in which you contact your plan plus the two full months that follow.

Part D Prescription Drug Plans:

Part D prescription drug plan members must notify their current plan about a permanent move. If the member notifies the plan prior to the move, the Special Enrollment Period begins the month before the move and continues for two full months after the move. If the member notifies the plan after the move, the SEP begins the month that notification was given and lasts for two full months. Once you sign up for the new plan, you can choose an effective date of up to three months following the month the enrollment was submitted. What Happens to Medicare Coverage When You Move
Preventative Care Covered by Medicare

What Happens to Medicare Coverage When You Move

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If you get Cancer what does Medicare Cover?
Medicare Plans

If you get cancer, what does medicare cover?

by Jagger Esch
written by Jagger Esch

A cancer diagnosis after the age of 65 can be overwhelming, but with Medicare and the right supplemental coverage, paying for medical care doesn’t have to be. Understanding the facts and benefits of Medicare regarding cancer coverage will make going through the process of treatment, from oral medication to surgery, a little bit easier for patients and their loved ones. If you get Cancer what does Medicare Cover?
Medicare does a very good job of covering cancer treatment for those 65 and over. The American Cancer Society reports that Medicare pays for nearly half of the $74 billion spent on cancer treatment each year.
Medicare covers most of the expenses involved with cancer treatment, and a Medigap plan can cover the rest.

What Does Medicare Part A Cover?

Medicare Part A covers hospital stays for cancer treatment. There is a deductible of $1340 (2018) that must be met before coverage begins. That expense can be covered by a Medigap plan, which is a supplemental insurance policy that pays for expenses that Medicare does not. A Medigap plan can greatly reduce the cost of cancer treatment for Medicare recipients.
Medicare Part A also pays for the full cost of skilled nursing facility care for 20 days after cancer surgery. This amount can also be increased with a Medigap plan. Those who don’t have money to pay such expensive medical bill may consider medical loans for bad credit. Low rates and easy repayments!
Skilled nursing care is vital to the successful recovery of patients who have cancer surgery, as it allows for time to heal while being expertly cared for by professionals, as opposed to returning home and having loved ones caring for patients. The idea of more time away from home may not be appealing, but in the long run the extra time in qualified hands will benefit not only the patient but their family members as well.
If hospice care is needed, Medicare Part A will cover it.

What Does Medicare Part B Cover?

Medicare Part B covers 80% of the cost of doctor’s office visits and treatments onsite, including cancer screenings, chemotherapy and radiation administered in the doctor’s office, tests and other outpatient care. A Medigap plan will pay for the other 20% of expenses for doctor’s office visits and treatments.
Part B covers some of the cost of medication for cancer treatment. Part B will pay for 80 percent of the cost of intravenous cancer treatment and intravenous anti-nausea drugs. If your doctor decides to treat your nausea with oral medication instead, it will cover 80% of those medications as long as they are taken within 48 hours of the cancer treatment. A Medigap plan will take care of the 20% of medication costs not covered by Part B.

What Does Medicare Part D Cover?

Medicare Part D, the prescription drug coverage plan, covers cancer prevention medications, anti-nausea drugs in pill form, and any injections that you give yourself during your cancer treatment. The cost of cancer drugs, from chemotherapy to immunotherapy, can be extremely high. Medicare Part D is essential to keeping those costs at a minimum for the patient.

What Does a Medicare Advantage Plan Cover?

Medicare Advantage plans, offered by private, Medicare-approved insurance companies, include all your Medicare Part A and Part B benefits. Medicare Advantage plans often include extra benefits, such as prescription drug coverage that are useful for a patient undergoing cancer treatment.
The downsides of a Medicare Advantage plan for cancer treatment is that patients may need referrals and will be limited as to which doctor they can choose to see based on who is in their plan. This can both slow down the process for getting treatment and prevent patients from seeing doctors who may be experts in treating their form of cancer.

Additional Things to Know About Medicare and Cancer

Medicare is invested in screening and prevention of cancer. Medicare members can and should take advantage of:

  • Mammograms every year for women over 40, including 3D mammograms in some states.
  • Pap smears and pelvic exams to screen for cervical and vaginal cancer, once every 24 months, or annually for women who are at increased risk.
  • Colorectal cancer screenings. A colonoscopy every 10 years is recommended for anyone over 50. Those with a higher risk can be screened more frequently under Medicare plans.
  • Annual lung cancer screenings for smokers or former smokers aged 55-77, if their physicians request the procedure.
  • Prostate cancer screening annually for men over 50. One in seven men is diagnosed with prostate cancer, but only one in 41 will die from it, due to early screening and intervention.
  • Although hair loss is a problematic side effect of some cancer treatments, Medicare does not cover the cost of wigs.
  • Medicare Parts A and B cover cancer treatment no matter how old you are.

Be prepared if you are diagnosed with cancer by understanding the coverage you have under Medicare and Medicare Advantage plans. Consider a Medigap plan to cover the costs that Medicare does not pay for. Get the care and treatment that is available to you through Medicare to stay healthy and get well.

If you get Cancer what does Medicare Cover?

If you get Cancer what does Medicare Cover? If you get Cancer what does Medicare Cover? If you get Cancer what does Medicare Cover? If you get Cancer what does Medicare Cover? If you get Cancer what does Medicare Cover?If you get Cancer what does Medicare Cover? If you get Cancer what does Medicare Cover? If you get Cancer what does Medicare Cover? If you get Cancer what does Medicare Cover? If you get Cancer what does Medicare Cover?

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