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Understanding the 2020 Policy Changes to Medicare

by Jagger Esch
written by Jagger Esch

The beginning of a new decade is upon us, and significant changes are happening. Understanding the 2020 Medicare Advantage Open Enrollment Period could bring you great benefit.

The enrollment period provides an extra opportunity for you to get the best coverage. Medicare is full of many parts, and it may be challenging to keep up with all the new rules.

Different enrollment periods have varying guidelines. Regulations include specific dates.

Beneficiaries can forget about the old Medicare Advantage Disenrollment Period. The new and improved Medicare Open Enrollment Period is the replacement.

The last time to enroll, according to federal law, allows you a final chance to switch Advantage plans. Yet, you must be a Medicare Advantage enrollee to use this option.

Understanding the 2020 Medicare Advantage Open Enrollment Period

The new chance to switch Medicare Advantage plans is happening right now in 2020. It starts January 1 and runs until March 31.

Beneficiaries with an Advantage plan may now use this time to switch. Another option is to drop a current Advantage policy and go back to Medicare and buy Part D.

In 2010, the ACA law put an end to the Medicare OEP. Replacing the OEP was the Medicare Advantage Disenrollment Period. The dis-enrollment period began on January 1 and only ran until February 14.

So, what makes this period different? Well, this period only allowed beneficiaries to return to Medicare. The Medicare Advantage Open Enrollment Period allows a one-time switch between Advantage plans.

What is the Medicare Advantage Open Enrollment Period

The Open Enrollment Period allows you to switch from one Advantage plan to another. Although, you may not use this period to switch from one Part D drug plan to another.

Think of this as your chance to make any last-minute policy shifts.

Life happens at the most inconvenient times, Medicare understands. As of 2019, Advantage plan enrollees may make policy changes until the end of March.

New policies or any adjustments begin the 1st of the following month. Let’s say Katherine has a Medicare Advantage policy. She realizes her benefits don’t cover the care she needs in the upcoming months.

It’s February 1, so Katherine decides to find a more accommodating plan. She must wait until March 1 for her plan to start.

When to use the Medicare Advantage Open Enrollment Period

One big question is why beneficiaries would make another change? The reasons vary, but a common issue is that most people don’t understand how Advantage plans work.

Often Medicare enrollees attempt to make changes on their own without the help of an agent. There are many factors to consider when choosing an Advantage plan or a drug plan.

When deciding what option is best for you, it’s easy to overlook essential elements. That’s why working with an expert is beneficial; they make sure you don’t miss anything.

Unfortunately, beneficiaries forget to check the plan’s provider network before switching. Using an out-of-network doctor means paying out-of-pocket for services.

Recipients see the low premium cost and miss all the other costs associated with the plan. Yet, most programs have copayments and other expenses.

Medicare Enrollment Periods – The Breakdown

Learning the ins and outs of Medicare can be confusing, to say the least. One thing that seems to confuse many is the different Medicare enrollment periods.

The various election periods happen during certain times of the year. Election periods allow beneficiaries to make changes to their current coverage. Understanding each election period is essential for all.

The Annual Election Period

From October 15 through December 7 each year is the Medicare Annual Election Period. The AEP is the most common time for beneficiaries to change their Medicare Advantage or Part D plans.

Changes made during this time take effect on January 1. The Annual Election Period is for making changes to Medicare Advantage or Part D plans.

Each year, beneficiaries receive a Notice of Change letter in September. After reviewing this letter, you may decide you don’t like the upcoming changes. Use the AEP to switch to more comprehensive coverage.

The Special Election Period

Trying a Medicare Advantage plan for the first time can be nerve-wracking. You have twelve months to change back to Medicare if you try an Advantage plan for the first time.

During your first 12 months on the plan, you can switch without underwriting using the SEP. Advantage plans aren’t for everyone. The coverage may not meet your expectations or healthcare needs.

In such cases, the Special Election Period exists as a chance to go back to Medicare coverage. Beneficiaries may only use the Special Enrollment Period once in their lifetime.

Many circumstances qualify a person for a SEP. Moving out of state is a good reason, which means finding coverage in a new area. Beneficiaries may use a Special Enrollment Period to find a plan in the new service area.

Any major change can open the door for a SEP. If you get married, divorced, or are planning to move, expect eligibility for a plan change.

The Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period is different than the fall AEP. Often the Annual Election Period is mistaken for the Open Enrollment Period.

The Advantage OEP is from January 1 – March 31 for Medicare Advantage or Part D enrollees. During this time, you have options for policy changes.

Although, this period doesn’t guarantee a pass into a Supplement. Choosing to enroll in a Supplement to go with your Medicare may save on costs of care.

First, you must apply and answer any health questions. Following your request, Medigap companies underwrite your application to determine your health risk.

Companies may deny coverage based on your health. When this happens, you may have Medicare coverage without Supplement insurance.

Changes in plan benefits or coverage take effect on the 1st day of the month following the request. So, if you have any changes to make, be sure to get the ball rolling.

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Medicare Plans

Understanding Medicare Enrollment

by Garrett Ball
written by Garrett Ball

When is the Medicare Open Enrollment Period?

The Medicare Open Enrollment period is terminology that many people often use to refer to the end of the year period during which you can change medical and prescription plans. However, there is definitely some confusion about this period and some misuse of the term. Let’s clear up the Medicare open enrollment period confusion. Understanding Medicare Enrollment

Medicare Open Enrollment: When You First Turn 65 or Start Medicare

The actual Medicare open enrollment period is when you first turn 65 or go on Medicare Part B. During this time period, you have “open enrollment” into a Medigap (Medicare Supplement) plan. This open enrollment period lasts for 6 months starting with the first day of the month you turn 65 (or your Part B effective date if that date is later). During this time, you cannot be made to answer any health questions or undergo any medical underwriting to be approved on a Medigap plan.

Likewise, when you turn 65 or start on Medicare Part B, you have an “initial election period” during which you can select a Part D plan (prescription drug plan) without restriction or penalty. This initial election period lasts for 7 months – the month you turn 65 and three months on either side of that month. During this time, you can select any Part D plan without restriction or penalty.

If you are opting to go with a Medicare Advantage plan, you get the same initial election period as detailed above – 7 months including the month of your 65th birthday and three months on either side of that month. Understanding Medicare Enrollment

So, What is the Annual Medicare Enrollment Period?

The period that occurs annually, at the end of each year, is actually the “annual election period” or AEP. This period does not apply at all to Medigap policies (Medicare Supplements). On the contrary, this period only applies to Part D and Part C (Medicare Advantage).

The annual election period runs from October 15 to December 7. During the AEP, you can make changes to your Part D prescription drug plan or your Part C Medicare Advantage plan. Any changes that you make will take effect at the start of the following calendar year.

Many people often mistakenly think that you can also make unrestricted changes to your Medigap plan during that period; however, that is not the case. While you certainly can compare and change your Medigap plan during that period, you do still have to answer medical questions and be approved (3 Steps to Compare Medicare Supplement Plans). It is not, technically, an open enrollment period for Medigap plans though. Understanding Medicare Enrollment

How to Prepare for the Medicare Annual Election Period?

If you have either a Part D plan or a Medicare Advantage plan (Part C), you will receive a notice of plan changes for the following year in the mail. This usually comes in late September or early October. It is crucial not to merely disregard this mailing. Some of these plans change drastically each year, and you don’t want to get stuck in a deteriorating plan. Understanding Medicare Enrollment

When you receive your notice of plan changes, you should look over it carefully. It should show a side-by-side comparison with the previous year’s benefits. See what changes have been made and decide, based on the plan changes, your satisfaction with your plan, and any changes to your health or finances, whether you want to “shop” for a new plan.

If you do want to shop for a new Part D or Advantage plan, keep in mind that you can do so during the annual election period, which runs from October 15 to December 7. Understanding Medicare Enrollment

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Medicare Plans

Difference between Medigap Plans and Medicare Advantage

by Jagger Esch
written by Jagger Esch

When it comes to insurance, it would be fair to say you either pay now or pay later. If you pay now, you are choosing to pay a higher premium with the expectation your insurance plan will pay more when you file a claim. The pay later option means a lower monthly premium and leaves the Medicare Beneficiary with a greater out of pocket expense when seeking medical treatment. Difference between Medigap Plans and Medicare Advantage
There are several reasons to choose a Medigap Plan over Medicare Advantage Plans. The comprehensive benefits provided by a Medigap, as known as Supplement Plans can limit or eliminate out of pocket costs. Individuals covered by a Medigap Plan avoid network restrictions and have coverage worldwide. Most importantly, Medicare Supplement Plans allow the insured to budget the cost of their coverage and reduce unexpected expenses.

Medicare Part A

For 2018, the Medicare Part A deductible is $1340, then the plan pays 100% of hospital expenses for that benefit period. The benefit period lasts 60 days from the start of the hospital visit. If your hospital stay lasts longer than 60 days, you will incur a per day coinsurance.
The Medicare Beneficiary is responsible for that daily coinsurance. After 60 days, or in the event of an unrelated condition, if the Medicare Beneficiary is admitted to the hospital, a new benefit period starts, and the $1340 deductible is applicable, again. This can continue throughout the policy year.

Medicare Part B

Medicare Part B covers preventive services and medically necessary services such as doctor visits, durable medical equipment, diabetic supplies, and drugs administered in a doctor’s office.
The Medicare Part B deductible is $183 for the 2018 year, after the deductible is satisfied, Medicare pays 80%.

Gaps in Coverage

As you can tell, Original Medicare leaves gaps in coverage. There are gaps in Part A and gaps in Part B. Original Medicare does not have any out of pocket maximums or provide any caps to minimize the loss incurred by the Medicare Beneficiary. Your exposure to loss is undefined; there is nothing to protect the Insured person from financial losses.

Take into account that it cost about $5,000 to go to the emergency room. That’s without being admitted and without a gamut of tests. The gaps in coverage left by Original Medicare can be filled quickly and affordably by enrolling in a plan offered by any reputable insurance provider.

Medigap Plans Protect

Medigap plans do have a premium that is in addition to your Medicare Part A and Part B. The premium amount for your Medigap Plan is paid by the Medicare Beneficiary directly to the Insurance Company.

With a Medigap plan, you choose the amount of risk you are willing to take, the premium is reflected in the amount of benefits you elect. Regardless of the underwriting company (the name on the card you carry), the benefits are the same and are differentiated by letters.

Most people choose Plan G. Medigap Plan G, covers everything not covered by Medicare except for the $183 Part B deductible. The Plan F, provides the most protection to the Medicare Beneficiary, and minimizes the medical costs that could be incurred.

Of course, you can save on premium dollars if you are willing to consider some of the other plans. This is where your licensed insurance agent can help, by shedding some light on the various options that will provide the most coverage and still keep the premium within your budget.

Medigap Offers Freedom

You’re free to choose your doctors and hospitals. These plans allow Medicare Beneficiaries to select doctor’s based on their personal preference, in addition to choosing the hospitals they utilize. The only requirement, is that the provider accept Medicare.

The freedom offered by being insured can be liberating. Just ask someone who has been limited to a list of doctor’s or had a claim from a specialty hospital denied. Treatment of medical conditions/ diseases can be determined by the patient and doctor.

The Disadvantages of a Medicare Advantage Plan

Medicare Advantage Plans require the Medicare Beneficiary to use network doctors and hospitals. With most advantage plans, going out of network isn’t an option as there are no out of network benefits. Most have network restrictions and seeing a specialist will require a visit to your primary doctor to obtain a referral.

There are only specific periods during the year when you can enroll or switch to another Medicare Advantage Plan. Otherwise, you can’t change your Plans during the year.
The premium on a Medicare Advantage Plan can be low or even zero. However, the Medicare Beneficiary will incur expenses over the course of the policy year, including deductibles, copayments and coinsurance. Typically, Medicare Advantage Plans have an out of pocket maximum of at least $6,000.

You Get What You Pay For

Medigap Policies are the best choice for securing the most comprehensive coverage. You keep your Original Medicare Parts A and B. Then choose the Medigap Plan that best fits your needs and fills the gaps in coverage left by Medicare. A qualified licensed insurance agent can help you compare the costs and benefits of your options. When comparing your choices, it will become apparent which option will best suit your needs and budget.

Medicare Beneficiaries choose supplement plans for several reasons. Most people buy a Supplement Plan because they want to protect their assets. After more than 40 years in the workforce, it’s prudent to protect that which you have worked so hard to earn.
Others select a Medigap Plan for the freedom to choose their caregivers, hospital and doctors.

Medigap Policies provide coverage at any doctor or facility that accepts Medicare. In addition, these Supplement Plans provide coverage when you travel outside the United States.

When choosing a plan to fill the gaps left by Medicare, Medicare Beneficiaries are electing to purchase one of the Medigap Plan options. These plans offer a set monthly premium amount that Medicare Beneficiaries can work into their fixed income.

A set monthly premium works best for Medicare Beneficiaries as the unexpected out of pocket costs associated with a Medicare Advantage Plans leaves the insured person financially vulnerable.

There are several options available and the best way to shop around for the plan that meets your needs is to contact a qualified licensed agent. Your agent will ask you some questions to better understand your concerns and budget.

Once your agent understands your specific needs, he/ she will be able to check with the carriers in your region to advise which companies offer the best premium amounts for the coverage you’ve elected.

Enrollment into a supplement plan is best when you are first eligible for Medicare Part B. However, if you have delayed enrolling in Part B, because of coverage through your (or your spouse’s) group health insurance plan with an employer, you may be able to enroll in Part B and your Medigap Plan when that coverage ends. You will want to take action prior to the group plans termination day. It’s a good idea to contact your insurance agent as soon as you suspect any changes to your coverage.

Difference between Medigap Plans and Medicare Advantage

Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage

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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

What Happens to Medicare Coverage When You Move What Happens to Medicare Coverage When You Move What Happens to Medicare Coverage When You Move What Happens to Medicare Coverage When You Move What Happens to Medicare Coverage When You Move What Happens to Medicare Coverage When You MoveWhat Happens to Medicare Coverage When You MoveWhat Happens to Medicare Coverage When You Move What Happens to Medicare Coverage When You Move
 



 

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Turning 65? How to Pick a Plan
Medicare Plans

Turning 65? How to Pick a Plan

by Garrett Ball
written by Garrett Ball

When you are turning 65, you most certainly get inundated with information from all different sources – direct mail, phone calls, TV ads, unsolicited advice from friends and more. So, how do you sort through the noise to find the right course of action for you? Turning 65? How to Pick a Plan

Medigap vs. Medicare Advantage

The first, and really most important, choice that you will have is whether you will stay with traditional Medicare and purchase a Medigap policy to fill in the “gaps” in Medicare or whether you will opt for a Medicare Advantage plan. The differences in Medigap and Medicare Advantage are numerous, so it is crucial to understand them and make an informed choice when looking at these two options.
To briefly address those differences, Medigap plans pay AFTER Medicare and “supplement” Medicare; Medicare Advantage plans pay INSTEAD of Medicare. Medigap plans do not have networks (can go to any doctor nationwide that takes Medicare); Medicare Advantage plans are usually HMOs or PPOs and do have networks and sometimes require referrals to see specialists.
As far as costs, Medigap plans typically have higher premiums than Medicare Advatnage plans in most areas of the country. But in terms of out-of-pocket costs, Medicare Advantage plans have a menu of co-pays and deductibles for each different service or procedure, whereas the out-of-pocket costs on Medigap plans are more limited and defined. Turning 65? How to Pick a Plan
The last consideration when comparing these two is future insurability. When you go with the Medicare Advantage plan initially, you may have to go through underwriting in the future if you decide you want to switch to a Medigap plan. Some people choose to start with Advantage plans, since they are in good health, then later try to switch when they have more health problems. Unfortunately, it can be difficult to do that. Turning 65? How to Pick a Plan

Next Step: Compare the Plans

Once you decide which route you are going to – Medigap or Medicare Advantage – you can start to compare the plans. Turning 65? How to Pick a Plan
Medigap plans are relatively straight-forward to compare. They all are required go by the standardized coverage chart. So, for example, a Plan G (usually the best deal) with one company is the exact same as a Plan G with another company. See more about what Plan G offers.
Comparing Medicare Advantage plans can be more difficult as there are more variables, but that makes it even more crucial to do. Some things you need to consider when comparing Medicare Advantage programs are the network of doctors/hospitals, the coverage for your specific medications, the premium for the plan, the co-pays for different medical services and procedures, and the rating and history of the plans you are considering. You can compare all the Medicare Advantage plans on Medicare.gov. Turning 65? How to Pick a Plan

Pick a Plan and Re-Evaluate Over Time

One of the big mistakes that I see with people on Medicare is that people choose a plan at age 65 and then stay on the same plan the rest of their lives. In most cases, this is not advantageous for you.
One, the plans change over time. With Medicare Advantage plans, they change in terms of cost, coverage, networks, and more. With Medigap plans, while the coverage can never change, the costs do change over time. Turning 65? How to Pick a Plan
It is crucial that, once you make your initial selection of a plan, you re-evaluate your needs over time to make sure you have the best plan for you. Turning 65? How to Pick a Plan

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3 Steps for Medicare Supplement Comparison
Medicare Plans

3 Steps for Medicare Supplement Comparison

by Garrett Ball
written by Garrett Ball

Doing a Medicare Supplement comparison is a crucial part of a sound financial plan for someone on Medicare. Premium rates and guidelines vary considerably from state to state and from situation to situation. But there is so much information out there, much of it contradictory, how do you know where to start? 3 Steps for Medicare Supplement Comparison

Step 1: Understand Medicare Supplement Standardization

Without a doubt, the first step in doing an effective Medicare Supplement comparison is understanding the most basic aspect of these plans – the plans are Federally-standardized. By this, I mean that the coverage is the exact same no matter what company sells you the plan. A Plan G, for example, is the same with one company as it is with a different company.
Not only is the plan coverage standardized, the claims payment process is also standardized, as all companies pay claims through the Medicare “crossover” system. Because of this plan standardization, “like” plans cover the same things and work the same way. So, once you understand this, you realize that Medicare Supplement plans are actually quite easy to compare.

Step 2: Study the Medicare Supplement Coverage Chart and Choose a Plan

The Medicare Supplement coverage chart shows exactly what each of the standardized Medicare Supplement plans cover.
You will see that Plan F is the most comprehensive plan. It pays everything that Medicare Parts A and B do not cover. On that plan, you have no out-of-pocket costs. Although it is the most comprehensive plan, it may not always make the most financial sense.
Every insurance company does not offer every plan. The three plans that most companies have focused on over the last five years are plans F, G and N. Those three plans represent a top, middle and lower level of coverage, within which most Medicare beneficiaries can find a plan that fits their specific situation and needs.
Once you narrow down a level of coverage that you want, or at least have a good idea of what the different plans cover, you can move to step 3 of the Medicare Supplement comparison.

Step 3: Gather Medicare Supplement Rates and Choose a Company

Now you understand the plan standardization and have a good idea of what the different levels of Medicare Supplement plans are, the next step is to look at some actual premium figures and insurance companies.
There are several options for doing this. Some states maintain online resources containing rates for that state. These can typically be found on the state’s department of insurance website; however, they should be verified for accuracy as rates change over time.
Another option is to use an independent broker or agent. This person can provide rates and information for all your options and answer your questions.
A final option would be to contact each of the companies that sell Medicare Supplement plans in your state to gather the rates and use those to make a comparison of your options.
Medicare Supplement rates are determined by your age, zip code, gender, and in some cases, tobacco usage and/or health. So, make sure you use accurate information when requesting and obtaining the premiums.
Once you have the rates for your zip code, you can compare the reputations and ratings of the insurance companies you are considering and pick a reputable company that has competitive rates. Keep in mind step 1 when you are doing step 3 – the coverage and way that the plans work. 3 Steps for Medicare Supplement Comparison

3 Steps for Medicare Supplement Comparison

3 Steps for Medicare Supplement Comparison 3 Steps for Medicare Supplement Comparison 3 Steps for Medicare Supplement Comparison

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