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Get Started With Medicare

Medicare is its own universe  with its own jargon, terms, rules, and regulations. This can be intimidating, especially for those of us just starting out. However, signing up for Medicare is a vital step in making sure that you and your family have access to the essential healthcare you need in your golden years. Beware of Medicare scams!   Protect your Medicare ID and enrollment information.    Read on to learn how to get stared with Medicare.

 Learn the Basics

Original Medicare has two parts: Part A and Part B. Part A is hospital insurance, and Part B is medical insurance. Within these two parts, many of the basic health care you will need is covered. There is also Part D, which are prescription drug plans that are purchased separately. Medigap, or Medicare Supplemental Insurance, refers to additional coverage purchased from private insurance carriers that helps pay for the out-of-pocket costs of Medicare. Another name for Medicare Part C is  Medicare Advantage.   Part C is an alternative to Original Medicare.  Private insurance companies offer MAPDs.   The federal government does not offer these plans. These are bundled plans that usually include hospital, medical, and prescription coverage.  You must enroll in Medicare to qualify for one of these plans.

Prepare to Sign Up – Enroll

Get started with Medicare.   Most become eligible at age 65. And, promptly sign up.  Individuals receiving benefits from Social Security are automatically enrolled in Part A of Original Medicare.   Part A is hospital insurance. When they sign up for Social Security benefits, they have a choice about whether or not to enroll in Part B (medical insurance). Therefore, individuals not receiving Social Security benefits, must enroll in Part A.  Enrollment is not automatic for these persons. Here are the easiest ways to sign up:

• Online, at Social Security. The website is the easiest, fastest way to sign up and access any financial help you may qualify for.

• Call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.

• You can contact your local Social Security office.

• If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.

Regardless of method used to get stared with Medicare,  beneficiaries receive a welcome packet.     The welcome packet includes a Medicare card.   After enrollment, it takes about   2-3 weeks for the card to arrive.

Using Medicare

New enrollees will receive their Medicare card and start their coverage. It is a good idea to keep the Medicare card private, and only share it with medical professionals if necessary, as there are many scams around filing false claims to Medicare. The majority of doctors and service providers in the nation accept Medicare – about 93%. The most commonly excluded health care professionals, those who opt out of Medicare assignment, are psychiatrists and mental health practitioners, as well as pediatricians. It may also be helpful to give Medicare permission to share your information with someone you trust.  They can help if there is ever a medical emergency and you are unable to discuss treatment.

With these three simple steps, you will be well on your way to using Medicare successfully.

After Enrollment

The rise of automated and exclusively-online enrollment means that it can be easier to use technology to scam the unsuspecting.  Beware of Medicare scams!   Protect your Medicare ID and enrollment information. Medicare beneficiaries should always remember that Medicare will not reach out to beneficiaries via call or email unless they are answering their inquiry. Medicare will also never offer free gifts, medical equipment, or any other service for free.

Additionally, beneficiaries on an advantage plan do not need to show their Medicare card to providers.   Therefore, best if this card remains in a secure location not on them.

Licensed Agents

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How to disenroll from Medicare Part B

In this post, we will go over how to disenroll from Medicare Part B.  Although it is a rare occurrence, you can terminate your Medicare Part B (Medical Insurance). Although you may need to have a However, you may need to have a personal interview with Social Security to go over the risks of dropping coverage.  They will also be able to help make sure you have everything you need to process your request.

If you  want help terminating your Medicare Part B or to schedule a personal interview, you can contact Social Security either at 1-800-772-1213 (TTY: 1-800-325-0778) or in person.  Click the following link to  find your local  Social Security office.

To cancel Medicare Part B, you will need to download and print Form CMS 1763.  Once you have the form, do not fill it out until you have your interview with Social Security.  They provide instructions on how to fill it out.  If you already have your Medicare card, you’ll need to return it.  You can do this either during the in-person interview or by mail once you complete the phone interview.

Some risks to disenrolling from Medicare Part B:

If you do not have health coverage, you could become injured or ill and be stuck paying for all your medical services out-of-pocket.

Any time you go without creditable coverage, you have a coverage gap and will pay a late enrollment penalty unless you have a SEP (special election period) once you do sign up.  You also need to wait until the next General Enrollment Period to get coverage.  This period runs from January 1 through March 31st annually.

Click here to learn more about the risks of late enrollment in Part B

Any month that you are enrolled in Medicare Part B, you will pay a premium.  Once you disenroll from Part B, it will end the first of the following month after you file the request. If you decide to keep Part A, you will receive a new Medicare card showing Part A only.

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Things to do when you turn 65

If you are turning 65 in the near future, it is probably a good time to find a knowledgeable Medicare agent to provide insight into some of the things to do when you turn 65.

Decide if you want to retire or keep working

In most cases, you have thought about long before you turn 65.  This is a good time to go over your financial health and see if you need to keep working or if you have had enough. You may have quite a bit of savings and are ready to travel the world.  On the other hand, you may truly enjoy your work and couldn’t imagine what you would do without it.  That is entirely up to you.

If you are considering retirement:

Check in with Social Security and see what your benefit amount will be if you retire and look at what it will change to if you wait a year or two.  You should be aware of when you will reach your full retirement age and how much higher your benefit amount will be if you wait until then to claim it.

Take advantage of available catch-up contributions to IRAs & 401ks:

Once you are over 50, you are allowed to contribute an extra $1,000 to your IRA annually.   If you have a 401k, you can contribute an additional $6,000 annually.  If you opted to keep working, this is an opportunity to add to your retirement savings.

Important healthcare coverage decisions:

Before a person turns 65, their IEP (initial Enrollment Period) for Medicare starts.  The IEP is a seven-month window around your birthday that you can use to sign up for Medicare coverage.  It includes the three months before, the month of your birthday, and three months after.

Even if you have health insurance coverage through your employment or a spouse’s, you may want to sign up for Original Medicare during your IEP.  Find out when to enroll in Medicare Part A & Part B.  This is a great time to enlist the advice of a licensed Medicare agent who can explain all your options.

Do you have medical coverage through yours or your spouse’s employment:

If this is the case, you should speak with the employer several months before your 65th birthday to see what their policy for Medicare eligible employees is. Once you have an answer, you should go online or contact a licensed Medicare agent and learn about the Medicare options available to you.

You should contact Social Security and confirm your eligibility for Medicare Parts A & B.  Even if you decide to stay on your employer plan, you may want to at least enroll in Part A.  If you qualify for free Part A coverage.  Because there is a cost to enroll in Part B, You might want to wait to enroll, as long as you have coverage through employment.  Be sure you will not be charged a penalty if you do decide to wait.

If you do not have health coverage through an employer or spouse:

Make sure you enroll in both Medicare Part A & Part B before the month you turn 65.  This will provide enough time have your enrollment processed and get your card to you.  Normally your coverage starts the first day of the month you turn 65.  If your birthday is on the first day of the month, your coverage starts on the first day of the previous month.

You will need to look at all the Medicare coverage options available to you.  Again, this is a great time to get help for a licensed Medicare agent.  The agent should take a list of your current doctors and medications.  That will make it easier for him to find the best coverage for you. There are several choices available including Medicare Advantage plans, Medicare Supplement plans and Medicare Part D( prescription drug plans).  Whatever plan you choose, be sure you have credible prescription drug coverage (Part D).  If you neglect to purchase Part D coverage, you may end up paying a late enrollment penalty once you decide to add this coverage.

Learn about the Medicare Part B premium

If you have an HSA and enroll in Medicare:

Once you enroll in Medicare, you are no longer eligible to contribute to your HSA. However, you can contribute to an HSA after 65 if you chose not to enroll in Medicare Part A or Part B and maintained coverage through a high deductible health plan.

Click here to learn more about HSAs

Have a complete physical exam:

Because we all get busy and tend to put things off,  we can forget to take care of ourselves.  This is a great time to make sure you are in top shape so you can enjoy the years to come and address any concerns with routine exams and screenings.

Make sure your legal documents are in order:

I know this doesn’t sound fun, and in most cases at 65, you are in good health, but this is a good time to get this out of the way.  Once this is taken care of, you can get it off your plate and move on.

Consider making a legal will. Be sure you make any health care choices known to family members. You can also make a living will or advanced medical directive.  This can save family and friends a lot of stress later on if you become ill, they will not be faced with difficult choices. It can also protect any assets you have.  You should also organize your finances and have important papers filed properly so they are easy to locate should the need arise.

Remember to have fun:

Do not forget to enjoy yourself.  Take that trip or go out with friends/family.  You have worked hard your whole life; now it’s time to stop and smell the roses.

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One of the biggest points of confusion for seniors seems to be making a decision between a Medicare Advantage Plan and Medicare Supplement Plan. I receive phone calls on a daily basis from people either turning 65, moving from an employer plan to Medicare or just trying to decide what to do for the Medicare Annual Election period. Often they are confused and feel overwhelmed by the amount of information and plan choices available.

The reality is that it is actually very easy to learn enough to make an educated decision. This article is going to point out the basic differences between the plans and point out the strengths and weaknesses of each. With this info, anyone will be on their way to having enough information to make a confident decision on the best plan for them. (This Article is for people in Connecticut and NY- I will write one for other states in the next few days)

First, we need to break down the differences between the two types of plans and also dispel some myths about both.

Medicare supplement plans-

-They are secondary to your Medicare A and B (In other words, providers bill Medicare first and then your supplement covers some or all of the remaining costs depending on the plan you choose.

-They are for Medical only. You buy Rx coverage separately

-There is not a network. You can go to any doctor that accepts Medicare

-There are plans A-N available but only a few are popular. They Plan F, Plan N and High deductible F

-The plans are standardized in both Ct and NY. If a company offers a plan N, the benefits are identical regardless of the company offering it. Price is the only difference. Once companies plan N is not better than other companies. Just go by the price.

-There is no medical underwriting for them and in Connecticut and New York you can change them the first of any month at any time during the year.

Supplements are a good choice for people that do not want to have any network constraints. They also work well if you have doctors that do not take managed care plans (Medicare Advantage Plans) or if you travel to other states often.

Some clients like the fact that some of the supplements basically cover all of their costs for medical care. (Plan F and Plan C, Plan J for those whom still have it)

Finally, supplements work well for people that are very sick and receiving a high volume of care such as multiple injections at an outpatient facility or in the doctor’s office or people going to a number of physical therapy visits on a weekly basis. If you are on a plan F, you will not be billed for the services

I hear a tremendous amount of incorrect information being given out on a daily basis when it comes to Medicare Supplement plans. Here are some of the major areas where bad info tends to be most prevalent.

-” Such and such a company has the best Supplement plans”- In the world of supplements, there is no such thing as one companies supplement being better than the others. Supplements are mandated to have identical benefits. If United offers a plan F supplement, it has the EXACT same benefits as every other companies Plan F benefits. Supplement plans A-N are subsidized in Connecticut and New York. All plan benefits are the same. The only difference is the price that the company charges for them. If you have decided on a supplement and know which plan you want, take the company with the lowest cost for that supplement. (Example: You decide to take a plan N, Simply choose the lowest cost plan N being offered at the time.)

– “I can’t find all the companies offering supplements and the prices” – This is easy. Each state has a list of all companies in the state offering supplement plans and the prices of them. They can be found on the insurance websites of each respective state. Here is a link to Connecticut Supplement plans and prices for 2011

https://croweandassociates.com/images/stories/Medicare_Supplement_Rates_Connecticut_2011.pdf

“Supplements have underwriting outside of the guaranteed issue period”- There is no underwriting for supplements in Connecticut and NY. Both are guaranteed issue states even outside of the election periods.

“High Deductible F is not a good plan” – This could not be more off base. In Connecticut and Ny there are plans that have very low high deductible F plans. In fact, in Connecticut, Anthem BCBS offers a high deductible F plan for $39.00 a month. This math cannot be beat by any other supplement plan offered in CT. For more information on High Deductible F go to… https://croweandassociates.com/blog/?p=223 for NY

Although there are many good things about supplements, there is also a negative or two. First off is that they do not cover RX, you need to buy a separate drug plan if you want coverage. The going rate for Rx plans is about $32.00 a month. Secondly is the price of the supplements. The lowest cost plan F in CT is about $219.00 a month. When you add your Rx cost to that it brings you to about $250.00 a month for a plan. Keep in mind that you are going to be paying $3,000 in premium for the year no matter what. Even if you have a very healthy year you will have $3,000 less at the end of the year.

Medicare Advantage Plans
Medicare Advantage plans are managed care plans being offered by private insurance companies. They give you your A and B coverage, secondary coverage and Rx coverage all in one package. With a Medicare Advantage plan, your Medicare A and B is administered by the insurance company. As a result, when you go to the doctor you show them your Medicare advantage plan instead of your A and B card.

There are many positives and also negatives about an advantage plan. Here are the positives….

-They are included in your Medical and Rx in one package. You do not need to go and purchase a separate PDP plan.

-They are very inexpensive. All major carriers even offer $0 monthly premium* plans.

-They have out of pocket maximums.

-Preventative care is covered at no cost to the member.

*They can offer you a plan for $0 monthly premium because Medicare is paying the insurance company money to handle your enrollment and care for the year.

-Some carriers have national networks and plans with out of network coverage.

Some negatives about advantage plans…

-They have networks. If you take an HMO advantage plan (Which does not have out of network coverage) and you try to go to an out of network doctor, you will NOT be covered. Many people believe that Medicare will still cover them for the usual Medicare A and B amount if they go to an out of network doctor but it does not. You will need to pay the full cost.

-They have copays for services. You need to be aware of the copays on the plans you choose. Some plans cover certain services better than others. For example, one carrier may cover Major Radiology at 80% while the other covers it for an $80 copay.

-They have pre-certification requirements for some procedures. Your doctor is responsible for obtaining pre certs but they can hold things up at times.

Advantage plans tend to work very well for people in relatively good health that see a reasonable amount of doctors. You need to check to see that all your Docs and any hospitals you go to are in the network. There are now a number of plans with out of network coverage and national networks. This is good if you have a doc or two that is out of network.* The copays on most plans are reasonable and with $0 premium plans available, they can save the right person a lot of money for the year.

*Make sure your out of network doctor will bill your insurance company for you and not make you submit yourself.

Often clients get upset when they go on an advantage plan and incur a large copay. (For example, a CAT scan which is a $150 copay on some advantage plans) They will say “If I was on a supplement, I would not have paid anything”. They tend to forget that the supplement is costing them money every month when the advantage plan is not.

The math on advantage plans actually makes sense for the majority of people but not everyone. Make sure you review the benefits and check networks prior to enrolling. Do the math and see how much you will save in monthly premium vs. how much exposure you have to copays. In the end, the advantage plan will likely win out but a little time needs to be devoted to make a comparison before you make a final decision.

*Make sure your out of network doctor will bill your insurance company for you and not make you submit yourself.