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Our thoughts on how Medicare could be improved
Medicare Plans

Our thoughts on how Medicare could be improved

by Garrett Ball
written by Garrett Ball

How could Medicare improve eldercare benefits?

Medicare, by itself, is very good coverage, often much better than what most people are accustomed to as they age into Medicare. However, there is certainly room for improvement. Our thoughts on how Medicare could be improved
Some of the aspects of medical care that are not covered, such as dental, vision and hearing for example, have often been discussed as possibly being added in to basic Medicare’s coverage. That would certainly be an improvement to the coverage offered by “original” Medicare.
Other changes that would potentially improve benefits offered by Medicare are reductions in the amount of the Medicare deductibles and out of pocket costs. It’s difficult to see that change happening any time soon, however, and this is why the majority of people on Medicare purchase some sort of coverage in addition to Medicare.

What’s the biggest challenge seniors face when applying for Medicare?

The biggest challenge that seniors face when going on Medicare is confusion about Medicare benefits, deadlines and processes. Because of the enormous amount of information that seniors receive leading up to their 65thbirthday or retirement, many seniors are paralyzed by the fear of making the wrong choice or confused by the system itself.
In our experience, many people applying for Medicare do not understand how to start the process of applying Medicare. Those that are already receiving Social Security benefits are automatically enrolled into Medicare upon turning 65, so that does simplify the process for people in that situation. But for those that are not yet receiving Social Security benefits, it is a challenge to know what to enroll in and when they should enroll. There is not one document that seniors receive from Medicare that explains, in easy-to-understand terminology, the steps that one should take when applying for Medicare.
Additionally, this is even more complicated for seniors that are continuing to work past age 65 or are covered by a group insurance plan of some type. The decision of whether or not to take Medicare when they are first eligible is a decision that leads to confusion and can have potential long-term consequences.
Medicare has late enrollment penalties for Part B (medical coverage) and Part D (Rx coverage). So if a senior does not enroll on Medicare’s pre-determined time schedule, they can face these financial penalties, which are steep and stay with you in perpetuity.

Is there a medical service you or a loved one has needed that you thought Medicare would pay for and didn’t?

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

Our thoughts on how Medicare could be improved

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What Medical Equipment is Covered by Medicare?
Medicare Plans

What Medical Equipment is Covered by Medicare?

by Garrett Ball
written by Garrett Ball

 
As you age, certain medical equipment may be necessary. If you use durable medical equipment (DME) and/or medical supplies which assist you in your daily functions, those items may be covered by Medicare Part B. Be aware that Medicare covers the basic model of that equipment. If you want to add on expensive upgrades, you typically will have to pay for any extra charges. What Medical Equipment is Covered by Medicare?

What Durable Medical Equipment (DME) is Covered by Medicare?

Some DME items must be purchased and other items can be rented. Generally, after 13 months of renting equipment, you will be able to own it. However, although oxygen equipment is always rented, you cannot purchase it. See below for a list of DME equipment and supplies that are covered when medically necessary:

  • Air-fluidized beds and other support surfaces (for rental use only)
  • Blood sugar monitors
  • Blood sugar (glucose) test strips
  • Canes (except white canes for the blind)
  • Commode chairs
  • Continuous passive motion (CPM) machine
  • Crutches
  • Hospital beds
  • Incontinence products
  • Infusion pumps and supplies (if necessary to administer certain drugs)
  • Manual wheelchairs and power mobility devices
  • Nebulizers and nebulizer medications
  • Oxygen equipment and accessories
  • Patient lifts
  • Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
  • Suction pumps
  • Traction equipment
  • Walkers

What Durable Medical Equipment (DME) is NOT Covered by Medicare?

  • Medicare will not pay for durable medical equipment which is used outside of the home. If you do not need it for assistance at home, then it will not be covered. An example would be a motorized scooter for use outside the home only, given that you can get around your house without it
  • Items only intended for ease or comfort, i.e. stairway elevators, grab bars, air conditioners, bathtubs and toilet seats
  • Any modifications made to your home, i.e. ramps, widened doors, to facilitate wheelchair access
  • Equipment not suitable for home use, i.e. paraffin bath units and oscillating beds
  • Disposable items or items not used with equipment, incontinence pads, catheters, surgical face masks, or compression leggings. Note: If you get home health care, Medicare will pay for some of these items as part of your benefit, such as intravenous supplies, gauze, and catheters.

There are criteria that the DME must meet prior to being approved by Medicare, as follows:

  • It must be “durable”, resilient and long-lasting
  • It must be medically necessary and prescribed by your physician or other health care provider to be used at home. Note: It cannot be more than 6 months before the date of the order
  • It must not be used by someone else who isn’t sick or injured
  • It must be strong enough to withstand repeated use and last for at least 3 years.

Special Requirements for Certain DME Items

There are special rules for items that are more expensive, some examples are below:
Wheelchairs: Your healthcare provider’s order should indicate the following:

  • that it is difficult for you to manage at home with just a cane or a walker. You must also be having difficulties in your daily functioning as getting dressed or bathing.
  • the date of your office visit
  • that you can use the wheelchair safely.

Power scooters:

  • The scooter must be ordered within 45 days of your healthcare provider’s prescription. His order will have to stipulate that you have the same problems listed above for getting a wheelchair. However, the order must also stipulate that you can’t use a manual wheelchair but could safely use a powered one.

Please note that some states have additional rules and required forms for wheelchairs and scooters. Check with your doctor to be sure you follow those rules.

How Do You Get Durable Medical Equipment (DME) Covered by Medicare?

You must get your DME from a Medicare-approved supplier. Both Original Medicare and Medicare Advantage plans have approved lists of suppliers. To find them in your area, go to the supplier directory at www.medicare.gov/supplierdirectory/search.html. You will need to use suppliers that are “approved” by your plan – either original Medicare or Medicare Advantage.
Medigap plans will also cover DME if Medicare approves it. It will be covered as a normal Part B charge – the Medicare Part B deductible will apply if you have a Medigap plan that does not cover the deductible. But after that Medicare and the Medigap plan should cover your costs in full for covered equipment.

DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

Competitive Bidding Program:

After suppliers submit their bids to provide certain DME and supplies in competitive bidding areas, an amount is agreed upon by Medicare for payment of each item. Medicare contract suppliers are selected from the suppliers with winning bids.

  • This program is cost-effective. Its primary goal is to save Medicare and its beneficiaries money.
  • It operates in certain zip codes in the Northeast, South, Midwest and West.
  • It ensures that you get top quality products from Medicare-approved suppliers.
  • It helps to minimize fraudulent and abusive practices in the Medicare system.

If you have questions about what Medicare will or will not cover, it is best to contact Medicare directly before agreeing to pursue purchasing or renting any equipment. You can find some information on Medicare’s website or by calling them at 1-800-MEDICARE.
Senior.com does not accept Medicare. However, our customers regularly get prior approval from Medicare for DME products and then submit the receipt with proper paperwork for reimbursement to Medicare.
 

What Medical Equipment is Covered by Medicare?

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How to Avoid Medicare Late Enrollment Penalties
Medicare Plans

How to Avoid Medicare Late Enrollment Penalties

by Garrett Ball
written by Garrett Ball

One of the common problems new Medicare beneficiaries encounter is missing important Medicare enrollment deadlines and incurring the resulting penalties. How to Avoid Medicare Late Enrollment Penalties
There are certain times that you are eligible to sign up for Medicare Part B, Part D, and Medigap plans. To avoid those potential late enrollment penalties, you should be aware of these deadlines and abide by them.
Medicare Part B Enrollment Period and Penalties
If you are already receiving Social Security at the time that you turn 65, you will be automatically enrolled into Medicare Parts A and B. You should receive your Medicare card in the mail automatically about three months before your 65th birthday. In this case, there is nothing you need to do to enroll in Medicare.
If you are NOT receiving Social Security, you will have to proactively sign up for Medicare Part B. You can do this online at http://ssa.gov or by visiting a local Social Security office. It is important to do this with three months of the month that you turn 65. If you do not do it by the end of that 3rd month, you would face a Medicare Part B late enrollment penalty. The penalty is 10% for each 12-month period that you did not sign up for Part B but were eligible to do so.
Additionally, you may not be eligible to enroll until the next general enrollment period for Medicare, meaning that you could be without coverage until that time.
NOTE: If you are covered under a group insurance plan, the Medicare late enrollment penalty does not apply to you.
Medicare Part D Enrollment Period and Penalties
Just like Medicare Part B, Medicare Part D, the prescription drug part of Medicare, also has late enrollment penalties. Similarly, these penalties begin accruing after the 3rd month following the month of your 65th birthday.
For Medicare Part D, the penalty for not enrolling in Part D when first eligible is 1% per month that you do not have a plan. For example, if you delay enrollment into Part D for 3 years, you would pay 36% of the standard Part D premium on top of whatever the Part D premium is for the plan that you select. This penalty is perpetual and does not go away for the rest of your life.
Just like with Part B, if you are covered by a group policy that includes creditable drug coverage, you are exempt from the Part D late enrollment penalty, but you must sign up for Part D when that group coverage ends to avoid the penalty.
Medigap Initial Open Enrollment Period and Penalties
Medigap plans also have an open enrollment period. The open enrollment period for these plans is 6 months long and begins on the 1st day of the month that you are 65 or over and enrolled in Medicare Part B.
In other words, if you turn 65 in April, your Medigap open enrollment period lasts through September of that year.
There is not an annual open enrollment period for Medigap plans (exceptions: CA, MO and OR).
The penalty for late enrollment into Medigap is not a financial one; however, it could potentially be much worse. If you do not sign up for a plan when you are in your initial open enrollment, you have to “qualify medically” to get a plan later in most cases. This means that, if you have pre-existing conditions or ongoing health problems, you can be excluded from getting the coverage altogether or made to pay more as a result of those conditions.
For these reasons, it is crucial to know the Medicare enrollment deadlines and follow them when you are turning 65 or signing up for Medicare for the first time. Doing so can save you major headaches and money in the future.

How to Avoid Medicare Late Enrollment Penalties

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Important Information About Your New Medicare Card
Medicare Plans

Important Information About Your New Medicare Card

by Garrett Ball
written by Garrett Ball

As part of a plan to reduce the likelihood of identity theft, CMS (Centers for Medicare and Medicaid Services) is mailing new Medicare cards to all 58 million Medicare beneficiaries. The mail-out will begin in April of 2018 and last for approximately a year, with the cards going out in waves based on your state of residence. Important Information About Your New Medicare Card

Why is Medicare Mailing Out New Medicare Cards?

Medicare cards have traditionally contained a beneficiaries Social Security number featured prominently on the card. With the increasing prevalence of identity theft, particularly among seniors, legislation passed in 2014 set a plan in place to replace all existing Medicare cards with a new card that does not contain your Social Security number.
In place of the Social Security number, the new cards will have an 11-digit unique, alpha-numeric identifier. This number, called the MBI (Medicare Beneficiary Identifier), is unique to you and tied to your Medicare account.

What Do You Need to Do to Get Your New Medicare Card?

Nothing. The Medicare cards are going out automatically starting in April. The first wave of cards will go out between April 2018 and June 2018 and will be sent to residents of the following states: Alaska, American Samoa, California, District of Columbia, Guam, Hawaii, Maryland, Northern Mariana Islands, Oregon, Pennsylvania, Virginia, and West Virginia. Other states will follow in subsequent months. By April 2019, all of the new Medicare cards should be in the hands of Medicare beneficiaries across the country.
You should always make sure that Medicare and Social Security have your current, most accurate address. You can correct any inaccuracy in your address by contacting Social Security at 800-772-1213 or online at http://ssa.gov/myaccount.

What Changes As a Result of the New Medicare Card?

The new Medicare card does not affect anything about your Medicare benefits or how you receive them. When you receive your new Medicare card, you should immediately destroy your old card and begin using your new Medicare card.
Remember, your old Medicare card contains your Social Security number, so you should take care to destroy it properly instead of just discarding it in the regular household trash.
The new Medicare card does not change anything about your Medigap or Medicare Advantage cards or coverage. And, the identification numbers on those cards are not changing as a result of the new Medicare cards.

A Word of Caution Regarding the New Medicare Cards

Medicare has cautioned seniors against related scams in which scammers may attempt to contact you directly about the new cards.
It is important to note that Medicare will not call you regarding your new Medicare card or require you to pay for your new card or provide personal information in order to receive it.
All you have to do is wait for your new card to arrive by mail, immediately destroy the old card and begin using the new card.

Important Information About Your New Medicare Card

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Am I covered for Travel Under Medicare?
Travel

Am I covered for Travel Under Medicare?

by Garrett Ball
written by Garrett Ball

How Much Does Healthcare Cost Around the World?

It is widely known that the United States spends more money per person on healthcare than any other developed nation in the world. If you are living in a country which has socialized medicine, the cost of medical treatments, office visits, etc. are typically much lower than in the U.S. Generally, speaking to cost only and not quality or ease of care, you will see the costs of healthcare in developed nations to be at least 50% lower than what you might pay in the U.S. Am I covered for Travel Under Medicare?

Medicare coverage for travel within the U.S.

Original Medicare:

Original Medicare is a national plan. The Medicare coverage is the same no matter what U.S. state you are visiting. With Medicare, you can travel domestically and still be covered under the same, identical Medicare coverage that you have when you are at home.

Medigap Plans:

Medigap plans “follow” Medicare. In other words, anywhere that takes Medicare will also take your Medigap plan. This, obviously, includes any doctor, hospital, facility in the United States that takes Medicare. Medigap plans provide additional coverage for the gaps that your existing Original Medicare does not cover. So, when traveling domestically, your Medigap plan will continue to supplement the costs of your care.

Medicare Advantage Plans (Part C):

Medicare Advantage plans are based on geographical areas. The plans you are eligible for depend upon where you reside and in which county you live. Please be aware that if you have been outside of your service area for 6 months or longer, your Medicare Advantage plan provider may automatically disenroll you.

Medicare coverage outside the U.S.

Original Medicare:

While original Medicare covers you without interruption within the United States and its territories, including Guam and the U.S. Virgin Islands, there is no coverage for any healthcare costs outside of the United States or any of its territories. You will be responsible for all the costs. Once you cross the border, you can say goodbye to your health coverage. The good news though, is that there are a few exceptions to this:

  • If you are on a cruise ship that is a maximum of 6 hours or less from a U.S. port, it is treated as domestic travel.
  • If you’re traveling directly to or from Alaska by way of Canada, you can visit a Canadian hospital.
  • If you happen to have a medical emergency in the U.S., but there is a foreign hospital nearer, then you may visit the foreign hospital without incurring any penalty.
  • In the case of a non-emergency – if you live closer to a foreign hospital, then you may go to that hospital without penalty.

For all the above exceptions, the total costs of your hospital stay will be covered. In addition, your emergency room visit will also be covered if you are not admitted to the hospital. Please note, your medical transportation or follow up care will not be covered until you return to the United States.

Medigap Plans:

Medigap plans C, D, F, G, M, and N, will provide coverage for foreign travel emergency health care when you travel outside the U.S. (or its territories). Although plans E, H, I, and J are no longer available, if you bought one of these plans prior to June 1, 2010, you have had the opportunity to keep it. If you are still on one of the discontinued plans, they also provide for foreign travel emergency health care coverage. The following provisions are included in this benefit:

  • The medical emergency must commence within the first 60 days of the start of your trip, and if Medicare won’t otherwise cover that care.
  • The plan pays 80% of the incurred charges for certain health care services or supplies for emergency care outside the U.S. after you have met a 250 deductible for the year.
  • There is a lifetime limit of $50,000.

Medicare Advantage Plans (Part C):

Medicare Advantage plans do not function like Medigap plans. Part C plans work differently. Each plan can decide which benefits to offer and that pertains also to foreign travel. To find out what the foreign travel coverage benefits are, you will have to ask your plan provider. Some plans cover travel emergencies and some do not. Part C plans also may not cover you in every country.
If you plan to travel outside of the U.S. for an extended period, there are long-term options for foreign health insurance, which is called “expatriate insurance”. Benefits may differ for each country.
The best advice you can have prior to travel abroad or within the U.S. and its territories, is to be prepared. Ask your plan provider or Medigap insurance company what coverage they will provide during your trip. Be aware of where you are covered and under what circumstances, and then plan accordingly.

Am I covered for Travel Under Medicare?

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What are Guaranteed Issue Rights for Medigap
Medicare Plans

What are Guaranteed Issue Rights for Medigap?

by Garrett Ball
written by Garrett Ball

Have you wondered why some people can bypass all those medical questions on Medigap applications, while others must answer them? These seniors have what is called “guaranteed issue rights, also known as “Medigap protections“. It is when insurance companies afford you the right, under certain circumstances, to enroll in Medigap policies without having to answer medical questions. What are Guaranteed Issue Rights for Medigap
The insurance companies that sell Medigap plans are required by law during this protected time to:

  • sell you a Medigap policy at the best available rate regardless of your health condition. They cannot deny you coverage
  • cover all your pre-existing health conditions
  • NOT to charge you more for a Medigap policy because of any health problems, whether in the past or present.

Although insurance companies must follow the Federal law, each state may include additional enrollment periods during which Medigap protection rights may exist. You need to check with your state SHIP (State Health Insurance Assistance Program) for more information.

In Which Situations Can You Use Guarantee Issue Rights for Medigap?

  1. If you currently have health coverage through an employer group plan (including retiree or COBRA) or through a union, and that coverage will be ending. Note: If you are on COBRA, you can enroll in a Medigap policy immediately or when your COBRA coverage is terminated.

To have your guaranteed issue right applied:

  • It must be no later than 63 calendar days from the date you lose your coverage; or
  • You get a notice telling you that your coverage is ending; or
  • You have proof of that date on a claim denial, if none of the other two options are available.
  • Please note, that your guaranteed issue rights may be extended for up to 12 months in certain situations depending on State law.

Make sure you keep a copy of any letters, notices, postmarked envelopes, and claim denials, as you may need to show proof and include them with your Medigap application.

  1. If you were enrolled in Medicare Part C (Medicare Advantage Plan) when you were first eligible for Medicare, or PACE (Programs of All-inclusive Care for the Elderly) and disenrolled within the first 12 months you had the plan to return to Original Medicare (Trial Right). Know the differences in Medigap and Medicare Advantage
  • The earliest date you must/can enroll in a Medigap policy is two months prior to the date your coverage will end; but no later than 63 calendar days following the termination of your coverage.
  1. You are in a Medicare Advantage Plan, and your plan is leaving Medicare or can no longer provide care in your area, or you are moving out of your Medicare Advantage plan’s service area.
  • The earliest date you must/can enroll in a Medigap policy is two months prior to the date your coverage will end; but no later than 63 calendar days following the termination of your coverage.
  1. You have a Medicare Select policy and you move out of your plan’s service area.
  • The earliest date you must/can enroll in a Medigap policy is two months prior to the date your coverage will end; but no later than 63 calendar days following the termination of your coverage.
  1. You lose your coverage because of your Medigap insurance company going bankrupt, or your Medigap policy coverage ends through no fault of your own.
  • You must/can enroll not later than 63 calendar days from the date your coverage ends.
  1. You leave a Medicare Advantage Plan or are disenrolled from a Medigap policy due to the insurance company ignoring the rules, or misleading you.
  • You have 63 calendar days from the date your coverage ended to buy a Medigap policy under guaranteed issue rights.

Note that you can enroll in a Medigap plan at any time. There is not an annual enrollment period for these plans. However, if you are not in one of these “guaranteed issue” situations, you have to answer medical questions and “qualify” in most situations. Regardless of your situation, it is important to follow the steps to compare Medicare Supplement plans before enrolling.
Lastly, it is strongly advisable to enroll in a Medigap policy before your current health care coverage ends. You can apply while you still have your coverage but the earliest effective date won’t be until the day after your current coverage ends. At all cost, try not to have any breaks in health care coverage, otherwise, you may not be eligible for Medigap protection when you most need it!

What are Guaranteed Issue Rights for Medigap

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Guide to Choosing a Part D Prescription Drug Plan
Prescription Programs

Guide to Choosing a Part D Prescription Drug Plan

by Garrett Ball
written by Garrett Ball

With the arrival of the Medicare annual election period, now is the time to compare your Part D plan to make sure you have the best “deal” for 2018. Guide to Choosing a Part D Prescription Drug Plan
First of all, it is important to understand that, each year, the Medicare Part D prescription drug plans have the ability to change their benefit structures, including premiums, deductibles, co-pays, networks and formularies. This means that keeping the “status quo” from year-to-year carries with it some definite risk. It is advisable to re-evaluate your Part D selection annually to ensure you have the plan that most closely fits your needs. Guide to Choosing a Part D Prescription Drug Plan

What is Part D?

Part D is the part of Medicare that covers prescription drugs. It is, technically, a “part” of Medicare; however, Part D plans are sold through private insurance companies. CMS, the Centers for Medicare and Medicaid Services, has oversight over Part D plans and approves them on an annual basis.
Each Part D provider decides how they are going to structure their plans. They may choose to have a higher premium and lower co-pays or vice versa, for example. They must meet Medicare’s minimum standards for what drugs they cover, but within those standards, they have flexibility in designing a formulary (list of covered drugs) and co-pay structure.
In early October of each year, the Part D plans for the following year are released. Around that same time, you should receive a notice in the mail from your current Part D provider, showing how the plan’s coverage and premium is changing for the next calendar year. This is the time that you should compare Part D plans. Guide to Choosing a Part D Prescription Drug Plan

How to Compare Part D Plans

Comparing Part D plans is actually relatively easy to do if you have some computer savvy. It can all be done on Medicare’s website, www.Medicare.gov. To compare the plans, you can use the “Medicare Plan Finder”. It can be a little difficult to use if you have not used it before – this step-by-step guide to comparing Part D plans on Medicare.gov may be helpful.
Another alternative to comparing the Part D plans on Medicare.gov is asking your local pharmacy, or pharmacist, for help. Many pharmacies now offer this service to their customers. They already have a list of your medications, so they can plug those in to the “Medicare Plan Finder” and make a recommendation that way.
The way the plan finder works is that it ranks the plans in order of lowest overall annual cost to you. It takes into account the drug plan premium, the deductible and the co-pays on each plan. This way, the results are customized to your specific medications and situation, and you can make an informed choice. Guide to Choosing a Part D Prescription Drug Plan

How to Change Your Part D Plan

Once you have done the Part D comparison, you may find that you should just stay with the same plan. If this is the case, you do not need to take any action, as the plans renew automatically if you make not changes.
If, however, you see that you should choose a different plan that would cover your medications more thoroughly or give you a lower overall annual cost, you can do so easily.
One option for changing your Part D plan is to do it directly on Medicare’s website. Changes can be made between October 15 and December 7 of each calendar year.
The other alternative for changing your Part D plan is to contact the new plan directly, either online or by phone, and enroll in the plan of your choice.
Any time you change Part D plans, Medicare automatically takes you out of the old plan when they approve your enrollment into the new plan. In other words, you do not have to proactively cancel the old plan – it happens automatically when you are enrolled into the new plan. All plan changes take effect on January 1, as the plans run with the calendar year.
Overall, comparing Part D plans annually is a crucial part of a sound financial plan for someone on Medicare. You should take the time to compare and make any needed changes for next year during this annual election period. Guide to Choosing a Part D Prescription Drug Plan

Guide to Choosing a Part D Prescription Drug Plan

Guide to Choosing a Part D Prescription Drug Plan Guide to Choosing a Part D Prescription Drug Plan Guide to Choosing a Part D Prescription Drug Plan

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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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Medicare and Dental: What You Need To Know
Medicare Plans

Medicare and Dental: What You Need To Know

by Garrett Ball
written by Garrett Ball

While Medicare does cover much more preventive care than many people realize, original Medicare (Part A and Part B) does not cover routine dental services and procedures in most cases. It’s important to understand what is not covered and explore your options for Medicare dental plans if you want to have dental coverage once you are on Medicare. Medicare and Dental: What You Need To Know

Medicare’s Coverage of Dental

First and foremost, you should understand that your regular dentist check-ups and any related services and procedures would not be covered under Medicare. Part B of Medicare is the part that covers anything outpatient, and Part B does not cover any dental.
There are very few situations in which Part A of Medicare (inpatient/hospital) would pay for dental surgeries if you are hospital-confined and need surgery as a part of another medical procedure. For example, Part A may cover a tooth extraction in preparation for radiation.
Overall, though, you should know that, if you go to the dentist once or twice a year, regular Medicare is not going to pay a dime for those visits. Likewise, if you have more frequent (and expensive) dental needs, such as fillings, crowns, or dentures, Medicare will not pay anything towards that.

Options for Medicare Dental Coverage

So, since Medicare itself does not provide any coverage for dental, what are your options? The good news is that you do have a few options to choose from if you still want to have dental coverage once you go on Medicare.
The first option is that you can purchase a stand-alone Medicare dental plan. There are about 5-10 companies that sell these in most states for people on Medicare. These plans can give you some coverage for regular check-ups as well as paying a percentage, usually after a waiting period, towards more comprehensive services and procedures. Premiums for this type of stand-alone dental coverage can vary greatly, but typically, you can get a dental plan for $20-40/month.
Another option is that you can go on a Medicare Advantage plan. Medicare Advantage plans are privatized versions of traditional Medicare, some of which include some minimal coverage for dental. Note that this type of plan takes the place of Medicare, so you should certainly look at all the benefits, restrictions, and long-term implications – don’t just choose to go with this type of plan because it covers a dental check-up once a year.
Lastly, you can choose to be a cash payer for dental once you go on Medicare. This is actually what the majority of people end up doing. Often, you can get a better price by paying cash for your dental services and procedures, and all you have to do is ask. This can be a good option if you are a minimal user of dental services.

Other Considerations for Medicare and Dental

One important thing to keep in mind when considering whether you should purchase additional coverage for dental once you go on Medicare is the waiting periods that these plans often have.
While these plans do not typically have underwriting (i.e. ask you medical questions when you apply), they do typically have waiting periods. This means that certain services and procedures would not be covered for a specified time (usually a few months). So, when your dentist tells you that the only way to eliminate your severe tooth pain is to do an expensive dental procedure, it’s too late to purchase dental insurance at that time.
Although Medicare does not cover routine dental care and procedures, you can still protect yourself by planning ahead. Look at your options to see if it is worthwhile to purchase a stand-alone dental plan. Or if you decide not to purchase a plan, you can budget for dental monthly, then be a cash payer with resources available when you need them.

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