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Medicare Plans

Your Spouse Retires and Gets Medicare: Now What?

by My Senior Health Plan
written by My Senior Health Plan

When your spouse retires and gets Medicare, they (and you) will lose their work health insurance.

For example, Sylvia is 63 years old. Her husband Mike is 65. Mike is about to retire and will soon receive Medicare benefits. They will lose Mike’s employment group insurance (a benefit they’ve both enjoyed for decades). Sylvia will not be eligible for Medicare coverage for another two years. For the first time, she will be without health coverage.

NOTE: Medicare does not cover family members. Your spouse will apply for Medicare benefits at retirement age. Once you are eligible to receive benefits, you will apply separately to your spouse.

Here are some things to consider as you start the process of getting coverage until you age into Medicare.

Start with your health care needs

Unlike the group coverage you accessed through your spouse’s employment, this insurance is solely for you! Before you speak with your plan specialist, take a moment to evaluate your healthcare needs and preferences:

1) How often do you go to the doctor?

It could be that since you last updated your insurance, your health needs have changed. Maybe your visits to the doctor are less frequent. Perhaps you have health concerns you’d like to give more attention to (e.g., skin health and nutrition counseling).

Also, think about your dental and prescription needs. Did your dentist create a long-term treatment plan that may exceed your current insurance’s expiration? Without coverage, what are the possible costs for your medications?

2) How important is it that you keep your existing health care provider?

If you have a close relationship with your physician and want to continue with them, that will be an important consideration when choosing a new plan. Generally, an in-network physician will be more cost-effective than choosing to go out of network.

3) Do you want coverage only until you’re Medicare eligible?

Depending on your needs and preferences, you may want a plan to get you through the period between losing your spouse’s work coverage and getting your Medicare benefits. As you explore your options, keep in mind the coverage you’ve had until now—what you like and don’t like and the coverage that’s important to you.

Know your healthcare budget

As your spouse heads into retirement, your household income level will probably change. As you explore coverage to carry you through to your retirement, take into consideration your budget and how much you want to apply to deductibles and monthly premium costs.

Having a cost range in mind will make the process of choosing a pre-Medicare plan more straightforward.

For example, depending on your income level, you may qualify for financial assistance through your state or the Federal government.

If you don’t qualify for assistance, your plan specialist will help you find coverage to fit your budget and health needs.

Also, you may qualify for COBRA (Consolidated Omnibus Budget Reconciliation Act). This plan allows you to keep your group health coverage for up to 18 months after retirement. However, COBRA tends to be expensive, as most employers don’t subsidize the plan. The beneficiary must cover that additional cost.

Once your spouse retires and gets Medicare, you’ll need to find your own coverage

As you prepare for your spouse’s retirement, you’ll be navigating new territory. You’ll have to adjust to changes in income, your spouse’s leisure time, and your health insurance.

Take the opportunity to explore your previous coverage, as well as your care preferences, your health status, and your financial needs. The more you prepare now, the easier the transition to retirement, signing up for Medicare, and for you—getting pre-Medicare coverage—will be!

At MySeniorHealthplan.com, we can help you navigate getting healthcare insurance for the time between your spouse’s retirement and your eligibility to receive Medicare benefits. We’ll explain your options, and guide you through the process of getting the coverage that best fits your medical and financial needs.

Get started today! Give us a call Toll-Free: 877.255.6273

What our customers say:

“The people that my husband and I have dealt with at MySeniorHealthPlan have been “extremely” helpful and most of all very patient. They know the industry well and were able to make suggestions that really helped me make a decision as to what health plan would benefit my needs. We highly recommend their professionalism and like I said their kindness, knowledge, and patience.” – Susan Y., California

 

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Medicare Plans

How to Claim Medicare without Claiming Social Security

by Jagger Esch
written by Jagger Esch

Can you get claim Medicare benefits without claiming Social Security? You sure can, and we’re going to outline the reasons to consider this option along with some of the pros and cons of delaying your claim to Social Security benefits.

First, let’s look at some important information about Medicare and Social Security. Then, we can better understand why it makes sense to enroll in Medicare without claiming Social Security.

Medicare vs Social Security

Health insurance is offered through the Center for Medicare and Medicaid Services (CMS). Social Security provides people with a monthly stipend.

Medicare Part A is free for most recipients and Part B is usually deducted from your monthly social security check.

When beneficiaries enroll in Medicare at full retirement age, they may enroll through one of the online options. However, be careful if you do not want to activate your Social Security Income, or SSI benefit.

Follow the options that allow you to enroll in Medicare separate from your Social Security benefit.

Starting Medicare Benefits

With Medicare coverage, it’s important not to miss any of the deadlines or you’ll be penalized. The most important deadline is the Initial Enrollment Period, or IEP. This is a 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65 and the 3 months after your birth month.

Even if you have creditable coverage through an employer, you will still want to enroll in Part A.

Part A is the hospital coverage. Since you are not enrolling in Social Security, that automatic trigger will not occur. You, as the Medicare beneficiary will need to enroll in Medicare only.

Part B, the medical coverage does have a premium that is imposed. When you decide not to claim your Social Security Income benefits, you will need to complete the enrollment form for Part B, and you’ll need to pay the monthly premium.

For most beneficiaries, it’s easiest to have the bill set as an automatic draft from a bank account.

Medicare Part D is the prescription drug coverage and you will need to select a drug plan and pay that premium directly to your insurance company.

In addition to your drug coverage, you’ll need to consider what type of coverage you want to fill the holes left by Original Medicare. A licensed agent can help you review your options, enroll and assist you in getting your reoccurring premium payments set up.

It’s imperative that you address how you will pay for Medicare Part B as delaying your Social Security benefit prevents SSI from paying that premium out of your monthly check.

Social Security

In this instance the Social Security benefit would be the SSI or Supplemental Security Income, commonly known as retirement benefits. SSI will serve as a monthly income when you’re ready to apply and start receiving benefits. Social Security benefits can be claimed as early as age 62 or as late as age 70.

If you claim social security benefits before you reach full retirement age, you will receive a reduced benefit for a longer period. If you wait until full retirement age (66 years and 4 months) or later, you will receive a higher benefit for shorter period.

This is a situation where you have to make a best guess. Consider some of the following:

  • Are you working?
  • How is your health
  • Does your family history indicate longevity of life
  • Do you have other income to support you if you delay taking your SSI benefit

 

If you apply to start receiving benefits before full retirement age, you’ll receive a reduced monthlybenefit. Your monthly benefit amount will always be reduced. Hence the reason so many beneficiaries opt to delay filing a claim with Social Security.

Furthermore, if you can delay applying for Social Security benefits until after “full retirement age”, your benefits are increased based on your birth year and the number of months you delay.

Once you reach age 70, the benefit increase no longer continues to grow. Currently, beneficiaries who delay receiving Social Security Income benefits are making about 8% more per month.

My Dad and his decision

My own dad, Joe, is receiving his social security income and started taking benefits when he was 65 years old.

Having been diagnosed with COPD in his late 20’s, then Atrial Fibrillation in his 50’s and a few other health conditions, Joe crunched the numbers around age 62. He decided that in order to get the most money from his years of paying into social security, collecting at age 65 presented the best-case scenario.

One in every four 65-year-olds will live past the age of 90. While it’s a tough pill to swallow, Joe doesn’t expect to live to 90.

So, in order to maximize his retirement earnings, he filed his claim for SSI at age 65. Yes, he filed prior to full retirement age. However, he now has the time and income to enjoy his golden years.

This is the reason why

Most people outlive their retirement savings and studies show we’re living longer than previous generations. With this in mind, we need to prepare for a longer retirement period.

That means if you can delay receiving benefits past age 65, you would receive a higher monthly payment. For most folks, that higher monthly payment would kick in around the time their personal savings has been exhausted.

Although you’re evaluating your life expectancy, you need would do well to keep in mind the life expectancy of your spouse. Especially if that spouse plans to collect Social Security Income based on your benefits.

Deciding when to collect your Social Security Income benefit will impact your retirement income as well as your spouse’s retirement income.

If your spouse plans to make a claim for Social Security Income based on their own benefits, then this is a moot point; your spouse would need to make these same decisions that you now face.

The short and skinny, there is no right or wrong answer. It’s never too soon to start considering your personal situation and begin evaluating where you are in life right now; measure that against how you want to live when you retire.

Every person is unique, and you need to weigh your options before deciding. Take heed of the call to action sang by the band Rush, “If you choose not to decide, you still have made a choice”.

It’s a lot to take in and it should take you more than an afternoon to decide if it’s in your best interest to claim Medicare without claiming your Social Security retirement income.

When in doubt, break out a pencil and paper and crunch the numbers.

Tip the scales in your favor and start planning for your future while it’s still in the future. After all, Medicare and Social Security have been planning how to fund your retirement since your parents were still part of the work force.

 

 

 

 

 

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Medicare Plans

Who Can You Trust to Help Make Your Medicare Decisions?

by My Senior Health Plan
written by My Senior Health Plan

The many choices and options related to Medicare Advantage and/or Supplement Plans are enough to overwhelm even the most educated among us. You want to make the right selections, but without the proper guidance and direction, these decisions are dizzying.

You’re aware of how easily you could get stuck with a plan you don’t need or want, but you’d probably rather endure a colonoscopy than spend countless hours researching different plans.

Yes, navigating the world of Medicare Advantage and Medicare Supplement Insurance is difficult. But it doesn’t have to be. My Senior Health Plan will help you find you the right coverage at the right price—the plan that truly fits your needs and budget.

Here’s why My Senior Health Plan is the right choice for your healthcare needs.

Understand your options

There are numerous Medicare Advantage and Medicare Supplement Plan options. Not all of these plans are created equal, and each one is designed to address a specific set of medical needs. So which one is right for you?

My Senior Health Plan prides itself on offering a comprehensive, personalized service that addresses these questions directly. Their representatives will work with you to determine what’s important to you and how that translates to a Medicare plan.

They take the time to not just listen but also understand where you’re coming from and why. With this information, they use their expertise to find the right options to satisfy your needs and budget. My Senior Health Plan takes the guesswork out of Medicare coverage by presenting plans that meet your coverage needs at a price you can afford.

Review your current plan

If you already have a Medicare plan in place, My Senior Health Plan will conduct a complimentary review of your coverage to ensure you’re protected. They take the time to get to know every one of their customers so they can offer the absolute right coverage options, no matter what your situation.

As they review your current coverage, they will provide insight on the right times to change your Medicare Advantage or Medicare Supplement Plans. Medicare has stringent rules on when beneficiaries can make changes to their plans, but with My Senior Health Plan, you don’t have to worry. They know when and how to make changes to your plan, and they’ll take care of the heavy lifting for you!

Save money on coverage

Understanding what coverage you need means also understanding your budget. If you’re on a fixed or low income, they’ll make sure you have an affordable plan with low out-of-pocket expenses.

My Senior Health Plan understands the budgetary constraints faced by most seniors. They don’t pressure their customers into buying coverage they can’t afford. They know there are plenty of options available to meet every seniors’ financial needs.

Check prescription coverage

For many seniors, prescription drugs are their biggest medical expense. They’ve got to have these costs covered, but few know how to find the right prescription drug coverage.

The Medicare professionals at My Senior Health Plan are well-versed in the prescription drug plans and will help you find a plan to suit your needs while keeping your out-of-pocket costs low.

Enjoy lifetime support

My Senior Health Plan is here for you, long after you’ve selected coverage. They provide personalized service to ensure their customers are happy and confident in their Medicare coverage selections.

They also understand how situations change and that when they do, needs change, too. An annual coverage review is standard at My Senior Health Plan. Every year, they’ll happily reevaluate your situation and coverage options to provide guidance on if and how you should change your Medicare Advantage or Medicare Supplement Plan.

Contact My Senior Health Plan today to learn more about their services and your coverage options.

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Medicare Plans

Do You Really Have to Wait Five Years to Access Medicaid Benefits?

by Guest Blogger
written by Guest Blogger

If you or someone you love is trying to qualify for Medicaid, you may have heard people talking about—or in most cases, complaining about—having to wait five years to access benefits. If you don’t have access to professional guidance, you could easily fall victim to this common misconception about Medicaid.

When people complain about waiting for Medicaid to kick in, what are they talking about? It’s what Medicaid calls its five-year lookback period.

How does this work? Let’s say you’re applying for Medicaid. As part of the application process, you may be required to provide financial information for the previous five years. This includes bank statements, brokerage statements, 401(k) statements, IRA statements, life insurance policies, deeds, and more for you—and your spouse, if you have one. The Medicaid office scrutinizes all transfers made by the individual during the preceding five years to determine if any of those transfers should trigger a penalty.

A penalty-triggering transfer can take a number of forms including a cash gift, a real estate gift, a gift of valuable personal property, such as a vehicle, and the sale of an asset at below fair market value. If the Medicaid applicant made any penalty-triggering transfers during the preceding five years, it results in a period of ineligibility for Medicaid benefits. Medicaid determines the period of ineligibility by taking the sum of all penalty-triggering transfers and dividing it by a “transfer of asset divisor,” which is intended to approximate the monthly cost of a skilled nursing facility. As of July 1, 2018, the “transfer of asset divisor” is equal to $9,171. The penalty period will start once you apply for Medicaid and are otherwise eligible.

For example, if your mom, a Medicaid applicant, transferred $200,000 to you within five years of applying, it would result in a period of ineligibility of about 20 months. This is meant to disincentivize Medicaid applicants from gifting their assets away in order to become “poor on paper.” The intention of the penalty period is to force the Medicaid applicant to use up those transferred funds before Medicaid will provide any benefits.

When people hear this, they usually panic. And if they don’t get professional advice from an attorney experienced in Medicaid Planning, that panic will often result in some very bad decisions.

Even if someone you love will need Medicaid right away, in most cases, at least some of those assets can be preserved. In the elder law world, we call that Crisis Planning. Depending on the language in your loved one’s Durable Power of Attorney, we can usually get them qualified for Medicaid immediately.

However, if you start planning earlier, before the nursing home crisis happens, we can save even more. The secret is what we call Pre-Crisis Planning. This often involves creating an Irrevocable Trust and transferring ownership of the elder’s assets into that trust. But not all seniors are thrilled about this powerful asset protection tool because it means giving up dominion and control of their assets. But those who are willing to follow the guidance of an elder law attorney experienced in Medicaid Planning will usually be able to save more of their hard-earned assets than those who wait. It may feel like the nuclear option to a senior who doesn’t need nursing home care—YET—but it will feel like a blessing to the family members who are looking out for the elder’s legal and financial well-being when the time comes.

You don’t have to wait five years for Medicaid benefits to kick in, even if you didn’t plan.

Written by Kathleen Flammia, Attorney at Law, one of Florida’s TOP Elder Law & Estate Planning Attorneys. Attorney Flammia is a Member of the National ElderCare Matters Alliance, and she and her firm are Featured in ElderCareMatters.com – America’s National Directory of Elde

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Durable Medical Equipment & Medicare
Medicare Plans

Durable Medical Equipment & Medicare

by Jagger Esch
written by Jagger Esch

Many baby boomers rely on Durable Medical Equipment (DME) supplies for their daily activities. Medicare covers medically necessary supplies such as a wheelchair, CPAP machine, or oxygen tank.

So, if you’re wondering about Medicare coverage on your Durable Medical Equipment; ask yourself this; is this medically necessary and is my doctor going to write a prescription for this?

If you can answer yes, then coverage will be likely.

Will My Medicare Coverage Pay for Durable Medical Equipment?

Durable medical equipment is covered under Medicare Part B. The yearly Part B deductible is applicable and then Medicare pays an 80% coinsurance.

That means the Medicare Beneficiary is responsible for the remaining 20%.

If you’ve purchased secondary coverage through a private insurance company, they may pay the remaining 20% of the equipment costs.

Of course, that is provided you have met the Medicare requirements; like paying any applicable deductibles or premiums.

How Do I Get Medicare To Cover My Durable Medical Equipment?

Medicare requires standard information to be included with all prescriptions for durable medical equipment.

Typically, a face to face office note detailing medical necessity and a prescription.

Occasionally, Medicare may require additional testing or documentation. The DME provider should be able to guide Medicare Beneficiaries through the process.

You can expect equipment to be covered if it provides a therapeutic benefit for a condition or illness and will be used in the home.

Keep in mind that Medicare will cover the base model, any upgrades will be billed to the Medicare Beneficiary.

What If I need Durable Medical Equipment To Be Discharged From The Hospital?

When being sent home from the hospital, most people need a few supplies to make the transition smoother.

The most common prescribed items at the time of hospital discharge are hospital beds, wheelchairs, and bedside commodes.

The items that are necessary for Medicare Beneficiaries to continue recovery in the comfort of their own home, are typically covered.

These items will be covered by your Medicare Part B when the prescription is submitted along with the provider’s progress note detailing your condition and the medical necessity of the equipment.

Depending on the length of need, Medicare may rent or buy the equipment being ordered.

What If I Can’t Get Around My Home?

In some cases, a Medicare Beneficiary may have a long-term need for mobility. This could be due to a disability that is classified as temporary or permanent.

In either event, Medicare will cover a Power Mobility Device (PMD) provided specific criteria have been met.

For example, Medicare will require a face to face office note detailing the disability along with the doctor’s recommendation the patient will benefit from the device.

Provided the PMD is primarily used in the home, it will be considered a covered expense. Just to be clear, the Power Mobility Device can used outside the home.

Other items that improve mobility are:

 

There are numerous types of walkers and your practitioner will be able to assist you in determining which one would best meet your needs.

What If I Have A Need for Supplemental Oxygen, A Nebulizer or A Ventilator?

These items are all considered durable medical equipment and are covered under your Medicare Part B coverage.

As you know, anything considered a covered expense by Medicare will be considered payable by your Medicare Supplement Plan.

Oxygen is covered when the doctor details in the face to face office note the specific reason for supplemental oxygen. Oxygen is prescribed for persons with conditions such as COPD, also known as emphysema.

Nebulizers are used to atomize liquid medicine so the beneficiary can inhale a mist that will help open the alveoli, or air sacs. Nebulizers are commonly used by persons with asthma and infants.

Ventilators come in many forms and offer different treatment options. Medicare Part B will require a prescription, a face to face office note from the doctor detailing the condition, and the reason this DME is being ordered.

Ventilators can be either invasive or noninvasive.

  • An invasive ventilator does require an endotracheal tube which is inserted either through the nose or mouth.
  • A noninvasive ventilator requires only a mask.

 

Both types of ventilation therapy provide a volume and pressure to assist the user and provide support breathing.

What Is the Most Common Durable Medical Equipment Ordered?

Diabetic equipment is the most common equipment prescribed under Medicare Part B. Monitors and strips are covered.

Prosthetics and orthotic equipment that supports the lumbar or cervical spine are frequently prescribed. Personal care items such as bath chairs and dressing aids are also commonly prescribed.

What About My Sleep Apnea?

Medicare Part B does provide coverage for machines that correct obstructive sleep apnea.

These items are called CPAP and BiPAP machine. Depending on the type of sleep apnea, a doctor would allow the machine to correct the Medicare Beneficiaries condition.

Diagnosing sleep apnea is a quick process, but most people don’t know what symptoms should be cause for concern.

Sleep apnea is caused by either a physiological condition where the weight of the neck closes making the person stop breathing or breathe very slow, or a condition where the brain forgets to breathe.

Both are cause for concern because they put added strain on your heart and brain.

Signs to report to your doctor are snoring, insomnia, morning headaches or persistent daytime sleepiness.

What About the Monthly Supplies I Need for Upkeep?

Recurring supply needs are covered by your Medicare Part B coverage. Your DME company will be able to advise the frequency with which you can replace any durable medical equipment supplies.

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Senior
Medicare Plans

How to compare Medigap and Medicare Advantage Costs

by Guest Blogger
written by Guest Blogger

Whether you’re enrolling in Medicare for the first time or taking advantage of the 2021 open enrollment period to explore your options, it can be hard to evaluate whether Medigap coverage or Medicare Advantage make more sense for your wallet. Have you ever thought to yourself, “how much does Medicare cost?” Figuring it out is far from simple. Here, we’ll explain the difference and how to identify which option will work best for you.

Understanding Medigap and Medicare Advantage

Medigap and Medicare Advantage can seem similar, in that both are different options for Medicare coverage and you can only choose one or the other. However, there are core differences between the two.

Medigap is a supplement to Original Medicare that helps pay for what Original Medicare doesn’t — which may include deductibles, coinsurance, and copayments. However, Medigap will also charge an additional annual premium on top of your Original Medicare premium depending on the plan you choose.

Medicare Advantage Plans are replacements for Original Medicare. Rather than supplementing Original Medicare coverage, Medicare Advantage Plans are private insurance plans that offer a variety of coverage levels at different premiums.

You can find Medicare Advantage Plans that offer $0 premiums, as well as plans that cover care Original Medicare doesn’t — such as dental and vision.

Key factors to compare

Are you willing to switch doctors?

Many of the lower premium Medicare Advantage plans are HMOs (health maintenance organizations), which only have a network of providers that they provide coverage for. If you want to switch to a Medicare Advantage plan, make sure that either your doctor accepts that insurance, or you’re willing to switch doctors to an in-network one.

How much do you plan to travel?

One of the advantages of Original Medicare is its wide acceptance nationwide at hospitals and private practices. If you plan to split your time between two locations, or if you simply want to spend a lot of time travelling in the future, Medigap may have a more appealing flexibility than Medicare Advantage plans.

What’s your IRMAA?

Some, but not all, Medicare Advantage plans include prescription drug coverage. Those are known as MAPD plans, and if you have a MAPD plan and earned a higher income, you’ll have to pay what’s known as an IRMAA, or Income-Related Monthly Adjustment Amount.

The IRMAA charges a progressive fee to high earners based on their tax returns, and you can be charged an IRMAA on both your Part B and Part D plans. However, as Part D is optional insurance coverage, if you don’t have Medicare Part D or a MAPD plan, you don’t have to pay the additional IRMAA (although you still have to pay one for Part B).

Do you have a pre-existing condition?

If you’re eligible for Medicare for the first time, you have a one-time, 6-month-long open enrollment period where you can buy a Medigap plan without any sort of medical screening.

However, unless you live in CT, MA, ME or NY, Medigap plans can deny you coverage or increase your premiums if you apply after that initial open enrollment window. If you fall into that category, you should fully investigate whether Medigap is worth the investment now so that you can have it for decades to come.

About the Author

Shana Aguilar is a content strategist at a digital marketing agency where she helps companies connect to people through informative and authoritative content. She is currently working with businesses in the healthcare finance sector to help doctors and dentists live their best financial lives.

 

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Medicare Plans

Medicare OEP 2020: How Mrs. Jones Made Changes to Her Medicare Advantage Plan

by My Senior Health Plan
written by My Senior Health Plan

The new year is upon us and so is Medicare Open Enrollment Period (OEP) 2020. Yes, just when Annual Enrollment Period 2020 has finished, it’s time for OEP 2020! We know the Medicare system can be difficult, so today we’re going to follow Mrs. Jones through the Medicare Open Enrollment Period.

Mrs. Jones is a little confused since the Medicare rules can be complicated. But we’re here to help!

What is Medicare Open Enrollment Period?

Mrs. Jones wasn’t happy with the Medicare Advantage Plan she chose in the fall during AEP, and she’s been waiting for January 1st so she can make a change to her Medicare coverage. She has until March 31st, and she’s allowed to make just one change to her plan.

During the Medicare Open Enrollment Period, she:

CAN switch from one Medicare Advantage plan to another Medicare Advantage Plan

CAN disenroll from a Medicare Advantage Plan and return to Original Medicare (with or without a Part D drug plan).

But Mrs. Jones:

CAN’T switch from Original Medicare to a Medicare Advantage Plan

CAN’T add or switch a Medicare Prescription Drug Plan (if enrolled in Original Medicare).

If Mrs. Jones was in the first three months of her Initial Enrollment Period, she would also be able to:

Change to another Medicare Advantage Plan (with or without drug coverage)

Or go back to Original Medicare (with or without a drug plan).

What kinds of changes can be made during OEP?

Mrs. Jones changed her Medicare Advantage Plan during AEP. That plan became active on January 1st. But just a month after her new plan began, she realized that plan doesn’t cover her prescription drug needs.

Fortunately for Mrs. Jones, she can make a change because it’s Open Enrollment Period. She’s choosing to switch from the Medicare Advantage Plan she chose during AEP to another Medicare Advantage Plan that covers her prescription drug needs. This is a one-time change for Mrs. Jones that will go into effect on March 1st.

But what if her new Part D plan begins, and she finds she doesn’t need the coverage? Unfortunately, she’ll have to wait until AEP on October 15th to make additional changes.

But she may qualify to change her coverage during a Special Election Period (SEP). Here’s how.

What is a SEP?

A Special Election Period is a time when you can make changes to your Medicare Advantage and prescription drug coverage outside the typical AEP and OEP periods.

SEPs are granted for many different circumstances. A few of these are:

  1. A change of address that impacts your coverage
  2. Residency in an area affected by a FEMA-sanctioned emergency or natural disaster during a previous enrollment period (either for the beneficiary or caregiver)
  3. Moving into or out of an institution.

 

Also, if you lost your previous insurance, whether it’s Medicaid or employer-provided, you may be eligible to enroll in Medicare Advantage during an SEP.

Medicare is complicated, but MySeniorHealthPlan.com is here to help you confidently navigate your health insurance decisions.

If you have questions or need to talk to a licensed Medicare specialist, visit our website or call (877) 255-6273. You’ll be able to talk to a knowledgeable member of our team who will help you find the right plan for you.

 

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Medicare Plans

3 Quick Tips before Medicare Deadline December 7th

by Guest Blogger
written by Guest Blogger

The December 7th DEADLINE is FAST APPROACHING…..

The Sosa Insurance Group in West Orange Offers THREE KEY QUICK TIPS to help you find if your current Medicare Health Plan is RIGHT FOR YOU.

With the deadline of December 7, 2020 just a few weeks away, there is still time for those who are eligible for Medicare to make an important decision about their Medicare Healthcare Plan needs for 2021.

Deadline for Medicare Open Enrollment Nears

With more Medicare Health Plan options than ever, it is important for people to understand their options and specifically, what their needs are when it comes to choosing the appropriate Medicare Health Plan for them. Medicare consumers want to also feel confident that the plan they choose will not only fill their needs but their budget as well.

Now that we are in November, the attention of many retirees has turned to getting as much advice and information possible to make the right decision for them. Not only have television commercials started but everyone has been overwhelmed with mailings that have started piling up.

Making Changes to your Medicare During Open Enrollment

During this time of year, it is important to understand exactly what changes you can make to your Medicare Health Plans and how to go about making those changes.

So, what is the best way to determine whether your current Medicare plan is right for you?

For 12 years, George A. Sosa, Jr., president of The Sosa Insurance Group in West Orange, NJ, has been assisting the Medicare eligible consumer with finding the right plan for them based on the individual’s needs and their budget.

He shares 3 important reminders that you should ask yourself in order to determine which Medicare Health Plan is right for you:

  1. Your current Health: Are you taking different medications since last year? Some plans change their coverage, so it’s best to know what those changes will be in 2021 and which medications are covered for 2021.
  2. Are you concerned about out-of-pocket expenses or extra benefits? Some Medicare Advantage plans may cover much of your overall healthcare costs but they also offer a financial safety net and additional benefits such as Dental, Vision and Free Gym Membership.
  3. If you are considering a Medicare Advantage, whether it’s a HMO or PPO, are your doctors in the network and are your current medications in the company’s Formulary? It is critical for you to review your doctors’ participation with the plan that you are reviewing for 2021 and if your medications are in the company’s formulary.

 

“The education of the basics of Medicare and how it works based on your specific healthcare needs and finding the right plan for you, is the key to selecting the right plan and considering the changes that occur each year. You should not hesitate to ask the right questions.” said George Sosa.

If you, parents or a loved one is new to Medicare, considering a change or just simply want to review their plan options, please call 973-902-5445 to speak with one of our expert agents. You can also reach us by email at info@thesosainsurancegroup.com to request a quote. Consultations are free of charge.

For more information, please visit us at www.thesosainsurancegroup.com

 

 

 

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What Happens If You Delay Medicare Coverage? ‎
MedicareMedicare Plans

What Happens If You Delay Medicare Coverage?

by Jagger Esch
written by Jagger Esch

When most people start Medicare, it begins on the 1st day of the month of their 65th Birthday. Of course, this is not what is the best for everyone. Frequently, people are choosing to continue working later into life. What Happens If You Delay Medicare Coverage?
In many cases with group insurance there is no need to start their Medicare Part B coverage. These Medicare Beneficiaries have a few options, and can delay their Part B enrollment with no penalty.
If you do not have creditable coverage and you decide to delay your Part B enrollment, you will have to wait until the General Enrollment Period. The General Enrollment Period starts on January 1st and runs through March 31st.
When you enroll during the General Enrollment Periodyour Part B start date will be July 1st. If you do not have creditable coverage, you will be subject to the Part B late enrollment period.

What is Creditable Coverage

Creditable coverage is defined as coverage that is expected to pay on average as much as the standard Medicare prescription drug coverage. There are a few disclosure requirements:

Written Disclosure

The first disclosure requirement is to provide a written disclosure notice to all Medicare eligible individuals annually who are covered under its prescription drug plan, prior to October 15th each year and at various times as stated in the regulations, including to a Medicare eligible individual when he/she joins the plan.
This disclosure must be provided to Medicare eligible active working individuals and their dependents, Medicare eligible COBRA individuals and their dependents, Medicare eligible disabled individuals covered under your prescription drug plan and any retirees and their dependents.
The Medicare Modernization Act (MMA) imposes a late enrollment penalty on individuals who do not maintain creditable coverage for a period of 63 days or longer following their initial enrollment period for the Medicare prescription drug benefit. Accordingly, this information is essential to an individual’s decision whether to enroll in a Medicare Part D Prescription Drug Plan.

Requirement for Entities

The second disclosure requirement is for entities (private health insurance companies) to complete and submit the Online Disclosure Form to the Centers for Medicare and Medicaid Services to report the creditable coverage status of their prescription drug plan.
The Online Disclosure Form should be completed annually no later than 60 days from the beginning of a plan year (contract year or renewal year), within 30 days after termination of a prescription drug plan, or within 30 days after any change in creditable coverage status. — This requirement does not pertain to the Medicare Beneficiaries for whom entities are receiving the Retiree Drug Subsidy (RDS).

Delaying your coverage in Initial Enrollment Period

Your Initial Enrollment Periodusually starts 3 months prior to the month of your 65th birthday, the month of your birthday (or the month you get your Medicare Part B), and continues for the 3 months after. Most Medicare Beneficiaries will start their Medicare Part B coverage the month of their 65th birthday.
However, some people will procrastinate. When this happens, the result can be a Medicare Beneficiary experiencing a lapse in coverage, that could potentially last for a month or two.
If you enroll before the month you turn 65 your Medicare coveragewill start the 1st of the month of your 65th birthday, unless your birthday is on the first day of the month, in that case it will start the 1st of the month prior to your birth month.
If you were to wait until the month your turn 65, your Part B will start one month after you enroll. If you wait until the month after, your Part B will not start until 2 months after you enroll. Waiting until the 2nd or 3rd month after you turn 65, it won’t start until 3 months after you enroll.

Omission of Medicare Part B Can be Problematic

While not having Medicare Part B coverage for a few months may seem like an insignificant gamble. Saving a few premium dollars is certainly not worth the risk imposed on oneself. If you were to get sick, you would be responsible for 100% of the doctors bills.

I Have Group Coverage, Do I Need to Take Part B

When you have group coverage, depending on several factors, you can delay your Part B coverage without being subjected to a penalty. The predominate question is, “does my group plan qualify as creditable coverage?”. To answer this question you should contact the benefits administrator for your employer.
The benefits administrator will be able to advise if you can stay on your group coverage without needing to enroll in Part B. Remember that some group coverages require you to pick up Part B in order to stay on their coverage.

Penalty

If you delay your Medicare Part B and do not have creditable coverage, coverage that pays on average as much as Original Medicare, you will be subject to a Part B late enrollment penalty.
The Part B late enrollment penalty is equal to 10% for each consecutive twelve months you have been eligible, but elected to delay your enrollment into Medicare Part B. This penalty will continue as long as you have Medicare Part B.

What Happens If You Delay Medicare Coverage?

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