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Industry Experts Explain What Medicare Actually Covers

by Jagger Esch
written by Jagger Esch

Industry Experts Weigh in on Medical Services that Beneficiaries thought Medicare Paid for that Don’t

New Medicare beneficiaries tend to assume they’re fully covered by Original Medicare benefits. Unaware of the gaps in coverage, they end up finding out the hard way when they receive a medical bill in the mail. Industry Experts Explain What Medicare Actually Covers
Medicare Parts A & B only covers 80% of your medical costs. It has no out of pocket maximum and no prescription drug coverage. If you, or someone you know, only has Original Medicare, then this article pertains to you. Below, you’ll learn from industry experts as they explain what Medicare covers.

Medicare Does Not Cover it all

“We hear from many people who assume that long term care is covered by Medicare. Most are caught by surprise by that fact that Medicare does not cover long term care, only short-term rehab. This usually comes up when a loved one is no longer able to return home after a hospital stay and the shocking reality of paying privately for a care option is upon them. Another area we hear about Medicare not covering is scooters and walk-in tubs. These items are rarely covered by Medicare and once again, people are surprised by this harsh reality.” Amie Clark – Co-Founder of TheSeniorlist.com

  • Medicare does not cover Long-term care or support for your personal care needs. Most long-term care is not medical care, it is help with activities of daily living or personal tasks of everyday life. Medicare does suggest visiting LongTermCare.gov for information and resources to help you plan your long-term care needs. Medicare does cover care in a long-term care hospital, skilled nursing care in a skilled nursing facility, eligible home health services, hospice and respite care. Medicare will help cover durable medical equipment (DME) like scooters, walkers and wheelchairs if you have a medical need and qualify.

“People often assume that long term care, such as that provided by a nursing home, or a home health aide, is covered by Medicare. Unfortunately, that is not the case. Medicare will only pay for some short-term services after a hospitalization. Long term care can become a massive financial burden for much of the elderly population in the United States.” – Rebecca Gilbert, MD, PhD, APDA Vice President, Chief Scientific Officer.

  • Long term care not being covered can be a burden on beneficiaries and their families. I would recommend getting long-term care insurance before it is needed or too late. Many people are uninsured or underinsured, talking to an Insurance Agent to get questions answered and find the right plan for you is the best thing you can do.

“Patients and physicians are frequently confused about personal care services covered under Medicare benefits. They do not understand the difference between skilled and non-skilled home care services. For example, Medicare benefits cover a home health CNA when there is a skilled need and the patient meets home health criteria, including homebound status. Receiving this home health CNA service is temporary and can only be offered while nursing and/or therapy services are being provided, and at a low frequency (e.g. 1-2 visits per week). Non-skilled personal care services are not covered by insurance at this time and are paid privately or through special waivers. There is no time limit or guidelines as to who can receive personal care services since they are paid privately. Furthermore, DME supplies, such as transfer benches, adaptive feeding equipment and braces, are thought to be covered by Medicare, but are not. This is needed for safety in the home and should be covered to reduce further decline.” Sarah Deal – Interim Healthcare Inc

  • Having affordable DME supplies is vital for the elderly and disabled. While there are some DME supplies covered by Medicare, there are strict standards and both the doctor and the DME supplier need to accept Medicare assignment.

“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 preconceived misconception that Medicare pays for everything. On the contrary, there are Medicare deductibles, coinsurance and copays 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 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 overall, 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.” Garrett Ball – Medicare Specialist at Senior.com

  • Medicare is not the most comprehensive coverage available. It does not cover many services. It is important for the Medicare beneficiary to purchase additional coverage. Some plans will include routine hearing, vision, and dental care. Part D Prescriptions Drug plans will need to be purchased through a private insurance company and you can be penalized if you are not enrolled in one when your part B goes into effect. Medicare is not the only insurance you want when something goes wrong with your health, you need to purchase additional coverage.

What you Can do to Prevent being Underinsured

Medicare does not cover everything; especially not long-term (custodial) care, routine dental, vision, hearing or prescription drugs. Working with an Insurance Agent or Counselor will help you get the coverage you need so you will be properly insured. Choose a plan that allows you to have the most consistent and reliable coverage year after year.

Looking for affordable DME products? Senior.com is a leader in the industry with affordable pricing and great customer service.
dustry Experts Explain What Medicare Actually Covers
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If you get Cancer what does Medicare Cover?
Medicare Plans

If you get cancer, what does medicare cover?

by Jagger Esch
written by Jagger Esch

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

What Does Medicare Part A Cover?

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

What Does Medicare Part B Cover?

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

What Does Medicare Part D Cover?

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

What Does a Medicare Advantage Plan Cover?

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

Additional Things to Know About Medicare and Cancer

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

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

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

If you get Cancer what does Medicare Cover?

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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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Download this Medicare Education APP
Medicare Plans

Download this Medicare Education APP

by Kimberly Johnson
written by Kimberly Johnson

The idea of an ALL VIDEO Medicare educational APP came to me on a beach in Ft Myers Florida. Download this Medicare Education APP
I was sitting there enjoying the sunshine and the beauty of the ocean and I noticed something. Many of the people walking up and down the beach were older (yes) but all had smart devices in their hands. Download this Medicare Education APP
Smart phones and tablets were all around me on the beach. They were in the hands of a generation of people that (I was told) had not embraced the use of such devices.
My eyes were opened.
I did some research and discovered quickly that the 65+ generation is 2nd only to the millennial generation in smart technology ownership and #`1 in actual daily usage!
I went to work talking with seniors about what they would want in an APP on Medicare.
They gave me great feedback!
They wanted education on their benefits and information on annual changes. They wanted it in an EZ to understand format. They wanted to be able to contact someone if they needed to ask questions.
They did not want to pay for this educational information.
This feedback is what I used to create The (FREE) Medicare Educational APP (MMQ APP).
The MMQ APP is FREE to all consumers and is available on The APP Store and Google Play.
The APP is in an easy to use ALL Video format for the consumers smart device. There are over 65+ individual videos that answer Medicare questions and answers.
If a consumer does not wish to look up Medicare information from individual Q&A’s, we have included a video seminar on Medicare 101 that covers all basic and intermediate information.
There is a video on Medicare supplement buying tips to possibly help a consumer save money on a Medicare supplement health plan.
The Medicare educational videos are arranged by category. These categories are basic, Intermediate, and advanced question levels.
Sample video questions and answers include:

  • What is the difference between Medicare and Medicaid?
  • What are Medicare Parts A,B,C,D and how do they work?
  • What are this year’s benefits for Part D?
  • How do my VA benefits work with Medicare?
  • I’m over 65 and still working. How does Medicare work with my employer plan?
  • The new Medicare card is being launched in April 2018. What are the details that I need to know?

Each video has full control features. You can search for videos by topic. Videos can be saves for future viewing with the APP’s “Favorite” button.
A consumer can “star” rate the Medicare educational videos which can assist others in their search for Medicare benefit answers.
All Medicare information is kept up to date for our users.
This Medicare educational APP will send the consumers notifications directly to their smart device when there are important enrollment deadlines or changes to Medicare benefits.
I know that seniors are very social.
I realized that once this APP got out into the public, seniors would want to share it with friends and family.
I needed to make that process easy.
The orange “Share with friends” button allows a person with the app to share it with a friend very easily. The person presses the button. Enters the friends email. Press the send button. The invitation to download this great free Medicare educational app is on its way. Easy!
There is another orange button to “Get a quote.” This button will allow you to get a FREE NO OBLIGATION quote on your Medicare health plan sent directly to the consumers email.
All quote information is private and secure. We do not share or sell consumer information with any third party not affiliated with the MMQ APP.
If a consumer wishes to find a no cost, local, independent Medicare agent there is an agent button on the APP. Press it and search for a Medicare agent by city and state. The APP will bring up agents closest to them.
When the consumer selects an agent, a profile page will appear with the ability to read about the agent’s services and how to contact them. Consumers will get the agents phone, email, and can even text the agent directly from the MMQ APP.
The Medicare educational APP (MMQ APP) currently has 11,000 consumers downloads with 3000+ daily users.
The MMQ APP has been averaging 4.5 – 5 star rating from these users.
I am very proud of the MMQ APP I created and wish to invite you to download it and share it with your friends and family.
We all know people on Medicare or on it ourselves. This 21st century tool is breaking new ground and helping people understand a complicated topic that directly affects them or their loved ones.
Go to The APP Store or GOOGLE Play and search MMQ APP
Download it for FREE and then make sure to open it and fill out the “Welcome Screen” to activate all the videos and information provided. Download this Medicare Education APP

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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

Important Information About Your New Medicare Card Important Information About Your New Medicare Card Important Information About Your New Medicare Card Important Information About Your New Medicare Card Important Information About Your New Medicare Card Important Information About Your New Medicare Card Important Information About Your New Medicare Card Important Information About Your New Medicare Card

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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

What are Guaranteed Issue Rights for Medigap What are Guaranteed Issue Rights for Medigap What are Guaranteed Issue Rights for Medigap What are Guaranteed Issue Rights for Medigap What are Guaranteed Issue Rights for Medigap What are Guaranteed Issue Rights for Medigap What are Guaranteed Issue Rights for Medigap What are Guaranteed Issue Rights for Medigap What are Guaranteed Issue Rights for Medigap 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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