Medicare
If you are turning 65 and comparing Medicare Supplement or Medigap plans, you will probably ask “do all doctors accept Medigap plans?“. This is one of the most common questions for people turning 65 – it can seem complex, but the answer is actually very straight-forward. Do All Doctors Accept Medigap
Put simply, when it comes to accepting Medigap plans, it all depends on if your doctor accepts Medicare itself. Medigap plans “follow” Medicare. So, if a doctor or hospital takes Medicare, they will accept your Medigap plan. It does not matter which company or plan you have since Medigap plans themselves do NOT have networks. Do All Doctors Accept Medigap
If your doctor is a non-participating provider with Medicare itself (rare), then they will NOT accept your Medigap plan either. If Medicare is not accepted, there is nothing for the Medicare Supplement/Medigap plan to “supplement”.
This is not the case, obviously, with many other types of insurance which rely heavily on network arrangements to determine which doctors you can/can not see. For example, under-65 individual plans, group plans, and Medicare Advantage plans all typically use a PPO or HMO network of providers.
What If My Doctor Does Not Accept Medicare Assignment?
There is a difference in accepting Medicare and accepting Medicare assignment. Medicare “assignment” is the terminology that essentially means whether or not a doctor accepts the Medicare payment as payment in full. Medicare has a pre-defined payment schedule for each service or procedure. This is the amount that they will pay to a provider for a certain service or procedure, and it is based on where you are located (varies by location).
Most providers DO accept Medicare assignment (most estimates show that around 95-96% of doctors do accept assignment nationally). This means they accept the terms and conditions (and amounts) on the Medicare payment schedule.
If a physician does not accept assignment, however, he or she can charge up to 15% above the Medicare payment schedule. This is called a “Part B Excess charge”. This is typically billed to you after the doctor visit. There are a few states that have prohibited the charging of these excess charges, including CT, MA, MN, NY, OH, PA, RI and VT (as of early 2017). In those states, doctors can not charge above the Medicare payment schedule if they are going to accept Medicare patients.
Even when doctors do charge excess charges, many of the standardized Medigap plans cover these Part B Excess charges, including Plans F and G. Plan N is the most common plan among the plans that do not cover Part B excess charges.
Why Won’t My Doctor Accept My Medicare Supplement Plan?
We often get this question in January and February of each year. Inevitably, what has happened is the person is in a Medicare Advantage plan that they are mistakenly calling a Medicare Supplement. The Advantage plans all have networks and are typically PPOs or HMOs. Those networks change each year – sometimes even in the middle of a year – and if your doctor is not in network with the specific plan you have, you may have to find a new doctor.
This is one of many reasons why it is crucial to understand the differences in Medigap plans and Medicare Advantage plans.
Do All Doctors Accept Medigap Plans: The Bottom Line
So in summary, do all doctors accept Medigap plans? The short answer is “No”. However, if a doctor accepts Medicare itself, which is your primary coverage, then they will also accept your Medigap plan, regardless of what company sold you the plan or which Medigap plan you have. The key thing to remember is that Medigap plans “follow” Medicare. Do All Doctors Accept Medigap
Do All Doctors Accept Medigap
Do All Doctors Accept Medigap
Do All Doctors Accept Medigap
Medicare Plan N is one of the 10 standardized Medigap plans that are offered to supplement traditional Medicare. Plan N is one of the options that is typically a lower premium with more cost-sharing. So, it can be a good fit for someone who is in relatively good health or who wants to go with a lower-premium option.
Plan N works just like other Medigap plans. Coverage is Federally-standardized, so one Plan N will be the exact same as any other Plan N in terms of coverage. In addition, you can go to any doctor or hospital that takes Medicare – there are no networks. Also, all claims under Plan N are paid automatically through the Medicare “crossover” system.
What does Plan N cover?
Plan N covers the Medicare Part A (hospital) deductible in full. It also pays in full for the hospital coinsurance, hospice coinsurance, and skilled nursing facility coinsurance (20%). So, it is essentially complete and full coverage under Part A charges, filling in the gaps in Medicare Part A.
The Part B (doctor fees and outpatient) charges are where Plan N differs from other, more comprehensive plans like Plan F, Plan C and Plan G. Plan N does not cover the Medicare Part B deductible, which is $183/year for 2017. Also, after that deductible is met, you have co-pays for doctor visits under Plan N – these co-pays are $20 per visit (primary or specialist) and $50 for a visit to the emergency room. Lastly, Plan N does not cover the Part B Excess charges. In short, Part B excess charges are when a doctor does not accept the Medicare payment schedule as payment in full. Under Plan N, you are responsible for paying these.
You must have Medicare Part A and B in order to purchase any Medigap plan, including Plan N. Rates vary considerably depending on your age and where you live. In some states, Plan N can be a very competitively priced plan and a great value. In other areas, the price difference between Plan N and more comprehensive plans is so small that it may not make sense.
It is advisable to research whether Plan N is right for you and how to choose a Medigap plan prior to turning 65 or selecting a plan. If you are in good health with minimal pre-existing conditions, it may make sense to go with a Plan N. However, it is always a good idea to think about your Medigap selection with a long-term perspective as you may have to “qualify medically” to change plans at a later time.
According to the National Alliance for Caregiving, there are over 33 million people in the U.S. who care for an aging relative or friend. Caregivers need to be aware that drug errors can happen and may be serious, but often are preventable. Helping The Elderly Avoid Prescription Drug Problems
The problem stems largely from the multiple drugs seniors are prescribed and the complex network of physicians and pharmacists caring for them. According to Medco Health Solutions, Inc., the average senior takes nine prescription medications a year. One in four seniors sees four or more different physicians and uses three or more different pharmacies.
To help prevent errors:
- Make and take a medication list including prescription and over-the-counter (OTC) medications, any vitamins or herbal supplements and present it to the doctor and pharmacist.
- Understand how medications should be administered, possible side effects and how to recognize if they occur. Changes such as poor eyesight, hearing trouble or decreased endurance may indicate an adverse reaction to a medication.
- Ask any specialist the patient sees to send a full medical report, including drugs prescribed, to the patient’s primary care doctor.
- Consider pre-packing your medications together to avoid errors
Seniors now also have to decide about the new Medicare Part D prescription drug program. It provides much-needed relief for many seniors with little or no drug coverage but may require research to determine which plan is best.
Consider the following:
- Weighing Medication Costs: Seniors currently on medications should determine if the plan covers their drugs and at what cost. They should also consider the cost of generics since they may be substantially lower. In addition, under some plans the deductible is waived for generic drugs.
- Access to Pharmacies: Each plan has its own pharmacy network. If several months of the year are spent in another state, a national plan may be best. Some plans include a mail-order prescription service.
- Patient Safety: A plan that includes a drug utilization review (DUR) program that identifies potential errors provides an important safety net.
Helping The Elderly Avoid Prescription Drug Problems Helping The Elderly Avoid Prescription Drug Problems Helping The Elderly Avoid Prescription Drug Problems Helping The Elderly Avoid Prescription Drug Problems Helping The Elderly Avoid Prescription Drug Problems Helping The Elderly Avoid Prescription Drug Problems Helping The Elderly Avoid Prescription Drug Problems Helping The Elderly Avoid Prescription Drug Problems
Taking care of your vision is about more than just seeing well. It’s about being well. When your eye health is at its best, you’re more likely to perform better in all aspects of your life. An eye exam is not just about your sight – it can detect other hidden health conditions too, like diabetes and high blood pressure. Early detection plays a key part in managing these diseases and improving your overall health. A Clear Look at Vision Insurance
Unfortunately, not everyone has the luxury of vision insurance to help pay for eye care. But there are affordable individual vision care options available that will save you hundreds of dollars, if you know what to look for.
When exploring vision insurance options, consider the following:
- Does it cover frames, lenses and contacts?
- Are the premiums affordable and do they give me the option of monthly payment?
- What co-pays will I be responsible for?
- Does it have convenient locations with a large network of doctors?
- How much will it lower my out-of-pocket costs?
- What customer service support is provided and do they have any satisfaction guarantees?
There are a number of companies that offer individual vision insurance. For example, the most prominent vision insurance company, VSP® Vision Care, offers individual plans direct to consumers. As the nation’s only not-for-profit vision care company, it meets all of the above criteria and has a reputation for taking care of its members. Plans are affordable enough that you can buy one for yourself or even give one as a gift to someone you care about. This will give you coverage that:
- Covers the eye exam with a low co-pay
- Provides an allowance for frames, lenses and contacts
- Gives you the lowest total out-of-pocket cost
- Is 100 percent satisfaction guaranteed
- Gives you access to the largest doctor network in the industry, with more than 29,000 doctors in convenient locations close to your home or office
A Clear Look at Vision Insurance
Every day, about 10,000 baby boomers turn 65 and become eligible for Medicare. Not everyone will sign up, but it’s important to understand the importance of early choices when enrolling in Medicare for the first time. Boomers turning 65 face complex healthcare choices
You can enroll in Medicare three months before turning 65, the month you turn 65 or up to three months afterward.
“Turning 65 opens the door to Medicare eligibility, but it brings with it some complex choices,” says Paula Muschler, manager of the Allsup Medicare Advisor, a personalized Medicare plan selection service. “Choices seniors make at this time can impact their healthcare costs over the long term and their entire family.”
Muschler offers the following key steps for Medicare first-timers.
1. Take a look at your existing group health plan coverage and think about how it will coordinate with Medicare. Many people work past age 65. As a result, Medicare-eligible individuals who have health coverage through their employer or their spouse’s employer may be able to wait to enroll in Medicare Part B, which covers outpatient medical care. This is not true in every case, however. This option depends on other factors, such as the size of the employer and how soon you expect to retire after reaching 65. You may want to consider enrolling in Medicare Part A, which includes hospital coverage, even if you defer Part B.
2. Consider the options for first-time enrollment, keeping in mind your current health needs and financial resources. If you choose traditional Medicare, you have an average of 31 Medicare Part D prescription drug plans from which to choose. You can also choose from 10 standard Medigap policies for supplemental coverage, ranging from basic to comprehensive coverage. The price for these plans also can differ from one company to the next.
Adding to the complexity, Medigap plans are not required to accept you after your initial enrollment period. This is one reason first-time choices are crucial. Seniors evaluating Medicare Advantage plans over traditional Medicare also have an array of options – an average of 20 plans, depending on where you live. “We’ve been able to help Allsup customers find plans that cost less and match their specific healthcare needs,” Muschler says.
3. Follow Medicare enrollment rules to avoid costly mistakes. Penalties are in place for decisions related to Part B and Part D coverage. The late-enrollment penalty is 10 percent for each full 12-month period you could have been enrolled in Part B. Likewise, Part D imposes a penalty if you go for more than 63 days without coverage after enrolling in Part B.
“Your first-time Medicare plan choices also are more complicated if you have retirement dates, COBRA coverage or dependent coverage to consider,” Muschler says. “These are good reasons to contact a Medicare specialist, who can help answer the right questions and provide guidance to seniors so they make choices that match their situations.”
4. Understand how higher income and changes in your income affect Medicare costs. Higher-income beneficiaries pay higher premiums for Medicare Part B and prescription drug coverage. For Part B, the 2013 monthly premium is $104.90 for joint filers with income of $170,000 or below ($85,000 for single filers). However, the premium increases to between $146.90 and $335.70 for those with incomes above these thresholds. Likewise, higher-income beneficiaries can expect to pay from $11.60 to $66.40 more each month in prescription drug premiums.
The Social Security Administration uses IRS records when determining premiums. Social Security may reduce an individual’s income-related monthly premium with verification. “Social Security has specific requirements about how you can document changes in your income when you are requesting reduced Medicare premiums,” Muschler explains.
5. Review healthcare coverage for your spouse and dependents to determine how your choices may affect their coverage. If you are nearing Medicare eligibility, you can find yourself at a crossroads when it comes to providing healthcare for your entire family.
Some employers may continue to provide coverage to a worker’s family, or you may need to purchase COBRA coverage or private coverage for family members. “One early step is to talk with your benefits plan administrator to see what options you may have and then plan for your family,” Muschler says.
Seniors turning 65 have seven months during their initial enrollment period to make critical decisions. But you can begin evaluating your options earlier to be better prepared.
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Boomers turning 65 face complex healthcare choices
Since over thousands of baby boomers enroll into Medicare every day, it’s important to know the facts about the health care insurance program. If you fail to learn, you remain open to expensive mistakes and catches. Tips to Avoid Medicare Pitfalls
Joe Baker, president of the Medicare Rights Center, says, “Avoiding the most common errors in Medicare is the difference between having good financial and health security — or not.” He warns older consumers to learn the rules to avoid higher premiums.
I enrolled in Medicare last year and found the process overwhelming. With the difficult language and limitless selections to choose, it’s no wonder the enrollment left me puzzled. The continuous flow of promotional mail from insurance carriers made the matters worse, not better regarding gaining knowledge. The marketing letters just added to the confusion. And now I face open enrollment and fear the process will take similar paths.
So, to make it easier for the younger boomer, I’ve researched Medicare myths and truths with the intention to save you time and headaches. Here is my assessment:
- Medicare is not free, and the program has an annual deductible. Beneficiaries do pay monthly premiums. Your income determines the amount.
- Never assume you don’t qualify or haven’t earned the necessary credits. You may be eligible for the full benefits for Part A – hospital insurance. Understand that the credits are not mandatory to be eligible for Part B, doctors’ services, outpatient care, medical equipment. It’s a requirement that you enroll in Part D, the prescription drug plan, even if you don’t take medications.
- You must sign up for Part B unless you are 65 and have health coverage at your job (or spouse job) and the employer has 20 plus workers, then delaying Part B is allowable.
- Even if you have a retiree health plan or COBRA, Part B check with your plan to understand how it works with Medicare.
- Never count on a friend, associates, or partner to steer you in the Medicare process. Assess your health needs, medications, treatments, physicians, etc. to learn which plan is best. Seek free consultations here.
- Enrollment begins when you turn 65. You have eight months to enroll when you have coverage at work (or if a spouse carries you on their plan) when it ends.
- Select a Part D plan according to the drugs you take. Compare coverage and costs among different plans by using the plan finder program on medicare.gov or by calling Medicare at 800-633-4227.
- Open enrollment comes up once yearly in the fall about an open season that allows you to switch plans.
- If you intend to buy Medigap, a supplement that covers some out-of-pocket costs like deductibles and copays, you must do it at the right time.
- Don’t ignore the Annual Notice of Change that comes in the mail each September if enrolled in a Medicare Advantage plan (HMO or PPO) or a Part D drug plan. It states changes and cost increases. It is your chance to make comparisons.
- There is help to pay for the Medicare, check the Medicare Savings Program and the Extra Help Program to see if you are eligible.
Tips to Avoid Medicare Pitfalls
Americans don’t celebrate it as a holiday, but July 30 is an important historical date in the United States. It was on this day in 1965 that President Lyndon Johnson signed Medicare into law, introducing a national health insurance program for citizens aged 65 and older. Understanding Medicare through Supplemental Insurance
In its first year of availability, more than 19 million Americans enrolled in the program. Medicare has since expanded to include individuals who are permanently disabled and those who suffer from kidney failure. This year the number of enrollees is expected to reach 57 million, according to the Centers for Medicare and Medicaid Services (CMS). As the Baby Boomer generation continues to leave the workforce, that number will continue to increase. In fact, Becker’s Hospital Review projects that 19.1 million more people will enroll in the program over the next 11 years. Understanding Medicare through Supplemental Insurance
That’s why it’s important for people approaching retirement to consider Medicare Supplement insurance. A Medicare Supplement policy can help patients cover some of the costs related to medical treatment that aren’t paid by Medicare. Understanding Medicare through Supplemental Insurance
But, before investing in Medicare Supplement insurance, consumers have to do their homework. They should review the 2016 Medicare and You guide published by CMS to find the latest updates to the Medicare program, and also research insurance companies. Not all companies are the same, and there are five things that people should consider before they decide which company to go with:
Insurance Company Ranking
There are many insurance companies that sell Medicare Supplement insurance in the United States today. Fortunately, there are third party organizations like Standard & Poor’s and A.M. Best that rate these insurance organizations for financial strength. These ratings are important to consider when choosing your coverage, as they rate an insurance company’s credit worthiness and its ability to pay its claims.
Experienced agents Understanding Medicare through Supplemental Insurance
When buying Medicare Supplement insurance, be sure to work with an agent who is knowledgeable and experienced in selling the ten standardized Medicare supplement plans.
Medicare is a complicated topic and consumers have so many other issues to think about after retiring from a lifetime of work that working with an agent has its advantages.
The majority of insurance companies will educate and provide training to their agents to ensure that they know the product and insurance laws before they allow them to sell. These insurance companies make sure that their agents stay updated on the annual changes the government makes to the Medicare program, which helps them to work with customers to find the insurance policy(ies) that is right for them.
Pre-existing conditions
Not all Medicare Supplemental insurance programs cover pre-existing conditions. Before reading through a policy, a number of seniors sign up for insurance, only to realize later that they aren’t covered for a second heart attack, or for hospital stays due to recurring back problems during the preexisting condition limitation period.
All companies that sell Medicare Supplement policies cover all pre-existing conditions during an insured’s open enrollment period, which is six months from their Medicare Part B effective date—so start researching your options right away and be sure to connect with a knowledgeable sales person well within those first 180 days. But, some will issue the policy beyond the open enrollment period with a pre-existing condition clause attached. If you are like most consumers, and don’t want to worry about what might not be covered at the time of a claim due to a pre-existing condition, then it is important to choose a company that does not issue policies with pre-existing clauses.
Multiple plan options
Medicare Supplement insurance isn’t a one-size-fits-all solution. There are four parts to Medicare:
Understanding Medicare through Supplemental Insurance
• Part A, covering in-hospital care
• Part B covering medical services and preventative care
• Part C, Medicare Advantage which is a combination of the first two
• Part D, medical prescriptions
There are 10 standardized Medicare Supplement plans (A, B, C, D, F, G, K, L, M, N). Find a provider that can talk with you about what plans they offer in your state, and who can talk you through what will work best for your specific situation.
Customer’s Choice Understanding Medicare through Supplemental
Technology has changed the way the business of insurance is done. Today’s seniors are more tech savvy than previous generations, with Pew Research data showing that 61 percent of people over the age of 65 go online. Seniors expect and want to buy insurance the way they want to buy it – whether it’s purchasing online, over the phone, or face-to-face. When researching insurance companies, find one that will work with you the way you want. Understanding Medicare through Supplemental Insurance
Millions of Americans are helped by the Medicare program each year, but supplemental insurance plays a critical role in helping policyholders to cover expenses they would otherwise have to pay. You worked your whole life to be in a position to enjoy your retirement. Don’t let the exorbitant medical expenses from an unexpected injury or illness prevents you from doing that. Research how supplemental insurance can help you, and find an informed agent who can help you select coverage that is right for you. Understanding Medicare through Supplemental Insurance
By Kevin Murray and John Fauzey, Combined Insurance
Kevin Murray is Vice President, Combined Affinity Markets and John Fauzey is VP, Director of Senior Sales at Combined Insurance. Understanding Medicare through Supplemental Insurance
Medicare, our national social insurance plan for seniors, has been severely disabled since 1964. Compared to individual health insurance plans for those under 65, it is excellent coverage. But you must take an active role in managing your coverage. How to Avoid Common Medicare Mistakes
When you are approaching your 65th birthday, keep the following advice in mind:
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Enroll on time How to Avoid Common Medicare Mistakes
In the months prior to turning 65, you are going to be inundated by junk mail. Somewhere in all that, you will also receive a notice from the Social Security Administration that contains your award letter. It lists effective dates for your Part A and Part B, and your Medicare claim number. You will also receive your Medicare card, with the same information on it. Make a copy of the card, and keep these in a safe place.
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Don’t assume you are enrolled
Even if you haven’t received a letter or card, don’t assume you are enrolled. Call 1-800-Medicare and get your enrollment information over the phone. Or, you can even enroll online at www.Medicare.gov.
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Choose a Medicare Supplement plan
This is particularly important f you spend a lot of time in another home. One of the most common mistakes we hear is seniors choosing an Advantage plan that narrows their choice of providers, when they spend a great deal of the year out of this area. Advantage plans are Regional HMOs. They expect you to choose a primary care physician from their participating group, and that you only see specialists in their referral network.
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Choose the best plan you can afford
It is a lot easier to downgrade coverage later than it is to upgrade. For Medicare Supplements, the F plan is the best coverage available. With this supplement plan added to your Medicare plan, you will have almost no out-of-pocket expenses at all and have the largest choices of providers.
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Medicare Supplements, review plans every year on your birthday
You have 30 days after your birthday to change your plan with no underwriting, as long you move to a similar or lesser plan. If you want to improve your coverage, you will need to go through medical underwriting.
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Prescription Drug Plans (Part D)
Schedule to review your plan each year during open enrollment, October 15 – December 7. Don’t assume that the premiums and co-pays for your medication will stay the same year to year.
If you receive a bill for any medical service, do not pay it until you receive the explanation of benefits from Medicare and/or your Medicare Supplement. It will explain why a charge was not paid. Often, it is as simple as incorrect coding and a simple phone call to the provider can get the bill resubmitted to Medicare. How to Avoid Common Medicare Mistakes