Home » Medicare Costs
Tag:

Medicare Costs

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.

 

0 comment
0 FacebookTwitterPinterestEmail
How do the Medicare Deductibles work? One of the most common misconceptions that Medicare Beneficiaries have relates to their deductible. Most people that are going into Medicare for the first time are accustomed to having group coverage, and they may incorrectly be under the impression that once they take Medicare they don’t have to pay anything. Do Not Pay Your Part B Deductible at Doctor Appointments All of us wish this was the way things work, unfortunately it is not. When starting Medicare it is important to know what costs you are responsible for are and how you pay those expenses. Medicare Part A (Hospital) With Medicare Part A, in 2018, you must meet a deductible of $1,340 for each occurrence into the hospital, once that is met the benefit period last 90 days. In other words if you go back to the hospital within 90 days for the same thing you will not have to pay the $1,340 again, but if you go in for another reason you could have to pay it again. If you are in the hospital for more than 90 days additional costs will occur. It is also worth a mention that when in the hospital certain services could be covered under Medicare Part B instead of A. This means you could have additional costs beyond the $1,340 for the stay. Medicare Part B (Doctors) Medicare Part B has a annual deductible of $183in 2018. Once you have satisfied that deductible you will then be responsible for 20 percent of all costs, and potentially excess charges in most states. What is an excess charge? When you go to a doctor that accepts Medicare, there are two designations that come up. A doctor that accepts Medicare assignment, and A doctor that accepts Medicare but does not accept Medicare assignment. When a doctor accepts Medicare assignment it means they agree to accept what Medicare pays as full payment; if a doctor does not accept Medicare assignment it means they are allowed to charge up to 15% more than the Medicare approved amounts. That 15% is called an excess charge. How do I know if my doctor imposes excess charges? One of the easiest ways to find this out is simply ask, “Do you accept Medicare assignment?”, or “Do you charge excess charges?” Your doctor’s office will disclose to you if they do or do not accept Medicare assignment. You can also go to Medicare.gov and use the Physician lookup to look up your doctor and find out if they take Medicare assignment. Should I pay my deductible when I go to the doctor? This is a reoccurring question for Medicare Beneficiaries. It is a very important question to get the correct answer to, and here is how it works. When you go to the doctor you should show your Medicare card, if you have additional insurance like a Medicare Supplement you should show it as well. Upon conclusion of the doctor visit, the office staff will send the bill to Medicare. Once Medicare receives the bill they will determine if your deductible(s) has been met. If not, you will be sent a bill up to the amount of the deductible. If the bill is greater than the deductible, you may receive additional bills. Those bills will be for your 20% or excess charges. If you have secondary coverage such as a Medicare Supplement, some or all of those costs could be paid for by your supplement plan leaving you with little or nothing to pay out of pocket. If you have a Medicare Advantage Plan, the process will work a little differently and you have other concerns. A Medicare Advantage Plan essentially replaces your Original Medicare with a network based plan. When covered by a Medicare Advantage Plan it is common that you would have to pay at the doctors office prior to being seen. Some have out of network benefits. If your Medicare Advantage Plan has out of network benefits, it will also have a separate own set of co-pays, deductibles, and out of pocket costs. Most of the time your out of network responsibility will be double your in network amounts. What if I paid my doctor up front already? If you paid your doctor already for your deductible, it is possible Medicare will send you a bill for the deductible amount. It happens when Medicare receives an invoice from your doctor, Medicare automatically sends you a notice requesting payment for your deductible. If this happens you will need to pay that deductible to Medicare, and go back to your doctor and try to straighten it out with their billing department. Most medical provider billing departments know that with Medicare Beneficiaries they should not collect the deductible or any funds up front. This can be a hassle. If you have a doctors office that tried to make you pay your Medicare deductible up front, you may want to consider if that doctor has your best interest in mind. What about the hospital deductible? When it comes to the hospital deductible, it should work the same way. Upon being discharged, the hospital should bill Medicare. After Medicare applies their billing process you will receive bills for your portion, whether it be just the deductible or additional amounts. Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments
MedicareMedicare Plans

Do Not Pay Your Part B Deductible at Doctor Appointments

by Jagger Esch
written by Jagger Esch

How do the Medicare Deductibles work?

One of the most common misconceptions that Medicare Beneficiaries have relates to their deductible. Most people that are going into Medicare for the first time are accustomed to having group coverage, and they may incorrectly be under the impression that once they take Medicare they don’t have to pay anything. Do Not Pay Your Part B Deductible at Doctor Appointments
All of us wish this was the way things work, unfortunately it is not. When starting Medicare it is important to know what costs you are responsible for are and how you pay those expenses.

Medicare Part A (Hospital)

With Medicare Part A, in 2018, you must meet a deductible of $1,340 for each occurrence into the hospital, once that is met the benefit period last 90 days.
In other words if you go back to the hospital within 90 days for the same thing you will not have to pay the $1,340 again, but if you go in for another reason you could have to pay it again.
If you are in the hospital for more than 90 days additional costs will occur.
It is also worth a mention that when in the hospital certain services could be covered under Medicare Part B instead of A. This means you could have additional costs beyond the $1,340 for the stay.

Medicare Part B (Doctors)

Medicare Part B has a annual deductible of $183in 2018. Once you have satisfied that deductible you will then be responsible for 20 percent of all costs, and potentially excess charges in most states.

What is an excess charge?

When you go to a doctor that accepts Medicare, there are two designations that come up. A doctor that accepts Medicare assignment, and A doctor that accepts Medicare but does not accept Medicare assignment.
When a doctor accepts Medicare assignment it means they agree to accept what Medicare pays as full payment; if a doctor does not accept Medicare assignment it means they are allowed to charge up to 15% more than the Medicare approved amounts. That 15% is called an excess charge.

How do I know if my doctor imposes excess charges?

One of the easiest ways to find this out is simply ask, “Do you accept Medicare assignment?”, or “Do you charge excess charges?” Your doctor’s office will disclose to you if they do or do not accept Medicare assignment. You can also go to Medicare.gov and use the Physician lookup to look up your doctor and find out if they take Medicare assignment.

Should I pay my deductible when I go to the doctor?

This is a reoccurring question for Medicare Beneficiaries. It is a very important question to get the correct answer to, and here is how it works. When you go to the doctor you should show your Medicare card, if you have additional insurance like a Medicare Supplement you should show it as well.
Upon conclusion of the doctor visit, the office staff will send the bill to Medicare. Once Medicare receives the bill they will determine if your deductible(s) has been met. If not, you will be sent a bill up to the amount of the deductible. If the bill is greater than the deductible, you may receive additional bills. Those bills will be for your 20% or excess charges.
If you have secondary coverage such as a Medicare Supplement, some or all of those costs could be paid for by your supplement plan leaving you with little or nothing to pay out of pocket.
If you have a Medicare Advantage Plan, the process will work a little differently and you have other concerns. A Medicare Advantage Plan essentially replaces your Original Medicare with a network based plan. When covered by a Medicare Advantage Plan it is common that you would have to pay at the doctors office prior to being seen.
Some have out of network benefits. If your Medicare Advantage Plan has out of network benefits, it will also have a separate own set of co-pays, deductibles, and out of pocket costs. Most of the time your out of network responsibility will be double your in network amounts.

What if I paid my doctor up front already?

If you paid your doctor already for your deductible, it is possible Medicare will send you a bill for the deductible amount. It happens when Medicare receives an invoice from your doctor, Medicare automatically sends you a notice requesting payment for your deductible.
If this happens you will need to pay that deductible to Medicare, and go back to your doctor and try to straighten it out with their billing department. Most medical provider billing departments know that with Medicare Beneficiaries they should not collect the deductible or any funds up front.
This can be a hassle. If you have a doctors office that tried to make you pay your Medicare deductible up front, you may want to consider if that doctor has your best interest in mind.

What about the hospital deductible?

When it comes to the hospital deductible, it should work the same way. Upon being discharged, the hospital should bill Medicare. After Medicare applies their billing process you will receive bills for your portion, whether it be just the deductible or additional amounts.

Do Not Pay Your Part B Deductible at Doctor Appointments

Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments Do Not Pay Your Part B Deductible at Doctor Appointments

0 comment
0 FacebookTwitterPinterestEmail
Explaining Medicare Part B Excess Charges
Medicare Plans

Explaining Medicare Part B Excess Charges

by Garrett Ball
written by Garrett Ball

Medicare Part B Excess Charges: What Are They and How To Avoid Them?

Medicare Part B is the part of Medicare that covers doctor’s visits and outpatient services. Medicare has a pre-defined fee schedule that most doctors that participate in Medicare use. This is called accepting Medicare “assignment.” Explaining Medicare Part B Excess Charges
However, doctors can choose not to accept that fee schedule and charge more than Medicare allows – these charges, over and above the Medicare payment schedule, are called Part B Excess charges. Explaining Medicare Part B Excess Charges

How Do Medicare Part B Excess Charges Work

When you go to a doctor that does not accept Medicare “assignment”, they have the option of “balance billing” above the Medicare payment schedule in most states. If you do not proactively ask the provider if they accept Medicare assignment, you may be surprised to receive a bill after services and after Medicare and your supplement insurance have paid their portions.
This bill will generally come to you 2-4 weeks after your visit to a non-participating provider in Medicare. The “excess charges” amount is limited to 15% above the Medicare-approved amount. Explaining Medicare Part B Excess Charges
Generally, we see these excess charges to occur with much more regularity at specialists as opposed to at primary care physicians.

How To Avoid Medicare Part B Excess Charges

There are two relatively easy ways to avoid Medicare Part B Excess charges altogether. The first is simply to make sure that you go only to doctors that participate in Medicare (i.e. accept Medicare assignment).
There is not a list of network providers maintained by Medicare, unfortunately. However, you can verify that your provider takes Medicare assignment by simply asking them. Anyone in the billing/insurance office should be aware of this practice and terminology and should be able to answer that question for you. Ideally, you would confirm this before seeing a doctor or receiving services.
The other way that you can avoid the excess charges is to be enrolled in a Medigap (Medicare Supplement) plan that covers those excess charges for you. Most of the more common Medigap plans do cover the excess charges; however, Plan N is one of the plans that does not.
If you have Medicare with a Medigap Plan N, you will still be responsible for the Part B Excess charges if your doctor does not accept the Medicare payment schedule. Other common Medigap plans – such as Plan G and Plan F – do cover the Part B Excess charges. Explaining Medicare Part B Excess Charges

Other Considerations Related to Medicare Part B Excess Charges

There are a few states which have prohibited excess charges from being executed – currently, these states are: CT, MA, MN, NY, OH, PA, RI and VT.
Nationally, Medicare Part B Excess charges are still relatively uncommon. Recent estimates show that patients get billed for excess charges on less than 5% of claims. Still, it is something that you should be aware of so that you can avoid this unneeded and preventable expense.
 

0 comment
0 FacebookTwitterPinterestEmail