Medicare Open Enrollment 2018

By | Medicare Open Enrollment | No Comments

It’s that time of year again.

With Medicare’s Annual Election Period (also know as Open Enrollment) starting in just a few days, I want to share some key things to be aware of so you don’t get surprised with a high prescription bill in 2018

Open Enrollment is a period that runs from October 15th to December 7th . During this time you have the opportunity to change your coverage for the new year.

And even more important, this is when the details for 2018 prescription plans are released. Therefore, the plan you had this year might not be the best for you in 2018. Your co-pays and deductibles may increase and your pharmacy may no longer be included in the plan’s network.

I’ve saved hundreds of dollars by changing prescription plans four times during the past seven years.

Those who don’t review every year are leaving millions of dollars on the table in over payments.

During open enrollment:

  • Determine which pharmacy you prefer and find out if your pharmacy is still in your plan’s network.
  • Make sure the medications you take are covered under your current plan.
  • Once you select your plan, visit with your pharmacist about the plan before December 7th. It is critical to double check directly with your pharmacy that they will accept the new plan and that they can obtain all the medications you need. Even if you enrolled in a plan, you can change plans before the deadline, and Medicare will accept the last plan you submit

I can not emphasize enough importance of reviewing your prescription plan.

Danielle today was about to find a 2018 prescription plan for a client that will save him $8,000 and another client $11,000.  We expect over 60% of our clients to switch prescription plans so save money in the new year.

Don’t miss your Open Enrollment window

 

PS: We offer a one-on-one service where we will do your Open Enrollment review for you. In this review we will find you a 2018 prescription plan that will cover your medications at the lowest cost. Please email me at larry@mymedicarecoach.com to learn more about this service

How Do I Know if My Doctor Accepts Medicare?

By | General Information | No Comments

If you are enrolled in Original Medicare, Part A and Part B, you can choose any doctor who accepts Medicare assignment (the maximum amount allowed for charges under the Medicare payment rules).

You can call the doctor and ask or use Medicare gov’s Physician Compare tool. The finder tool lets you search through a list of physicians in your area to see which ones accept Medicare.

A beneficiary enrolled in a private Medicare Advantage program is faced with more research before knowing which doctors will accept your plan because it will depend on the type of plan you are enrolled in.

It’s important to understand the differences between the types of Medicare Advantage plans.

An HMO (Health Maintenance Organization) plan allows you to see your doctor if he or she is already participating in the plan.

PPO (Preferred Provider Organization) plans cover both in and out of network providers so you can choose any doctor that accepts Medicare assignment.

PFFS (Private Fee-for-Service) plans determine how much the plan will pay providers and how much you must pay to get care. Your doctor must accept the plan’s payment terms and agree to treat you. If your doctor does not agree to those terms, then the PFFS plan will not cover any services performed by your doctor.

SNP (Special Needs Plans) cover Medicare beneficiaries living in institutions who are dual-eligible for Medicaid and Medicare and those with chronic conditions like diabetes or End Stage Renal Disease (ESRD).

HMO-POS (Health Maintenance Organization-Point of Service) plans cover both in and out-of-network services, but at different rates. You pay less out-of-pocket when you use in-network doctors, labs, hospitals, and other health providers.

MSA (Medical Savings Account) plans include both a high deductible and a bank account to help you pay the deductible. The amount deposited into your account varies from plan to plan. The money is tax-free if you use it on IRS-qualified medical expenses, which include the health plan’s deductible.

The best way to determine if you doctor accepts your Medicare plan is to call before the appointment. You can also go to the Medicare.gov website and find and compare doctors, hospitals and other providers.

Why Pat didn’t join Medicare at 65

By | Uncategorized | No Comments

This week I’m sharing part of a recent interview I did with my friend and colleague Pat.

Pat decided not to enroll in Medicare at 65, and in this video we talk about why that makes sense for him (and may make sense for you too).

Click the “Play” button below to watch this week’s blog

 

What You should know when comparing Original Medicare and Medicare Advantage?

By | Uncategorized | No Comments

Eligible Medicare beneficiaries continue to be confused on the differences between the Federal (Original) Medicare and the (Private) Medicare Advantage programs. The programs differ in these three basic ways: Delivery, Ideology and Equity.

Let’s begin with delivery. Original Medicare was designed to deliver coverage for all beneficiaries nationwide who could receive their care by all physicians and hospitals who accept Medicare.

Medicare Advantage was approved by Congress in 2003 but private insurers primarily use limited provider networks to contract the most favorable rates leaving out many rural areas in the country.

Original Medicare combines the Federal red, white and blue Medicare card for doctors and hospitals along with private supplemental insurance to pay the 20 percent Medicare does not pay. The beneficiary then buys a standalone prescription plan from a private insurer.

Enrollees in a private Medicare Advantage plan must enroll in Medicare A (Hospital) and B (Doctors) but provide their beneficiaries with one private company insurance card. In most cases the one card is used for all care providers including prescriptions. No supplement insurance may be purchased.

Ideology favoring market solutions for health care financing is driving the Medicare Advantage program by enough members of Congress who approve excess tax payer funding to help the private market attract new members with extra benefits like dental, vision and hearing even though the administrative costs are much higher than Original Medicare.

Now more than 30 percent of Medicare beneficiaries are enrolled in Medicare Advantage and the goal by insurance companies is to increase this number to 50 percent over the next ten years.

But what about equity for the 70 percent of Medicare beneficiaries who don’t get the extras that the Federal government is paying for? Let’s just review quickly what accounts for the positives and negatives of each program before you make your decision.

Original Medicare

You are required to enroll and pay for Medicare Part A and B
Plan is stable from year to year
Plan is accepted by nearly all doctors and health care facilities in the US
No need for referrals or prior authorization
Maximum out of pocket with supplement plan (none with C-F)
Coinsurance where Medicare pay 80% of expense and you (or your supplement plan) pays the other 20%
Radiation therapy follows 80/20 rule. No out of pocket with supplemental plans
Chemotherapy follows 80/20 rule. No out of pocket with supplemental plans
Includes medically necessary vision only (i.e. Cataract treatment)
Requires a 3 night hospital stay to receive skilled care.
Standard Affordable Care Act Preventative Services
Because you buy a separate prescription plan, you have the option to change prescrription plan every year to get best price
The federal government manages and regulates

Medicare Advantage

You are required to enroll and pay for Medicare Part A and B
Providers can join or leave a plan’s provider network anytime during the year. Your plan can also change the providers in the network anytime during the year.
Plans accepted only at in network doctors and hospitals. (Acts like HMO, PPO, or PFFS)
Plans require prior approval
Out of pcoket up to $6,700
Co-pays for your treatment where rates vary by plan
Radiation therapy you pay 20%
ChemotherapyYou pay 20%
Includes vision, dental, and hearing. And many times gym memberships
Not requiring a three night stay in the hospital to receive skilled care
Standard Affordable Care Act Preventative Services
Most come with a set prescriptin plan and no room to change based on your medications
Private health insurance companies sell Medicare Advantage plans. The federal government regulates them.

The primary benefit differences are minimal except for the extras like vision, dental and hearing benefits included in many Advantage plans. Not requiring a three night stay in the hospital to receive skilled care is also a positive. Original Medicare requires a 3 night hospital stay to receive skilled care.

It still boils down to your personal preference. If you want to choose your own doctor and specialists and use your plan anywhere in the US where Medicare is accepted, then Original Medicare is for you.

If you live in a large metro area or state where Medicare Advantage is accepted by a wide range of specialists, doctors and quality care hospitals, then Advantage could be best. Just be sure to get all the facts before you make that decision.

What will Medicare cost me?

By | General Information

Did you know that you will be required to pay a fee for most, if not all, parts of Medicare?

Many people assume that Medicare is free because you have paid into “Medicare” through taxes for most of your life…but that assumption is not correct.

Today I want to clarify how Medicare is financed and what we, as Medicare beneficiaries, pay for when it comes to our Medicare coverage.

According to a July 18, 2017 report from The Henry J. Kaiser Family Foundation, in 2016 Medicare was funded primarily from three sources: general revenues (45 percent), payroll taxes (36 percent), and beneficiary premiums (13 percent).

Part A (Hospital) is financed primarily through a 2.9 percent tax on earnings paid by employers and employees (1.45 percent each) (accounting for 88 percent of Part A revenue.) Higher-income taxpayers (more than $200,000/individual and $250,000/couple) pay a higher payroll tax on earnings (2.35 percent).

Most of us won’t pay any extra fees for Medicare Part A once we join Medicare.

Part B is financed through general revenues (75 percent), beneficiary premiums (23 percent), and interest and other sources (2 percent).

Most of us will pay $134/month for Medicare Part B once we join Medicare.  There are two unique aspects of the Part B fee

  1. This rate is subject to change every year and likely will change each year
  2. The rate varies on your situation.  For example, if you are claiming Social Security you likely pay less than $134 and if you have a higher income (more than $85,000/individual or $170,000/couple) you will pay more than $134.

In addition to the standard payments above, we likely have additional payments based on which of the two Medicare programs we pick: Original Medicare or Medicare Advantage.

If you pick Medicare Advantage, you will enroll in Part C. Part C comes with a wide range of premiums, deductibles and out-of-pockets depending on the plan you pick.

If you pick Original Medicare you will enroll in prescription plan (Part D) and we recommend you get supplement plan which helps pay some of the health care costs that Original doesn’t cover, like copayments, coinsurance, and deductibles.

There are many parts to Medicare that will determine how much you will pay on a monthly basis for coverage, but most of our clients have monthly Medicare payments range from $150 to $200.

I hope these Medicare explanations will help you understand how Medicare is financed and what you can expect to pay.

What to Look For When Comparing Costs of Original Medicare with Medicare Advantage?

By | General Information, Medicare Advantage

One of the most common questions people ask me when making their decision is “What is the difference in the two Medicare programs: Original Medicare and Medicare Advantage?”

Original Medicare has one plan accepted by most health care providers in the United States while private Medicare Advantage has many different plans accepted by fewer providers on a case by case basis.

But what about the cost?  Cost can determine which plan to pick, but when comparing costs between these two programs please be careful.

When comparing costs, both programs require you to enroll in Medicare A (Hospital), and Medicare B (Doctors) with Part B premiums ranging from $134 per month all the way up to $429 depending on your income.

If you select Part C Medicare Advantage (MA), in addition to paying the Part B premium, you will pay any MA premiums, along with co-pays and deductibles.

Out of pocket costs in a MA plan can be high. In 2017, the average out-of-pocket limit in a MA plan is expected to be about $5,332 with a maximum out-of-pocket limit of $6,700. So while these plans may have low premiums, you can expect to pay more on the back end.

Although, it is often noted that Medicare Advantage plans have a maximum limit of out-of-pocket spending and Original Medicare does not, you can accomplish the same result of limiting your exposure with a supplement plan that picks up the difference of what Medicare does not pay, including the Medicare annual deductible.

If you don’t pick Part C Medicare Advantage, you will pick a Part D prescription plan and a supplement plan.

Original Medicare doesn’t have a maximum out-of-pocket cost.  Therefore out-of-pocket costs in Original Medicare plan depend on the supplement plan you pick.

Here’s the bottom line.

With Original Medicare you can keep the doctors and hospitals you know and trust, and have the freedom to use any doctors, medical centers and hospitals in the U.S. that accept Medicare.

What’s the benefit of having a free gym club membership with Medicare Advantage if the plan refuses to pay for your cancer treatment at M.D. Anderson clinic because the lifesaving care recommended by your doctor is not covered in your MA plan’s network?

Original Medicare has stability while MA plans don’t necessarily. Each year the insurance company who offers MA plans can choose whether they want to stay in Medicare or not.

They can also change costs and benefits each calendar year. Under the Affordable Care Act, there was a significant reduction in the way the MA plans are paid which could have an impact with increased costs that beneficiaries may pay in the future.

Original Medicare will always be there for you and your basic plan won’t be dropped or changed.

With Original Medicare, you avoid the hassle factor of having to research other plans every calendar year. If you have a MA plan, you will be required to look for changes in your existing plan. Changes could include increases in cost sharing, premiums and removal of certain medications you currently take from the insurance company’s formulary list.

If you still want to compare premium costs of a Medicare Advantage plan with Original Medicare, I can get you an Original Medicare plan, with a low supplement insurance premium of $35 per month along with a Part D prescription plan of $18 and a maximum out of pocket expense of $2200, compared to a MA maximum out of pocket expense of $6,700.

And best of all, you’ll be in control of your health care choices.

Medicare’s Special Enrollment Periods

By | General Information, Medicare Open Enrollment

When you are first eligible for Medicare you have a 7-month Initial Enrollment Period (IEP) to sign up for Part A and/or Part B. The (IEP) begins 3 months before the month you turn age 65 including the month you turn 65 and ends 3 months after the month you turn 65.

But today more and more of us are delaying our Medicare enrollment past our IEP.

You may decide not sign up  during your Initial Enrollment Period because you are eligible to remain on your group health insurance plan or spouse’s plan at work.

 

Once your Initial Enrollment Period ends and you remain on a group medical insurance plan, you will be eligible to sign up for Medicare any time in the future under the Special Enrollment Period (SEP) rules.

You qualify for the SEP rule if you’re covered under a group health plan based on current employment.

Your 8-month SEP window to sign up for Part A and/or Part B starts at one of these times (whichever happens first):

  • The month after the employment ends.
  • The month after group health plan insurance based on current employment ends.
  • If you are a volunteer, serving in a foreign country.

Often times the SEP rule is not taken into consideration and the Medicare beneficiary assumes there is a penalty if one does not enroll in Part B when first eligible. If you follow the SEP enrollment criteria above, there is no penalty.

Note: COBRA and retiree health plans aren’t considered coverage based on current employment. You are not eligible for a Special Enrollment Period when that coverage ends.

If you do remain on a  group health insurance plan when you are first eligible for Medicare, make sure you check with your human resource person to see if the group prescription coverage is “Creditable” meaning as good as or better than what Medicare Part D prescription coverage offers.

If it’s not “Creditable” you may want to sign up for a Medicare Part D plan and still remain on the group insurance. In this case you would need to sign up for Part A only to get on the Medicare drug plan and avoid future penalties.

So if you don’t join Medicare at 65, there are other times you can enroll in Medicare under SEPs.  Ensure you identify your SEP and get the proper paperwork from you employer.  This paperwork will prove you are eligible to join Medicare and prove you don’t need to pay penalties.

To learn more about whether or not you need to join Medicare, CLICK HERE read my recent blog “The #1 Reason You Don’t Need to Join Medicare”

How to Time Medicare Services to Save Money

By | General Information

Just the other day I went to my doctor’s office to get a PSA (Prostate Specific Antigen) blood test ordered by my urologist knowing Medicare would pay 100% of the cost for the blood work. (As a side note, Medicare only pays 80 percent for the digital exam.)

When I arrived, the nurse said in addition to the PSA, I will do a complete test for cholesterol, lipid and triglyceride levels. I told her to only test the PSA blood levels or Medicare would not pay the 80% for the lipid profile screening until September.

Why September and not now? Unless the patient has hypertriglyceridemia (excessive amounts of fat in the blood), Medicare only pays every 12 months for this type of lipid profile blood testing. I was one month short of my 12 month window.

If the technologist would have proceeded to do the lipid testing, I would have been stuck with the bill.

After the PSA test was finished, I marched down to my doctor’s office assistant to confirm the next appointments. She said, “You’ll meet with the physician assistant on September 6th to conduct your annual “wellness visit” paid for by Medicare at 100 percent. Then you’ll go to the lab for the lipid profile blood work paid by Medicare at 80 percent.”

She wasn’t done yet. “Remember, you will then meet with your doctor two days later on September 8th to conduct a complete annual physical which Medicare will pay 80 percent of the assigned amount.”

Wow! Talk about confusing.

Here’s my Medicare coach tip: You need to be your own quarterback and take charge of your scheduled appointments to know what you are eligible for and when Medicare pays.

Go to MyMedicare.gov and register to get direct access to your preventive health information-24 hours a day, every day. You can track your preventive services, get a 2-year calendar of the Medicare covered tests and screenings you’re eligible for, and print a personalized “on-the-go” report to take to your next doctor’s appointment.

That’s what I plan to do next time.

How To Enroll in Medicare and Verify your Status    

By | General Information

There are many things confusing about Medicare, even the simple things such as “How do I sign up?” and “How can I confirm I’m enrolled in Medicare?”

In this week’s blog I will share with you exactly how enrollment works and how to confirm your enrollment status.

If you started drawing Social Security at, or prior to, age 65, you will be automatically signed up for Medicare Parts A and B. If you fall into this category, the Centers for Medicare and Medicaid Services (CMS) and Social Security will notify you of your enrollment.

If you are not drawing Social Security, you will need to enroll in Medicare on your own.

There are several ways you can enroll in Medicare including:

-making an appointment with the Social Security office , or

-completing your enrollment online by visiting the Social Security website

Once you sign up for Medicare, it’s important to verify your enrollment before proceeding with any other Medicare insurance components.

For example; if your Medicare enrollment has not been processed, then your Medicare Part D prescription plan application will be rejected.

The best way to verify, and track, your Medicare enrollment is by creating an individual account on Social Security’s website. This account will also provide you information about Medicare claims and your Social Security benefit.

Another way to verify the status of your Medicare enrollment is by going directly to Medicare’s website: www.medicare.gov.

From the homepage, under the “Sign Up/Change Plans” tab; select the “Check your enrollment” option. Provide the required information and the website will provide you with a generic answer as to whether or not you are currently enrolled in Original Medicare or Medicare Advantage.

 

Now you know how to enroll in Medicare and check your status…without going to the Social Security office or waiting on hold.

If you have more questions on this or other Medicare questions, please email me at larry@mymedicarecoach.com

 

 

 

 

 

 

Don’t Pick The Wrong Supplement Plan

By | Medicare Open Enrollment, Medigap Supplement Insurance

Did you know you may not be able to switch Supplement plans?

 

We have many people come to us years after making their decision without our guidance. They come to us for help because they realize they are in the wrong Medicare program or in the wrong supplement plan.

 

But for most of them they aren’t able to change plans because of the guaranteed issue rules.

 

Don’t make the same costly mistake they did!!

 

Because of insurability rules with Medicare, you have a small 6-month window where you can pick any Supplement plan and you are guaranteed issuance. This means an insurance company cannot turn you down or charge you more for pre-existing conditions.

 

But once this window closes, you are no longer able to join a Supplement plan without providing health backgrounds. So after the 6-month window companies can refuse you coverage based on preexisting conditions or can charge you more.

 

The only way you can change plans after your initial window is under the “Trial Right” or “Guaranteed Issue Right”.

 

Guaranteed Issue Rights encompass more than an opportunity to obtain supplemental coverage. Medicare Supplement Insurance providers are required to cover pre-existing conditions, and to do so without charging a higher premium.

 

There are a few situations you can qualify for Guaranteed Issue after your 6-month window and in addition to your “Trial Rights”.

 

For example, in the event that your current Medigap insurance provider goes bankrupt, or your coverage ends through no fault of your own, you can apply for a supplement with another company using Guaranteed Issue Rights.

 

You should keep all documentation should this be the case, as it may be required of you to prove your GI status.

 

You have the right to leave your current Medicare Supplement insurer if they do not follow the rules set forth by the Centers for Medicare and Medicaid Services, or if they have misled you.

 

Again, keep any documentation to support your claim.

 

Because Guarantee issue status is only issued in the situations, it is IMPERATIVE that you chose the right plan when you first join Medicare in case you become uninsurable.

 

Be sure the plan you choose covers your medical needs at a level that is acceptable to you, and that you are comfortable with the premium amount.

 

So as you make your Medicare Supplement decision, ensure you pick the right plan and pick the right provider to get the best coverage at the lowest cost. And if you decide to join Medicare Advantage, don’t expect to later join Original Medicare because you may not be able to get a Supplemental plan

 

If you have questions on making your Supplement decision, email me at larry@mymedicarecoach.com

 

 

Larry

 

PS: You can change your prescription plans each year even if you are uninsurable, so there are options to move. But changing Medicare Supplement Plans requires you to qualify for “Trial Rights”, Guarantee Issue