Author Archives: Kayla Willis

7 Costly Medicare Mistakes Seniors Should Avoid Making

There are many parts to Medicare, and with that comes confusion and a good chance at missing something. It is essential for everyone approaching age 65 to get informed on Medicare and sign up for the right plan at the right time. Neglecting the chance to act at making the best Medicare decisions could cost you. Here’s how to avoid these seven common mistakes so you can get the right coverage without overpaying on premiums and deductibles, experiencing gaps in coverage, or getting hit with high penalty fees.

  1. Deciding without fully understanding each Medicare plan.

Medicare has many plan options making it very confusing and hard to decide which plan is best. It is essential for new enrollees to do their homework on Medicare before their enrollment period, so they know precisely the action they need to take. It’s necessary to become familiar with the differences between Original Medicare with a Medicare Supplement or “Medigap” plan, and Medicare Advantage plans, also known as “Part C.” Not knowing what your final choice has to offer could leave you with a plan that doesn’t fully cover your specific healthcare needs.  

  1. Going out of your plan’s network.

It is essential to realize when you sign up for Medicare, not every health provider will accept your specific plan and that this could change every year. Most places accept original Medicare and therefore, any Medicare supplement plan, but if you have a Medicare Advantage plan, you might not be covered if the provider is out of network. Always make sure to check if the doctor or hospital you are going to is in your network or it could mean an expensive bill. One more thing to be wary of here is that doctors and hospitals can stop taking Medicare Advantage plans ANY TIME, even though you have to wait until fall to change your plan. We see doctors jumping out mid-year, and that puts people at a crossroads: either I see my current doctor and pay for visits/procedures out of pocket, or, I find a new doctor who is in my network (for now). One more thing – if you think that your plan covers emergencies out-of-network, we want to kindly remind you that the insurance companies dictate what is considered an “emergency.” What you find emergency room-worthy actually isn’t up to you.

  1. Missing your enrollment periods.

There are enrollment periods that vary from person to person, depending on when an individual turns 65 or when they decide to leave their current job that provides them with healthcare benefits. When turning 65, eligibility to sign up for Medicare begins three months before your birthday month and continues for three months after. If you turn 65 and still have healthcare coverage through your job, you may want to delay your Part B enrollment until you seek full benefits from Medicare. This depends on the situation, size of the company, and the cost comparison, so you definitely want to discuss this with an expert to be sure you make the right moves. The Annual Enrollment Period (AEP) is the same for everyone, every year, which begins October 15th and goes until December 7th. This is the only time frame for current Medicare beneficiaries to change Part D prescription plans or Medicare Advantage plans. You can change a Medicare Supplement plan any time you want, however. It’s important to become familiar with these time frames, so you aren’t left without coverage at any time or hit with late-enrollment fees or penalties.

  1. Ignoring your Annual Notice of Change (ANOC).

The Annual Notice of Change (ANOC) is sent out to all Medicare beneficiaries before the Annual Enrollment Period stating any changes to plans and costs that will take place the following January. If you don’t read your NAOC, you might not know if your plan details or costs have changed, and it could leave you without coverage in certain areas and/or more expensive bills. You might learn it is in your best interest to keep the plan you have, but ignoring this critical update from your insurance company could result in getting stuck in a plan that costs way too much or doesn’t take care of your needs.

  1. Improperly signing up for Medicare Part B.

Once you turn 65, you are automatically enrolled in Medicare Part A (which covers your facility costs at the hospital) because you worked more than 40 quarters (10 years) and it does NOT come with a premium. Medicare Part B, however, not only comes with a premium (income-based, starting at $135.50 per month for 2019) but also comes with huge penalties and expenses if you enroll or delay enrollment improperly. If you are still working and you plan to continue working after your 65th birthday, you will need to find out the answers to a few critical questions. First off, is your company larger than 20 employees? If so, they MUST offer you health coverage while you are still employed. However, this does not mean you have to or should take this. It’s best at that point to compare your predicted costs with your employer plan versus your options under Medicare. About 50% of the time, it makes sense to leave your employer plan for Medicare. Definitely something you want to discuss with an expert. Okay, here is another common situation, let’s say you decide not to take Medicare Part B, and your employer is found to be less than 20 employees, otherwise known as not-credible coverage. If your plan is found to be not-credible coverage then when you go to take Medicare Part B, Medicare charges you a 10% penalty of the premium (about $13.50 per month at the lowest income bracket) for the rest of your life. That penalty can really add up. Lastly, let’s say that you take your Medicare Part B while you are still working and your employer has over 20 employees, so you stay on this insurance, too. The problem people run into with this is that when you take your Medicare Part B, not only are you paying a premium for coverage you aren’t using, but you run the risk of lapsing your Open Enrollment window. This is the time that lasts for six months (three months before and three months after your 65th birthday) in which you can choose any Medicare Supplement plan you want, with no medical questions asked. When you lapse this window while it’s sitting as your secondary insurance to employer coverage, when you retire, you will have to be reasonably healthy to get supplemental coverage.

  1. Missing your opportunity to switch plans.

There are many reasons a beneficiary might want to change Medicare plans, but it is easy to miss the chance to do so when it comes to prescription and Medicare Advantage plans. Just like enrollment, there are only specific periods where switching is possible. You can make changes to your prescription and Medicare Advantage plans during AEP. With Medicare Advantage plans, you have a 1-year trial period from the first date active, which allows you to switch to Original Medicare anytime within that timeframe if necessary. There are other unique opportunities to change, including life events like moving to a new area where your current plan doesn’t exist. The most common reason to switch plans is to save money, so make sure you understand your enrollment windows.

  1. Signing up for the same plan as your spouse.

When you get health insurance through an employer, often you can choose a plan that covers you and your spouse. With Medicare, you each need an individual plan, and it isn’t always the best option to go with the same insurance company, let alone plan. As you age, the chances of having different healthcare needs than your spouse become higher, so it is significant for beneficiaries to pick a plan that is specific to you and your personal needs. Often, healthy couples can and should take the same plan, because some insurance companies offer household discounts. Comparing companies and rates is the best way to decide what’s most cost-effective for you and your spouse.

Medicare is confusing, and finding a helpful resource isn’t always easy. Here at Senior Health Medicare, we aim to be that helping hand that you can rely on so you can avoid making these mistakes and navigate Medicare with ease. If you have any further questions about this blog or anything Medicare-related, please feel free to comment on this post or contact one of our helpful experts by phone.

 

How You Can Help Prevent Medicare Fraud

Medicare fraud is happening all the time, which results in higher taxes and healthcare costs for everyone. People and companies who get access can steal your Medicare number and personal information to scam the system for illegitimate products and services. It is important for beneficiaries to understand how to spot and protect from fraud to keep costs from rising even higher in the future. Not to mention, keeping your confidential information safe.

Doing Your Part

  • Keep your Medicare card, Medicare number, and Social Security number safe as you would protect a credit card. Only give this information to doctors, Medicare providers or someone you know should have it.
  • Keep records of all doctor’s visits and services provided. Always check your Medicare statements to ensure every detail is accurate.
  • Be sure to check you were given the right medications before leaving the pharmacy.
  • Never accept special offers on free or discounted Medicare.
  • Ask any questions about your Medicare or billing costs. It is your right to know.
  • Be aware of providers who claim they know how to bill Medicare even though they don’t usually offer that particular service.
  • Always report suspected incidences of Medicare fraud.
  • Never accept anything from a door-to-door salesperson claiming they are from Medicare. Medicare never sends representatives to your home.
  • Don’t let the media influence you about your health because they don’t always have your best interest in mind.

How to Spot & Report

If you have any suspicions whatsoever never hesitate to call Medicare. If you think a charge on your statement isn’t correct, call your provider and ask them about it. Always review your Medicare claims for any errors to stop fraud from happening early on. View your claims as soon as they are processed by logging into MyMedicare.gov or give them a call. When reporting Medicare fraud, make sure you have any records indicating possible existing errors and documents providing proof of services. To report any suspicious activity, you can call 1-800-MEDICARE (1-800-633-4227), report online at the Office of Inspector General or call them at 1 800 447 8477.

Medicare can be confusing for enrollees, which makes it easy for criminals to take advantage. If you have any questions or would like more general knowledge on Medicare, leave a comment, or give us a call. Here at Senior Health Medicare, we strive to educate beneficiaries on Medicare so that you and your loved ones stay protected and feel confident in your Medicare decisions.

Everything Enrollees Should Know About This Year’s Changes in Medicare

Since there are changes in Medicare all the time, it is essential for all beneficiaries to stay informed regardless of how minor the changes from the previous year might be. 2019 has brought in many variations including an early close in the Donut Hole, expansion in Medicare Advantage, and changes in premiums and deductibles. Also, Medicare is eliminating all “Cadillac” Medicare Supplement plans (including F and C) as a way to save money as the baby boomers come into the Medicare system at a rate of 10,000 every day.

High Volume of Enrollees

In 2020 it is expected that the Medicare costs will double due to the amount of retiring baby boomers. At this point, there will be more people on Medicare than paying in. For Medicare to save money in the future, it must make changes in Plans or rule them out for new beneficiaries. Medicare taxes and the Trust Fund continue to cover less since health care costs are rising faster than economic growth.

Plans F and C

2019 marks the last year for Plans F and C. On January 1, 2020; these plans will no longer be available to new enrollees. In 2015 the Medicare Access and CHIP Reauthorization Act (MACRA) was passed to prohibit the sale of Medigap plans that pay for Part B deductibles. If a beneficiary already has Plan C or F you can continue to purchase these plans after the New Year. People that already have these plans are “grandfathered” in, but we have found that when plans close to new enrollees, the likely outcome is rate increases on the premium at a faster volume and rate than open plans.

Part B

In 2018 the standard premium for Medicare Part B was $134 a month and had gone up to $135.50. Some Enrollees will pay less because their premium amount depends on their Social Security Cost of Living Adjustment, which may not cover the increase.

Previously, the highest income bracket for Part B enrollees was $160k and above. This year a new bracket of $500k and above was added with a premium of $460.50 a month.

The deductible has increased from $183 to $185 per year, and once you meet this, then you are responsible for 20% of the Medicare-approved amount for services. This exposure has no cap- if you go in for major surgery, you will pay 20% unless you have a Medicare Supplement or Advantage plan to ease the burden.

Medigap plans that cover the Part B deductible can be sold in 2019 but can no longer be purchased starting 2020. Those who already have these programs can keep Plans C and F, but no new enrollees can buy plans that cover the Part B deductible.

Medicare Advantage

Test drives

Once enrolled in the Medicare Advantage plan, beneficiaries will now be able to try it out for three months, and if they aren’t satisfied, they can switch plans.

Open Enrollment

Starting this year from January 1st to March 31st anyone enrolled in a Medicare Advantage plan can switch plans. New beneficiaries with both Medicare Part A and B plans have a three-month Medicare Advantage Enrollment period.

Broader Span of Coverage

Additional services are available within Medicare Advantage plans including coverage on meal deliveries and transportation services.

The Donut Hole

The Donut Hole is gradually closing due to the Affordable Care Act (ACA). In the past, Medicare beneficiaries experienced higher costs on medications at a certain point in the year due to a gap in coverage. At one point it was 100%. Since the beginning of 2019, the Medicare donut hole only affects generic medications. Beneficiaries will now save money by just paying 37% of those costs while in the donut hole.

Part A

Premiums for people whose work history (or spouses) isn’t 40 quarters are required to pay dividends for Part A coverage (hospitalization costs). Premiums for 30-40 quarters of work history have gone from $232 a month to $240. For less than 30 quarters it was $422 and is now $437. For all enrollees, every benefit period, Part A deductibles increase, though most beneficiaries have coverage that pays for all or part of it.

 

Every year there are changes in premiums and deductibles, but Medicare is striving to make changes for the better. Some parts that have improved the system include the removal of the therapy cap, an updated handbook, and a broadening of telehealth programs. For any questions about these topics or an expansion on changes in the donut hole, Part B, Part A or Medicare advantage, please leave a comment or give our Medicare Experts a call. We aim to be your educational Medicare resource!