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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.

Travel smart with Medicare

Before going on any trip, creating a checklist is always recommended. While you are updating your passport, checking the weather to prepare to pack, you should also make sure to check on your health coverage while traveling. Medicare can be great for travelers if the proper decisions are made.

Original Medicare covers you in the United States of America, including the District of Columbia, Guam, U.S. Virgins Islands, Puerto Rico, Northern Mariana Islands, and America Samoa. If you are going outside of these lands and/or overseas, for a majority of the time Medicare will not pay for the health services or supplies. There are some rare occasions where Medicare will cover your service or supplies.  An example of the rare occasions where Medicare will cover your service or supplies is as the following: If your emergency happens in the United States of America but nearest hospital to treat you is in Canada or Mexico.

According to Medicare.gov “In some cases, Medicare may cover medically necessary health care services you get on board a ship within the territorial waters adjoining the land areas of the U.S. Medicare won’t pay for health care services you get when a ship is more than 6 hours away from a U.S. port. “  As you can see, understanding the boundaries, the loop holes and the safety net created by Medicare is best left to an expert to fully understand.

Many experts advise their clients to invest in travel insurance as a “just to get home” safety net. when you have travel insurance you will have coverage for things that aren’t an emergency. It’s reasonably priced, and a great asset to have to in your back pocket if you are a frequent traveler, particularly an international traveler. If you have an emergency under $50,000, Medigap is a great option for you. With Medigap you can go anywhere in the U.S. that accepts Medicare . Also most Medigap plans include foreign travel emergency coverage up to  $50,000- but this coverage is meant to be reimbursed. For example, if you were hurt abroad, depending on the procedure needed you would either Medivac to the United States or receive treatment abroad. Either way, it would be your responsibility to pay for that procedure out of pocket, and then the insurance company will reimburse the claim. The Medigap covers 80% up to 50k, so you could still end up with a big bill.

So before setting sail, or boarding the plane, make sure you speak to your Medicare advisor and ask many questions. No one plans to have a medical emergency while on vacay, but it’s better to be proactive rather than reactive.

7 Medicare Tips for New Enrollees

1 Medicare doesn’t have a family plan

Medicare plans are only individual coverage, not family. This means that spouses each need to have their own Medicare coverage. Additionally, no dependents receive coverage. In the event that your spouse is younger than you, when you enroll in Medicare they can seek employer coverage or individual coverage through the marketplace (healthcare.gov — the Affordable Care Act website). Note, that if you and your spouse are entering Medicare around the same time, you may be recommended different plans from different companies if they are a better individual fit for you. Some companies to offer household discounts for enrolling with the same company, but other than that it is unique to the individual.

2 There is no cap on out-of-pocket costs in Original Medicare

Most employer plans have annual limits on your out-of-pocket health expenses. Medicare pays 80% of approved medical expenses, then the beneficiary is responsible for the remaining 20%, without a cap. For example, if you have an $100K surgery, you will have to pay $20K, which is why people buy Medicare Supplement plans or Medigap plans to fill this gap.

3 Make a plan for any pending procedures

If your employer plan offers you better benefits than Medicare or costs less, then you may want to have the elective surgery sooner than later. Or wait until you are enrolled in the Medicare system. Surprisingly, the first year for a Medicare beneficiary usually has the highest number of claims because people wait for elective surgery until they are covered on the system.

4 Observation VS  Inpatient 

Medicare pays different rates according to status. Even if the patient is admitted in a hospital for one week, if they are under “observation” they are considered as out-patients.  Medicare requires a three-day hospital inpatient stay minimum before the covering of cost. When a patient is admitted under “observation” , the time frame is not counted toward the Medicare’s requirement regardless of the length.

5 Research can mean more money in your pockets

In the employer health insurance world, you are stuck with the benefits designed for the group. With Medicare, it should be custom to you and your individual needs. Finding an educational resource to learn more about Medicare and how it works, will only help you make smarter decisions when it comes to health insurance. It can also mean saving money in the process.

6 When you enroll into a Medicare Advantage plan, you are disenrolling from Original Medicare

Medicare Advantage plans were introduced in the early 2000’s as an alternative to Original Medicare parts A and B. The way they are marketed is that they offer the same benefits as Original Medicare, but it’s a little more complex than that. While Original Medicare and Medicare Supplement plans are programs regulated by the government, Medicare Advantage plans are controlled by the insurance companies. It literally takes an act of Congress to change Original Medicare, whereas Medicare Advantage plans are  in the company’s hands. You essentially give up your Medicare to work with a network provider. Learn more about the difference between Medicare Advantage and Original Medicare with a Supplement here.

7 You can change your Medicare Supplement coverage whenever you want

You don’t have to wait for AEP to change your Medicare Supplement coverage. You can change your Medigap plan anytime during the year, as long as you can pass medical underwriting. The programs that must wait for changes until AEP are Part D Prescription plans and Medicare Advantage plans.

 

Leave a comment, let us know which tip is the most useful.

Making Medicare Simple and Easy

If you ever wanted a personal assistant, especially with the confusing world of Medicare, My Medicare.gov is an amazing tool! My Medicare.gov is a free, secure, online portal that manages your personalized information regarding Medicare benefits and services. It is very simple to set-up, and can be used to check  information about your coverage, enrollment status and Medicare claims.

You can make getting all the necessary information about your coverage, prescription drugs, and health records easy for your doctor and any doctor you may need in the future. You never know when you’ll need to see a doctor while traveling. As you may know, not every doctor has your personal list of medications. This tool allows you to have everything you need at your finger tips.

According to sources at eHealth Medicare, your personal information is protected by the CMS.  The CMS is the Centers for Medicare & Medicaid Services,  The CMS has many guidelines such as, what type of information is being used, who is collecting the information, and how are they using the information collected.  This amazing tool has many other functions for your disposal, so give it try!

Leave a comment, and let us know what would you use My Medicare.gov for?

For more information, click the link below https://www.mymedicare.gov/

3 Things Medicare Buyers Should Stop Doing Right Now

Retired couple working on Medicare plans

The undeniable truth about our Medicare system is that the entire process is daunting. There are so many different terms and phrases; the supplemental plans, the “Advantage” plans, the Part D options. And enough acronyms to drive a sane person completely bonkers.

 

Add to that the growing number of insurance agents pounding on your door or filling your inbox, the pile of confusing mail awaiting you, and the government “experts” constantly modifying plans and procedures- now, you’re in trouble.

 

If you take ownership of Medicare knowledge, these pitfalls won’t affect you. In order to be the most educated Medicare buyer, you just have to stop doing these 3 things right now. What happens if you don’t? You waste money and time.

  1. Stop buying insurance from agents.

 

Despite any claims otherwise, most insurance sales people tend to play favorites with carriers and products. In many cases the commission rates, incentive trips, and sales leads provided to the agent all contribute to the favoritism. On top of that bias, the Medicare landscape changes indefinitely; carriers in the Medicare realm usually enter the market at a great price, then are followed by substantial increases. Agents aren’t always giving the best advice, and you should really seek an advisor over an agent any day.

 

  • Make sure that the agent you are working with has access to a multitude of carriers (they’re called many names like “non-captive”, “independent” or “non-exclusive”) and definitely avoid “captive” agents, who work exclusively for one carrier.

 

  • Always ask, “What other carriers offer the same plan in my area?” We have literally seen scenarios where one carrier pays close to $300 more commission than another…for the same exact plan! In most cases, carriers who pay less commission to the agent have had more stable rates with smaller increases.

 

  1. Don’t take the “easy” way out.

 

Most agents love to sell Medigap plan “F”, but it’s usually not the best plan for you. The honest truth is that because commission is a percentage of the premium you pay, plan F pays the agent the most. Plus, it’s the only plan that pays both Medicare part A and B deductibles, and all Part B co-insurance, which makes it very attractive. If you are in “open enrollment”, or can qualify for coverage, plan G is almost always the way to go.

 

Here’s why: Plan G requires you to pay the Part B deductible of $140 per year, but pays everything else the same as plan F. Most plan F premiums are far more than its friend plan G, but only for the convenience factor. Would you pay $300 more per year just to have a $140 deductible paid on the insurance companies’ behalf?

Here’s the other big secret about plan F: It has larger and more frequent rate increases than the other plans. Because Plan F is used for the “Guaranteed Issue” privilege, (for those who have lost coverage from somewhere else), Plan F almost always has more claims due to the absence of medical underwriting. The sicker the pool of people, the more the rates go up. When you apply for a plan G…you’ll know that everyone, except those who just turned 65, had to qualify based on their health. Healthier people=lower rates.

 

  1. Stop buying into marketing tactics and sales clichés.

 

Here’s a short list of some of the most popular sales pitches used to convince a person to enroll, followed by the real interpretation:

 

  • “The customer service is great and they pay claims really fast.” Tell us something we don’t know. Every sneaky agent uses this line, and they usually know darn well it’s out of their control. A good Medigap plan pays everything automatically that Medicare approves, and most clients will NEVER have to work with the carrier except for premium payment changes or a billing address change, etc. What’s more…it’s not as if the Medigap carrier is paying you, they are paying the doctor or the hospital. So whether they pay the claim in 2 days or 2 weeks is completely irrelevant to you. Don’t fall for this one!

 

“This carrier hasn’t had a rate increase in years!” Bad sign. A carrier who hasn’t taken a rate increase in more than 2 years is probably long overdue for one, and you’ll be along for the ride when it happens. It is far smarter to enroll in a plan that has just recently adjusted its rate, as the chances of you experiencing a large bump in price are far less. Little increases are fine, and necessary based on the claims activity. But huge ones are usually the result of a carrier trying to “buy” the business by maintaining a lower rate until it hits the number of clients it wants; then treating those “lucky” recipients to a whopping increase.

 

“This company also offers the Part D benefit, so you can have both plans with same carrier.” Run away from this line-giver as fast as you can. It makes no sense to even consider a Medicare supplement plan based on the Part D benefit. Any responsible agent would offer to run a complete prescription drug analysis before recommending a part D. The best one for you is the one that has the least out of pocket costs for that year, and it rarely ends up being the same company as your Medigap policy. You could end up overpaying WILDLY. A reputable, good company would offer a Part D analysis to determine what medicines you actually take, before trying to determine prescription coverage.