5 Things to Know About Medicare

  1. Medicare Advantage plans (Part C) are not the same as Medicare Supplement (Medigap) plans.  Even though most people don’t understand the differences, they are very different kinds of insurance.  As such, the rules that the beneficiary must follow to receive health care are also very different.  Make sure you understand these differences before enrolling.
  2. If original Medicare (Parts A & B) is your primary insurance, you are not restricted by HMO or PPO networks for your medical care.  Without referrals, you may see any doctor or provider within the U.S. that agrees to see you. 
  3. Sometimes you can shift drug coverage from Part D to Part B.  If you are using insulin, pain medication, or certain inhalers (which can all be pricy, even under Part D), the same active ingredients may be available for use in insulin pumps, pain pumps or nebulizers.  These devices are considered Durable Medicare Equipment (DME); therefore, the equipment, as well as the medications administered through the equipment, are covered under Part B, which in many cases will result in substantially lower out of pocket costs for the beneficiary.  Talk to your doctor to see if this is an option for you.
  4. Medicare Supplement (Medigap) carriers are still allowed to deny coverage due to pre-existing conditions, even with the ACA becoming law.  This is one of the most misunderstood aspects of the ACA (Obamacare).  When you apply for a Medigap policy outside of being new to Medicare (or recently turning 65), the insurance company in most cases can review your health history and deny coverage if you’re health history or current condition doesn’t meet their underwriting criteria.  This hasn’t change under the ACA.  Note: There are numerous exceptions to this rule.  Consult with a qualified Medicare advisor to learn more.
  5. You are allowed to change your Medicare Supplement (Medigap) policy any time throughout the year, not just at open enrollment.  If you encounter a large rate increase at any time, you may apply for a Medigap from a different carrier.  There are no calendar restrictions.  Once approved, you can make the switch.  Consult with your qualified Medicare advisor to learn more.

 

Editor’s Note: This article was submitted by Bill Gundelfinger-’Mr. Medicare®’ of Total Retirement Alliance, Medicare Experts. ‘Helping Medicare Beneficiaries get the most out of their health insurance.’ He can be reached at 720-675-8032 or 800-376-5450

5 Things to Know About Medicare

  1. If you or your spouse are still working and covered under your employer’s group health plan (EGHP), you don’t need to enroll in Part B and you can avoid the Part B late enrollment penalty (LEP).  When you finally do enroll in Medicare Part B, the LEP will be waved if you’ve been continuously covered by your employer since turning 65.  This is also true of the Medicare Part D LEP.
  2. Social Security will attempt to automatically enroll you in Medicare if you are currently drawing any Social Security benefits (retirement, disability, survivors).  If you aren’t drawing Social Security benefits, you will need to initiate the enrollment process yourself, which you’re allowed to begin up to three months prior to the month of your 65th birthday.
  3. Sometimes you can shift drug coverage from Part D to Part B.  If you are using certain inhalers (which can be pricy even under Part D), the same active ingredients may be available for use in nebulizers.  Nebulizers are considered Durable Medicare Equipment (DME); therefore, the equipment, as well as the medications administered through the equipment, are covered under Part B, which in many cases will result in substantially lower out of pocket costs for the beneficiary.  Talk to your doctor to see if this is an option for you.
  4. Medicare Supplement (Medigap) carriers are still allowed to deny coverage due to pre-existing conditions, even with the ACA becoming law.  This is one of the most misunderstood aspects of the ACA (Obamacare).  When you apply for a Medigap policy outside of being new to Medicare (or recently turning 65), the insurance company in most cases can review your health history and deny coverage if you’re health history or current condition doesn’t meet their underwriting criteria.  This hasn’t change under the ACA.  Note: There are numerous exceptions to this rule.  Consult with a qualified Medicare advisor to learn more.
  5. You are allowed to change your Medicare Supplement (Medigap) policy any time throughout the year, not just at open enrollment.  If you encounter a large rate increase at anytime, you may apply for a Medigap from a different carrier.  There are no calendar restrictions.  Once approved, you can make the switch.  Consult with your qualified Medicare advisor to learn more.

 

Editor’s Note: This article was submitted by Bill Gundelfinger- ‘Mr. Medicare®’ of Senior Benefit Advisors, Medicare Experts. ‘Helping Medicare Beneficiaries get the most out of their health insurance.’ He can be reached at 720-675-8032 or 800-376-5450