http://www.benefitspro.com/2017/07/10/working-past-70-americans-cant-seem-to-retire
Working past 70: Americans can’t seem to retire.
August 2, 2017 by
How Medicare Advantage Plans Can Improve Care and Save Money.
July 11, 2017 by
How Good Is Medicare Advantage?
August 11, 2016 by
https://www.mainstreet.com/article/how-good-is-medicare-advantage
Should You Enroll in Medicare If You Are Still Working?
March 3, 2016 by
The size of your employer is a key factor in determining the answer.
You’re turning 65 but still working and covered by your employer’s health insurance plan. Should you enroll in Medicare? The answer to that question is not as simple as it may appear.
The size of your employer could determine in part whether you enroll in Medicare Part B, which covers outpatient services. If your employer has 20 or more employees, your employer’s insurance will be your primary coverage. As long as you’re still working, neither you nor your spouse — if your spouse is older than 65 and covered by your plan — need to enroll in Part B. When you leave your job, you and your spouse can enroll in Part B during a special enrollment period, which lasts for eight months after you stop working.
You can always drop your employer coverage while you’re still working and enroll in Part B. (Stick with your employer plan if your spouse is not eligible for Medicare.) You should compare benefits and costs of your employer coverage and Medicare. If you’re considering traditional Medicare, consider costs for Part B, a Part D prescription-drug plan and a Medigap supplemental insurance plan.
If your employer has fewer than 20 employees, you should enroll in Medicare as soon as you are eligible because it becomes the primary payer. As secondary payer, your employer’s plan will not pay for any expenses covered by Medicare. If your spouse is on your employer plan, she or he can continue on your employer plan until age 65 as long as you keep the plan for yourself as secondary coverage. Here are other questions to consider.
If my employer is the primary payer, should I enroll in Part B anyway? It usually doesn’t make sense to pay premiums for both plans, unless your spouse needs coverage. Because of a complex formula that Medicare uses to determine how much it will pay for services when it’s a secondary payer, the program will not necessarily fill in all the gaps between what a provider charges and what your employer pays.
Should I keep my employer coverage if I work for a small company? Ask the employer’s insurance company what kind of gap coverage it offers as a secondary payer to Medicare. Smaller plans often limit the choice of providers. Unless your spouse needs coverage, you’re better off buying a private Medigap plan.
If I leave my job after 65 with retiree health benefits until I turn 70, do I need to enroll in Part B? Corporate retiree health benefits are always secondary to Medicare — even if you have not enrolled in Medicare. Retiree health plans differ on the amount of gap coverage they provide, so it’s a good idea to check with the benefits administrator. You may be better off with a Medigap plan. If your spouse is younger than 65 and on your employer plan, find out whether the retiree health plan will continue to provide full coverage.
Medicare Open Enrollment: Are You Ready?
September 15, 2015 by
More than 50 million people receive Medicare; but you have to be smart about the choices you make.
Source: Medicare.
Medicare covers more than 50 million recipients, with the vast majority 65 or older and relying heavily on the healthcare coverage it provides in their retirement years. Yet, Medicare actually involves some serious choices and, once a year, Medicare open enrollment allows participants to reconsider choices they’ve made about their coverage. This year, Medicare open enrollment runs from Oct. 15 to Dec. 7, with any changes you make taking effect on Jan. 1, 2016. Let’s take a look at some of the facts you should know when considering your best strategy for Medicare going forward.
1. Medicare doesn’t involve as many choices as private health plans
For many workers who get coverage from their employers during their careers, open enrollment is a stressful time in which you have to consider just about every aspect of health-insurance coverage. Different plans can vary in how they cover anything from routine doctors’ visits and basic medical services to high-cost hospital stays and chronic disease treatment. Choosing among all those options can be a tough call to make, with huge consequences if you’re wrong.
With Medicare, though, most of the basic benefits of the program are locked in if you choose traditional coverage rather than Medicare Advantage plans. Traditional Part A coverage of inpatient hospital care, skilled nursing facilities, and certain other intensive care tends to be straightforward, and Part B coverage for outpatient care, doctors’ visits, and other medical services also has fixed provisions. Unless you decide to seek alternatives to traditional Medicare coverage, you won’t have to do much with those key elements of the program.
2. Medicare Advantage plans have gotten more popular
Despite the coverage that traditional Medicare offers, it doesn’t cover all of your healthcare costs. That’s one reason why Medicare Advantage plans have gotten more popular, with about 30% of all Medicare beneficiaries participating in these types of plans. Some believed that Medicare Advantage plans would end up being uneconomical in light of healthcare reform; but, despite some regional squeezes, the overall number of plans available hasn’t fallen at a steep rate thus far.
Offered by private healthcare companies like UnitedHealth (NYSE:UNH), and WellPoint (NYSE:ANTM), Medicare Advantage plans typically offer managed care solutions. Integrated with prescription drug coverage under Part D, Medicare Advantage plans often require additional premium payments above what Medicare alone would charge; but, in exchange, recipients can get more extensive benefits under some policies.
Source: Medicare.
Participants can switch from traditional Medicare to Medicare Advantage, from Medicare Advantage back to Medicare, or among different Medicare Advantage plans throughout the open enrollment period. But because Medicare Advantage plans can be location-specific, you can also get permission to switch plans during certain special election periods if you move out of the service area that your current plan covers. By looking at your particular health needs, you can assess the best Medicare Advantage plans available to you, and often save money in healthcare costs as a result.
3. Be sure to look at Part D prescription drug coverage
Even if you’re covered by traditional Medicare, Part D prescription drug plans are still available. These plans can vary greatly in cost and services provided, with various plans even covering different individual drugs.
Because of the detail in which many Part D prescription drug plans go in describing covered drugs, it’s extremely important to look closely at the prescriptions you have, and make sure that they’re included in your current plan. Otherwise, you could be paying money for coverage that doesn’t give you the benefits you deserve. In addition, many Part D plans are eliminating features like zero deductibles and filling in gaps in coverage, which reduces premiums, but also forces you to pay more of your healthcare costs yourself.
Most older Americans rely on Medicare to cover most of their healthcare costs; so making the most of your benefits under the program is vital to your financial security. By knowing as much as you can about your options under Medicare open enrollment, you’ll be best able to get the most in benefits at the lowest possible cost.
Medicare Open Enrollment.
September 9, 2015 by
You only have one chance a year to make changes to your Medicare coverage. The annual Medicare open enrollment period is that chance.
Whether this is your first Medicare open enrollment or you’ve been doing it for years, it pays to take time each autumn and study your options. The number and types of plans available in your area change each year, bringing new options and eliminating previous options.
The benefits and costs associated with a plan you’ve had for years can change. This is your chance to do something about it.
When Is Medicare Open Enrollment?
Medicare open enrollment starts October 15 and ends December 7, Pearl Harbor Day. The changes you make during open enrollment take effect January 1 the following year.
You don’t have to wait until October 15 to start planning for open enrollment. You can start doing research on plan options when you get each year’s “Medicare & You” booklet in the U.S. mail or by email. The booklet alerts you to changes in Medicare that might impact your coverage or plan choices.
You’ll likely get information from you current Medicare Advantage and Medicare Part D drug plans as well as Social Security in the mail around that same time.
What You Can Do During Open Enrollment
- Switch back and forth between Original Medicare and a Medicare Advantage Plan.
- Switch from one Medicare Advantage plan to another.
- Enroll in a Medicare Part D drug plan.
- Switch from one Medicare Part D drug plan to another
- Drop your Medicare Part D drug plan completely, perhaps because you switched to a Medicare Advantage plan that includes drug coverage.
What if You Miss Open Enrollment?
If you miss open enrollment, you won’t be allowed to make changes to your Medicare coverage until next year’s open enrollment. Your current Medicare coverage choices will roll over to next year.
There are a few exceptions that will allow you to make coverage changes outside of open enrollment. Some things, such as moving outside of your Medicare Advantage plan’s service area, trigger a special enrollment period allowing you a brief period to make changes even though it’s not open enrollment.
From January 1 through February 14, you can change your mind about your Medicare Advantage plan and switch back to Original Medicare. You can’t switch to another Medicare Advantage plan or join an Advantage plan you don’t already belong to, though.
How To Prepare for Open Enrollment
- Gather information about your current coverage so you’ll be able to compare and contrast the new offerings with what you have now. You’ll need information on the premiums, deductibles, copay or coinsurance amounts, which of your drugs are on your plan’s drug formulary and how much they cost.
- Go to the Plan Finder tool at Medicare.gov to get information about which plans will be offered in your area next year, what they’ll cost and how their quality scores stack up.
- Compare what you have now with what you’d have next year if you kept the same coverage. Are your premiums or cost-sharing going up? Are your drugs all still covered at the same level on the plan’s drug formulary? Are your doctor and hospital still in-network if you have a Medicare Advantage plan?
- Look at the other Medicare coverage options in your community. Check the drug formulary of each plan you’re interested in. Do any of them have better coverage for your particular drugs? Can you find a plan with a lower premium but similar coverage? Can you find a plan with a similar premium but better coverage? Do the plans you’re considering have good quality scores? Make sure to check out Medicare Advantage and Medicare Part D provider networks to make sure you’ll be satisfied with the doctor, hospital and pharmacy choices.
How To Make Changes During Open Enrollment
If you decide to change your Medicare coverage during open enrollment, you have several options for how to do that.
You can sign up for most plans on the Medicare.gov website.
You can sign up with the plan directly by:
- Visiting its website
- Telephone
- Filling out a paper application and mailing or faxing it to the health plan
- Attending a community meeting put on by the health plan to educate Medicare recipients—and to market the health plan to them. Often, these plans will allow you to enroll in the plan during the meeting. Not all plans hold community meetings, and some communities don’t have any meetings.
How to Get Help
If you’re having difficulty understanding the rules of Medicare open enrollment, how to accomplish your Medicare open enrollment goals, or comparing plans, you have several resources for help. Learn more in “Get Help With Medicare Problems & Medicare questions.”
If you’re having trouble understanding how Medicare Advantage plan types differ, learn more in “HMO, PPO, EPO & POS—What’s the Difference & Which Is Best?”
If you need clarification about what a particular plan does or doesn’t offer, contact the health plan.
Yes, you need to signup for Medicare benefits.
September 7, 2015 by
It happened 50 years ago, today. On July 30, 1965, President Lyndon Johnson signed legislation to establish Medicare.
You probably know that your benefits start at age 65, but you need to sign up for them – and a lot of people don’t know that.
The Centers for Medicare and Medicaid Services want you to apply for your Medicare benefits three months before your 65th birthday, even if you’re not ready to retire yet.
If you don’t sign up at age 65, and you decide to enroll later, you may pay a lifetime late enrollment penalty and you may have a gap in medical insurance coverage.
You can sign up for Medicare online in less than 10 minutes. That’s a lot more convenient than going to the Social Security Office.
At that time, you’ll be asked if you also want Medicare Part B. This coverage helps pay for doctors’ services and many other medical services and supplies that hospital insurance doesn’t cover.
There are no forms to sign and in most cases, no documentation is required. Your Medicare card will arrive by mail.
Hospital Industry Raids The Medicare Trust Fund.
April 28, 2015 by
Every year, millions of Americans pay federal taxes to support government programs that provide health, wellness, and other benefits to those who need it most. One would assume that safeguards are in place to ensure that our taxpayer dollars are used appropriately and efficiently. However, a recent Government Accountability Office (GAO) report states that rampant waste exists within the Medicare program. In 2014 alone, Medicare overpaid hospitals and other healthcare providers nearly $60 billion for services that were unnecessary or billed improperly. That’s billion—with a “B.”
Would you allow yourself to be overcharged for your groceries and not ask for a refund? Would you go out to dinner and pay for items on your check that you never ordered? The federal government would, and it is wasting your taxpayer dollars while doing so.
The GAO report states that Medicare has the highest level of improper payments government-wide, which should be unacceptable given the program’s important role as the healthcare safety net for the nation’s seniors and other beneficiaries. Pair that with a recent Medicare Trustee report that says Medicare will go bankrupt in the next 15 years (by 2030). Clearly, Medicare waste needs to be made a higher Congressional priority, or we can bid farewell to a program that we hoped would be there for us when we turn 65.
In 2009, Congress launched a program to provide vital oversight to Medicare, the Recovery Audit Contractor (RAC) program, which leverages the expertise of independent contractors to review post payment Medicare claims and determine if they have been billed according to Medicare policy. Since the RAC program began, these contractors have returned more than $9 billion back to the Medicare Trust Fund while reviewing less than 2% of all Medicare claims. This work to recoup dollars that have been inappropriately billed helps prolong the life of this vital healthcare program.
So, what’s the problem? Congress has benched the RACs, the only program looking out for taxpayer dollars, while Medicare hemorrhages billions due to provider complaints that they are “burdened” by Medicare oversight programs.
In fact, in an effort to game a broken system and retain as much money as possible, whether billed correctly or not, hospitals have spent tens of millions of dollars lobbying Congress to shut down the RAC program, one of the most successful oversight programs in U.S. history. Hospitals most passionately fight against review of Medicare Part A claims, which are directly paid for by taxpayer dollars.
Medicare improper billing runs across a wide spectrum—including everything from simple coding mistakes to outright fraud. For example, providers have inappropriately charged Medicare ten times what it costs to administer a single medication, have billed for care provided after a patient’s death, and also have held patients in the hospital longer than necessary in order to recoup a higher reimbursement rate.
Guest post written by Kristin Walter
Ms. Walter is spokesperson for the Council for Medicare Integrity, a non-profit organization.
What Is Medicare?
September 24, 2014 by
Overview
Medicare is a federal health insurance program that covers millions of Americans. In general, you are eligible for Medicare if you are 65 or older, or you are younger than 65 and meet criteria for certain disabilities, or have End-Stage Renal Disease (ESRD).
The Medicare basics have four main components:
Medicare Part A helps pay for inpatient hospital care, skilled nursing care, some home-health services, and hospice care.
Medicare Part B helps pay for physician services, outpatient hospital care, and other medical services not covered by Part A. Together, Parts A and B are known as Original Medicare.
Medicare Part C, usually known as Medicare Advantage, is offered by private health care organizations. These plans cover all services under Parts A and B and usually offer additional benefits.
Medicare Part D helps pay for outpatient prescription drugs and is available through private health care organizations such as Kaiser Permanente. Part C plans often include Medicare Part D coverage.
Medicare Advantage
September 9, 2014 by
What is Medicare Advantage
The Medicare Advantage program was created by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) which was passed in 2004. The program was designed to bring more affordable healthcare and prescription drug coverage to Medicare beneficiaries, expand health options and preventive care services and improve health access for those living in rural areas. Medicare Advantage plans replaced “Medicare + Choice” plans, an alternative to Original fee-for-service Medicare, and that is why Medicare Advantage plans are also known as Medicare Part C. An important aspect of Medicare Advantage plans is a mandatory maximum out-of-pocket amount for all Original Medicare services. After a beneficiary reaches the maximum out-of-pocket limit in a given coverage year, the plan must cover 100% of your remaining Original Medicare-covered costs for the remainder of the year. The mandatory maximum out-of-pocket limit for 2014 Medicare Advantage plans is $6,700 or less.
A Medicare Advantage Plan is a Medicare health insurance policy offered by a private insurance company. Medicare reimburses the insurance companies a fixed monthly amount for each member according to factors such as Medicare Advantage risk scores. Medicare enrollees often decide to receive healthcare coverage through a Medicare Advantage plan because many of these Medicare Part C plans can include more benefits (such as vision, dental, hearing, and health/wellness plans) than Original Medicare and most Medicare Advantage Plans provide prescription drug coverage.1 Medicare Advantage beneficiaries may have to pay a monthly premium for their additional benefits and most Medicare Advantage plans require copays for services. Some copays are lower than what a beneficiary would have to pay if they were enrolled in Original Medicare but copays for certain services can cost more.