How Medicare Advantage Plans Can Improve Care and Save Money.
July 11, 2017 by
Happy Birthday, You Qualify For Medicare. Now What?
July 11, 2017 by
Understanding Long-Term Care Insurance.
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.
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.
3 Medicare Enrollment Myths.
July 18, 2015 by
Medicare can be deeply confusing, and there are a lot of myths out there about how it works and what works best for a particular situation. Here are three myths that you need to watch out for to ensure that you don’t lose out on important coverage or get hit with big penalties.
Myth #1: I’m automatically enrolled
Unless you’re already getting Social Security or Railroad Retirement Board benefits when you turn 65, you will not be automatically enrolled in Medicare. You need to apply directly with Social Security to get on the books.
You can enroll anytime from three months before your 65th birthday month to three months after, meaning that you have a seven month period in which to choose the right plan for you. Part A is free, so it makes sense to sign up right away.
Of course, if you’re still working you might think that you don’t need Medicare Part B (which isn’t free), so there’s no point in enrolling. That brings us to myth number two:
Myth #2: I can wait to enroll
One thing you don’t want to do when it comes to Medicare is wait. Part A is free, so, again, no matter what your situation it makes sense to enroll right away.
When it comes to Part B, it generally makes sense to enroll as soon as you’re eligible, as making a mistake can be quite costly. Missing your enrollment can mean a permanent 10% annual increase in your Part B premium and a 1% monthly increase in your Part D premiums, which is probably not something you want to deal with.
What if you or your spouse are still working and have health insurance? In this case, check with your current provider to see how they work with Medicare. It might make sense to postpone — but don’t forget about signing up when you do retire. You’ll have eight months to do so.
Also, as a rule of thumb, if you work for a company with fewer than 20 people, it makes sense to sign up when you’re first eligible. That’s because smaller plans are allowed to drop you once you’re eligible for Medicare, and they might even refuse to pay Medicare-eligible claims.
If you’re retired and have health coverage, sign up anyway. This applies even if you have COBRA, a retiree health insurance plan, or veteran’s benefits. All of these plans become secondary plans once you’re signed up — and none of them exempt you from the late-enrollment penalties.
Myth #3: Once I’ve signed up, I’m done
While Parts A and B cover a fair amount, neither has out-of-pocket limits. That means that the 20% of costs you’re responsible for under A and B could add up to a lot of money should you need extensive treatment. This is the main argument for getting Medigap’s supplemental coverage or signing up for an Advantage plan.
But even here, it’s important to keep an eye out for gaps in coverage.
The Part D donut-hole is a great example. Part D provides for prescription drug coverage, but once you and the insurance company have collectively paid a certain amount on prescription drugs ($2,960 in 2015), you become responsible for significantly more of the cost — 45% of brand name drugs and 65% of generics. Once your out-of-pocket spending reaches $4,700, the donut-hole closes and you’ll pay a small amount on drugs for the rest of the year.
In other words, take the time to do your homework. Don’t just stop at Parts A and B, and remember to note the deductibles, premiums, and coverage limits in the plans you’re reviewing. Taking the time now can save you a lot of stress down the line.
What Medicare Does and Does Not Cover.
May 12, 2015 by
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Introduction
Medicare pays for many of your health-care needs and expenses—but not everything. Knowing what’s covered and what isn’t can help you plan for unexpected costs and budget for your annual health-care expenses.
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What Does Medicare Not Cover?
Medicare coverage doesn’t provide:
- long-term care (also called custodial care), such as nursing home stays or stays in an assisted-living center
- routine dental or eye care
- dentures
- cosmetic surgery
- acupuncture
- hearing aids and exams for fitting them
What Does Part A Cover?
Medicare Part A covers your inpatient hospital stays.
- You pay a deductible and no co-payment for days one to 60 each benefit period.
- You pay a co-payment for days 61 to 90 each benefit period.
- You pay a co-payment per “lifetime reserve day” after day 90 each benefit period (up to 60 days over your lifetime).
- You pay all costs for each day after the lifetime reserve days.
Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.
What Does Part A Cover? Continued
Medicare Part A will cover an inpatient stay in a skilled nursing facility—after you have stayed a minimum of three days in the hospital.
- You pay nothing for the first 20 days each benefit period.
- You pay a co-insurance per day for days 21 to 100 each benefit period.
- You pay all costs for each day after day 100 in a benefit period.
Hospice care facilities
- You pay nothing for hospice care.
- You pay a co-payment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management.
- • You pay five percent of the Medicare-approved amount for inpatient respite care.
Home health-care services
- You pay nothing for covered home health-care services.
- Blood transfusions
- You pay for the first three pints of blood if the hospital treating you had to buy the blood. It’s free if the blood was donated to the hospital or to you.you pay 20% of the Medicare-approved amount for durable medical equipment.
What Does Part B Cover?
- Doctor’s appointments, including specialists. You pay 20 percent co-insurance.
- Outpatient care, including outpatient hospital, medical, urgent care, tests, therapies, outpatient mental health, emergency, and ambulance services. You pay 20 percent co-insurance.
- Home health services. This is limited to medically necessary part-time care. You pay 20 to 25 percent co-insurance.
- Durable medical equipment. You pay a 20 percent co-insurance for items like oxygen, wheelchairs, and walkers.
Preventive and screening services. You pay 25 percent co-insurance for some screenings.
Preventive and screening services covered by Medicare Part B
Preventive and screening services covered by Medicare Part B
- abdominal aortic aneurysm ultrasound
- bone mass measurement (bone density)
- mammograms
- cardiovascular disease behavioral therapy
- cervical and vaginal cancer screenings
- colorectal cancer screenings
- diabetes screening
- glaucoma tests
- hearing and balance exams
- flu shot
- hepatitis B shots
- HIV screening
- obesity screening and counseling
- prostate cancer screenings
- tobacco cessation therapy
- yearly wellness visits
Emergency Services Covered by Medicare Part B
Medicare Part B covers ground ambulance transportation when you need to be taken to a hospital or emergency medical center. Medicare may also pay for emergency transportation in an airplane or helicopter if you need immediate and rapid transportation. You may have to pay a co-insurance payment on this service.
Supplies Covered by Medicare Part B
- diabetes self-management training
- diabetes supplies
- kidney dialysis services and supplies
- transplants and immunosuppressive therapy