Medicare Mistakes That Can Cost You

Medicare Supplement Insurance Plans are devised to aid people to pay for their additional health care expenses. These policies are blessings to those who are suffering from certain medical ailments. However, for some people, a Medicare Supplement Plan can prove to be costly because of common mistakes they make. Wondering what these mistakes are? You will find your answer in this post. Continue reading!

Not Choosing the Right Policy

One of the biggest mistake people make when buying Medicare Supplement Plans is that they choose the wrong policy. Thus, not all medical expenses are covered. As a result, they must pay for them and the plan isn’t as effective for them as they had thought of.  It is important to thoroughly compare different Medicare Supplement Insurance Plans, know their details and make the decision accordingly.

Not Signing Up at the Right Time

This is another common mistake made by people that cost them in the long run. People who have already received social security are automatically signed up for Medicare. However, for those who haven’t, it is important to sign up at the right time to avoid facing premium penalties.

Not Signing Up for Part D

Some people believe that buying Medicare Supplement Insurance Plans Part D is a mere waste of money if they don’t use prescribed drugs. However, this is a mistake that can cost them a fortune. This is because no one can predict the injuries or diseases they may suffer from in the future for which they require the use of prescribed drugs that can burn a hole in their pockets. Therefore, it is advised to sign up for part D so to avoid late penalties and get expensive drugs easily in case of emergency.

Not Paying Attention to Annual Notice of Change

All those people who have signed up for Medicare Advantage Plan or Part D, they receive notice of change in September every year. This notice contains vital information about changes in premiums and coverages. It is important to carefully read this notice of change and compare the premium price and coverage details of the current year with the next year. This will help you to decide whether you need to change your plan or stick to the current one. However, many people tend to ignore this notice of change and end up paying more for their Medicare policy.

There you go! These are some of the common mistakes that the owners of Medicare Supplement Insurance Plans make and end up paying a lot more than they should. It is firmly recommended to avoid making any of these mistakes with regards to your Medicare policies so that you can avail the maximum benefits out of them without disturbing your budget a great deal.

Learn more about Medicare Supplemental Insurance plans, rates and more at http://www.emedicare-supplemental-insurance.com.  Medicare Supplemental Insurance brokers will help you compare Medicare Supplemental Insurance rates and plans.  To talk to an expert in Medicare coverage toll free 877-202-9248 today!

How Medicare’s Private Plans Surpass the Traditional Program

Medicare Advantage, a system of competing private health plans, is surpassing the traditional Medicare fee-for-service program in delivering high quality, cost-effective medical care for senior and disabled citizens.

The prominent research firm Avalere recently published a major study showing that Medicare Advantage generally outperformed traditional Medicare. This was especially so in caring for the most challenging patients who suffer from chronic conditions and complicated medical problems.

Major structural differences between traditional Medicare and Medicare Advantage largely account for the differences in performance.

Traditional Medicare, enacted in 1965, pays doctors and other medical professionals on a fee-for-service basis, meaning that the government reimburses medical professionals a specific fee for every one of thousands of services provided to Medicare patients.

After almost two futile decades of trying to control costs, in the 1980s Congress overhauled hospital and physician payment. In 1989, Congress created a new physician payment system in which the government would reimburse Medicare doctors based on a calculation of the putative value of individual medical services—including the resources and time required to provide them—and capping the payment.

This bizarre reimbursement formula, plus subsequent payment updates, proved faulty. Medical stakeholders compromise the entire process because they also are involved in setting the prices of Medicare’s services and continuously fight to evaluate their own services higher, leading to questionable fee schedules, confusion, and inefficiency.

For years, traditional Medicare’s payment system generated perverse incentives, allowing hospitals, for example, to overtreat their patients, delivering more care and more services, more reimbursements, and higher revenues.

Congress created Medicare Advantage in 2003 as a new and improved market-based alternative to traditional Medicare, where private health plans, paid on a defined contribution basis, would provide comprehensive as well as tailored benefits and services to senior and disabled citizens.

Medicare Advantage turned out to be immensely popular, evident by sharply increasing annual enrollment. Today, those plans enroll 36 percent of all Medicare beneficiaries and the number should reach 41 percent by 2027.

Since its inception, Medicare Advantage has not escaped criticism. Initially, critics focused on failure to achieve cost savings. They also charged Medicare Advantage plans with using schemes such as gym memberships in selectively choosing healthier patients.

In fact, many of these early studies were narrow in scope. By contrast, the Avalere study used a much broader dataset known as the MORE2 Registry to generate representative samples of 1,813,937 Medicare Advantage beneficiaries to compare against data from the Centers for Medicare and Medicaid Services for 1,376,573 traditional Medicare beneficiaries.

Medicare Advantage does not enroll healthier beneficiaries. In many cases, the plans had fewer healthy beneficiaries. The Avalere data: 36 percent of Medicare Advantage beneficiaries enrolled with disabilities, compared to 22 percent in traditional Medicare.

Perhaps more importantly, in comparing beneficiaries with complex medical conditions (two or more of the following: hypertension, hyperlipidemia, and diabetes), the Medicare Advantage population essentially mirrored the traditional Medicare population.

While 30.6 percent of the Medicare Advantage population suffered from all three medical conditions, 27.9 percent of the traditional Medicare population also did. Among Avalere’s total study population, the traditional Medicare population was not “sicker” than the Medicare Advantage population.

Of special interest to Washington policymakers, Medicare Advantage still achieved better outcomes for beneficiaries than traditional Medicare did with equivalently sick, chronically ill populations.

For example, 8.2 percent of Medicare Advantage beneficiaries with complex diabetes had complications, compared with 17.1 percent of traditional Medicare beneficiaries. And Medicare Advantage beneficiaries with clinically complex diabetes had 5.7 percent lower costs than those in the Medicare fee-for-service program.

Medicare Advantage plans also had far better results in caring for dual-eligible beneficiaries with chronic conditions. The plans achieved a lower total cost of care, with more office visits but fewer hospitalizations than beneficiaries in traditional Medicare. Dual-eligible beneficiaries also received more preventive care services than traditional Medicare beneficiaries, resulting in lower aggregate costs for “high need” patients, less use of high-cost health care services, and higher quality results.

Avalere’s results confirm previous findings in the professional literature. For instance, a large 2015 study in the American Journal of Managed Care found that relative resource use, the medical resources used to treat disease, was lower in Medicare Advantage compared to traditional Medicare patients with diabetes and cardiovascular conditions.

The study also found that patients with Medicare Advantage plans received better quality ambulatory care. This echoed the Avalere finding that Medicare Advantage spent proportionally more money on office visits than inpatient hospital services, compared to traditional Medicare.

Health Affairs study found that the increasing proportion of enrollees on Medicare Advantage was associated with a decrease in per capita spending under traditional Medicare.

Counties that had larger increases in Medicare Advantage spent less per patient on Medicare, suggesting that it delivered more cost-effective care than traditional Medicare and was able to generate cost savings throughout the system.

The availability of more comprehensive data shows that Medicare Advantage is, in fact, a genuine advantage for Medicare beneficiaries. As this latest Avalere study indicates, Medicare Advantage is more cost-effective than traditional fee-for-service Medicare, especially in treating patients with complex medical problems.

Congress and President Donald Trump should recognize the success of the Medicare Advantage program and its superior performance in serving Medicare beneficiaries in a cost-effective fashion while increasing their quality of care.

Future reform of Medicare is necessary, and Washington policymakers should build upon this successful expansion of personal choice and market competition.

Original Source: https://www.dailysignal.com/2018/08/06/how-medicares-private-plans-surpass-the-traditional-program/

These are the biggest mistakes people make with Medicare

How you can avoid them

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Prescription medicine is the most significant medical expense for most Medicare beneficiaries.

This article is reprinted by permission from NextAvenue.org.

Most Americans in, or near, retirement know too little about Medicare, causing them to pay far more out-of-pocket for retirement medical care than they should and make big Medicare mistakes.

Many people believe Medicare — the federal health insurance program for people 65 and older — covers all or most retirement medical expenses. It doesn’t. The average Medicare beneficiary pays $8,000 or more for medical expenses annually, or about half the medical costs he or she incurs. And at least 90% of Medicare beneficiaries pay more out-of-pocket for their medical care than necessary, according to Katy Votava of Goodcare.com, an independent consulting firm specializing in the economics of health care.

Fortunately, you can reduce out-of-pocket payments for retirement medical care whether you enroll in traditional Medicare (also known as Medicare Part B) or in a Medicare Advantage plan (also known as Medicare Part C), offered by private companies to cover Medicare benefits.

Traditional Medicare

Let’s first look at the Traditional Medicare option.

Traditional Medicare has premiums, deductibles, copayments and coinsurance. But dental, vision, prescription drugs and some other types of care aren’t covered.

You can decide to enroll only in Medicare Part B. Then, you’ll pay out of pocket for everything it doesn’t cover. You’ll also have a lot of uncertainty about your future health care spending.

Before deciding to sign up for only Medicare Part B, consider its two biggest gaps: prescription drugs and coinsurance (when you and your insurance plan share the cost of a medical service; for most Medicare Part B services, you pay 20% and Medicare pays 80%).

Prescription medicine is the most significant medical expense for most beneficiaries, and the fastest rising. Over the past five years, according to a 2018 report from Sen. Claire McCaskill (D-Mo.), the prices for each of the 20 most prescribed brand-name drugs for Medicare Part D beneficiaries increased 12% a year, on average — about 10 times higher than inflation.

Even if you don’t need prescription medicines now, you’re likely to in the future. You’ll be on your own for those costs if you have only Medicare Part B.

The coinsurance gap also is potentially substantial. When you need an expensive procedure, such as a hip replacement or heart surgery, you owe 20% of the total cost. That can be tens of thousands of dollars, or more.

Two steps to cover gaps in health coverage in retirement

Two steps can help you cover a large part of these two gaps as well as other gaps in traditional Medicare:

Step 1: Purchase a Medicare Supplement (or Medigap) insurance policy.

There are 10 standardized Medigap plans, identified by letters, with varying amounts of coverage. Choose the plan that meets your needs and budget.

For example, Plan F provides the broadest coverage, which means you’ll have few out-of-pocket expenses with this one. Medicare Plan F will be eliminated beginning in 2020, but you’ll be able to renew an existing Plan F if you enroll before 2020.

Plan G has the next broadest coverage and will continue in 2020 and after. The only difference between Plan F and Plan G is that Plan G doesn’t cover the annual Part B deductible, which is $183 in 2018. Other Medigap plans cover fewer of the gaps, but they are likely to charge lower premiums.

After deciding on the Medigap plan you want, shop around. Since the plans are standardized, insurers compete on premiums and service, not coverage. Surveys have found that premiums on identical Medigap policies differ by as much a 100%.

Step 2: Purchase a Medicare Part D Prescription Drug policy.

Part D policies aren’t standardized. In most areas of the country, you can find policies with a range of premiums, deductibles, and copayments. But the most important feature is the covered medications, known as the formulary. Insurers decide which medicines they’ll cover, so you need to compare the specific medications covered by a policy with those you are taking or think you might need in the future.

Details about Medigap and Part D policies available in your area can be found at medicare.gov or by calling 800-MEDICARE. You also might receive help from your local Area Agency on Aging or you can consider working with a financial professional with expertise in Medicare.

Medicare Advantage plans

Now back to Medicare Advantage plans: Enrolling in a Medicare Advantage plan is the alternative to traditional Medicare. About a third of Medicare beneficiaries are enrolled in Medicare Advantage plans, and that’s expected to grow to 40% in the next few years.

Most Medicare Advantage plans offer in one package all the elements of traditional Medicare, Medigap and Part D. Many also add vision and dental benefits and often other benefits. Medicare Advantage plans tend to be managed care plans in which doctors and care are more coordinated and proactive than under traditional Medicare.

Importantly, a Medicare Advantage plan has an annual limit on a beneficiary’s out-of-pocket spending for covered care.

With Medicare Advantage plans, you’re likely to receive broader coverage than Traditional Medicare at a lower cost. But you’ll also give up some flexibility and choice.

Under Medicare Advantage plans, you generally see doctors and other health providers that are in the plan’s network. Care by specialists usually isn’t covered unless it is approved in advance. When you see an out-of-network provider or seek care without prior approval, you might pay extra or find the care isn’t covered by the plan at all. (Under Traditional Medicare, the plan pays the doctor of your choice if the physician participates in Medicare. You can also decide whether to see a specialist and which specialist to see. If Medicare Part B covers the treatment, Medicare pays its share.)

Prescriptions are covered under Medicare Advantage plans, but with the same caveats as for Part D plans. Before choosing a Medicare Advantage plan, review the formulary and other details to ensure that your prescriptions will be covered.

Medicare Advantage plans aren’t all the same, so if you’re attracted to the concept and more than one is offered in your area, compare their coverage and cost details.

Also, be aware that Medicare Advantage plans aren’t available nationwide. If you move, your plan might not be available in the new area. You’ll then have to find a new Medicare Advantage plan or opt for Traditional Medicare.

Whichever route you choose, keep in mind that neither Medicare option covers much long-term care. You’ll need to make other plans to pay for long-term care costs.

Original Source: https://www.marketwatch.com/story/these-are-the-biggest-mistakes-people-make-with-medicare-2018-07-23

Original Date: July 23 2018

Written By: Bob Carlson

Benefits of Working with a Medicare Supplemental Insurance Plan Agent

Medicare supplemental insurance plans can be downright confusing, which is why it is always best for a person to utilize an agent throughout the entire process of finding a plan.  A Medicare supplemental insurance agent knows the details of each plan and can help a person choose the one that fits their needs the best.

Here are 6 Benefits of Working with a Medicare Supplemental Insurance Plan Agent:

  • Saves Time

Since the Medicare supplemental insurance plan agents know all the lingo and idiosyncrasies of each plan, they can save a person a lot of time during the researching process.  A person can simply go talk to a Medicare supplemental insurance plan agent instead of spending hours doing their own research to come up with the same results.

  • Learn More

Medicare supplemental insurance plan agents take their jobs seriously, and they want everyone that they talk to, to learn as much as they can about the different types of available plans.  Everyone will know all their options and how they work side by side with Medicare Parts A and B.

  • Saves Money

There are never any fees when a person works with a Medicare supplemental insurance plan agent, so no one needs to worry about receiving a large bill at the end of the session.  Plus, these agents can give a person multiple quotes for different policies, so that they can choose the best coverage for the lowest rate.

  • Receive Unbiased Advice

No Medicare supplemental insurance plan agents make more money selling one plan over any of the others, so everyone can remain confident that they are receiving unbiased advice during their meetings.

  • Purchase a Medicare Supplemental Insurance Plan at the Right Time

Medicare supplemental insurance plan agents will ensure that everyone knows when the best time is to purchase their plan.  It is important for a person to apply for coverage during their initial enrollment period, because during that time they cannot be rejected, charged a higher premium, or have the start of their coverage delayed.

  • No Second-Guessing Choices

There is never a need for a person to second guess their choices when they work with a Medicare supplemental insurance plan agent, because they know that they are receiving the best coverage for the lowest price without overlooking anything important.

Anyone that is in the process of purchasing a Medicare supplemental insurance plan or who will be in the future, will want to set up a meeting with an agent sooner than later.  After all, why should anyone do a ton of work, when someone has done it all for them already?

Learn more about Medicare Supplemental Insurance plans, rates and more at http://www.emedicare-supplemental-insurance.com.  Medicare Supplemental Insurance brokers will help you compare Medicare Supplemental Insurance rates and plans.  To talk to an expert in Medicare coverage toll free 877-202-9248 today!

 

10 Things You Need to Know About Medicare

Heading into retirement brings a slew of new topics to grapple with, and one of the most maddening may be Medicare. Figuring out when to enroll in Medicare and which parts to enroll in can be daunting even for the savviest retirees. There’s Part A, Part B, Part D, medigap plans, Medicare Advantage plans and so on. And what the heck is a doughnut hole, anyway? To help you wade into the waters of this complicated federal health insurance program for retirement-age Americans, here are 10 essential things you must know about Medicare.

Medicare Comes With a Cost

Medicare is divided into parts. Part A, which pays for hospital services, is free if either you or your spouse paid Medicare payroll taxes for at least ten years. (People who aren’t eligible for free Part A can pay a monthly premium of several hundred dollars.) Part B covers doctor visits and outpatient services, and it comes with a monthly price tag—the standard premium in 2018 is $134 per month. Part D, which covers prescription-drug costs, also has a monthly charge that varies depending on which plan you choose; the average Part D premium is about $35 a month. In addition to premium costs, you’ll also be subject to co-payments, deductibles and other out-of-pocket costs.

You Can Fill the Gap

You Can Fill the Gap

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Beneficiaries of traditional Medicare will likely want to sign up for a medigap supplemental insurance plan offered by private insurance companies to help cover deductibles, co-payments and other gaps. You can switch medigap plans at any time, but you could be charged more or denied coverage based on your health if you choose or change plans more than six months after you first signed up for Part B. Medigap policies are identified by letters A through N. Each policy that goes by the same letter must offer the same basic benefits, and usually the only difference between same-letter policies is the cost. Plan F is the most popular policy because of its comprehensive coverage. A 65-year-old man could pay from $1,226 to $7,405 in 2018 for Plan F, depending on the insurer, according to Weiss Ratings.

There Is an All-in-One Option

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You can choose to sign up for traditional Medicare: Parts A, B and D, and a supplemental medigap policy. Or, you can go an alternative route by signing up for Medicare Advantage, which provides medical and prescription-drug coverage through private insurance companies. Also called Part C, Medicare Advantage has a monthly cost, in addition to the Part B premium, that varies depending on which plan you choose. With Medicare Advantage, you don’t need to sign up for Part D or buy a medigap policy. Like traditional Medicare, you’ll also be subject to co-payments, deductibles and other out-of-pocket costs, although the total costs tend to be lower than for traditional Medicare. In many cases, Advantage policies charge lower premiums but have higher cost-sharing. Your choice of providers may be more limited with Medicare Advantage than with traditional Medicare, and recent research has found that sicker enrollees often dump Medicare Advantage in favor of original Medicare.

High Incomers Pay More

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If you choose traditional Medicare and your income is above a certain threshold, you’ll pay more for Parts B and D. Premiums for both parts can come with a surcharge when your adjusted gross income (plus tax-exempt interest) is more than $85,000 if you are single or $170,000 if married filing jointly. In 2018, high earners pay $187.50 to $428.60 per month for Part B, depending on their income level, and they also pay extra for Part D coverage, from $13.00 to $74.80 on top of their regular premiums.

When to Sign Up

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If you are already taking Social Security benefits, you will be automatically enrolled in Parts A and B. You can choose to turn down Part B, since it has a monthly cost; if you keep it, the cost will be deducted from Social Security if you already claimed benefits.

For those who have not started Social Security, you will have to sign yourself up for Parts A and B. The seven-month initial enrollment period begins three months before the month you turn 65 and ends three months after your birthday month. To ensure coverage starts by the time you turn 65, sign up in the first three months.

A Quartet of Enrollment Periods

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There are several enrollment periods, in addition to the seven-month initial enrollment period. If you missed signing up for Part B during that initial enrollment period and you aren’t working (or aren’t covered by your spouse’s employer coverage), you can sign up for Part B during the general enrollment period that runs from January 1 to March 31. Coverage will begin on July 1. But you will have to pay a 10% penalty for life for each 12-month period you delay in signing up for Part B. Those who are covered by a current employer’s plan, though, can sign up later without penalty during a special enrollment period, which lasts for eight months after you lose that employer coverage. If you miss your special enrollment period, you will need to wait until the general enrollment period to sign up.

Costs in the Doughnut Hole Shrinking

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One cost for Medicare is decreasing: the dreaded Part D “doughnut hole.” That is a coverage gap in which you’ll face higher out-of-pocket costs for your drugs. For 2018, the coverage gap begins when the total amount you and your plan have paid for your drugs reaches $3,750. While in the doughnut hole, you’ll receive a 65% discount on brand-name drugs and a 56% federal subsidy for generic drugs in 2018. Catastrophic coverage, with the government picking up most costs, begins when a patient’s out-of-pocket costs reach $5,000.

You Get More Free Preventive Services

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Medicare beneficiaries can receive a number of free preventive services. You get an annual free “wellness” visit to develop or update a personalized prevention plan. Beneficiaries also get a free cardiovascular screening every five years, annual mammograms, annual flu shots, and screenings for cervical, prostate and colorectal cancers.

What Medicare Does Not Cover

While Medicare covers your health care, it generally does not cover long-term care—an important distinction. Under certain conditions, particularly after a hospitalization to treat an acute-care episode, Medicare will pay for medically necessary skilled-nursing facility or home health care. But Medicare generally does not cover costs for “custodial care”—that is, care that helps you with activities of daily living, such as dressing and bathing. To cover those costs, you will have to rely on your savings, long-term-care insurance or Medicaid—if you meet the income and asset requirements. Traditional Medicare also doesn’t cover routine dental or eye care and some items such as dentures or hearing aids.

You Have the Right to Appeal

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If you disagree with a coverage or payment decision made by Medicare or a Medicare health plan, you can file an appeal. The appeals process has five levels, and you can generally go up a level if your appeal is denied at a previous level. Gather any information that may help your case from your doctor, health care provider or supplier. If you think your health would be seriously harmed by waiting for a decision, you can ask for a fast decision to be made and if your doctor or Medicare plan agrees, the plan must make a decision within 72 hours.

Original Source: https://www.kiplinger.com/slideshow/retirement/T039-S009-10-things-you-need-to-know-about-medicare/index.html

Original Date: July 24 2018

Original Author: the Editors of Kiplinger’s Retirement Report

What Do Medicare Plans Actually Cover?

Medicare, which was launched in 1966, is the national health insurance program for people over 65 years old and is administered by the United States federal government’s Social Security Administration. It is funded by worker payroll taxes, taxes from beneficiaries and a few government subsidies. The overarching goal of Medicare is to cover enrollees over 65 years old for at least half of their healthcare costs while they cater for the other half out-of-pocket. As already mentioned, in order to qualify for Medicare, one has to be 65 years of age or older or be receiving social security disability or have End Stage Renal Failure. The program is divided into Medicare Part A, Part B, Part C and Part D.

Understandably, Medicare is designed to defray healthcare costs for seniors and those with certain disabilities. Initially, Medicare consisted solely of hospital insurance but was later adjusted to pay for additional services prescription drugs. This entailed the creation of the four parts to the plan: Part A, B, (Original Medicare) C (Medicare Advantage) and D (Medigap Prescription Plan Coverage).

Medicare Part A is actually hospital insurance and covers anyone who is found eligible. It covers mostly inpatient care including hospital stay, skilled nursing facilities, and care, and hospice facilities with some home health care also included. It is not intended to cover custodial or long-term care. The good news about Medicare Part A is that enrollees need not pay a premium for this portion.

Part B is termed medical insurance. Its goal is to cover medically-necessary services such as lab tests, doctors’ services, diagnostics, therapy and general outpatient care including some preventive screenings. It is intended to cater for portions of Medicare that Part A does not cover. Enrollees have to pay a premium for Medicare Part B although it is optional.

Medicare Part C is also known as Medicare Advantage. It is said to contain more or less the same coverage and enrollee gets from parts A and B. The only difference is its benefits are administered by private insurers rather than the federal government. Enrollees, in turn, pay their premiums directly to this private insurer. Medicare Part C is optional as well and enrollees can opt for it instead of Part A and B.

Medicare Advantage is often compared to coverage of Original Medicare and Medigap as it a plan that covers gaps left with Original Medicare. An enrollee has the option to choose one or the other with the difference being benefits are administered by the private entity rather than Medicare itself. Many people view Medicare Advantage plans (Part C) as subtle replacements for Parts A, B, and D.

Medicare Part D involves prescription drug coverage and is only offered through private companies which are government-certified and approved by the Centers for Medicare and Medicaid Services. It is also optional, and enrollees have to pay a premium directly to the private insurance company.

Learn more about Medicare Supplemental Insurance plans, rates and more at http://www.emedicare-supplemental-insurance.com.  Medicare Supplemental Insurance brokers will help you compare Medicare Supplemental Insurance rates and plans.  To talk to an expert in Medicare coverage toll free 877-202-9248 today!

 

 

 

Avoid These Big Medicare Mistakes People Make

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Most Americans in, or near, retirement know too little about Medicare, causing them to pay far more out-of-pocket for retirement medical care than they should and make big Medicare mistakes.

Many people believe Medicare — the federal health insurance program for people 65 and older — covers all or most retirement medical expenses. It doesn’t. The average Medicare beneficiary pays $8,000 or more for medical expenses annually, or about half the medical costs he or she incurs. And at least 90% of Medicare beneficiaries pay more out-of-pocket for their medical care than necessary, according to Katy Votava of Goodcare.com, an independent consulting firm specializing in the economics of health care.

Fortunately, you can reduce out-of-pocket payments for retirement medical care whether you enroll in traditional Medicare (also known as Medicare Part B) or in a Medicare Advantage plan (also known as Medicare Part C), offered by private companies to cover Medicare benefits.

Traditional Medicare

Let’s first look at the Traditional Medicare option.

Traditional Medicare has premiums, deductibles, co-payments and co-insurance. But dental, vision, prescription drugs and some other types of care aren’t covered.

You can decide to enroll only in Medicare Part B. Then, you’ll pay out of pocket for everything it doesn’t cover. You’ll also have a lot of uncertainty about your future health care spending.

Before deciding to sign up for only Medicare Part B, consider its two biggest gaps: prescription drugs and co-insurance (when you and your insurance plan share the cost of a medical service; for most Medicare Part B services, you pay 20% and Medicare pays 80%).

Prescription medicine is the most significant medical expense for most beneficiaries, and the fastest rising. Over the past five years, according to a 2018 report from Sen. Claire McCaskill (D-Mo.), the prices for each of the 20 most prescribed brand-name drugs for Medicare Part D beneficiaries increased 12% a year, on average — about 10 times higher than inflation.

Even if you don’t need prescription medicines now, you’re likely to in the future. You’ll be on your own for those costs if you have only Medicare Part B.

The co-insurance gap also is potentially substantial. When you need an expensive procedure, such as a hip replacement or heart surgery, you owe 20% of the total cost. That can be tens of thousands of dollars, or more.

Two Steps to Cover Gaps in Health Coverage in Retirement

Two steps can help you cover a large part of these two gaps as well as other gaps in traditional Medicare:

Step 1: Purchase a Medicare Supplement (or Medigap) insurance policy.

There are 10 standardized Medigap plans, identified by letters, with varying amounts of coverage. Choose the plan that meets your needs and budget.

For example, Plan F provides the broadest coverage, which means you’ll have few out-of-pocket expenses with this one. Medicare Plan F will be eliminated beginning in 2020, but you’ll be able to renew an existing Plan F if you enroll before 2020.

Plan G has the next broadest coverage and will continue in 2020 and after. The only difference between Plan F and Plan G is that Plan G doesn’t cover the annual Part B deductible, which is $183 in 2018. Other Medigap plans cover fewer of the gaps, but they are likely to charge lower premiums.

After deciding on the Medigap plan you want, shop around. Since the plans are standardized, insurers compete on premiums and service, not coverage. Surveys have found that premiums on identical Medigap policies differ by as much a 100%.

Step 2: Purchase a Medicare Part D Prescription Drug policy.

Part D policies aren’t standardized. In most areas of the country, you can find policies with a range of premiums, deductibles, and co-payments. But the most important feature is the covered medications, known as the formulary. Insurers decide which medicines they’ll cover, so you need to compare the specific medications covered by a policy with those you are taking or think you might need in the future.

Details about Medigap and Part D policies available in your area can be found at www.medicare.gov or by calling 800-MEDICARE. You also might receive help from your local Area Agency on Aging or you can consider working with a financial professional with expertise in Medicare.

Medicare Advantage Plans

Now back to Medicare Advantage plans: Enrolling in a Medicare Advantage plan is the alternative to traditional Medicare. About a third of Medicare beneficiaries are enrolled in Medicare Advantage plans, and that’s expected to grow to 40% in the next few years.

Most Medicare Advantage plans offer in one package all the elements of traditional Medicare, Medigap and Part D. Many also add vision and dental benefits and often other benefits. Medicare Advantage plans tend to be managed care plans in which doctors and care are more coordinated and proactive than under traditional Medicare.

Importantly, a Medicare Advantage plan has an annual limit on a beneficiary’s out-of-pocket spending for covered care.

With Medicare Advantage plans, you’re likely to receive broader coverage than Traditional Medicare at a lower cost. But you’ll also give up some flexibility and choice.

Under Medicare Advantage plans, you generally see doctors and other health providers that are in the plan’s network. Care by specialists usually isn’t covered unless it is approved in advance. When you see an out-of-network provider or seek care without prior approval, you might pay extra or find the care isn’t covered by the plan at all.  (Under Traditional Medicare, the plan pays the doctor of your choice if the physician participates in Medicare. You can also decide whether to see a specialist and which specialist to see. If Medicare Part B covers the treatment, Medicare pays its share.)

Prescriptions are covered under Medicare Advantage plans, but with the same caveats as for Part D plans. Before choosing a Medicare Advantage plan, review the formulary and other details to ensure that your prescriptions will be covered.

Medicare Advantage plans aren’t all the same, so if you’re attracted to the concept and more than one is offered in your area, compare their coverage and cost details.

Also, be aware that Medicare Advantage plans aren’t available nationwide. If you move, your plan might not be available in the new area. You’ll then have to find a new Medicare Advantage plan or opt for Traditional Medicare.

Whichever route you choose, keep in mind that neither Medicare option covers much long-term care. You’ll need to make other plans to pay for long-term care costs.

Original Source: https://www.forbes.com/sites/puremichigan/2018/06/25/5-reasons-michigan-has-become-the-silicon-valley-of-mobility-tech/#290a865f3bfa

Original Date: Jul  10 2018

Written by: Bob Carlson

What Do Medicare Plans Actually Cover?

Medicare, which was launched in 1966, is the national health insurance program for people over 65 years old and is administered by the United States federal government’s Social Security Administration. It is funded by worker payroll taxes, taxes from beneficiaries and a few government subsidies. The overarching goal of Medicare is to cover enrollees over 65 years old for at least half of their healthcare costs while they cater for the other half out-of-pocket.

 

As already mentioned, in order to qualify for Medicare, one has to be 65 years of age or older or be receiving social security disability or have End Stage Renal Failure. The program is divided into Medicare Part A, Part B, Part C, and Medicare Supplemental Insurance Policies including Medicare Plan D, prescription drug coverage.

 

Understandably, Medicare is designed to defray healthcare costs for seniors and those with certain disabilities. Initially, Medicare consisted solely of hospital insurance and medical insurance but was later adjusted to cover additional expenses with the purchase of additional insurance called Medicare Supplemental Insurance Plans.

 

Medicare Part A is actually hospital insurance and covers anyone who is found eligible. It covers mostly inpatient care including hospital stay, skilled nursing facilities, and care, and hospice facilities with some home health care also included. It is not intended to cover custodial or long-term care. The good news about Medicare Part A is that enrollees need not pay a premium for this portion.

 

Part B is termed medical insurance. Its goal is to cover medically-necessary services such as lab tests, doctors’ services, diagnostics, therapy and general outpatient care including some preventive screenings. It is intended to cater for portions of Medicare that Part A does not cover. Enrollees have to pay a premium for Medicare Part B although it is optional

 

Medicare Part C is also known as Medicare Advantage. It is said to contain more or less the same coverage and enrollee gets from Medicare Parts A and B and supplemental insurance plans. The only difference is its benefits are administered by private insurers rather than the federal government. Enrollees, in turn, pay their premiums directly to this private insurer. Medicare Part C is optional as well and enrollees can opt for it instead of Part A and B.

 

Medicare Advantage has often been referred to as supplemental insurance because it covers the gaps left by Medicare. The difference between Medicare Advantage and Medicare Supplemental Insurance Plans, Medigap, is that Medigap coverage is purchased in addition to Original Medicare coverage. An enrollee has the option to choose one or the other with the difference being benefits are administered by the private entity rather than Medicare itself. Many people view Medicare Advantage plans (Part C) as subtle replacements for Parts A, B, and D.

 

Medicare Plan D involves prescription drug coverage and is only offered through private companies which are government-certified and approved by the Centers for Medicare and Medicaid Services, it is just one of ten Medicare Supplemental Insurance Plans available to Original Medicare Part A and Part B enrollees. It is also optional, and enrollees have to pay a premium directly to the private insurance company.

 

Learn more about Medicare Supplemental Insurance plans, rates and more at http://www.emedicare-supplemental-insurance.com.  Medicare Supplemental Insurance brokers will help you compare Medicare Supplemental Insurance rates and plans.  To talk to an expert in Medicare coverage toll free 877-202-9248 today!

13 Things Medicare Won’t Tell You

Medicare provides health coverage for than 57 million people—it’s a godsend, but it can be a challenge to navigate. Here’s some insider know-how that will help you put the Medicare pieces together.

Tap into savings programs

Miniature business people stand on pile of money coin. Cash is king financial concept and more buy power.Vanilllla/ShutterstockThere are Medicare Savings Programs that can help pay for Part A and B premiums and out-of-pocket medical costs associated with deductibles and co-pays. “In addition, growing numbers of seniors who qualify for Medicaid are unaware of their eligibility for special Medicare Advantage plans that offer broader provider networks and richer medical benefits than available under Medicaid alone,” says Lisa Zamosky, senior director of consumer affairs for eHealthMedicare.com. If some of these Medicare terms sound like alphabet soup, this Medicare glossary of terms and definitions can help.

Use expert resources

Business Concept. Two tiny miniature figures of businessman standing on a bank book document with a handshake and group of businessman miniature figure standing around for a meeting.Montri Thipsorn/ShutterstockCustomer support teams for your Medicare or Medicare Advantage providers can be extremely valuable assets. They have the personalized data and resources to help make recommendations suited to your specific needs. “For example, if Spanish is your first language and you have difficulty scheduling or attending pre-determined appointments, they can help you find a Spanish-speaking primary care physician that encourages walk-ins. Additionally, if you have to visit a cardiologist, but are not fond of rigorous medical exams, they can help you find one that avoids over-testing,” says Vivek Garipalli, CEO and co-founder of Clover Health. If you’re still puzzling over the differences in these two plans, here’s our quick-tips guide to understanding Medicare.

Find state relief

Drog overdose concept. Macro photokirill_makarov/ShutterstockMany states offer subsidies to help with medical costs for Medicare recipients below a certain economic threshold. However, there is no systemized process for applying, and you may have to reapply every year, says Garipalli. “Customer support specialists from your Medicare provider can help or provide you with additional information in considering these options.” Here are 10 secrets to lowering your medical bills.

Realize you have some wiggle room

Miniature businessman thinking and standing on calendars using as business goals or future thinking.eamesBot/ShutterstockThere are limited periods during the year when people can sign up, change, or leave a Medicare Advantage or Part D drug plan. However, many people are unaware of their options when they’re not in the open-enrollment period. Life-changing circumstances, such as moving, entering a skilled nursing facility, or losing coverage because a Medicare plan is no longer available, can allow you to make changes to coverage throughout the calendar year. “During a special enrollment period, people can switch from Original Medicare with a stand-alone Part D plan to a Medicare Advantage plan that includes Part D drug coverage at no extra cost and find savings,” says Zamosky. If you’re a caregiver of a Medicare patient, here’s a quick lesson in how Medicare works.

Medicare Mistakes That Can Cost You

Medicare supplement insurance plans are devised to aid people to pay for their health care expenses. It isn’t wrong to state these policies are blessings to those who are suffering from certain medical ailments. However, for some people, a Medicare supplement plan can actually prove to be costly because of the common mistakes made when selecting a Medigap plan.

Not Choosing the Right Policy

One of the biggest mistake people make when buying Medicare supplement plans is that they choose the wrong policy. Thus, not all of their medical visits are covered. As a result, they still have to pay for them and the plan isn’t as effective for them as they had thought of. Therefore, it is important to thoroughly go through different Medicare supplement insurance plans, know their details, and take the decision accordingly.

Not Signing Up at the Right Time

This is another common mistake made by people that cost them in the long run. Those people who have already received their social security, they are automatically signed up for Medicare. However, for those who haven’t, it is important to sign up at the right time to avoid facing premium penalties.

Not Signing Up for Part D

Some people believe that buying part D Medicare supplement insurance plans is a mere waste of money if they don’t use prescribed drugs. However, this is a mistake that can cost them a fortune. This is because no one can predict the injuries or diseases they may suffer from in the future for which they require the use of prescribed drugs that can burn a hole in their pockets. Therefore, it is advised to sign up for part D so in order to avoid late penalties and get expensive drugs easily in case of emergency.

Not Paying Attention to Annual Notice of Change

All those people who have signed up for Medicare advantage plan or Part D, they receive notice of change in September every year. This notice contains vital information about changes in premiums and coverages. It is important to carefully read this notice of change and compare the premium price and coverage details of the current year with the next year. This will help you to decide whether you need to change your plan or stick to the current one. However, many people tend to ignore this notice of change and end up paying more for their Medicare policy.

There you go! These are some of the common mistakes that the owners of Medicare supplement insurance plans make and end up paying a lot more than they should. It is firmly recommended to avoid making any of these mistakes with regards to your Medicare policies so that you can avail the maximum benefits out of them without disturbing your budget a great deal.

Learn more about Medicare Supplemental Insurance plans, rates and more at http://www.emedicare-supplemental-insurance.com.  Medicare Supplemental Insurance brokers will help you compare Medicare Supplemental Insurance rates and plans.  To talk to an expert in Medicare coverage toll free 877-202-9248 today!