Which letter? Find the right Medicare package

It’s open enrollment season; here’s a primer in finding the right Medicare answers for you

If picking a Medicare plan makes you panic, you’re not alone.

Most people avoid the whole thing as long as possible, but “it’s not as scary as it seems,” said Jim Murphy, a Statewide Health Insurance Benefits Advisors volunteer in Moscow who offers free advice about health insurance to senior adults.

With enrollment currently open for Medicare parts C and D, now is the time for many seniors to take some decisive action. And thanks to volunteer advisers, it’s not something you have to figure out on your own.

Murphy offered this basic information about Medicare, the current open enrollment season and help that is available for those seeking to enroll:

Q: What are the different parts of Medicare?

A: Medicare is broken into four main parts:

Medicare Part A is hospital insurance that covers inpatient stays and is free or very low cost.

Medicare Part B is medical insurance that covers doctors’ services, diagnostic and preventive care. This low-cost insurance generally covers 80 percent of the fees.

Medicare Part C, also called Medicare Advantage Plans, are offered by private companies that contract with Medicare to provide coverage. This can include dental and vision coverage.

Medicare Part D is prescription drug insurance provided through private companies.

Additionally, Medicare supplemental insurance, also called Medigap, is offered by private insurers and helps to cover costs not covered by other parts of Medicare, for example, the 20 percent not covered by Medicare Part B. For more information visit www.medicare.gov.

Q: When do I enroll for Medicare?

A: It depends. People younger than 65 who are already receiving Social Security or railroad retirement benefits will be automatically enrolled in Medicare parts A and B when they turn 65.

Anyone using Medicaid will get Medicare for free (Medicaid pays the Medicare premium), plus extra help to assist with Part D.

Most people enroll in Medicare around age 65, during a seven-month window called the Initial Enrollment Period that begins three months prior to the month of their birthday and continues through their birthday month and the three months following. Some people are automatically enrolled for Medicare parts A and/or B, and some must enroll manually. Advisers can help individuals determine if they need to enroll.

A person can also enroll during the General Enrollment Period from Jan. 1 to March 31, but there can be late-enrollment penalties for not signing up for Medicare when you are first eligible. If a person has health coverage through their employer or spouse’s employer, however, they can delay Medicare Part B enrollment without penalty by enrolling during the General Enrollment Period or an eight-month Special Enrollment Period that begins the month the employment or health coverage ends.

Q: How do I enroll for Medicare?

A: There are three ways to enroll for Medicare parts A and/or B. You can visit your local social security office, call (800) 772-1213 or go online to www.socialsecurity.gov.

Q: Am I required to enroll in Medicare?

A: No. However, if you do not enroll when you are first eligible, you may have to pay higher premiums as a penalty when you enroll later.

Q: What is the purpose of the current open enrollment season?

A: The current enrollment season allows those with Medicare to enroll in or make changes to Medicare parts C or D without penalty. The enrollment window runs from Oct. 15 to Dec. 7.

More information about enrolling in other parts of Medicare is available by talking to a SHIBA volunteer advisor or visiting www.medicare.gov.

Q: Why might I want to get help selecting a Medicare Plan D or Medicare Advantage Plan?

A: There are many Medicare Part D plans to choose from, and a person’s prescription drug needs are highly personalized.

The number of prescriptions people take and where they buy them will influence how much their Medicare Part D coverage will cost. For example, there are 25 Medicare Part D plans available for Latah County residents. Some may benefit from a more expensive plan that covers a larger percentage of drug costs, while another would not benefit from the same plan. Likewise, Medicare Advantage Plans vary significantly in cost and coverage, and many people benefit from personalized advice.

Q: How do I get help selecting a Medicare Plan D or Medicare Advantage Plan?

A: Each state provides advisors to help people select Medicare plans that are best for them.

In Idaho and Washington, this free service is offered by SHIBA.

The advisers are primarily volunteers who are certified after training each year to help people understand what their options are and the best way to get health care coverage. They don’t sell insurance or recommend one company or agent over another, but they provide unbiased and confidential help in determining options.

Q: How do I meet with a volunteer advisor?

A: You’ll want to meet with an adviser that specializes in the options available in your county. Someone in Whitman county, for example, is able to access a list of options in Asotin county, but will not be as familiar with them. To find a volunteer adviser in your area and make an appointment, see the accompanying information in “Free Medicare open enrollment help” or call the state office: (800) 562-6900 in Washington and (800) 247-4422 in Idaho.

Q: What should I bring to the appointment?

A: Bring your Medicare card, along with a list of your medications and dosages. If you aren’t currently enrolled in Medicare, do that first, as it will take a few weeks to receive your Medicare card.

Original Source: https://lmtribune.com/golden_times/which-letter-find-the-right-medicare-package/article_55dfcd3c-f3d3-5669-a1b0-83a06f0a6a66.html

Original Date:  Nov 5 2018

Written By:

Quick guide: Do you need Medicare supplemental insurance?


You’ve worked your entire life. All of that work has led up to you reaping the benefits of the Medicare program. Given the rich history of this program that’s been around since 1965, those benefits seem like a sure thing.

Now, quickly approaching the ripe old age of 65, you’re almost ready to claim your Medicare benefits. Have you ever asked yourself just how far those benefits will take you? More specifically, have you ever asked yourself:

Do I need Medicare supplemental insurance?

But why would you need supplemental insurance anyway? Isn’t Medicare good enough to support you in old age? Given the rich history of this program that’s been around since 1965, those benefits seem like a sure thing.

Perhaps not. Keep reading to find out why.

When Medicare Isn’t Enough

Medicare provides our elderly population with an important safety net. In fact, when Lyndon B. Johnson first established the program decades ago, he had one particular goal in mind:

To ensure that older Americans could enjoy the “healing miracle of modern medicine.”

Unfortunately, though, Medicare has its drawbacks.

One such drawback is the out-of-pocket expenses. Some plans, for instance, only cover a certain percentage of your costs (e.g. 70 or 80 percent). That means that you have to shoulder the rest of the costs of your treatment.

As it turns out, Medicare only covers the cost of certain medical treatments. Let’s say, for example, that you started losing your hearing at age 67. Well, Medicare typically won’t cover the cost of your treatment.

Furthermore, Medicare doesn’t usually cover the cost of visits to eye doctors or dentists. In other words, you’d rack up a lot of out-of-pocket costs if you didn’t have a supplemental plan and received these treatments.

Do I Need Medicare Supplemental Insurance?

So do you need Medicare supplemental insurance? If what we’ve said thus far is any indicator, it’s an absolute must.

That does leave you with one important question:

What’s the cost of a Medicare supplemental insurance (or Medigap) plan?

Let’s take a closer look:

The Cost of Medigap

Medigap plans aren’t free, but they’re well worth the cost. Fortunately, the costs aren’t exponential.

Typical insurance plans, for example, take your age into consideration. Medigap plans, however, don’t use your age to calculate costs–assuming, of course, you enroll during your Initial Enrollment Period.

The type of plan you choose will also affect the cost of your supplemental insurance. There are several plans to choose from, some more comprehensive than others. Needless to say, the more comprehensive plans come with higher premiums.

All in all, it’s up to you to select the plan which best suits your needs. You can view more information about the costs of Medicare supplemental insurance if you click the link we’ve provided for you.

Consider Getting Medical Supplemental Insurance

“Do I need Medicare supplemental insurance?” In truth, if you’re still asking yourself that question, we recommend that you invest in a Medigap plan.

Because here’s the truth:

Disaster can strike at any moment. And while Medicare is great, it’s just not as comprehensive as disaster calls for.

After you’ve selected a Medigap plan, don’t forget to check out our lifestyle section for other useful tips. You can also contact us if you have any questions about the content you find here.

Original Source: https://azbigmedia.com/quick-guide-do-you-need-medicare-supplemental-insurance/

Original Date: 10-29-2018

Written By: Darren Wilson

Key Considerations Now That Medicare Open Enrollment Has Begun

Medicare open enrollment runs from October 15, 2018 to December 7, 2018.  Open enrollment is the period in which current Medicare enrollees can adjust their current coverage.  Participants can move from Original Medicare to Medicare Advantage or vice versa, change Medigap plan coverage, and more.

Many people believe the best thing about turning 65 is that they become eligible for Medicare.  Obtaining health insurance without worrying about pre-existing conditions, your age, your overall health, and more is something that we all covet.  It is important, when enrolling in Medicare, to be cautious of what you need to do and when to avoid some expensive pitfalls that can add to the cost of your premiums as well as medical expenses.

These pitfalls can be avoided by making smart decisions when it comes to your Medicare coverage.  Right now, during open enrollment, participants are in the ideal position to ask questions, gather information, and make the vest decisions on their health care coverage.

Pitfalls to Avoid

#1 Pitfall – Not Covering the Gaps in Coverage

Medicare is medical insurance however it is not like the health insurance that is provided by your employer.  With employer sponsored health care plan participants most often pay one premium for their comprehensive insurance plan.  Once this is paid, the participant is then required, in most cases, to cover their yearly deductible and regular co-payments and that is as tricky as it gets.  That is not the case with Medicare.

Medicare insurance is offered in a number of different combinations.  Traditional Medicare, Plan A and B, cover hospital and outpatient services.  Each has its own premium, own deductible, and own copayments.

Many enrollees assume this is all the health insurance coverage that they will need.  This is however, not the case.  Medicare Part A and Part B are not comprehensive medical insurance plans.  There are gaps that need to be filled in such as prescription drug coverage, overseas medical coverage, and other out-of-pocket expenses.  To fill in the gaps that are left by traditional Medicare Part A and Part B participants have the opportunity to enroll in additional insurance plans, Medigap.

Another major difference to note between employer sponsored health care and Medicare is the out of-pocket limits.  With most employer-sponsored plans there is a limit to the amount of money, out-of-pocket, that participants will have to pay, a cap.  This is not the case with Medicare.  With Medicare coverage there isn’t a cap to the amount of money that participants are expected to cover.

Again, this is a pitfall that is easily taken care of with the purchase of additional Medigap coverage.  Medigap, or Medicare Supplemental Insurance as it is also known, are plans that reduce the out-of-pocket costs participants are required to pay.

During open enrollment you are allowed to change plans if a different Medigap plan will better suit your situation or choose a Medigap plan to enroll in if you have not previously done so.

The experts at eMedicare Supplemental Insurance, powered by Omega, have all the answers you are looking for when it comes to your Medicare Supplemental Insurance needs.  More information can be found at http://emedicare-supplemental-insurance.com/.

How to figure out Medicare and choose the right plan


October 20

For those approaching Medicare or already covered by it, now is a critical time of year to review health benefits.

Philip Moeller — author of a popular Medicare book, “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs,” and a blogger on Medicare for the “PBS NewsHour” website — knows well about the program’s fine print that has ensnared many in what he dubs the “no one told me” syndrome.

Last year, Moeller almost made a costly mistake himself. He didn’t get a chance to check his Medicare Part D drug coverage plan until one day before Medicare open season ended. He discovered that a key medication he needed had been dropped from his drug plan’s list of covered drugs.

“It would have cost me $20,000 a year to buy the drug on my own,” said Moeller, who scrambled to find another plan to cover this drug and signed up just in time.

Such are the complexities of Medicare that almost anyone can get snared in the fine print. Each day, about 10,000 baby boomers turn 65, making them eligible to join the 58.5 million Americans already enrolled in the national health insurance program for older Americans. Medicare now accounts for 15 percent of all federal spending, according to the Congressional Budget Office. Costs are projected to grow nearly 5 percent a year over the next decade, according to the Henry J. Kaiser Family Foundation.

At this rate, Medicare Part A, which covers inpatient hospital care, short-term care in a skilled nursing facility, hospice care and some in-home care, will exceed its trust fund in 2026. For that reason, controlling Medicare costs is a big priority. In 2018, new enrollees began paying premiums based on income for Medicare Part B, which covers doctor visits, lab work, outpatient surgeries and preventive care and screenings.

Several changes are coming in 2019, including to Medicare Part D drug coverage insurance and to some Medicare Advantage plans, which are offered by private insurance companies and are known as Medicare Part C. (See “Get ready for changes next year” below. )

That is why it is more important than ever for Medicare recipients — and anyone approaching age 65 — to begin looking at all the details right now, during Medicare’s open enrollment period, which began Oct. 15 and ends Dec. 7. This is the prime time of year when changes can be made in a plan without penalty. There are a lot of different plans that can work better or worse depending on your health status and finances. Experts say you should choose a plan that will not just take care of your health needs today but also what they could be in 10 years.

Here are some other important elements of Medicare:

1. Most people qualify for “premium-free” Part A by having paid Medicare taxes through payroll deductions for 10 years or more. Part B premiums range from about $134 per person per month to $429 per month for those earning about $160,000 as an individual or more than $320,000 for a joint tax return. The cost of Part C Medicare Advantage plans varies by the company offering the plans and benefits covered. One other thing to know: Medicare covers most, but not all, costs. For 2018, the Part A deductible that a patient must cover is $1,340 for each hospital admission during the year. For extended hospitals stays beyond 61 days, there are additional costs of at least $335 per day that recipients pay.

2. You must sign up for Medicare when you turn 65 through the Social Security Administration, unless you are already drawing Social Security or receiving Railroad Retirement benefits, in which case enrollment may have been done for you. The clock actually starts ticking three months before your 65th birthday and ends three months after the month you were born. Enroll online or by mail, but many experts advise signing up in person at a Social Security office. Drop-ins are allowed, but it will be faster to schedule an appointment either in person or via phone by calling 800-772-1213.

Delayed enrollment can result in costly penalties. How much? Up to 10 percent more per year for each year missed. You could also face a delay in the start of coverage, leaving you with a health insurance gap. One ­caveat: If you work at a large employer and plan to keep working, you do not have to immediately sign up for Parts B, C or D as long as you can keep an insurance plan through work. You’ll have eight months after you retire to enroll. Check with your employer and with the SSA before you turn 65.

3. Given the possibility of penalties or delayed coverage, experts say you shouldn’t wait until the last minute to sign up. A few months before retirement, ask your Human Resources department when your employer health coverage ends. Some insurance plans stop at midnight on the last day of employment, which could leave you without coverage. As you prepare to retire, ask your employer to fill out a federal form , which will verify that you have had uninterrupted, creditable health insurance coverage.

4. If you’ve been putting money in a Health Savings Account (HSA), you must stop those payments before Medicare or Social Security benefits begin. HSAs are tax-exempt accounts in which people contribute pretax dollars through their work. They are used to pay for such medical expenses as health insurance deductibles. Internal Revenue Service rules prohibit Medicare recipients from contributing to HSAs. If you continue to do so while on Medicare, you could face stiff tax penalties.

But you can draw down any money left in the HSA after enrolling in Medicare or going on Social Security. Know this, however: Premium-free Part A is backdated six months from the date you apply for Medicare or Social Security. That means once it is in place, it covers costs from six months previously. So the Centers for Medicare and Medicaid Services (CMS) advises you to stop contributing to your HSA at least six months before you apply for Medicare to avoid paying tax penalties.

5. If you’ve enrolled in parts A and B, consider buying Medigap supplemental insurance. Medigap plans, which are offered by private insurers, can help cover the annual deductibles for Part A and Part B, as well as additional costs for extended hospital stays and other excess charges beyond what Medicare pays. About 14 million Americans buy a Medigap plan, according to the American Association for Medicare Supplement Insurance. Some of these plans also cover medical expenses that occur when you travel abroad. Medigap coverage can be used at any doctor or hospital accepting Medicare.

6. Medicare Advantage plans — Medicare Part C — may work better for you than signing up for the various parts of Original Medicare, so learn how they work. More than 20 million Americans annually sign up for these private insurance plans. Because they roll Parts A, B and D into one, and also can provide vision and dental coverage, some people find them easier to use and, depending on the plan chosen, less costly. If you are enrolled in a Medicare Advantage plan, you will not need a Medigap plan. Advantage plans generally require you to stay within their network of doctors and hospitals to control costs. Your choice of plans will depend on where you live; some places have 20 or more plans available, others have only one or two.

7. The cost of drugs can be a big part of health-care expenses in retirement. There are many different Part D prescription-drug coverage plans. It pays to examine the list of drugs offered by each. Find one that will match up well with your needs. Be sure to review the drug list every year during open enrollment period. If a prescription drug you need is dropped from your plan, you can switch without penalty then. You can also set up a personalized drug formulary at CMS.gov to compare Part D drug plans.

Beyond the annual premium, Part D coverage requires users to pay a yearly deductible that in 2018 could not exceed $405 per person per year.

8. If this is confusing, you can find more information at ­Medicare.gov, CMS.gov/medicare/medicare.html and AARP.org/health/medicare-insurance.

Get ready for changes next year

Among the changes in Medicare slated to occur in 2019 are:

The Part D yearly deductible will increase by $10 to $415. The coverage gap called the “doughnut hole” will continue to shrink for brand-name prescription drugs covered by Part D insurance. (This change goes into effect for generic drugs in 2020.) The doughnut hole means that, once your drug coverage hits the yearly limit of $3,820 for 2019, you are then responsible for drug costs above that.

What has changed is that you will get a 75 percent “doughnut hole discount” on brand-name drugs until your out-of-pocket costs reach the $5,100 yearly limit. Then, the Part D drug plan will resume paying for your prescription drugs. So if you hit the doughnut hole and need a brand-name medication that costs $100, you will only have to pay $25 and $95 will be applied toward your out-of-pocket spending for 2019.

Starting Jan. 1, new Medicare recipients will also no longer be able to sign up for two Medigap supplemental insurance plans now offered. Medigap Plans C and F require no out-of-pocket costs for recipients. Both plans will continue operating, but since no new members will be added, current members will probably see premiums rise as the pool of people sharing costs in these plans shrinks.

Some Medicare Advantage plans will begin offering coverage of lifestyle-support services, such as meals delivered at home, installation of bathroom grab bars and transportation to medical appointments. Previously, costs for such services had to be paid out of pocket. These services will be covered only if they are prescribed by a health professional.

Original Source: https://www.washingtonpost.com/national/health-science/how-to-figure-out-medicare-and-choose-the-right-plan/2018/10/19/419854da-c70e-11e8-9b1c-a90f1daae309_story.html?noredirect=on&utm_term=.cd929230931a

Original Date: Oct 20 2018

Written By: Sally Squires

2019 Changes in Medicare

Medicare has under gone a number of changes since it originated in 1965.  With over 60 million participants Medicare continues to have the highest satisfaction rate of any form of health insurance available.  With every year that passes, Medicare and Medigap keeps getting better and 2019 is no different.  Some of the modification that Medicare is making only affect individuals enrolled in Medicare Advantage plans while other updates will affect all beneficiaries.

Donut Hole

One unappealing element of Medigap Plan D, prescription drug coverage is that once participants have reached a certain level of spending in a year they are required to pay more for the prescription medicine they need.  This creates what is known in Medicare lingo as a “donut hole”.  A second threshold is in place that once reached participants are then “rewarded” with lower cost prescription drugs.  This feature of Medigap Plan D was scheduled to be closed in 2020 however, Congress passed a bill that will close the donut hole for brand name prescriptions in 2019.  The gap for generics is still scheduled to close in 2020.

Therapy Cap

Congress has repealed the therapy cap limiting coverage to outpatient physical, speech, and occupational therapy services.  Original Medicare enrollees will not longer be required to pay the full cost of therapy services.

 Improved Information

The Medicare handbook is sent out to its enrollees every fall.  As if 2019 the handbook will be updated to include checklists and flowcharts to help participants make decisions on coverage decisions.  The Medicare Plan Finder will be included online and updated to make it simpler to use.  Enrollees will also have a chance to compare out-of-pocket costs and coverage options between Medicare and Medicare Advantage with updated online coverage tools.

Increased Telemedicine

All methods of technology are advancing, and Medicare is using this to their advantage with increased telehealth programs.  These programs allow patients to confer with doctors and nurses over the internet.  Telehealth services will be covered in 2019 for people with end-stage renal disease and stroke treatment.

Lifestyle Support

For enrollees in Medicare Advantage there will be the option to have meals delivered to their home, transportation to the and from the doctors, and the installation of safety devices like bathroom grabs bars and wheelchair ramps.  For home safety improvements and prepared meals to be covered a medical provider will need to recommend them.

In-Home Assistance

In 2019 Medicare Advantage plans will also have an option to pay for home health aides.  These aids assist in everyday activities such as dressing, eating, and personal hygiene.  This is part of a broader definition of traditional services required by Medicare.

Trial Period

Participants will now be able to try the Medicare Advantage plan for three months.  If they aren’t satisfied they can switch to Original Medicare Part A and Part B or another Medicare Advantage plan.

The experts at eMedicare Supplemental Insurance, powered by Omega, have all the answers you are looking for when it comes to your Medicare Supplemental Insurance needs.  More information can be found at http://emedicare-supplemental-insurance.com/.

Medicare prescription drug coverage: You may need a new plan

Do you have the right Medicare prescription drug coverage? The answer could help you save big money on your out-of-pocket health care costs during your retirement years.

“Retirees who regularly take prescription drugs can potentially save hundreds or even thousands of dollars with careful shopping for a Medicare Part D prescription drug policy,” said Diane Omdahl, president of 65 Incorporated, an independent firm that helps people make smart choices regarding their Medicare coverage.

If you’re new to Medicare, you may not even realize you need to buy a separate policy that covers prescription drugs. A possible exception: If you select a Medicare Advantage Plan that simplifies and combines Medicare’s various parts and also covers prescription drugs. Even then, not all Medicare Advantage Plans cover prescription drugs, and when they do, they often have different features regarding their coverage.

As a result, if you regularly take one or more prescription drugs for chronic conditions, it’s a very good use of your time to shop carefully for prescription drug coverage. You can make changes during Medicare’s upcoming open-enrollment period, which runs from Oct. 15 to Dec. 7, with the changes becoming effective at the beginning of 2019. Unlike Medicare supplement plans, you can change your Part D plan each year without needing to satisfy medical underwriting.

Omdahl said if one or more of these red flags apply to you, it might be time to shop for new drug coverage:

  • If you haven’t changed your Part D policy for several years
  • If you take brand-name prescription drugs or many drugs
  • If your doctor has prescribed different drugs for you during the year

Comparing prescription drug plans can be a daunting task. A key component of each plan is its drug “formulary,” a list that assigns drugs to various tiers. Each tier can have a different set of co-payments and co-insurance features. The lowest tiers typically cover the least expensive or generic drugs, whereas higher tiers will cover more expensive, brand-name drugs. You’ll typically pay less out of pocket for lower-tier drugs compared to those in higher tiers.

Each year, insurance companies can change a specific drug’s tier level or change the co-insurance and co-payment features that apply to each tier. In addition, some plans negotiate for lower prices with specific pharmacies, identifying them as a preferred drugstore that charge less if you use them. Many policies also provide price breaks for mail-order prescriptions.

Due to all these potential changes, anyone regularly taking one or more prescription drugs will want to determine how much you might pay for them under a new plan. Medicare’s Plan Finder is a free, online resource that can help you make this determination. Or you can hire an independent firm such as 65 Incorporated to help you select a plan.

If you’re already enrolled in a prescription drug plan, you should soon receive a disclosure from your drug company about changes for 2019. Be sure to read it carefully — don’t toss it with your junk mail!

If you became newly eligible for Medicare during 2018 and selected a Part D insurance policy for the first time, it’s effective only for 2018, and it might change for 2019. Again, read any paperwork you receive carefully to find out if your plan is changing.

Omdahl shares that all of her clients who’ve never previously changed their Part D plan ended up doing so as a result of an independent review — which had an average out-of-pocket savings of $973. This example applies to people who regularly take either expensive, brand-name drugs or many drugs. If you take only a few, low-cost generics, your potential savings by changing policies could be much less.

Smart choices regarding Medicare prescription drug coverage will help keep you healthy and could potentially save you a lot of money. Be sure not to neglect your homework: Shopping for coverage is part of your new “retirement job.”

Original Source: https://www.cbsnews.com/news/medicare-prescription-drug-coverage-open-enrollment-starts-oct-1-how-a-new-plan-can-save-money/

Original Date: Sept 26 2018

Written By: Steve Vernon

The Pros to Medicare Supplemental Insurance Plans

Protection from Astronomical Medical Bills

Health coverage through Medicare only covers 80% of the total costs which leaves you to cover, out of pocket 20%.  In order for Medicare Part B to begin paying it’s 80% you must reach the yearly deductible.  Depending on the Medicare Supplemental Insurance Plan you choose the extra 20% will be partially covered.

Coverage When Visiting Outside the United States

Some Medicare Supplement Plans offer coverage outside of the U.S. in case of an accident or unexpected illness.  If you find that you travel outside of the United State on a regular basis it is important to purchase a Medigap plan that covers your health care needs outside of the country.

During Open-Enrollment – Guaranteed Acceptance

If you apply for Medigap within your open enrollment period (six months after the 1st of the month in which you turn 65) coverage and rates are guaranteed.  This means that it doesn’t matter what illness you bring to the table, Medicare and Medicare Supplemental Plans are guaranteed to accept you for coverage.  This is just one of the reasons it is important to enroll during the open enrollment period.  After this time, insurance companies can deny you coverage or increase your rates, on top of a late enrollment penalty that you will be responsible for.

Renewable Policies

No matter what health problems arise, all standard Medigap plans are assured to be renewable to you.  This means that no matter what you are diagnosed with insurance companies cannot deny you plan coverage as long as you make the premium payments.  Your policy renews automatically each year.

Choice of Medicare Doctors

When you purchase Medicare Supplemental Insurance you will be covered when you visit doctors that participate with Medicare.  The only exception is Medicare SELECT.  This is a type of Medicare Supplemental Insurance that requires use of select medical providers and hospitals within the network.

Multiple Plans to Choose From

Medigap offers 10 different plans to choose from to help Medicare enrollees pay for expenses not covered by Original Medicare costs.  Medigap plans that offer the most coverage also have the highest monthly premiums whereas the opposite is true with lower premium Medigap policies.

Standard Policies

There are ten different Medigap policies.  The plans are standard throughout the U.S. and are regulated by the law.  Plan benefits are the same from state to state meaning that the Medigap Plan F coverage in Michigan is the same as Medigap Plan F coverage in Texas.  In Massachusetts, Minnesota, and Wisconsin standardized plans are a bit different.

The experts at eMedicare Supplemental Insurance, powered by Omega, have all the answers you are looking for when it comes to your Medicare Supplemental Insurance needs.  More information can be found at http://emedicare-supplemental-insurance.com/.


Now’s the time to sign up for Medicare

People with Medicare, it’s time to mark your calendars! Open Enrollment Period runs from Oct. 15 to Dec. 7.

Open enrollment is but one of the terms you will encounter when trying to decipher the maze known as Medicare. Let’s not forget initial enrollment period; general enrollment period; original Medicare; Medicare Advantage; supplemental insurance; prescription drug coverage; and late enrollment penalties.

So, yes, if you think it’s a complicated issue, you’re right — and you’re not alone!

Even the experts agree that signing up can be a daunting experience.

“It is complicated and intimidating,” suggests Barry Klitsberg, president of Queens Interagency Council on Aging and a longtime employee of the U.S. Department of Health and Human Services. “People don’t know where to start.”

A good place might be to get an understanding of what Medicare is and what it provides.

Medicare is a federal health insurance program run by the Centers for Medicare & Medicaid Services. It provides healthcare insurance for Americans aged 65 and up who have worked and paid into the system through payroll tax and for certain younger people with disabilities.

Among the items Medicare does not cover are long-term (or custodial) care, most dental care, eye exams related to prescribing glasses, dentures, cosmetic surgery, acupuncture, hearing aids and routine foot care. Still, Medicare has much to offer.

Depending on the situation, some people may get Medicare automatically and others need to apply. Individuals collecting Social Security or Railroad Retirement benefits before they turn 65 will be automatically enrolled into Medicare when they turn 65. Individuals who are eligible for Medicare but who are not yet collecting Social Security of Railroad Retirement benefits will have to actively enroll into Medicare by contacting the Social Security Administration.

It is important to note that, while Social Security works with the CMS by enrolling people in Medicare, they are not the same.

An individual is entitled to apply for Social Security benefits beginning at age 62. Eligibility for Medicare comes approximately three years later during the initial enrollment period, with eligibility beginning three months prior to one’s 65th birthday, extending through one’s birth month and continuing for the next three months, giving new enrollees a seven-month window.

There are two choices for how to obtain Medicare coverage, original Medicare and Medicare Advantage.

Original Medicare includes Part A (hospital insurance), which covers hospital inpatient care, skilled nursing facility care, home health and hospice care; and Part B (medical insurance), which covers doctors’ services, outpatient care, durable medical equipment (like wheelchairs) and preventive services (like screenings, shots and yearly wellness visits). To this you may add Part D  (prescription insurance) as well as supplemental insurance.

Medicare Advantage, also known as Part C, includes Part A, Part B and usually prescription drug coverage as well. Additional benefits may be included such as dental, eye care and hearing care.

According to the CMS, you usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working for a certain period of time. For Part B, most individuals pay a monthly premium; the amount can vary depending on income. The premium is generally deducted directly from a person’s Social Security.

The CMS indicates that if you have original Medicare, you may see any doctor who is enrolled in Medicare and accepting new patients. Referrals are not needed. You generally pay a portion of the cost for each covered service. You can join Part D and you may buy supplemental insurance to pay costs that original Medicare doesn’t cover.

If you don’t have prescription drug coverage, or the coverage you have isn’t at least as good as Medicare, you should consider enrolling in Part D. If you need prescription drug coverage, you have to sign up for it.

Medicare.gov, the official federal government website, indicates two ways to get prescription drug coverage: Medicare Part D or a Medicare Advantage Plan (see below) that offers drug coverage. Costs will vary, depending on the drugs you use, the plan you choose and other factors.

Note that there are different types of Part D plans, and each one may cover different prescriptions. Each drug plan has its own list of covered drugs (called a formulary). Many plans place drugs into different “tiers” on their formularies, with drugs in each tier having a different cost. It is important to find out which plans cover the drugs you need.

Something else to look out for is what is known as the coverage gap, or donut hole, a temporary limit on what a plan will cover. This gap begins after you have spent a certain amount for covered drugs. The amount may change each year.

Klitsberg indicated that the donut hole has been shrinking and, in 2019, the gap will be disappearing for brand-name drugs. He suggested that in 2020, it will do likewise for generic drugs.

According to the CMS, you have up to three months after your Medicare coverage starts to join a Part D plan. It warns that “if you don’t join a Medicare drug plan when you’re first eligible for Medicare, you may have to pay a monthly Part D late enrollment penalty if you join a plan later.” The penalty goes higher the longer you wait to enroll.

The CMS also warns that there are risks for not signing up for Part B: You may pay all of the costs for doctors’ services, outpatient care, medical supplies and preventive services; you will have to wait until the general enrollment period (Jan. 1 to March 31 each year) to sign up if you decide you want Part B later; and you may have to pay a late enrollment penalty for as long as you have Part B. The penalty amount increases the longer you go without Part B coverage.

Whether it’s best for you to sign up for Part B depends on your individual situation, such as your employment status, among other considerations.

Do you need a supplemental insurance (or Medigap) policy? Original Medicare pays for much, but not all, of the cost for healthcare services and supplies. Some people opt for additional coverage from a private company to fill in the gaps in Parts A and B. You need both Part A and Part B to buy a Medigap policy, which can cover costs like coinsurance, copayments and deductibles. According to Elder Law Review, a publication of Ronald Fatoullah & Associates, “Under Original Medicare, there is no limit on how much you pay out of pocket per year unless you have supplemental insurance.”

Medicare Advantage Plans (Part C) are offered by private companies approved by Medicare. You must have both Medicare Part A and Part B to join. The CMS suggests that “it may be more cost effective for you to join a Medicare Advantage Plan because your cost sharing is lower or included.”

Signing up for Part C places an individual in a health maintenance organization. Members must generally get a referral from their primary care physician in order to see a specialist or other doctors. You may pay lower costs for covered services as long as you see doctors or go to hospitals that belong to the plan’s network.

You can join a Medicare Advantage plan when you first become eligible for Medicare (the seven-month window). These plans include Part A, Part B and usually Part D coverage. Some offer extra benefits like vision, hearing or dental.

You usually have to pay a monthly premium, in addition to your Part B premium, and a copayment or coinsurance amount for covered services.

Premium deductibles and copayments can vary significantly from plan to plan, so it is important to compare costs and coverage each year.

Medicare Advantage insurers negotiate with healthcare providers to find the lowest cost providers each year. In recent years, these provider networks have become smaller, with fewer specialists, according to reports. In addition, providers can join or leave a network at any time.

The right coverage can make all the difference. It is important, therefore, to be aware of any changes in coverage.

“In October, you should start comparing your current coverage with other options to see if you can save some money and to ascertain whether your provider(s) are still covered under your plan’s network,” Fatoullah’s publication advises. You can change your health or prescription drug coverage between Oct. 15 and Dec. 7 each year, the open enrollment period, or annual election period or annual coordinated enrollment period.

Klitsberg suggests it is vital for anyone enrolled in a Medicare plan to “read your mail.” Every year, you will be receiving information on any changes in costs and coverage. And, he points out, during the open enrollment period “you have a lot of choices.”

There is a lot to consider when choosing Medicare coverage. For further information, visit Medicare.gov, where the government’s official guide to the program, “Medicare & You,” runs more than 100 pages, or call 311 and ask for “HIICAP,” the Health Insurance Information Counseling and Assistance Program.

Original Source: http://www.qchron.com/editions/central/now-s-the-time-to-sign-up-for-medicare/article_c07d3876-c680-11e8-83e2-9b686d3de1d0.html

Original Date: Oct 42018

Written By: Mark Lord Chronicle Contributor

Medicare vs Medicaid

Both Medicare and Medicaid are both health care programs sponsored by the government, many people mistake the two for being the same.  This is of course, not the case.  Medicare is a federal health care plan that is available to enrollees over 65 years of age.  Medicaid is a jointly funded health care program that is funded at both the state and federal level and is intended to supplement a need for coverage in lower-income families and individuals.

Medicare/Medigap Supplemental Insurance  

As stated earlier, Medicare is a program that supplies health insurance to individuals who have attained 65 years of age.  Qualification for Medicare comes when a participant or their spouse has worked at least ten years and paid Medicare taxes.

Medicare covers the basic health care needs of enrollees.  Medicare breaks down into multiple parts: Original Medicare (Part A and Part B), Medicare Advantages, Medicare Supplemental Insurance Plans, and Medicare Part D, prescription drug coverage.  Medicare Part A and Part B cover most health insurance needs.  Voids and gaps in coverage are filled with the purchase of additional coverage in the form of Medigap Plans A – Z.

It is important to note that Medicare/Medigap do not cover vision, dental, or hearing.  Coverage for the services will need to be purchased separately from any Medicare or Medigap policies.


Medicaid aids low-income families and individuals with health care assistance.  Coverage is funded through both the state and federal government and is available to people of all ages.  The requirements that are needed to qualify for Medicare vary greatly depending on where you live.  Medicaid is eligible for Medicaid if they meet certain requirements such as passing a necessity test, an asset test, and an income test.

Medicaid offers additional coverage that Medicare does not such as dental coverage, vision, and hearing care.  Medicaid also covers prescription drugs without having to add additional coverage.  To check availability in your state, check out the Medicaid website.

Differences Between the Two

The biggest difference between Medicaid and Medicare don’t stop at funding.   Coverage between the two vary a great deal as you can see from above. Medicare doesn’t offer coverage for dental, vision, or hearing. Medicare doesn’t have financial limits on who qualifies and who doesn’t.  It is possible to have dual-eligibility.  This means that a participant is over 65 and has met the financial or medical eligibility requirements associated with enrollment in Medicaid.

The experts at eMedicare Supplemental Insurance, powered by Omega, have all the answers you are looking for when it comes to your Medicare Supplemental Insurance needs.  More information can be found at http://emedicare-supplemental-insurance.com/.

Senior Living: Two ways to get your Medicare

Senior Living: Two ways to get your Medicare

Contributing writer

At a family reunion, my Aunt Abby and Uncle Glen got into a squabble over the best way to get their Medicare benefits.

Uncle Glen is an Original Medicare man, and has been for a decade or so. Aunt Abby prefers Medicare Advantage, which is similar to a health plan she had before enrolling in Medicare.

Greg Dill

When they turned to me, asking me to referee and declare which form of Medicare is better, I gave them a big smile and answered, “Well, it depends.”

Original Medicare and Medicare Advantage have different benefits and costs that you should consider based on your personal needs. Medicare open enrollment season runs from Oct. 15 to Dec. 7, and it’s a good idea to know how the two types of Medicare work before you select one.

With Original Medicare, you can choose any doctor, hospital, or other healthcare provider you want, as long as they accept Medicare. When you receive medical services or goods, Medicare pays the provider directly. About 70 percent of all people with Medicare have Original Medicare.

The other way to get your benefits is Medicare Advantage, which is a form of managed care, like an HMO or PPO. Medicare Advantage is provided by private insurance companies approved by Medicare. If you’re in Medicare Advantage, you generally must go to doctors and other providers in the company’s network.

If you go outside the network, you may have to pay more.

On the other hand, Medicare Advantage plans may offer some services – such as dental, hearing, vision, and prescription drug coverage – that Original Medicare doesn’t.

Most people with Original Medicare pay a monthly premium. If you’re in Medicare Advantage, you may have to pay an additional monthly premium to the private insurer that covers you.

With Original Medicare, you or your supplemental insurance must pay deductibles, co-pays, and coinsurance.

To cover these “gaps” in Medicare, some people buy supplemental insurance called Medigap. If you have a Medigap policy, Medicare pays its share of the covered costs, and then your Medigap policy pays its share.

Original Medicare does not cover prescription drugs. If you want drug coverage, you can buy a separate Medicare Part D plan. Such plans are sold through private companies approved by Medicare. You have to pay an additional monthly premium for Part D.

Medicare Advantage companies must cover all of the services that Original Medicare covers. (However, Original Medicare covers hospice care, some new Medicare benefits, and some costs for clinical research studies, even if you’re in a Medicare Advantage plan.) In all types of Medicare Advantage plans, you’re always covered for emergency and urgent care.

You can join a Medicare Advantage plan even if you have a pre‑existing condition – except for end-stage renal disease. People with ESRD usually are covered through Original Medicare.

Keep in mind that Medicare Advantage plans can charge different out-of-pocket amounts and have different rules for how you get service.

For example, you may need a referral to see a specialist. And you may need to stay in the plan’s provider network, unless you’re willing to pay more to go outside the network.

You should always check with the plan before you get a service to find out whether it’s covered and what your costs may be. If the plan decides to stop participating in Medicare, you’ll have to join another Medicare health plan or return to Original Medicare.

How can you decide whether Original Medicare or Medicare Advantage is better for you?

There’s a good comparison of Original Medicare and Medicare Advantage in the “Medicare & You” handbook. “Medicare & You” is mailed to all Medicare beneficiaries every fall. You can also find it online, at www.medicare.gov.

Original Source: https://www.presstelegram.com/2018/09/26/senior-living-two-ways-to-get-your-medicare/

Original Date: 9/26/2018

Written By: Greg Dill