What is Medicare? Medicare is a national health insurance program in the United States, begun in 1965 under the Social Security Administration and now administered by the Centers for Medicare and Medicaid Services.
When can I apply for Medicare? During your Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65.
Medicare vs. Medicaid: Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income.
What is Medicare Part A? Part A is hospital insurance. ... You will also have to pay a deductible before Medicare benefits begin. Medicare will then pay 100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility. After that, you pay a flat amount up to the maximum number of covered days.
What is Medicare Part B? Part B is medical insurance. Benefits cover certain non-hospital medical expenses like doctors’ office visits, blood tests, X-rays, diabetic screenings and supplies, and outpatient hospital care. You pay a monthly premium for this part of Original Medicare. The fee can be higher for people with high incomes. A different government program, Medicaid, can help cover Medicare Part B premiums for low-income beneficiaries.
What is Medicare Part C? Medicare Part C is also known as Medicare Advantage. This insurance often includes every type of Medicare coverage in one health plan. It’s offered by private insurance companies contracted through CMS to provide a Medicare benefits package as an alternative to Original Medicare. Enrolling into a Medicare Advantage plan is optional, but to obtain this private insurance, you must also have Original Medicare, Part A and Part B. You also may have to continue to pay your Part B premium if you have a Medicare Advantage plan.
What is Medicare Part D? Part D is optional prescription drug coverage. Medicare Part D is available as a stand-alone prescription drug plan through private insurance companies, and the monthly fee varies among insurers.
Medicare Open Enrollment: This period is also known as Fall Open Enrollment, and the Annual Election Period. This Medicare Open Enrollment period happens every fall, from October 15 to December 7.
This Medicare Open Enrollment period generally lets you:
- Sign up for a Medicare Advantage plan
- Change from one Medicare Advantage plan to another
- Drop your Medicare Advantage plan and return to Original Medicare
What is Medigap? Also called Medicare Supplement Insurance, is health insurance coverage provided by private companies designed to pay for costs not covered by Original Medicare. Depending on which plan you get, these costs might include copayments, coinsurance, and deductibles, as well as services Original Medicare doesn't cover, such as travel outside of the U.S. Rx not included.
Dental: Some Medicare Plans have reimbursement of dental expenses. If a dentist has opted out of Medicare, no benefit will be paid.
In-Person Q & A from the Alignment Medicare Seminar with Trout Insurance:
Is this something we need to do every year like U65?
Your plan may change. Review any notices from your plan about changes for next year October 15—December 7th is when Open Enrollment begins This is the one time of year when everyone with Medicare can make changes to their health and drug plans for the next year.
If you decide to make a change your new coverage begins January 1. If you stay with the same plan, any changes to coverage, benefits, or costs for the new year will begin on January 1. If you are in a Medicare Advantage Plan, you can drop your plan and switch to another Medicare Advantage Plan with or without drug coverage, or to Original Medicare. If you switch to Original Medicare, you’ll also have the option to join a Medicare drug plan. Your coverage will begin the first day of the month after the plan gets your enrollment form. In some cases, you may be able to make other changes if you qualify for a Special Enrollment Period.
What do I have to do if I’m not drawing Social Security when I turn 65? When do I call to start Plan B?
If you are not drawing Social Security at the time you are eligible for Part B coverage you will pay Medicare directly (most likely quarterly). A bill will be sent to your home. You can first sign up for Part A or Part B (together or individually) during the seven-month period that begins three months before the month you turn 65. If your birthday is June 5th you can apply starting the March prior to your birthday through September.
Do I have to take a drug plan if I don’t take any drugs?
Part D coverage (prescription) has a late penalty surcharge if you do not apply when eligible. The late enrollment penalty (also called the “LEP” or “penalty”) is an amount that may be added to a person’s monthly premium for Medicare drug coverage (Part D). A person enrolled in a Medicare plan may owe a late enrollment penalty if they go without Part D or other creditable prescription drug coverage for any continuous period of 63 days or more after the end of their Initial Enrollment Period for Part D coverage.
The recommendation would most likely be to go on a basic plan to meet the eligibility criteria.
If I have a MAPD HMO plan and travel outside of my state, will I have coverage for emergencies/surgery?
With Medicare Advantage plans, you’ll have emergency and urgent care coverage when traveling outside of your network, within the United States. That means you don’t have to worry about coverage if you get a sudden illness or break a bone while traveling. If you need non-emergency or non-urgent care while traveling, it may not be covered, and you’ll likely have to pay more out of pocket.
You also have the option to choose a PPO Preferred Provider) Plan – This type of Medicare Advantage will have a preferred network where your costs will be lower. But if you do choose a doctor out of network, the plan is will a percentage of the claims.
Since my plan has foreign travel coverage do I need to purchase travel insurance?
Some Medicare Advantage plans include travel benefits for when you need care away from home. These travel benefits usually cover just emergency and urgent care and help ensure you have coverage no matter where you are.
Travel insurance might also cover trip cancellation, trip cancellation, missing bags, in addition to medical and dental emergencies that might not be covered during your trip.
How do you help people choose a plan? Supplement or Advantage?
During our assessment we will review what is most important to you in a health insurance plan as well as your doctors, hospitals, medications, lifestyle and budget. You will see all of the options available to you.
If I have a supplement Plan G now and want to switch carriers do I have to do medical underwriting?
The decision to change your Medicare Supplement depends on your unique situation. To determine if you should change companies, it’s a good idea to first shop your rates. If there is a lower premium for the plan you currently have, you can apply to change your coverage. We find that many people will even switch to a plan that has a similar rate. They’ll do this to take advantage of the rate lock, or a guaranteed rate, and avoid a rate increase from their current carrier. If there is not a lower rate available, you can stay with your provider, and feel comfortable knowing that you have the best rate available.
If a health company declines my supplement application what do I do?
The process of changing your Medicare Supplement company is straight-forward. Changing your Medicare Supplement company begins with applying to the carrier you would like to have. The rules on applying vary by state, but you will most likely need to undergo a process called medical underwriting. You don’t need an exam for this process, but you will typically need to answer questions over the phone about your health. We will help find you a carrier that will be likely to accept you and help you submit your application. The process is low-risk because you can keep your current coverage in place even if you are declined by the new carrier.
Can I shop my supplement every year?
YES.. and in fact: You can change Medicare supplement plans at any time of year – you will have to pass medical underwriting to do so.
Are drugs covered differently on a MAPD and stand-alone PDP? Yes & No:
Yes – In many cases, the your costs for are Rx will be different for the same list of medications with a MA plan compared with a PDP – even with the same list and often with the same company.
NO – The mechanics of Medicare Rx plan is exactly the same either stand alone or within a Medicare Advantage plan.
Some technical info: A Medicare drug plan offers drug coverage to people with Original Medicare (Part A and Part B). In general, a Part D-covered drug must meet all of these conditions:
■ Available only by prescription
■ Approved by the Food and Drug Administration (FDA)
■ Used and sold in the U.S.
■ Used for a medically accepted indication, as defined under the Social Security Act
■ Not covered under Part A or Part B
■ Included on the plan’s Part D drug list (also called a formulary) or coverage approved through the exceptions or appeals process.
Plans can vary depending on providers, deductibles, coinsurance, and copays.
What factors are different this year than last year?
Medicare Advantage plans are becoming stronger and stronger here in western NC. These plans with a variety of companies; UHC, Humana, Aetna, Alignment only became available over the four years. If you are in your 70’s – you may be well served by these options. The plans adding more value added benefits including flex cards, over the counter benefits, dental, vision, hearing and Part B premium reduction.
Is there an advantage to use your PDP coverage or GoodRX or would out of pocket be better?
You may want to use GoodRx instead of Medicare in certain situations, such as when Medicare doesn’t cover your medication, the GoodRx price is cheaper than your Medicare copay, or you won’t reach your annual deductible. GoodRx may be a good option if you have a new brand Rx during the last couple of months of the year.
Your plan may change. Review any notices from your plan about changes for next year October 15—December 7th is when Open Enrollment begins This is the one time of year when everyone with Medicare can make changes to their health and drug plans for the next year.
If you decide to make a change your new coverage begins January 1. If you stay with the same plan, any changes to coverage, benefits, or costs for the new year will begin on January 1. If you are in a Medicare Advantage Plan, you can drop your plan and switch to another Medicare Advantage Plan with or without drug coverage, or to Original Medicare. If you switch to Original Medicare, you’ll also have the option to join a Medicare drug plan. Your coverage will begin the first day of the month after the plan gets your enrollment form. In some cases, you may be able to make other changes if you qualify for a Special Enrollment Period.
What do I have to do if I’m not drawing Social Security when I turn 65? When do I call to start Plan B?
If you are not drawing Social Security at the time you are eligible for Part B coverage you will pay Medicare directly (most likely quarterly). A bill will be sent to your home. You can first sign up for Part A or Part B (together or individually) during the seven-month period that begins three months before the month you turn 65. If your birthday is June 5th you can apply starting the March prior to your birthday through September.
Do I have to take a drug plan if I don’t take any drugs?
Part D coverage (prescription) has a late penalty surcharge if you do not apply when eligible. The late enrollment penalty (also called the “LEP” or “penalty”) is an amount that may be added to a person’s monthly premium for Medicare drug coverage (Part D). A person enrolled in a Medicare plan may owe a late enrollment penalty if they go without Part D or other creditable prescription drug coverage for any continuous period of 63 days or more after the end of their Initial Enrollment Period for Part D coverage.
The recommendation would most likely be to go on a basic plan to meet the eligibility criteria.
If I have a MAPD HMO plan and travel outside of my state, will I have coverage for emergencies/surgery?
With Medicare Advantage plans, you’ll have emergency and urgent care coverage when traveling outside of your network, within the United States. That means you don’t have to worry about coverage if you get a sudden illness or break a bone while traveling. If you need non-emergency or non-urgent care while traveling, it may not be covered, and you’ll likely have to pay more out of pocket.
You also have the option to choose a PPO Preferred Provider) Plan – This type of Medicare Advantage will have a preferred network where your costs will be lower. But if you do choose a doctor out of network, the plan is will a percentage of the claims.
Since my plan has foreign travel coverage do I need to purchase travel insurance?
Some Medicare Advantage plans include travel benefits for when you need care away from home. These travel benefits usually cover just emergency and urgent care and help ensure you have coverage no matter where you are.
Travel insurance might also cover trip cancellation, trip cancellation, missing bags, in addition to medical and dental emergencies that might not be covered during your trip.
How do you help people choose a plan? Supplement or Advantage?
During our assessment we will review what is most important to you in a health insurance plan as well as your doctors, hospitals, medications, lifestyle and budget. You will see all of the options available to you.
If I have a supplement Plan G now and want to switch carriers do I have to do medical underwriting?
The decision to change your Medicare Supplement depends on your unique situation. To determine if you should change companies, it’s a good idea to first shop your rates. If there is a lower premium for the plan you currently have, you can apply to change your coverage. We find that many people will even switch to a plan that has a similar rate. They’ll do this to take advantage of the rate lock, or a guaranteed rate, and avoid a rate increase from their current carrier. If there is not a lower rate available, you can stay with your provider, and feel comfortable knowing that you have the best rate available.
If a health company declines my supplement application what do I do?
The process of changing your Medicare Supplement company is straight-forward. Changing your Medicare Supplement company begins with applying to the carrier you would like to have. The rules on applying vary by state, but you will most likely need to undergo a process called medical underwriting. You don’t need an exam for this process, but you will typically need to answer questions over the phone about your health. We will help find you a carrier that will be likely to accept you and help you submit your application. The process is low-risk because you can keep your current coverage in place even if you are declined by the new carrier.
Can I shop my supplement every year?
YES.. and in fact: You can change Medicare supplement plans at any time of year – you will have to pass medical underwriting to do so.
Are drugs covered differently on a MAPD and stand-alone PDP? Yes & No:
Yes – In many cases, the your costs for are Rx will be different for the same list of medications with a MA plan compared with a PDP – even with the same list and often with the same company.
NO – The mechanics of Medicare Rx plan is exactly the same either stand alone or within a Medicare Advantage plan.
Some technical info: A Medicare drug plan offers drug coverage to people with Original Medicare (Part A and Part B). In general, a Part D-covered drug must meet all of these conditions:
■ Available only by prescription
■ Approved by the Food and Drug Administration (FDA)
■ Used and sold in the U.S.
■ Used for a medically accepted indication, as defined under the Social Security Act
■ Not covered under Part A or Part B
■ Included on the plan’s Part D drug list (also called a formulary) or coverage approved through the exceptions or appeals process.
Plans can vary depending on providers, deductibles, coinsurance, and copays.
What factors are different this year than last year?
Medicare Advantage plans are becoming stronger and stronger here in western NC. These plans with a variety of companies; UHC, Humana, Aetna, Alignment only became available over the four years. If you are in your 70’s – you may be well served by these options. The plans adding more value added benefits including flex cards, over the counter benefits, dental, vision, hearing and Part B premium reduction.
Is there an advantage to use your PDP coverage or GoodRX or would out of pocket be better?
You may want to use GoodRx instead of Medicare in certain situations, such as when Medicare doesn’t cover your medication, the GoodRx price is cheaper than your Medicare copay, or you won’t reach your annual deductible. GoodRx may be a good option if you have a new brand Rx during the last couple of months of the year.