Tag Archives: medicare

7 Costly Medicare Mistakes Seniors Should Avoid Making

There are many parts to Medicare, and with that comes confusion and a good chance at missing something. It is essential for everyone approaching age 65 to get informed on Medicare and sign up for the right plan at the right time. Neglecting the chance to act at making the best Medicare decisions could cost you. Here’s how to avoid these seven common mistakes so you can get the right coverage without overpaying on premiums and deductibles, experiencing gaps in coverage, or getting hit with high penalty fees.

  1. Deciding without fully understanding each Medicare plan.

Medicare has many plan options making it very confusing and hard to decide which plan is best. It is essential for new enrollees to do their homework on Medicare before their enrollment period, so they know precisely the action they need to take. It’s necessary to become familiar with the differences between Original Medicare with a Medicare Supplement or “Medigap” plan, and Medicare Advantage plans, also known as “Part C.” Not knowing what your final choice has to offer could leave you with a plan that doesn’t fully cover your specific healthcare needs.  

  1. Going out of your plan’s network.

It is essential to realize when you sign up for Medicare, not every health provider will accept your specific plan and that this could change every year. Most places accept original Medicare and therefore, any Medicare supplement plan, but if you have a Medicare Advantage plan, you might not be covered if the provider is out of network. Always make sure to check if the doctor or hospital you are going to is in your network or it could mean an expensive bill. One more thing to be wary of here is that doctors and hospitals can stop taking Medicare Advantage plans ANY TIME, even though you have to wait until fall to change your plan. We see doctors jumping out mid-year, and that puts people at a crossroads: either I see my current doctor and pay for visits/procedures out of pocket, or, I find a new doctor who is in my network (for now). One more thing – if you think that your plan covers emergencies out-of-network, we want to kindly remind you that the insurance companies dictate what is considered an “emergency.” What you find emergency room-worthy actually isn’t up to you.

  1. Missing your enrollment periods.

There are enrollment periods that vary from person to person, depending on when an individual turns 65 or when they decide to leave their current job that provides them with healthcare benefits. When turning 65, eligibility to sign up for Medicare begins three months before your birthday month and continues for three months after. If you turn 65 and still have healthcare coverage through your job, you may want to delay your Part B enrollment until you seek full benefits from Medicare. This depends on the situation, size of the company, and the cost comparison, so you definitely want to discuss this with an expert to be sure you make the right moves. The Annual Enrollment Period (AEP) is the same for everyone, every year, which begins October 15th and goes until December 7th. This is the only time frame for current Medicare beneficiaries to change Part D prescription plans or Medicare Advantage plans. You can change a Medicare Supplement plan any time you want, however. It’s important to become familiar with these time frames, so you aren’t left without coverage at any time or hit with late-enrollment fees or penalties.

  1. Ignoring your Annual Notice of Change (ANOC).

The Annual Notice of Change (ANOC) is sent out to all Medicare beneficiaries before the Annual Enrollment Period stating any changes to plans and costs that will take place the following January. If you don’t read your NAOC, you might not know if your plan details or costs have changed, and it could leave you without coverage in certain areas and/or more expensive bills. You might learn it is in your best interest to keep the plan you have, but ignoring this critical update from your insurance company could result in getting stuck in a plan that costs way too much or doesn’t take care of your needs.

  1. Improperly signing up for Medicare Part B.

Once you turn 65, you are automatically enrolled in Medicare Part A (which covers your facility costs at the hospital) because you worked more than 40 quarters (10 years) and it does NOT come with a premium. Medicare Part B, however, not only comes with a premium (income-based, starting at $135.50 per month for 2019) but also comes with huge penalties and expenses if you enroll or delay enrollment improperly. If you are still working and you plan to continue working after your 65th birthday, you will need to find out the answers to a few critical questions. First off, is your company larger than 20 employees? If so, they MUST offer you health coverage while you are still employed. However, this does not mean you have to or should take this. It’s best at that point to compare your predicted costs with your employer plan versus your options under Medicare. About 50% of the time, it makes sense to leave your employer plan for Medicare. Definitely something you want to discuss with an expert. Okay, here is another common situation, let’s say you decide not to take Medicare Part B, and your employer is found to be less than 20 employees, otherwise known as not-credible coverage. If your plan is found to be not-credible coverage then when you go to take Medicare Part B, Medicare charges you a 10% penalty of the premium (about $13.50 per month at the lowest income bracket) for the rest of your life. That penalty can really add up. Lastly, let’s say that you take your Medicare Part B while you are still working and your employer has over 20 employees, so you stay on this insurance, too. The problem people run into with this is that when you take your Medicare Part B, not only are you paying a premium for coverage you aren’t using, but you run the risk of lapsing your Open Enrollment window. This is the time that lasts for six months (three months before and three months after your 65th birthday) in which you can choose any Medicare Supplement plan you want, with no medical questions asked. When you lapse this window while it’s sitting as your secondary insurance to employer coverage, when you retire, you will have to be reasonably healthy to get supplemental coverage.

  1. Missing your opportunity to switch plans.

There are many reasons a beneficiary might want to change Medicare plans, but it is easy to miss the chance to do so when it comes to prescription and Medicare Advantage plans. Just like enrollment, there are only specific periods where switching is possible. You can make changes to your prescription and Medicare Advantage plans during AEP. With Medicare Advantage plans, you have a 1-year trial period from the first date active, which allows you to switch to Original Medicare anytime within that timeframe if necessary. There are other unique opportunities to change, including life events like moving to a new area where your current plan doesn’t exist. The most common reason to switch plans is to save money, so make sure you understand your enrollment windows.

  1. Signing up for the same plan as your spouse.

When you get health insurance through an employer, often you can choose a plan that covers you and your spouse. With Medicare, you each need an individual plan, and it isn’t always the best option to go with the same insurance company, let alone plan. As you age, the chances of having different healthcare needs than your spouse become higher, so it is significant for beneficiaries to pick a plan that is specific to you and your personal needs. Often, healthy couples can and should take the same plan, because some insurance companies offer household discounts. Comparing companies and rates is the best way to decide what’s most cost-effective for you and your spouse.

Medicare is confusing, and finding a helpful resource isn’t always easy. Here at Senior Health Medicare, we aim to be that helping hand that you can rely on so you can avoid making these mistakes and navigate Medicare with ease. If you have any further questions about this blog or anything Medicare-related, please feel free to comment on this post or contact one of our helpful experts by phone.

 

How You Can Help Prevent Medicare Fraud

Medicare fraud is happening all the time, which results in higher taxes and healthcare costs for everyone. People and companies who get access can steal your Medicare number and personal information to scam the system for illegitimate products and services. It is important for beneficiaries to understand how to spot and protect from fraud to keep costs from rising even higher in the future. Not to mention, keeping your confidential information safe.

Doing Your Part

  • Keep your Medicare card, Medicare number, and Social Security number safe as you would protect a credit card. Only give this information to doctors, Medicare providers or someone you know should have it.
  • Keep records of all doctor’s visits and services provided. Always check your Medicare statements to ensure every detail is accurate.
  • Be sure to check you were given the right medications before leaving the pharmacy.
  • Never accept special offers on free or discounted Medicare.
  • Ask any questions about your Medicare or billing costs. It is your right to know.
  • Be aware of providers who claim they know how to bill Medicare even though they don’t usually offer that particular service.
  • Always report suspected incidences of Medicare fraud.
  • Never accept anything from a door-to-door salesperson claiming they are from Medicare. Medicare never sends representatives to your home.
  • Don’t let the media influence you about your health because they don’t always have your best interest in mind.

How to Spot & Report

If you have any suspicions whatsoever never hesitate to call Medicare. If you think a charge on your statement isn’t correct, call your provider and ask them about it. Always review your Medicare claims for any errors to stop fraud from happening early on. View your claims as soon as they are processed by logging into MyMedicare.gov or give them a call. When reporting Medicare fraud, make sure you have any records indicating possible existing errors and documents providing proof of services. To report any suspicious activity, you can call 1-800-MEDICARE (1-800-633-4227), report online at the Office of Inspector General or call them at 1 800 447 8477.

Medicare can be confusing for enrollees, which makes it easy for criminals to take advantage. If you have any questions or would like more general knowledge on Medicare, leave a comment, or give us a call. Here at Senior Health Medicare, we strive to educate beneficiaries on Medicare so that you and your loved ones stay protected and feel confident in your Medicare decisions.

Travel smart with Medicare

Before going on any trip, creating a checklist is always recommended. While you are updating your passport, checking the weather to prepare to pack, you should also make sure to check on your health coverage while traveling. Medicare can be great for travelers if the proper decisions are made.

Original Medicare covers you in the United States of America, including the District of Columbia, Guam, U.S. Virgins Islands, Puerto Rico, Northern Mariana Islands, and America Samoa. If you are going outside of these lands and/or overseas, for a majority of the time Medicare will not pay for the health services or supplies. There are some rare occasions where Medicare will cover your service or supplies.  An example of the rare occasions where Medicare will cover your service or supplies is as the following: If your emergency happens in the United States of America but nearest hospital to treat you is in Canada or Mexico.

According to Medicare.gov “In some cases, Medicare may cover medically necessary health care services you get on board a ship within the territorial waters adjoining the land areas of the U.S. Medicare won’t pay for health care services you get when a ship is more than 6 hours away from a U.S. port. “  As you can see, understanding the boundaries, the loop holes and the safety net created by Medicare is best left to an expert to fully understand.

Many experts advise their clients to invest in travel insurance as a “just to get home” safety net. when you have travel insurance you will have coverage for things that aren’t an emergency. It’s reasonably priced, and a great asset to have to in your back pocket if you are a frequent traveler, particularly an international traveler. If you have an emergency under $50,000, Medigap is a great option for you. With Medigap you can go anywhere in the U.S. that accepts Medicare . Also most Medigap plans include foreign travel emergency coverage up to  $50,000- but this coverage is meant to be reimbursed. For example, if you were hurt abroad, depending on the procedure needed you would either Medivac to the United States or receive treatment abroad. Either way, it would be your responsibility to pay for that procedure out of pocket, and then the insurance company will reimburse the claim. The Medigap covers 80% up to 50k, so you could still end up with a big bill.

So before setting sail, or boarding the plane, make sure you speak to your Medicare advisor and ask many questions. No one plans to have a medical emergency while on vacay, but it’s better to be proactive rather than reactive.

10 Healthy eating tips for seniors.

As we all know, when we increase in age our metabolism decreases. As a result, our food intake has a higher level of importance compared to when we were in our 20’s or 30’s.  Here are some quick and easy tips to eating healthier and living a longer life.

 

  1. Eat a variety of foods

Some of us stick to our favorite foods, and aren’t open to trying anything new. To ensure that we are getting all of the necessary vitamins needed, we must have a well-balanced diet. According to the National Council on Aging, our meals need to consist of fruits, whole grains, vegetables, low-fat dairy, and lean meats. Not only will this meal make your body feel amazing, but it will look more amazing, too.

  1. Minimize the salt

As we age, our sense of taste becomes weaker and we try to compensate for that by using extra salt. According to many studies, salt has a direct connection to high blood pressure. We know that stress, lack of physical activity, some medications, and a whole list of other factors can lead to hypertension. To combat this, exchange some of the salt for fresh herbs and spices.  Herbs and spices like basil, cardamom, garlic and ginger are known to lower blood pressure. These ingredients also add a punch of bright flavor where you might normally add salt.

  1. Drink more water

We all need water to survive. Our muscles are about 70% water, our brains are about 85% water, and our blood is about 80% water. Not only do these percentages show we obviously need water, but our body gives physical signs when it is lacking water.  Drinking fresh juice and some sugary drinks are okay once in a while, but water needs to the main source of hydration in our diets. You may be surprised how much better you feel just by upping your daily water intake!

  1. Read the labels

Sometimes we can fall into the habit of buying the same things.  We should question ourselves and ask “How often do I read the nutrition label?” Those labels are not there to take up space, they actually hold real value. Some of the numbers on the labels may shock you. The next time you’re shopping, take a peak at the nutrition labels and see what you find.

  1. Consider supplements

Some of us are taking a lot of pills, medications, and other things already, and the thought of adding another thing to the list is overwhelming.  Fruits and vegetables are great sources for vitamins, but in some cases they’re just not enough. For example, people over the age of 50  do not get enough vitamin B12 according to the Academy of Nutrition and Dietetics.  Talk to your doctor and see what they supplements they recommend for you.

  1. Reduce sugar

Reducing the sugar in our diets is something many dietitians and nutritionists agree on throughout the world of nutrition.  We should aim to exchange some of our sugary snacks and treats with fresh fruits. According to the Academy of Nutrition and Dietetics, strawberries are great for eyes and contain plenty of vitamin C. Vitamin C is an antioxidant that can help lower your risk of cataracts.

  1. Eat more Kale, if you can

Kale is an amazing source of lutein and zeaxanthin, both are needed for healthy eyes and retina protection. Kale can help protect our eyes from sun damage, lower the risk of cataracts, and it can help protect our eye from macular degeneration. Even though this amazing leafy-green can help many, some of us who are taking blood thinners like Coumadin, and others who have a cruciferous vegetable allergy should speak to their doctors before eating kale.

  1. Try Green Tea

According to many studies, green tea has been considered to help reduce our risk of cancer, neurodegenerative diseases, and more. The studies referenced here focus on breast, prostate, and colorectal cancer.  Not only does green tea help with lowering our risk of cancer, it can also help lower our risk of Alzheimer’s and Parkinson’s. Both diseases are classified as neurodegenerative, and studies show that the compounds in green tea can have various protective effects on neurons.

  1. Not all fats are bad

Omega-3 fatty acids are essential for good brain health.  Studies shows that is can help with improving healthy memory function. Seafood and fatty fish is an amazing source of omega-3 fatty acids.  Not everyone likes fish, for those of us who doesn’t , plant sources like nuts and seed also contain omega-3 fatty acid.

  1. Enjoy your food

Eating is not only necessary for living, it can add the spice life that we all need. So have fun, make revisions to old recipes, and share your knowledge of food to the younger generations.

Leave a comment and tell us which tip are you most excited about trying.

Understanding Part D

Part D may feel difficult to understand, but it is a very important element to grasp an full understanding of.  The very first thing to understand is that having a yearly review considering your Part  D plan is vital. It is vital because your Part D plan can change on a yearly basis.  Your medication, dosage, provider’s location, and cost may change on the since last year.

Medication has tiers ranging from big name brands to generic brands. The cost, and tier requirements may change in which you may benefit or pay extra for the same drugs.   When speaking to our experts at Senior Health Medicare, we will not only review your current Part D plan, but we will put together a plan that will give you the same coverage with the best prices. 9 times out of 10 you and your spouse do not share the exact medication, to combat that our experts will create an individual plan for you and your spouse.

Call us now- before October 15th to get an appointment with our advisers. Enter your medications into our Part D Analysis form on the website. We will do a FREE drug plan comparison and recommend the plan with lowest out of pocket cost based on your medications.

Part D Analysis form: https://seniorhealthmedicare.com/health-ins-form2.php

7 Medicare Tips for New Enrollees

1 Medicare doesn’t have a family plan

Medicare plans are only individual coverage, not family. This means that spouses each need to have their own Medicare coverage. Additionally, no dependents receive coverage. In the event that your spouse is younger than you, when you enroll in Medicare they can seek employer coverage or individual coverage through the marketplace (healthcare.gov — the Affordable Care Act website). Note, that if you and your spouse are entering Medicare around the same time, you may be recommended different plans from different companies if they are a better individual fit for you. Some companies to offer household discounts for enrolling with the same company, but other than that it is unique to the individual.

2 There is no cap on out-of-pocket costs in Original Medicare

Most employer plans have annual limits on your out-of-pocket health expenses. Medicare pays 80% of approved medical expenses, then the beneficiary is responsible for the remaining 20%, without a cap. For example, if you have an $100K surgery, you will have to pay $20K, which is why people buy Medicare Supplement plans or Medigap plans to fill this gap.

3 Make a plan for any pending procedures

If your employer plan offers you better benefits than Medicare or costs less, then you may want to have the elective surgery sooner than later. Or wait until you are enrolled in the Medicare system. Surprisingly, the first year for a Medicare beneficiary usually has the highest number of claims because people wait for elective surgery until they are covered on the system.

4 Observation VS  Inpatient 

Medicare pays different rates according to status. Even if the patient is admitted in a hospital for one week, if they are under “observation” they are considered as out-patients.  Medicare requires a three-day hospital inpatient stay minimum before the covering of cost. When a patient is admitted under “observation” , the time frame is not counted toward the Medicare’s requirement regardless of the length.

5 Research can mean more money in your pockets

In the employer health insurance world, you are stuck with the benefits designed for the group. With Medicare, it should be custom to you and your individual needs. Finding an educational resource to learn more about Medicare and how it works, will only help you make smarter decisions when it comes to health insurance. It can also mean saving money in the process.

6 When you enroll into a Medicare Advantage plan, you are disenrolling from Original Medicare

Medicare Advantage plans were introduced in the early 2000’s as an alternative to Original Medicare parts A and B. The way they are marketed is that they offer the same benefits as Original Medicare, but it’s a little more complex than that. While Original Medicare and Medicare Supplement plans are programs regulated by the government, Medicare Advantage plans are controlled by the insurance companies. It literally takes an act of Congress to change Original Medicare, whereas Medicare Advantage plans are  in the company’s hands. You essentially give up your Medicare to work with a network provider. Learn more about the difference between Medicare Advantage and Original Medicare with a Supplement here.

7 You can change your Medicare Supplement coverage whenever you want

You don’t have to wait for AEP to change your Medicare Supplement coverage. You can change your Medigap plan anytime during the year, as long as you can pass medical underwriting. The programs that must wait for changes until AEP are Part D Prescription plans and Medicare Advantage plans.

 

Leave a comment, let us know which tip is the most useful.

Making Medicare Simple and Easy

If you ever wanted a personal assistant, especially with the confusing world of Medicare, My Medicare.gov is an amazing tool! My Medicare.gov is a free, secure, online portal that manages your personalized information regarding Medicare benefits and services. It is very simple to set-up, and can be used to check  information about your coverage, enrollment status and Medicare claims.

You can make getting all the necessary information about your coverage, prescription drugs, and health records easy for your doctor and any doctor you may need in the future. You never know when you’ll need to see a doctor while traveling. As you may know, not every doctor has your personal list of medications. This tool allows you to have everything you need at your finger tips.

According to sources at eHealth Medicare, your personal information is protected by the CMS.  The CMS is the Centers for Medicare & Medicaid Services,  The CMS has many guidelines such as, what type of information is being used, who is collecting the information, and how are they using the information collected.  This amazing tool has many other functions for your disposal, so give it try!

Leave a comment, and let us know what would you use My Medicare.gov for?

For more information, click the link below https://www.mymedicare.gov/

Medicare Annual Election Period (AEP)

6 Things You Should Do Before Medicare AEP Begins Oct. 15

Medicare Annual Election Period (AEP)

It’s that time of year again, the Annual Election Period (AEP) is upon us. If you’ve been a Medicare recipient prior to this year, then you are all too familiar with the implications of AEP. If this is your first enrollment season, then you’re about to experience what can be a frustrating and stressful time as a Medicare enrollee.

 

During the Medicare AEP, beneficiaries are able to alter their coverage under specific programs such as Medicare Advantage and Part D Prescription Drug plans. Often times, people make the mistake of thinking this is also the only time to change Medicare supplement plans, however those can be changed anytime throughout the year. The main things to focus on during AEP are switching from or to a Medicare Advantage plan, and entering into or changing your prescription drug plans.

 

You may be wondering why it is necessary to monitor these plans during the AEP, and the simple answer is that these plans change in coverage and price every year. If you don’t change or do anything to your existing plans, they will likely be much different in price and/or coverage as you enter into the next year. In many cases, the change can be significant. That’s why it’s always worth having your Medicare advisor analyze your existing plans and medications to ensure you’re still in the most cost-effective plan every year during AEP. Don’t wait, you could end up locked into a plan with a much higher premium or with holes in your coverage if you miss the AEP window (October 15th through December 7th).

 

In an effort to curb the stress and confusion that comes from Medicare AEP season, we’ve developed a list of 6 things that you should do to prepare.

 

  1. Confirm your eligibility. This is pretty obvious, but you must be eligible to enroll in Medicare plans. If you’re unsure of your eligibility, consult this article from the US Department of Health & Human Services website: http://www.hhs.gov/answers/medicare-and-medicaid/who-is-elibible-for-medicare/index.html

 

  1. Analyze your existing coverage thoroughly. Take some time to consider your past year of coverage. Weigh the pros and cons of the specific plan you’re in, the company/carrier of the plan, the total expenses (including prescription meds) of the year. Consider aspects like how quickly your claims were paid, if your doctor had any trouble with your insurance at any point, and if the out of pocket expenses were worth the healthcare you received.

 

  1. Make note of any changes in medication or health that could impact your plans. After you’ve done a thorough self-analysis of your past coverage, make sure to note any looming changes that could be upcoming in your health. For example, if your doctor suggested a new medication or treatment that wasn’t previously needed when you set up your original plan. Write this all out and give your coverage an overall satisfaction rating for the year. This will help determine what the next move for you should be, and will make you aware of what you need most out of your healthcare coverage.

 

  1. Compare prices of plan options for the coming year. There are MANY plans, programs, and carriers to choose from. When it comes time to select your coverage for the upcoming year, it’s essential to decide what type of Medicare beneficiary you are. Are you someone who would prefer to pay a little more on a monthly basis in exchange for peace of mind that you won’t have any unexpected expenses? Or would you rather pay a lower monthly premium and take the risk that your coverage may require high out-of-pocket expenses should you have a health issue? If you can answer this question for yourself, you’ll give a better starting point to determine what plan/program is a better fit and how much you will spend on said plan.

 

  1. Make a list of your current medications, dosages, and frequency. After analyzing the entirety of your coverage, the next step would be to write down every medication you take, the dosage, frequency, and brand. This list is going to guide your Part D plan selection.

 

  1. After completing steps 1-5, set an appointment with a Medicare advisor. After you’ve done the previous five steps, you have painted yourself a pretty thorough picture of your healthcare needs. Now it’s time to take this information to your Medicare advisor, so they can analyze and help you select the best coverage at the best price. Completing steps 1-5 prior to your call or appointment will make the process go much faster and smoother for you. *Helpful Tip: Always work with a non-captive Medicare advisor. They have access to all the plans and companies, not just one of them. This ensures you are in the best plan at the best price.

 

Remember, in order to ease the confusion, contact a Medicare representative to help make this AEP much smoother. If you don’t have a dedicated agent or aren’t sure, our toll-free Medicare hotline is open for questions, comments, concerns for anyone in the United States who needs consult on their Medicare plans/coverage at (888)-404-5049.

 

 

10 Things You Might Not Know About Medicare in the US

Doctor taking blood pressure of her smiling patient

We’ve said it before, and we’ll say it again, Medicare is confusing. Which is why we dedicate our lives to helping seniors PREPARE for Medicare before they enroll. Knowledge is power! So with that being said, here is a list of 10 things that you probably don’t know about Medicare, and some of them may surprise you!

 

  1. Medicare covers more than just senior citizens. Medicare is designed for the aging population, but under certain circumstances, people under the age of 65 can be enrolled. If you have a qualifying disability or End Stage Renal Disease (ESRD), you can get covered under Medicare.
  2. Baby boomers are aging into Medicare at a rate of 10,000 per day. Back when Medicare was first designed, people weren’t living nearly as long as they are today. Add that to the baby boomer generation who are rapidly aging into Medicare at a rate of 10,000 people PER DAY, and you can see how Medicare is quickly going to get into trouble.
  3. Enrollment can happen outside of AEP. There is a common misconception surrounding Medicare that you can’t change your plans unless it’s during the Annual Election Period (AEP) from October 15-December 7. While this is true for Medicare Advantage (Part C) and Prescription Drug Plans (Part D), you can change from Medicare supplement plan to plan anytime you want. There are always “special election periods” and change of status that can warrant a change outside of AEP as well.
  4. Each part of Medicare covers something different. While the parts of Medicare can be the most confusing part, it’s all for good reason. Each part of Medicare means something different and works differently. Part A is for your hospital care, Part B is for healthcare outside of the hospital such as routine doctors’ visits and preventive care, Part C is Medicare Advantage, and entirely different program from original Medicare altogether, and Part D is the prescription drug plan. Every part works differently to make one whole picture.
  5. How much Medicare actually pays out. Medicare supplemental insurance was created to fill in the coverage gaps left behind by original Medicare. Did you know that traditional Medicare only covers 80% of the Medicare-APPROVED costs? That means, YOU as the enrollee are responsible for that other 20%. This is where Medicare supplement insurance comes in. It covers your 20% if you keep up with your monthly premiums, and can save you a ton.
  6. A “non-participating” doctor still takes Medicare. Despite what the status title of “non-participating” doctors suggests, doctors under this status DO accept Medicare. They just don’t accept it at the amount that Medicare pays, meaning these doctors reserve the right to charge the patient additional money on top of what Medicare approves. While it seems confusing, don’t be too alarmed if your doctor becomes a “non-participator”- it just means that they reserve the right to charge you 15% more than Medicare approves. This is typically only found with specialty doctors/treatments.
  7. Waiting to enroll in Part D can cost you FOR LIFE. Once you’ve reached Medicare enrollment time, you also have to enroll in your Part D drug plan. If you don’t, you have to wait until the following AEP, AND Medicare charges a fee every month for the rest of the time you’re on Medicare (aka, the rest of your LIFE!) While the fee is minor, it can add up depending on your lifespan. 1% of the national average in premiums in what you pay PER month, so 12% per year, lasting forever.
  8. Medicare doesn’t cover everything. If you’ve been to your doctor for a physical and you WEREN’T charged for it, your doctor didn’t file it properly. Physicals and some other procedures aren’t covered under Medicare. While Medicare paired with a supplement covers almost everything, and mostly the big stuff, it doesn’t cover everything.
  9. Medicare doesn’t work outside the USA. Getting ready for a big vacation to Europe? Make sure you understand before you go that your traditional Medicare coverage doesn’t apply out of the country. If you have a Medicare supplement, you’re covered. However, traditional Medicare without a supplement or Medicare Advantage does NOT work outside the United States.
  10. On average, with Medicare you get WAY more than you pay for. While your Medicare premiums and co-pays do add up, compared to the average amount of usage, you are saving a TON. Medicare may not be perfect, but it is still possibly the greatest government healthcare coverage known to us. Take advantage of it by preparing yourself properly with a supplement so you don’t get stuck with huge bills, but rather a predictable monthly premium.

 

It’s true; Medicare is complex. But it’s one of the best working healthcare systems out there, and if used properly it can save enrollees a ton of money in their health care and keep them healthier, longer.

 

What is the Difference Between Medicare Part A and B?

Non captive agents help you get the best coverage at the best price

Ever wondered what all the different parts of Medicare actually mean? There are many terms and ideas associated with Medicare that are constantly thrown around, but do you truly know what they mean? Our blog is aiming to answer some of the common and consistent Medicare questions so that you can better understand the industry, and furthermore, your coverage.

 

So let’s dive in today with the basics: defining the two primary parts of original Medicare, Part A and Part B. We’ll get into Part C & D on another day.

 

Okay, so let’s start with the more basic Medicare Part A.

 

Medicare Part A

 

This is your hospital insurance. Any inpatient hospital stays, care received in a skilled nursing facility, hospice care, and some health care are covered under Medicare Part A. This is pretty straight forward; however, it can be more complex depending on your healthcare status and provider. Often times “under observation” can be a troublesome status for a patient covered under Medicare to have, because it can cause trouble with coverage. That’s a story for another day though, so for now, just remember that “Medicare Part A covers your stay” (in most cases).

 

Medicare Part B

 

Okay, so this is your actual health insurance coverage. This covers two types of medical services:

 

  • Preventive medical services such as flu shots, illness screenings, and the like, are considered preventive services. The lines here can become a bit blurred, but essentially, any sort of screenings or lab work that is done in an attempt to prevent major illness is considered preventive. Additionally, coverage can extend to necessary durable equipment like walkers or wheelchairs, when a diagnosis requires that.
  • Necessary treatment is covered when patients require treatment and care to treat conditions or illnesses. Included in this category are x-rays, lab work, outpatient services, and doctors visits that are necessary per your condition.

 

For part B, just remember it either helps prevent illness with preventive care coverage or treats an illness or condition.

 

If you don’t have a Medicare supplement plan in addition to your original Medicare coverage, then you are responsible for paying a deductible annually, as well as 20% of the Medicare-approved amount with participating providers. This 20% can really add up quickly, especially if you are being treated for a serious illness. This is why in most cases it makes sense to have a Medicare supplement plan to back up your original Medicare.

Well that in a nutshell is Medicare Part A and B. Stay tuned for more Medicare news, tips, and facts by following our blog or social channels.