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Got questions? We’ve got answers. Here are some of the most commonly asked questions about Medicare. If you can’t find an answer to your question here, give us a call or email Info@MyMedicarePartners.com
Which should I choose: Medicare Supplement or Medicare Advantage?
Thankfully, seniors have options when it comes to choosing a plan to enhance their Original Medicare coverage and to reduce their financial risk. Many seniors choose Medicare Supplement plans, while others choose Medicare Advantage plans…and you might be stuck wondering which is best for you.
Medicare Advantage plans are sometimes called MA or MAPD plans. Medicare Supplements are also known as MediGap plans because they fill in the gaps in coverage left by Original Medicare only. It is recommend you enroll in a MediGap or an MA plan as soon as you are first eligible (also known as your Initial Election Period), which may begin as early as 6 months before the month you turn 65. Delaying enrollment could result in penalties and higher costs.
Both Medicare Supplement plans and Medicare Advantage plans:
- Both of these types of plans help lower the costs otherwise incurred for medical bills covered under Part A and Part B only
- Both of these help reduce your financial risk. (Remember, there is no limit to what you may have to pay for medical bills under Original Medicare)
- Both are administered by private insurance companies
- Greatly reduce medical bills – sometimes even eliminating out of pocket costs – especially covering the gaps left by Original Medicare only. Provide you the lowest out of pocket costs when visiting a Dr.
- Offer standardized benefits which may eliminate deductibles and co-pays
- Allow you to visit any Medicare provider in the country without referrals and waiting periods
- A Part D prescription drug plan must also be purchased
- Offer you lower co-pays for provider visits
- Often have limited networks of providers you can access and often require referrals before a Specialist Dr visit
- While most MA plans come with Prescription Drug coverage (called MAPD plans), some do not offer drug coverage and therefore it must be purchased separately
Do you still need to weigh your options? Have more questions about the differences between MA and MediGap plans? Call our licensed Agents at 1-844-305-6169 for more information and quotes!
Do I have to collect my Social Security to become eligible for Medicare?
Nope! If you are already getting Social Security benefits (or benefits from the Railroad Retirement Board), you will be automatically enrolled in and sent your Medicare Part A and Part B card. Your coverage becomes effective the 1st day of the month in which you turn 65. You will also begin paying Part B premiums at that time. (If your birthday is on the 1st of a month, your coverage will begin the 1st day of the prior month)
If you have enrolled in Medicare Parts A and B, don’t forget to also sign up for a Part D drug plan and a Supplement plan to enhance coverage and reduce your financial risks.
If you are not yet claiming your Social Security, you will not be automatically enrolled. Please read more here about how to enroll in Original Medicare.
How do I enroll or find out of I am eligible for Medicare?
Or, you can contact the Social Security Administration to check your enrollment status for Medicare Part A and Part B. If you are not yet enrolled and are eligible, you can apply for Part A and Part B through Social Security. After your enroll in Part A and Part B, give us a call and we’ll handle the rest!
Do I need prescription drug coverage? Why?
Yes! By law, everyone must have health insurance that satisfies the “creditable coverage” requirements, part of which is coverage of medications. If you’re a Medicare beneficiary, this means you must be covered through a Medicare Part D plan, a Medicare Advantage with Prescription Drug Coverage (MAPD) plan, or an employer plan. *Medicare Part A and Part B alone do not satisfy the prescription drug requirement!
Please note that enrollment in a prescription drug plan is not automatic! Even if you are automatically enrolled in Original Medicare’s Part A and Part B, you still must manually enroll in drug coverage through a Part D plan, a Medicare Advantage with Prescription Drug Coverage (MAPD) plan, or an employer plan.
Part D prescription drug plans fit nicely with Medicare Supplement plans and offer the ultimate medication coverage. With over 800 plans available, allow one of our Medicare Agents to find a plan that will best meet your needs and your budget.
A few other items to note about prescription drug coverage….
- By law, you must have drug coverage even if you are not currently taking any prescription medications. If you do not have creditable coverage, you may face a penalty.
- You never know how or when your health care needs may change. You may not need a bunch of prescription medications today…but that could change in the blink of an eye.
- There are deadlines of when you can sign up for prescription drug coverage. Therefore, My Medicare Partners recommends you enroll in a prescription drug plan when you enroll in your other Medicare coverage – or you may be locked out from buying a plan and face a penalty.
My Medicare Partners’ friendly agents can assist you in determining which plan is best for you. We can also help you find a plan that covers your drugs at the lowest co-pays and will allow you to visit your preferred pharmacies. Contact us at 1-844-305-6169 today and read more about Part D plans here.
Will preexisting conditions affect the price of my insurance? Will tobacco use affect my price?
It is against the law for an insurance company to charge you more for a Medicare Supplement plan based on preexisting conditions or illnesses you had before signing up for the plan. However, a plan can refuse to cover you based on some medical conditions. Some insurance policies require that applicants complete “medical underwriting” which is when your medical history and current health are examined.
However, people new to Medicare (i.e. people turning 65) are “guaranteed to be issued” meaning that the insurance company cannot refuse to provide coverage, no matter what medical conditions they may have. This Guaranteed Acceptance Period only lasts for a certain period of time, so it’s important to enroll as soon as you become eligible!
Tobacco use can affect an individual’s premium rate, as insurance companies are allowed to charge more to current tobacco users.
Medicare Supplement plan prices are determined by a variety of factors. Plan benefits are standardized and benefits do not vary from one insurance company to another. However, premiums may vary from person to person — even from company to company — so it’s important to review your rates on an annual basis!
Is it true that Medicare always covers 80% of Part B services, and I only have to pay the other 20% coinsurance?
It depends. In most cases, people who are covered by Original Medicare only (Part A and Part B only with no additional coverage) typically pay 20% for Part B services, after the Part B deductible is met. Keep in mind that Medicare Part A has its own, separate out of pocket costs not covered by Medicare Part B.
However, it is also possible to be charged excess charges for Medicare Part B services and be stuck paying more than just 20%. Also, keep in mind that there is no limit (no out of pocket maximum) to the 20% you could be forced to pay. For example, you could be forced to pay 20% of a medical bill that is $100, or even $100,000!
On the other hand, some people pay even less for their medical costs. Medicare Supplement plan beneficiaries often pay $0 for their medical expenses. Also known as MediGap plans, Medicare Supplement plans cover the gaps in Original Medicare’s coverage and reduce your financial risk.
In other words, if you enroll in a MediGap plan, you won’t be on the hook for the large expenses you could encounter with coverage only through Original Medicare (see graphic below)
- Original Medicare (which is Part A and Part B only) does not have a Maximum Out of Pocket limit – meaning that you have to pay 20% of the bills, whether that is 20% of $10,000 or $10,000 or more! There is no limit to the dollar amount you may have to pay.
- Under Original Medicare only, after your Part B premium is met, you usually pay 20% of the Medicare-approved amount for your doctor’s services.
- Under Medicare Supplement plans, the portion you pay – the coinsurance – varies based on the type of Plan selected.
- To ensure your out of pocket costs are low, contact My Medicare Partners to see which plan will meet your budget and provide you the most benefits!
There’s a history of cancer in my family. If I were to be diagnosed with cancer, will my treatments be covered by Medicare? Can I visit specialists?
There are many features in Medicare Supplement plans that are especially great for people with major health concerns. Whether it be cardiovascular disease, stroke, or cancer, it’s important to have a great plan in place that gives you the peace of mind to focus on your health rather than medical expenses.
Medicare Supplement plans, also known as MediGaps, do allow for treatment such as chemotherapy.
Also, Medicare Supplement plans allow you to visit providers and hospitals all over the nation! So whether you want to go to MD Anderson for their renowned cancer care or Mount Sinai for their amazing cardiovascular team, or any other prominent facility, chances are, they accept Medicare.
- Medicare Advantage plans, unlike Medicare Supplement plans, oftentimes have networks of providers and hospitals. These networks often only consist of providers in your local county. If a Medicare Advantage beneficiary visits providers outside of the plan’s network, their services will not be covered and they will pay all costs out of their own pocket.
Your personal, licensed Medicare Agent will be there to assist you throughout your treatment and beyond, allowing you to spend time with loved ones while you return to health.
Also be sure to also take advantage of the preventive screenings offered through Medicare plans, including many cancer screenings. Many preventive care screenings are offered at no cost to you!
What is the difference between Medicare and Medicaid?
Medicare and Medicaid sound similar…but they are two very different programs. They’re overseen by the same federal government agency (The Centers of Medicaid and Medicare Services). But the two programs are vastly different in who can qualify for them and how someone becomes qualified.
- Medicare is primarily for seniors over age 65, but people who are younger may also qualify if they have certain disabilities or live with end-stage renal disease. Original Medicare pays a majority of your bills, while Medicare Supplement plans fill in any gaps in coverage. Click here to read more about how Medicare Supplements enhance the coverage Original Medicare provides.
- Medicaid is primarily for individuals and families with low income. It helps to cover medical costs for people of all ages. While Medicaid is a federal program, it is administered by each of the 50 states and each state has different requirements and rules. Contact your state’s Medicaid services for more information.
- Some people qualify for both Medicare and Medicaid.
Are there medical expenses that Medicare does not cover?
Original Medicare is great – but there are many holes in coverage.
Unfortunately, Medicare does not cover hearing aids or dental care. Vision care is also limited. Although Medicare does not cover dental procedures such as cleanings and crowns, it does cover procedures to help structural damage to the facial region (such as jaw problems not caused by dental problems) as well as dental care needed by those undergoing other medical care which may damage the teeth (such as radiation for cancer).
Medicare also doesn’t cover alternative medicine, cosmetic surgery, and a few other things. Even in states where medical marijuana is legal, Medicare does not cover cannabis.
Original Medicare (Part A and Part B) does have deductibles that need to be met and other out of pocket costs that could put you at financial risk. We recommend a Medicare Supplement (also called MediGap) plan to cover the gaps in Original Medicare’s coverage. Medicare Supplements reduce your financial exposure and allow you the freedom to visit any Medicare doctor in the US (and beyond) without the need for pesky referrals.
Can I have Medicare and Obamacare?
No, if you qualify for Medicare, you are no longer allowed to stay on your Obamacare plan.
If someone does not qualify for Medicare and are over the age of 65, they may qualify for Obamacare. This may occur if you or your spouse do not have enough “work credits” (have not paid enough Medicare taxes) in the United States.
How do I find out if my Doctor takes my plan?
If you’re looking to change plans, we can guide you to a plan that not only accepts your Doctor, but also provides you with the flexibility to see that Doctor when you need them most and keeps your costs low. In fact, some of our plans lower your office visit costs to $0!
Medicare Supplement plans, also known as MediGaps, allow you to visit Specialists without first needing permission from your Primary Care Dr. They also allow you to visit any provider or facility in the nation that accepts Medicare. Some even cover you while traveling abroad! MediGap plans greatly lower – and some eliminate – out of pocket costs.
Am I covered outside of the US? Am I covered when I travel to visit family out of state?
The short answer is, it depends on which type of Medicare plan you have. Medicare Supplement plans provide you coverage anywhere in the United States (and its territories), and most plans offer coverage while traveling outside of the US.
- Original Medicare does not provide coverage while traveling abroad in most situations. In the exceptions where health care is covered by Original Medicare while overseas, you are responsible for 20% of the approved amount plus the Part B deductible.
- Most Medicare Advantage plans (also known as Part C) offer a limited network of providers, and do not cover services outside of the US. Most Medicare Advantage plans don’t even cover services outside of your home county!
- Medicare Supplement plans offer the most coverage for travelers. Medicare Supplement plans, also known as MediGap plans, will fill in the gaps that Original Medicare doesn’t cover while abroad by covering 80% of emergency care after a $250 deductible (there is a lifetime maximum of $50,000 in coverage).
If you are a world traveler or want the piece of mind that you’ll be covered while away, we suggest a Medicare Supplement plan that covers foreign travel.
Contact us to learn more about protection while you travel outside of the US.
I hear a lot about Plan F. Why should I bother researching other MediGap plans?
While half of Medicare Supplement beneficiaries chose a Plan F, we have learned that health insurance is not one-size-fit- all. It’s important to consider many factors, such as monthly premium and other out of pocket costs to you. A plan that works well for your spouse or friend may not be the best fit for you.
Keep in mind that the plan with the lowest premium may not be the plan that costs you the least out of pocket over time! In addition to the monthly premium, it’s important to also consider the plan’s coinsurance, deductible, and other features.
Call us today and we will discover which Plan is best for your individual needs. The best plan that you’ve been on for several years may not be the best plan for you today – and we can help you decide at no cost to you!
I’ve been with the same insurance company for years. Shouldn’t I just stick with them?
Why should you? Insurance companies may offer different plans at different prices each year. Don’t get stuck with less coverage or higher costs – take advantage of our free assistance to find out if you are in the right plan. Be loyal to yourself and your needs — not the insurance company’s!
It’s always important to assess your coverage annually, since your health may change every year, just like plans may change from year to year. My Medicare Partner’s licensed, friendly Agents track each plan’s history of rate changes so you can be rest assured your plan won’t give you any big price surprises!
Especially among drug plans, you may see increases in premium and deductible as frequently as once per year. Drug plans can also change the drugs they cover (called the “formulary”) and how much each drug costs (called “tiers”) from year to year. An annual audit of your insurance is important, responsible, and could save you tons.
Don’t go at it alone – let us provide a plan assessment or an Annual Rx Checkup, free of cost, today!
Does My Medicare Partners offer other types of insurance?
My Medicare Partners focuses on what our Medicare Agents do best, and that is finding you a Medicare plan that meets your needs. Our licensed Agents spend over 40 hours each year completing government- and insurance-carrier required training, and spend time every day working as a Team to learn the latest changes and news related to Medicare.
However, we do have partners in the insurance business who work with a variety of other types of insurance products including Dental+Vision+Hearing plans as well as Life Insurance with Living Benefits. Contact us with what you’re looking for and we’ll put you in connect with experts in the field.
Can I be dropped from a Medicare Supplement plan? Do Medicare Supplement plans have to accept me?
No, you cannot be dropped from a Medicare Supplement plan! Supplement plans, also known as MediGap plans, are required to continue to offer you coverage, even if you become ill. Medicare Supplements are what we call “guaranteed renewable” meaning that an insurance company cannot drop or terminate your coverage.
The only circumstances (which are very rare) in which an insurance carrier can terminate your plan are if
- You do not pay the monthly premium, or
- You were not honest on the application, or
- The insurance carrier went bankrupt (in which case, you would be able to enroll with a different Supplement insurance carrier without having to go through medical underwriting. See below for more details)
Medicare Supplement plans also offer other protections, or rights, to beneficiaries, including the “guaranteed issue” clause. Guaranteed Issue means that the insurance company must accept your application for enrollment in a plan, cannot exclude any preexisting conditions or illness you may have, and cannot ask you questions related to your health.
Everyone has a once-in-a-lifetime Guaranteed Issue Period when they first become eligible to enroll in a Medicare Supplement plan (most people become eligible for Medicare when they turn-65. This is also called “ageing in”). The Guaranteed Issue Period begins the 6 months before the month you become eligible for Medicare (i.e. the 6 months before the month of your 65th birthday), continues the month you become eligible, and ends 6 months after the month in which you become eligible. This 13 month period is very important to take advantage of! Outside of the Guaranteed Issue Period, an insurance company can deny providing you coverage because of preexisting conditions.
- For example, if Don turns 65 in September of 2017, his Guaranteed Issue Period for Medicare Supplement lasts from March 2017 through March 2018 – before and after he turns 65! Yes, Don can enroll in his Supplement plan before he ages-into Medicare. By taking advantage of the Guaranteed Issue Period, Don locks in his Supplement plan and has peace of mind it will cover him, no matter how ill be may become.
- Meanwhile, Don’s golf buddy, Hank, missed his Guaranteed Issue Period (he’s always been a procrastinator!) when he turned 65 two years ago; he opted to enroll in an Advantage plan rather than a Supplement. Now, Hank’s heard about Don’s great Supplement plan and wants one, too, but unfortunately, Hank has a heart attack last year. Hank is unable to enroll in a Supplement because of his preexisting condition and because he’s outside of his Guaranteed Issue Period. Sorry, Don!
- (Keep in mind that “guaranteed renewable” and “guaranteed issue” are two different things.)
Can my spouse and I be on the same plan?
In short, no. Just like each person has to enroll individually in Medicare, each person also has to enroll individually in a Supplement or an Advantage plan. Unlike group or family plans you have have had before you reach Medicare eligibility, Medicare plans are all individual.
However, some Medicare Supplement insurance companies offer “household discounts!” These discounts vary from company to company, but can be as high as 12%! Requirements to receive the household discounts vary, so check with your My Medicare Partners Agent to see if you quality to save even more money.
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