Thirty-Fourth of 65 Things Everyone Needs to Know About Medicare before Age 65

65 Things Everyone Needs to

Know About Medicare

before Age 65

Medicare Supplement plans are also known as Medigap plans because they fill in some or all of the gaps left by original Medicare A and B.

For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

 

Thirty-Second of 65 Things Everyone Needs to Know About Medicare before Age 65

65 Things Everyone Needs to

Know About Medicare

before Age 65

A Medicare Supplement Plan works WITH Medicare Part A and B. Medicare Supplements pay all or a portion (depending on the plan selected) of Medicare approved costs not paid by Medicare.

For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

 



Twenty-Ninth of 65 Things Everyone Needs to Know About Medicare before Age 65

65 Things Everyone Needs to

Know About Medicare

before Age 65

If at or after age 65 you are covered by a small employer (less than 20 employees) group health plan or are covered under your spouse’s small employer group health plan, in most cases, Medicare is PRIMARY (pays first) to your group health plan. You must enroll in Medicare Part A and B or be assessed a penalty should you later enroll.

For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

Twenty-Seventh of 65 Things Everyone Needs to Know About Medicare before Age 65

65 Things Everyone Needs to

Know About Medicare

before Age 65

After age 65 and your initial Medicare enrollment period, should you leave or lose qualified employer group health insurance coverage, you will have a new enrollment period for Medicare Part B. (as well as Medicare Part A if you had not yet begun to receive Social Security Retirement benefits).

For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

Twenty-Sixth of 65 Things Everyone Needs to Know About Medicare before Age 65

65 Things Everyone Needs to

Know About Medicare

before Age 65

If your employment continues after age 65 and you are covered by an employer large (20 or more employees) group health plan or if you are covered under your spouse’s large group health plan, you are entitled to the same health benefits provided to employees under age 65. You may delay enrollment in Medicare Part B without a penalty if you keep the employer group coverage. (This applies to Medicare Part A also as long as you are not receiving Social Security benefits.)

For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

Medicare Annual Disenrollment Period 2012

Question:  Is the Medicare Annual Disenrollment Period (January 1 through February 14, 2012) the only time one can drop the Advantage plan? I mean, jobs run out or situations change meaning less money during the year. What if you can’t afford it any longer in the middle of the year?? Thanks.

Answer:  During the period of Jan. 1 to Feb. 14, an existing Medicare Advantage member can dis-enroll from their Medicare Advantage plan and go back to original Medicare and a standalone part D plan if they do not have other creditable coverage (meaning Rx coverage at least as good as the standard Part D plan offered by Medicare). Medicare Annual Enrollment (October 15 through December 7) is also a time you may make changes to Medicare Advantage and Part D plans.

The situation you refer to of change in finances could fall under a Special Election Period (SEP) that would offer extra help to pay premiums and would allow the member to make changes. Special Election Periods are available for people who qualify for extra help; who move to or are in a nursing home; who move out of a service area or who lose other coverage. 

It’s a good idea to confirm and never assume your situation qualifies for an SEP. The more you know the more options you have.

For answers to your Medicare Questions or for a quote on a Medicare Supplement or Part D plan visit www.MedicareAnswersfromConnie.com

2012 Medicare Premiums and Deductibles

2012 Medicare Premiums and Deductibles

Question:  What are my Medicare premiums and deductibles for 2012?

Answer:  Centers for Medicare and Medicaid Services (CMS) released the 2012 Medicare premiums and deductibles the end of October, 2011. These figures were not listed in the initial publication of CMS “Medicare and You 2012. Following is a summary of 2012 Medicare premiums and deductibles:

                                           

                                          2012                     2011

Part A Deductible        $1156/Event               $1132/Event

Hospital Days

61-90                    $289/Day                   $283/Day

Hospital Days         

91 & After            $578/Day                    $566/Day

Skilled Nursing

          Facility            $144.50/Day               $141.50/Day

Part B Deductible      $140/Year                    $162/Year

If you have a Medicare Supplement, the Supplement will automatically adjust coverage to reflect the 2012 amounts.

                                    2012                           2011 

Part B Premium       $99.90/month            $115.40/month

Most people who became eligible for Medicare in 2009 or before have been paying $96.40 per month for their Medicare Part B premium 2009 - 2011. Most that became eligible for Medicare in 2010 paid $110.50 per month in 2010 and 2011. Those who became eligible this year(2011)have paid $115.40 per month . All of these people will pay $99.90 per month in 2012, an increase for some, a decrease for others.

People with incomes above $85,000/year may pay a higher premium for their Medicare Part B as well as their Medicare Part D Prescription Drug Plan coverage. 

Most people pay no premium for Medicare Part A based on their or their spouse’s work credits. For those who must pay a premium for Part A, there has been an increase for the 2012 Part A premium as well.

For complete information about 2012 premiums and deductibles as well as premiums for those with higher incomes or those who must pay a Part A premium, follow this link: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4140

For answers to your Medicare Questions or to request a quote on a Texas Medicare Supplement or Part D Drug Plan visit www.MedicareAnswersfromConnie.com .

VA Benefits without Medicare After Age 65

VA Benefits without Medicare After Age 65

Question: I am a veteran about to turn 65. I am on Social Security and make 780.00 a month. I go to the VA for medical. Am I required to sign up for Medicare or can I just use the VA?

Answer:  You may continue to just use the VA. You are not required to sign up for Medicare, BUT…  You will receive Medicare Part A premium free, so long as you have earned enough work credits, and because you are receiving Social Security, you will be automatically enrolled in Medicare Part B. You may contact Social Security and decline Medicare Part B. If you choose to do this, should you ever decide you want or need Part B, you may only apply during general enrollment, January through March of each year, and Part B will not begin until July of that year. You will also be assessed a premium penalty based on the length of time you have gone without Part B coverage. 

While you don’t have to, I advise you to, enroll in Medicare Part B. There is a very good possibility, based on your income, that you would qualify for extra help through Social Security paying your Part B premium. Whatever you decide, you will need to contact Social Security – 1-800-772-1213. Here is a link to a Medicare Publication about who pays first when you have other health insurance and Medicare   http://www.medicare.gov/publications/pubs/pdf/02179.pdf

Medicare, What to Do, When to Do It?

What to Do About Medicare and When to Do It!

Question:  I turn 65 soon. I have no idea what I’m supposed to do about Medicare or when I’m supposed to do it!

Answer: First, you automatically get Medicare Part A when you turn 65 so long as you or a spouse has earned enough work credits. Part A is the part of Medicare that pays for hospitalization. Next you have to decide if you need Medicare Part B. Medicare Part B pays for doctor visits and outpatient procedures. Basically it comes down to whether you have other qualifying insurance. For instance, if you have insurance from an employer you may not need Medicare Part B. In these situations you will not be penalized for failing to enroll in Medicare Part B when you reach age 65. Otherwise, you have 3 months before you turn 65 and 3 months after you turn 65 to enroll in Medicare Part B. You will receive a penalty for enrolling late once outside your initial enrollment. If you are receiving Social Security payments you will automatically be enrolled in Medicare Part B at age 65. If you have postponed receiving Social Security, you must contact the Social Security office (1-800-772-1213) to enroll in Medicare Part B or let them know you are delaying or declining enrollment.

Once you get Medicare Part A and B taken care of you have to decide how you will get your prescription coverage and if you need a supplement. You may have discovered that you get your prescription coverage through an employer group plan or through military service-related coverage. If not, you have the option of a stand-alone drug plan or some Medicare Advantage plans offer prescription coverage as part of their plan (you have the same 3 months before/3 months after your 65th birthday time frame to make this decision). Medicare and Medicare Advantage Plans do not cover 100% of all services. A Medicare Supplement picks up what original Medicare does not pay. You have several options when choosing prescription coverage and coverage for the GAPS left by Medicare A and B.

Here are two videos. One explains what Medicare is, the other explains details about Medicare Part D. Hope you find them helpful.

Medicare, Tricare and Private Health Insurance

Medicare, Tricare and Private Health Insurance – OH MY!

Question: I have Blue Cross Blue Shield and Tricare. I turn 65 this October. I then must apply for Medicare or a replacement and Tricare for life. But one of the requirements to get Tricare for life is I must have Medicare Part B. My Blue Cross Blue Shield will at 65 go to my secondary insurance and Tricare for life will be third. I have two questions. What is best for me, Medicare or a Medicare replacement? If I choose a replacement for Medicare, do I pay the company of the replacement or the government? Also one more question. Can I apply for Medicare then get Medicare Part B from a replacement company?

Answer:  First, you need to be enrolled in Medicare Parts A and B and the only way to do this is through the federal government. Unless you are receiving Social Security Benefits, you will need to call Social Security (1-800-772-1213) to enroll in Part B. You may do this 3 months prior to your 65th birthday and I encourage you to do it sooner rather than later! (July for you) You should automatically be enrolled in Part A at age 65, but Social Security can confirm that for you when you enroll in Part B. Then you have the option of using your original Medicare Parts A and B as primary insurance and TRICARE for Life as secondary insurance (like a Medicare Supplement). TRICARE for Life will also cover your prescription drugs. When you refer to a replacement I am guessing you are talking about a Medicare Advantage plan where you assign your Medicare Parts A and B to the Advantage plan to manage and use their network. Unless you just really don't like TRICARE, there is no reason for you to do this. Tricare for Life will cover the deductibles and copays of Medicare. Unless your Blue Cross coverage is through an Employer paid group plan that costs you nothing, you don't need that either. It would be an unnecessary, added expense.


Medicare and Other Health Benefits: Your Guide to Who Pays First, a booklet available from The Centers for Medicare & Medicaid Services, may clear up some of this for you. I will be happy to e-mail you a copy of the booklet. Click the “Ask A Question” button and request “Who Pays First” Booklet.

First Medicare Beneficiary

On Facebook, Medicare Answers From Connie asked:  Who was the first Medicare beneficiary?

Tony Pallcaorolla - 0 people picked this one
Former President Harry Truman - 1 person picked this one
Ida May Fuller - 2 people picked this one

Former President Harry Truman was officially the first Medicare beneficiary. President Lyndon Johnson enrolled President Truman and presented him with the first Medicare card. Truman's wife Bess was the second person to enroll. Thank you for participating!

Medicare Eligibility While Employed

Medicare Benefits While Employed

Question: At what age can you sign up for Medicare without retiring?

Answer: You become eligible for Medicare at age 65 (unless you were eligible earlier due to a disability). Your employment status at age 65 and older has no effect on your eligibility for Medicare. Most people receive Medicare Part A automatically and premium free, so long as they or a spouse have worked and accumulated minimum credits. Enrollment in Medicare Part B is not automatic unless you are already receiving Social Security benefits. You also must pay a premium for Medicare Part B. If you continue to work past age 65, which many people are doing now, you may have some additional options for health insurance with your employer. These options can effect whether or not you enroll in Medicare Part B at age 65.

2012 UPDATE:  Enrollment in Medicare Part A is no longer automatic unless you are receiving or have signed up to begin receiving Social Security Benefits. Medicare Part A IS premium free as long as you or a spouse have earned minimum work credits (40). You will need to enroll in BOTH Medicare Part A and B at age 65 unless you qualify for an exception.

For answers to your Medicare Questions or to request quotes on a Medicare Supplement or Part D Drug plan visit www.MedicareAnswersfromConnie.com.

Be sure to Read my Book - Available at Amazon.com

 

 

Medicare and Foreign Travel

On Facebook, Medicare Answers From Connie asked: Parasailing in Cancun, Mexico ~ Seemed like a good idea at the time! A day in the hospital and you’re good as new. WHAT PART PAYS?

Medicare Part A - 1 person picked this one
Medicare Part B - 1 person picked this one
Do They Take American Express??? - 1 person picked this one.

Do they take American Express???, I'm afraid you're on your own with this one. Medicare does not pay for treatment outside of the US. BUT..., If you had a Medicare Supplement, it would pick up all but the first $250 of up to $50,000 in charges. Did you know that there is low cost travel insurance available also? Thanks for participating!

Medicare and Social Security Benefits While Employed

Medicare and Social Security Benefits While Employed

Question:  I will be 65 in Oct. Am I able to collect any old age benefits, qualify for Medicare/Medicaid and still work? I will earn a BS in May, 2012 and plan to work till I can’t, thus contributing to my Social Security.

Answer: Medicaid is a Federal program for people and families of any age with very low incomes. Medicare is the Federal program that provides health insurance for people 65 and older. You may qualify for both but if you're working you probably won't. Anyone 65 and older may get Medicare. If you've worked and earned enough credits (which the majority of people have) or you are the spouse of someone who has, you do not pay a premium for Medicare Part A. There is a premium for Medicare Part B. Most people pay the base premium which is $115.40 this year but people with higher incomes pay more. If you will be working for a large company, 20 or more employees, you may want to postpone enrolling in Medicare Part B because your employer's health plan (if they offer one) will be primary to Medicare. You are allowed to do this without a penalty. Here is a video about Medicare and large group health insurance:

Here is a link to a question on my blog about using Medicare or Group Health Insurance: http://blog.medicareanswersfromconnie.com/2010/05/choosing-medicare-or-group-health.html


You may begin collecting Social Security retirement benefits at age 62; however the benefits will be reduced. Here is a link to Social Security that provides details: http://www.socialsecurity.gov/retire2/agereduction.htm

You may work while collecting Social Security Benefits prior to retirement age (66 for you) but may only earn $14,160 per year or your benefits will be reduced. The limit and reduction changes as you near retirement age. Here is another link to Social Security that provides details on allowable earnings prior to and after retirement age: http://www.ssa.gov/pubs/10003.html

Waiting to draw Social Security until age 70 gives you the greatest benefit. Should you choose to begin collecting Social Security prior to retirement age, you may repay what you have received at age 70, interest free right now, and essentially start over at the higher percentage pay out.

What is Medicare

Medicare with VA Benefits

Medicare with VA Benefits

Question: I am 61, on VA disability, and get free health care except dental. When I turn 65 and get Medicare, will I still be able to go to the VA for medical care?


Answer: Qualified veterans may have and use Medicare and VA benefits at the same time.

You're several years away from 65, so bear in mind this answer is for current guidelines and those could change by the time you reach 65.

In most cases you will have your VA benefits and Medicare once you reach age 65. With VA, there are several levels of eligibility so it is important to contact VA as the time nears to find out exactly what your coverage will be.

Typically, to automatically receive Medicare Part A you must have a minimum number of credits earned from employment or receive them under a spouse's coverage. You can find out how your disability effects this requirement by calling Social Security (1-800-772-1213). You likely will need to enroll in Medicare Part B. There is a premium for Part B. Your disability and financial circumstances will effect what you are required to pay. Also, there is a penalty for enrolling outside your initial enrollment period if you are not covered under a qualified plan. VA can advise you on how your VA coverage fits these guidelines.

 Right now VA prescription coverage is considered "creditable coverage" to Medicare Part D -the drug plan for Medicare. This means you are not penalized for failing to enroll in a Medicare drug plan (Part D). You may have both Medicare Part D and VA but may only fill a prescription with one or the other, not both.

 You don't say how long you have been on VA disability. I have talked to some disabled veterans who are under 65 and because they qualify for Social Security Disability they begin receiving Medicare benefits in their 25th month of disability. VA benefits, in general, and disability benefits even more so, are complicated so be sure to check with VA for specifics to your situation.

Medicare Initial Enrollment

Medicare Initial Enrollment Time Periods

Question: I will be 65 on August 1st, six months from now. Can I sign up early for Medicare--so it will be effective on my birthday?
Answer: You may enroll in Medicare 3 months prior to your 65th Birthday. So, you can enroll in Medicare Part B in May. Because your birthday is 08/01, your effective date will be July 01 (that is only the case for people with birthdays on the 1st of the month) You may apply for a Medicare Supplement 6 months prior to your 65th birthday and up to 6 months after your 65th birthday. In your case the supplement would be effective July 01 also. You may apply for a Part D drug plan 3 months prior to your birthday and the effective date will be July 01.

Medicare and Other Health Insurance

Medicare with Other Health Insurance

Question: Hi Connie, this is ALL NEW to me (Medicare Supplement/Advantage Plans) I know you sell insurance for a living, however it appears from your site that you do have an interest in the recipients (and THEIR best interests) - so - let me fire this at 'ya.

I am 67 years old now. I've been enrolled in PART A since 65 (however, never used it) Now that I'm being forced to retire (due to hearing loss) I will NOT have a GROUP health plan available to me after May 31. Medicare has told me that I may sign up for PART B after March 1 (but before May 1) in order to have coverage by June 1.

Since I am a Service Connected Veteran, I do have VA medical benefits available to me should the need arise, however would prefer to use an outside provider for health maintenance and less serious health matters (including medications) The Advantage Plans that I've looked into will provide this for my Medicare Premiums (NO EXTRA COST. )Bearing in mind that you are an insurance salesman; would this not be my best route?

Answer: Even though I AM a salesperson, I'm not going to try and sell you any particular thing! But I will try to help you answer your question.

There are several points you need to consider to make the best choice for YOU! They all revolve around cost and convenience.

The most convenient option is original Medicare (A&B) paired with a Supplement and Drug plan. You can go anywhere you want and with the exception of some copays for drugs, your medical treatment will be covered 100%. This option will run you about $250 /month (in Texas) in premiums, including your Part B premium (assuming you make less than $85,000 single/ $170,000 jointly)

The next level of convenience would be original Medicare (A&B) plus your VA benefits. In most cases VA only pays if you get services directly from them. How far away is the VA facility from you? Medicare A has a deductible of $1132 per hospitalization for 2011. Medicare B (outpatient) has a deductible of $162 for the calendar year 2011. After that, you pay 20% for outpatient services. If you use the VA you will have little if any out of pocket cost based on how you are entered in the system. VA will provide prescriptions by mail order with little or no copay. Should you use Medicare B for doctor visits you may go where you want (as long as they accept Medicare) and it will cost you around $20- $40 for a typical office visit after deductible. Your cost would be your Part B premium of $115.40/month for 2011 and whatever your arrangement with VA is. You would have the risk of the additional A & B costs I mentioned. (This is the option my dad uses)

The least convenient would be a Medicare Advantage plan. You assign your part A & B Medicare to the company you enroll with and you must go to their in-network providers to realize the benefits from the plan. You may not revert to your original Medicare if you are unhappy except at certain times of the year. If you are healthy and are just seeing the doctor a couple times a year for checkups, this can work very well. Of course you don't really have insurance for those situations. You have it for the emergencies and catastrophic events. Advantage plans make money by managing the care they allow members to have. They may be generous with the little expenses but when it gets to the big expenses, they are tightly managed. I haven't talked to anyone who has gone through a catastrophic event in an Advantage plan that was happy with the service provided by the plan. If you're aware of this and the cost outweighs the possible inconvenience, this could be the best option. You do have the risk of out of pocket expenses of up to $5000 in-network with most Advantage plans. If you go out of network your cost risk is unlimited. If an Advantage Plan is the route you choose, ask lots of questions about what is and is not covered as well as what out of pocket expense risk there is, before enrolling. Also check the provider list for providers in your area.

Some other points to consider

Getting VA to pay in an emergency situation outside VA facilities is difficult. This is also the case with an Advantage plan. With the Medicare/VA option you at least have the flexibility of being treated anywhere with your Medicare and Medicare paying a substantial portion of the cost. With the Advantage Plan option, if they don't pay, it's your bill.

You didn't mention if you qualify for any special assistance based on your income or the hearing loss. Have you checked in to that?

Enroll in Part B early rather than late! You will need to call Social Security ( 1-800-772-1213 ) to do that and often they can take care of enrollment over the phone. You may also get information about special help because of the disability or income level from them. The sooner the better!!

I hope this helps you answer your question. Please let me know if I may be of further assistance. I can help you with Supplements, Drug plans and Advantage plans so when you decide on the route you want to take I hope you will consult with me.

Medicare Coverage for Dental and Vision Care

Medicare Coverage for Dental and Vision Care

Question: Is there any way Medicare pays for dental work or eye exams?

Answer: Original Medicare does not cover routine dental or vision care. Some Medicare Advantage plans offer some coverage for vision and dental but make sure you know what is and IS NOT covered before enrolling. Read the fine print! Some Advantage plans only cover vision and dental as covered by original Medicare.

Medicare Part A will pay for certain dental services that you get when you are in the hospital. Medicare Part A can pay for hospital stays if you need to have emergency or complicated dental procedures, even when the dental care itself is not covered.

Medicare provides limited vision coverage in some cases such as after cataract surgery or for some cases of macular degeneration. If you are in a high risk category for glaucoma, Medicare will cover screenings every 12 months. It is a good idea to check with Medicare or your Advantage plan rather than assume a procedure is covered. For more information on Medicare coverage go to www.medicare.gov/coverage .

Medicare Supplement ~Medicare Advantage Plan, That is the Question

Medicare Supplement ~Medicare Advantage Plan, That is the Question

 

Question: What is the difference in a Medicare Supplement and a Medicare Advantage plan?

Answer: Day and Night! Control and choice are the biggest differences. You have more control and choices with a Medicare Supplement than you do with a Medicare Advantage plan.

A Medicare Supplement works with your Medicare A and B and pays the Medicare approved charges not picked up by Medicare. You may use any doctor or facility you choose. Plan F is the favorite plan and covers 100% of charges not picked up by Medicare. Medicare Supplements are regulated by the federal government and all plans must offer the same benefits (with a few exceptions in a couple states – not Texas). Insurance companies may charge whatever they choose for the different plans, so costs vary.

A Medicare Advantage plan takes the place of your Medicare A and B. When you enroll in a Medicare Advantage Policy, you assign your Medicare A and B to that plan. As long as you are enrolled in the plan, you do not have the option of using just your original Medicare. Some plans allow you to go out of network for a higher cost share but many plans pay nothing if you go outside the plan network. You are responsible for the total out of network bill except in emergency situations. You MUST use the doctors and facilities in an Advantage plan’s network to see the full benefit in cost savings. If you are considering a Medicare Advantage Plan, be sure your doctor and a convenient hospital are in the plan network. Some Advantage Plans include drug coverage and other benefits like vision, dental and hearing plans. The services of these additional benefits are limited.

Costs of both types of plans can vary. Some Advantage plans do not charge a premium to be enrolled in their plan. If you are old enough to be on Medicare, you probably know by now there is nothing completely free, especially in health care. In many instances a Medicare Supplement Plan N is competitive in premium with an Advantage plan.

I use the analogy of driving your own car – the Medicare supplement option, (you can go when and where you would like) versus taking public transportation – the Medicare Advantage option, (it can get you there often for less money but will be less convenient).

Both Medicare Supplements and Medicare Advantage plans have their place. It is important to do your homework and understand either type of plan before you enroll.

SOURCE:  www.Medicare.gov , Medicare and You, 2011 Handbook