Medicare Coverage and Benefits
A: Here are some key facts to help you navigate.
- Know your deadlines: There are only certain times throughout the year that you can sign up for a Medicare Advantage or Prescription Drug plan. These times are called enrollment periods. It’s important to know when these enrollment periods occur so that you can evaluate your coverage and make a change if you need to.
- Know the lingo: Like any big industry, Medicare has its own language. Getting familiar with the terms bandied about can make a big difference in researching your options.
- Decide on Medigap: It’s often best to shop for a Medicare Supplement Insurance plan (AKA, Medigap plan) when you first become eligible for traditional Medicare because you’re guaranteed coverage regardless of your medical history. It may be challenging to change Medigap policies later because you may be subject to underwriting, so think about your medical needs in the future when deciding which Medigap policy is best.
- Calculate the costs: Most people don’t pay a premium for Part A (hospital) Medicare, but you will pay premiums for Part B and other types of Medicare coverage. After you meet the Part B deductible, Medicare will pay 80 percent for covered services, and you’ll pay the remaining 20 percent unless you have a Medigap policy. Your out of pocket costs will be different if you decide to get a Medicare Advantage plan or Medigap policy.
- Compare plans: The cheapest premium doesn’t always result in the lowest total cost. Remember to include your prescriptions for premium quotes and to look closely at copayments and deductibles. You should also check with your doctors to see what plans they accept. Or…save yourself the time and have Healthpilot do the hard work for you. Just answer a few questions regarding doctors, prescriptions, pharmacies, and any benefits you want to be taken into consideration to receive an unbiased, reliable Medicare plan recommendation from Healthpilot’s algorithm. Then, enroll online easily (did we mention Healthpilot enrollment process takes less time than it takes the average person to do their dishes?)
A: Yes, if eligible you may enroll in Original Medicare, a Medicare Advantage Plan and Prescription drug plan with a pre-existing condition. If you apply for a Medigap policy during your Open Enroll Period or qualify for a Guarantee Issue, you will not be subject to underwriting.
A: Some of the items and services Medicare doesn’t cover include but aren’t limited to:
- Routine physical exams
- Long-Term Care
- Hearing aids and exams for fitting them
- Most dental care
- Eye exams (for prescription glasses)
- Cosmetic surgery
- Massage therapy
- Concierge care
Covered items or services you get from an opt-out doctor or another provider (except in the case of an emergency or urgent need)
A: It depends. Part A and Part B of Medicare will always go with you as long as you live in the United States or in one of the U.S. territories (Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa). You can also keep your current Medigap policy (except Medicare Select) no matter where you live as long as you still have Original Medicare. But if you have a Medicare Advantage (Part C) plan or a prescription drug plan (Part D), you could lose your current plan and have to sign up for a new one. Still, you do have some choices.
Both Medicare Advantage and Part D have geographic service area limits. Depending on where you move (changes in county or state), your Medicare plan may or may not be offered. You will have a special enrollment period that will allow you to enroll in a new Medicare Advantage or Prescription Drug plan. The Special Enrollment period starts the month before your move and continues for three additional months. One unique feature of this Special Enrollment period is that you can choose your effective date with your new Medicare Advantage or Prescription Drug plan up to three months after you complete an enrollment application, it just cannot start before the date you move.
A: In most cases, you will be able to delay signing up for Part B beyond age 65 without paying a penalty as long as you have other creditable coverage such as group health insurance from an employer or union for whom you or your spouse still actively works.
A: Medicare.gov has a handy-dandy tool that can help! Your Medicare Coverage. If Original Medicare covers the service, a Medicare Advantage plan is required to also cover the service. If you have Medicare Supplement, it may cover some or all of your cost sharing depending on which plan you have.
If you want to know more about the cost you will have to pay for the service, you can call your plan’s Customer Service Department. If you have a Medicare Advantage plan, you can review the Summary of Benefits or Evidence of Coverage document. Your plan should have sent you a copy of these documents. You can also access them on Healthpilot.com. The Healthpilot Customer Service team can also help review your plan’s Evidence of Coverage and answer any questions you have about your plan.
If you have a Medicare Supplement plan, the benefits and any plan limitations are outlined in the Outline of Coverage document, which is also available on Healthpilot.
A: First, unlike employer group coverage, Original Medicare and Medicare plans are offered by individual. Each Medicare eligible individual will have their own plan (even if spouses choose to enroll in the same plan).
Secondly, most of the time, you should choose Medicare coverage based on what you need for your own health care. The only time this isn’t the case is if both spouses are offered retiree coverage outside of Medicare. If you are offered an employer sponsored retiree plan, you should consider your needs and that of your spouse to determine if the plan is right for you both. You may find a Medicare Advantage plan that better meets your needs. However, if you choose a Medicare Advantage plan over the retiree plan, you may not be able to switch back to the retiree plan at a later date.
A: Doctors don’t have to take Medicare to work as doctors. Still, finding a medical provider who hasn’t signed up with Medicare at some point is unusual.
A: The ABN lists items and/or services that your doctor or health care provider thinks Original Medicare will not pay for. It also estimates how much the items or services will cost and explains why Medicare may not pay. It is issued in order to transfer potential financial liability to person receiving the services in certain instances.
A: Yes, if you have both full Medicaid and Medicare coverage. Medicare defines these group of beneficiaries as, “dual eligible”. Some insurance companies offer plans specifically designed for these eligible beneficiaries to enroll in. When you are dual eligible and receive Medicare-covered services, Medicare pays first. After Medicare and whatever additional health insurance you may have is then next following Medicare’s Coordination of Benefits rules and Medicaid is the last to pay.
A: There are several of ways:
- New Prescription Drug plan and Medicare Advantage plan options may be introduced every year. Already have a Medicare Advantage or Prescription Drug plan? Every fall, your current plan will provide you a letter in the mail called the Annual Notice of Change. If there will be changes to your plan starting in the new year, it will be summarized in the Annual Notice of Change letter.
- If you have Original Medicare, any changes in benefits will also be communicated in writing.
- To learn more about Medicare coverage on your mobile device, download the free What’s Covered mobile app from the App Store or Google Play.
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We’re here Monday - Friday, 9am - 6pm Central.