Private Medicare plans like Medicare Advantage and Medicare Supplements can cover a lot of benefits, but they generally don’t cover everything. Ancillary insurance products like separate dental plans, heart attack insurance, and life insurance are all important too.
Depending on what Medicare plan(s) you have, ancillary insurance products might be necessary to provide you with the comprehensive coverage and peace of mind you need.
What Are Ancillary Insurance Products?
What Are Ancillary Products? | Medicare Plan Finder
Our ancillary insurance definition is any insurance product that is beyond the scope of traditional health insurance or is not included in your healthcare plan. One of the most common ancillary products is life insurance – but ancillary goes far beyond that. Ancillary private health insurance can help you cover the healthcare needs that your Medicare insurance does not cover.
Here are some of the ancillary products that our agents sell:
You might think, “wow, do I really need all of those?” You might not – but if you do, you might be able to bundle your benefits. For example, you might be able to find a combination dental and vision plan, or a combination heart attack and stroke plan. Whether or not you need any of these products can depend on your finances, your genetic probability of contracting certain conditions, and what types of plans are available in your area.
Ancillary insurance products are never meant to replace your current health insurance. They are additional products that supplement your existing coverage.
What are examples of ancillary services?
The term “ancillary services” refers to medical services that are not typically provided by your primary care physician. It could mean a service provided by a specialist for your critical illness, a therapist for your long-term disability, etc. Some of these services might already be covered by your disability insurance, Medicaid, or another health plan – but many are likely not covered.
Here’s a list of ancillary services to consider when deciding whether or not you need ancillary insurance:
Ambulance care
At-home preventative care
Audiology
Behavioral health
Chronic care
Heart monitoring
Home healthcare and private nurses
Home medical equipment
Hospice
Infusion therapy
Lab tests
Medical daycare
Mobile services and testing
Orthotics/prosthetics
Radiology
Rehabilitation of any kind
Specialized imaging
Transitional care
Ventilator services
Dental, Vision, and Hearing
Three of the most common types of ancillary insurance plans are those for hearing, vision, and dental coverage. Original Medicare will only pay for some of your very specific dental, vision, and hearing costs.
Medicare Part A and Medicare Part B ancillary services are limited to what your primary physician or hospital staff can do. For example, if you schedule an annual wellness visit with your primary physician and they perform a quick hearing and eye exam, that visit is still covered under your Medicare Part B. Additionally, if you have a medically necessary jaw surgery or receive face tumor treatment in a hospital, most of the related dental work falls under your Medicare Part A. However, if you end up needing more dental, hearing, or vision care, it won’t be covered by Original Medicare.
Private vision, hearing, and dental insurance can help you cover your costs and help you stay on top of your healthcare. Some Medicare Advantage plans include all of these benefits, so before you select an ancillary product, check to see if there is a Medicare Advantage plan in your zip code that makes sense for you.
Short-Term Care
A short-term plan will cover you for up to a year for a temporary injury or illness. For the most part, long-term care is included in your Original Medicare. Short-term care, however, is always an add-on option through a qualified ancillary insurance plan. If you’re concerned about short-term care, let your insurance agent know. They will help you decide whether Medicare Advantage, Medicare Supplements, or another ancillary product will be best for your short-term care needs.
Cancer, Heart Attack, Stroke
Medicare parts A and B, respectively, will cover your hospital stays and doctor visits relating to cancer, heart attacks, and strokes. Some policies are as simple as large payments upon diagnosis.
Others may include annual payouts based on costs, even including loss of income, childcare, travel to facilities, home health care, rehabilitation/therapy, and any other out-of-pocket costs that Original Medicare does not cover.
If you feel comfortable, it helps to disclose your and your family’s medical history when speaking with an agent. That way, the agent can determine whether an ancillary plan for cancer, heart attacks, or strokes is right for you.
Hospital Indemnity
Ancillary hospital indemnity policies are the best, cheapest way to save your piggy bank in the event of an extended hospital stay.
The average cost for one night in the hospital is between $1500-$3000. Your Medicare plan will help cover most of that, but not all, and does not include additional procedures and prescription drugs.
You’ll send in a claim stating what your copayment was, and your carrier will send you a check for a percentage of that amount. This will be especially beneficial if you foresee any medical procedures that will require an extended hospital stay.
Life & Final Expense
Final expenses are any costs associated with funerals, burials, and sometimes medical bills for your final hours. You can buy a final expense whole life plan, meaning the policy lasts for your entire life, or a final expense term life plan, which lasts for a set number of years.
Final expense policies help to reimburse your family members for expenses surrounding your death. You must appoint a beneficiary to receive the reimbursement when you purchase your policy. You will have the ability to change your beneficiary after your policy has been active for a year.
Life insurance is different from final expense because it insures additional finances. For example, it can help your family pay off your mortgage or other debts after you pass. If you don’t already have life insurance, it’s best to invest as soon as possible, because costs will increase as you age.
How Ancillary Benefits Work
Your ancillary insurance carriers could be the same as your carriers for other insurance plans, or they could be different. For example, carriers who sell auto and home insurance are likely also to sell life insurance. Additionally, carriers who sell Medicare Advantage plans are likely to sell other individual health benefit plans.
Even if you have Medicare, ancillary plans provide voluntary benefits and do not fall under Medicare laws. You can enroll in ancillary products during any time of the year (unless you are enrolling through your employee benefits package, in which case your employer might have an enrollment period).
Ancillary billing will be completely separate from your Medicare coverage. If you are still employed, some ancillary benefits can be employer-contributory, meaning your employer agrees to pay part of your premium.
Many ancillary products, like cancer insurance plans, pay by lump sum. With our cancer example, you would receive a lump sum cash benefit upon diagnosis. Keep in mind that a product like that may not be available after you’ve already been diagnosed. Unlike Medicare Advantage plans, ancillary products can and will put you through medical underwriting and can deny you for preexisting conditions.
The Advantages of Ancillary Benefits
When you start looking through all of the available Medicare health plans, you may discover that while many of the available plans could work for you, they aren’t perfect. Additional benefits for Medicare beneficiaries can be hard to come by, especially if you live in an area that does not have many plan options to choose from. Some Medicare plans do offer additional rider insurance (extra health benefits), but they might not be exactly what you need.
That’s why ancillary services insurance may be a good idea. If you can’t find a good Medicare Advantage plan that covers all of your additional medical concerns, like dental, vision, hearing, cancer, heart attack, etc. – ancillary might be the route to go. You will still need coverage for healthcare, so make sure you stay enrolled in Medicare. Then, you can add whichever ancillary products make sense for you.
Frequently Asked Questions About Ancillary Insurance Products
Discussing Ancillary Insurance Products With an Agent | Medicare Plan Finder
You may have many questions about ancillary products, insurance coverage, and costs, including:
Q: Why aren’t these ancillary benefits included in my Medicare plan?
A: Each individual who has enrolled in Medicare has different healthcare needs. You can select a Medicare Advantage or Medicare Supplemental insurance plan that fits your needs, then select any additional ancillary products separately.
Q: Why didn’t my agent discuss these with me sooner?
A: If an agent visited with you to discuss Original Medicare, Medicare Advantage, or Medicare Supplements, they likely were not legally allowed to discuss ancillary plans with you. The Centers for Medicare and Medicaid Services (CMS) has specific rules in place to protect you. If you’d like to discuss ancillary insurance products, your agent will need to come back another day.
Q: How much do these products cost?
A: Costs for ancillary plans vary depending on your needs and what the policy covers. Your agent can discuss any details and help you find the right fit.
Q: So how do I get ancillary insurance?
A: If you are employed, your employer may or may not provide ancillary plans. The best way to get information about ancillary benefits is to speak to your agent.
Get the Ancillary Plans You Need Today
We have insurance agents available who can help you select from the available Medicare Advantage plans for 2020 as well as other ancillary products. Speak with a licensed & local agent today by calling 844-431-1832 or contact us here.
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How Mail Order Prescriptions Can Save You Time and Money
Did you know that you can order your prescriptions online and save money? That’s right – no more rushing to get to the pharmacy on time or having to ask someone to pick up your prescriptions for you. You may even be able to schedule your prescriptions to deliver exactly when you need them with automatic refills!
Pros and Cons of Mail Order Pharmacy
Using a Mail-Order Pharmacy | Medicare Plan Finder
Ordering prescriptions from a mail order pharmacy comes with pros and cons.
Pros
Time Saving: You can save hours by not having to make monthly, weekly, or daily trips to the pharmacy. All you’ll have to do is click a button and wait to receive your medications – no standing in line, no rushing to get to the pharmacy.
Cost Saving: You can save money on gas and help minimize wear and tear on your car. Using a mail order pharmacy eliminates the need to travel.
Automatic Refills: Most mail-order offer an automatic refill option. This is great for people who forget to have their prescriptions refilled or pick them up. Some pharmacies will even call your doctor to renew your prescriptions!
Cons
Waiting for Prescriptions: Even though you can order your prescriptions with the click of a button, you still have to wait for your prescriptions. That can be a drawback if you need your prescription immediately.
Prescriptions Can Be Lost: It’s rare, but sometimes prescriptions can be lost in the mail. However, most mail-order pharmacies will re-ship your medication at no additional cost. If you’re concerned about package theft, it may be in your best interest to pick up prescriptions in person.
Automatic Refills: Having your prescriptions refilled automatically can be both a pro and a con. If you’re someone who usually sets and forgets, you could end up with a lot more pills than you need!
The Delivery Fee
Contrary to popular belief, most mail order prescriptions can be delivered without a shipping fee! If delivery fees are what was holding you back from using an online pharmacy, you can check that off your list. Pharmacies don’t have to charge a shipping fee because mailing your prescriptions can actually save them money.
They don’t have to pay for the time and labor it takes to stock prescriptions in-store and they can ship to you directly from a warehouse. There may be shipping fees associated with medical equipment and supplies, but most prescriptions can ship free.
When Should I Stick to my Local Retail Pharmacy?
There are only a few downsides to mail order prescriptions. Mainly, you will lose out on the face-to-face interaction with your pharmacist. However, you can always call your pharmacist to ask questions or speak to your doctor instead.
Your local retail pharmacy, like a CVS or Walgreens, can delivery your prescriptions to your door as well. If you are comfortable using your local retail pharmacy instead of searching for a new mail order pharmacy, stick to it instead of trying to fix what is not broken.
When Should I Expect to Receive my Prescription?
Some prescriptions may take up to 14 days to arrive at your door, so you may still need to visit your pharmacy in person to get your cold medicine and other immediate needs.
Long-term prescriptions, though, can be automatically mailed when you need them. If you work with your pharmacy to set up auto-refills, you should receive your prescription in the mail well before you need it so that you never run out of your medication.
Top Mail Order Pharmacies
It’s always a good idea to start by checking if your health plan has its own mail order pharmacy. Many carriers do, and they can save you a lot of money that way! For example, Cigna just merged with digital pharmacy Express Scripts. You can also check with your favorite drugstore chain. CVS, Walgreens, and Publix are just three examples of chains that offer prescription delivery services. You can also consider the following:
Blink Health – What’s unique about Blink Health is that you can have your prescriptions delivered to your home, or you can pick them up from a local participating pharmacy. Either way, you can see the prices before you buy and choose the cheapest and easiest option for you.
EnvisionPharmacies – Envision is divided into three parts. Envision Mail is a typical mail order prescription service, EnvisionSpecialty provides patient, caregiver, and provider support, and Envision Compounding is quite different. The compounding sector creates alternative forms of medications and sends them to patients who cannot swallow pills or have unique allergies.
HealthWarehouse.com – Selling both brand name and generic prescriptions for both you and your pets! Over the counter drugs, diabetic supplies, and home medical equipment is also available. Just create an account and ask your doctor to send your prescriptions to HealthWarehouse.
PillPack – Not only does PillPack allow you to order your medications online, but they can also sort your pills by dose for you. For example, if you both Drug A and Drug B at 8 AM every day, and you take Drug C at both 8 AM and 8 PM every day, you’ll receive two packs for each day: one that contains Drug A, Drug B, and Drug C and is labeled “8 AM,” and one that contains Drug C and is labeled “8 PM.” They are dated so that you won’t lose track. PillPack is now owned by Amazon.
How to Find a Safe Online Pharmacy
Any pharmacy your Medicare plan recommends will likely be legitimate. However, there are many fake online pharmacies that will try to scam you. They appear to be legitimate pharmacies but they actually send fake drugs.
To help raise awareness about these fake online pharmacies, the Food and Drug Administration (FDA) launched BeSafeRx. According to the FDA, a legitimate pharmacy will:
Require a valid prescription from your provider
Be licensed by your state board of pharmacy, or equivalent state agency. (To verify a pharmacy’s licensing status, check your state board of pharmacy.)
Have a U.S. state-licensed pharmacist on staff and on call to answer your questions
Be located in the United States, and provide a physical street address, not just a post office box
How to Report Illegal Medicine Sales
If you become aware of unlawful medicine sales, you can report the rogue pharmacy with the FDA. Fill out the form here with as much detail as possible.
How is my Insurance Plan’s Mail Order Pharmacy Different From Other Online Pharmacies?
Excellent question! Not every insurance plan has its own Medicare mail order pharmacy, so it is important to check your coverage and be sure that you have access to mailed prescriptions.
Additionally, some insurance plan mail order pharmacies are limited in what they can offer, while private online pharmacies operate independently and can function just like a brick and mortar drug store.
Compare Prescription Costs
Even if you don’t want to use the internet for ordering prescriptions and having them delivered, you can at least use it to view drug prices. GoodRx is a leader in drug price tracking. All you have to do is type in the name of the prescription drug you need, and GoodRx can tell you what pharmacy has the best price! You can also use GoodRx to print free coupons and save as much as 80% on some drugs!
GoodRx Prescription Finder Tool
To use GoodRx’s prescription finder tool, click here. Then type your prescription in the search bar. We’re using atorvastatin (Lipitor) for demonstration purposes, but you can use any medication you want prices for. Then click “Find the Lowest Price” beside the red arrow.
Prescription Finder Step 1 | Medicare Plan Finder
Then you’ll come to the price list with several pharmacy options.
Prescription Finder Step 2 | Medicare Plan Finder
Prescription Savings Coupons
When GoodRx, mail-order prescriptions, and your Medicare coverage aren’t enough, there are prescription drug discount cards! Since these cards are not part of Medicare, you can sign up for a card at any time. Having a prescription drug savings card is sort of like having a coupon book.
There may be times when you don’t need your Rx card because your Medicare coverage gets you even bigger savings, but there are other times when your card can save you a lot of money!
Free Prescription Discount Card
Get Medicare Mail Order Pharmacy Coverage Today
Do you have a Medicare Advantage or a Part D prescription drug plan? Do you know if you qualify for LIS, a prescription drug savings program for Medicare beneficiaries? We can help answer your questions and make sure you are getting the best benefits at the best price, and make sure you are eligible for mail order prescriptions.Set up an appointment at no cost to you by calling us at 844-431-1832 or contact us here.
Contact Us | Medicare Plan Finder
*This post was originally published on February 8, 2018 and last updated on September 23, 2019.
How to Find the Right Geriatric Doctor
Finding an internal medicine doctor you really connect with can be difficult, and finding the right geriatric doctor, or geriatrician, can be even more difficult. You must have confidence in your provider’s ability to treat your conditions or to refer you to other providers with extensive experience working with older adults.. Your health is the most important thing you have, and you need a doctor you’re comfortable with.
What to Look for in Geriatric Doctors
All geriatric doctors specialize in the diagnosis, treatment, and prevention of disease and other medical or chronic conditions common to seniors. You want healthcare providers who know how to treat your population and provide quality care plans. However, a doctor’s area of focus is just one thing you should look for. You also want to find a doctor that you can feel comfortable with.
It’s important that you feel comfortable asking questions about personal health concerns and that you can trust that your doctor is listening. You should feel like your health is as important to your doctor as it is to you.
The right geriatrician will take pride in providing the best quality of care possible. You should feel like your doctor thinks of you as a whole person, not just a list of conditions and symptoms.
Your geriatrician should be capable of finding solutions to your health problems. For example, let’s say you get sick one day, so you go to the doctor. Your doctor diagnoses your health condition and prescribes a medication he or she thinks is best. You should have follow-up appointments to assess how the medication works, and your doctor should be committed to finding a prescription that works if the first one doesn’t.
A good place to start is to find out what other patients say about doctors in your area. Talk to friends, family, and caregiver if you have one to see if they like their geriatricians. Ask for recommendations from healthcare professionals you know and trust.
Look at doctor reviews on websites such as Healthgrades.com and read Google reviews. When you look for reviews on Google, also search for the doctor’s name and see if he or she is in the news. If his or her name pops up with a long history of legal trouble, you should move on.
How a Medicare Advantage Plan can Help
Look for a doctor who takes your insurance. If you have Medicare, you have a great resource to receive quality healthcare. However, Original Medicare doesn’t always approve every charge, and Medicare Parts A and B can be limited in what they cover.
That’s where Medicare Advantage (MA) plans come in. MA plans come from private insurance carriers and they can cover a lot of services Original Medicare does not. Medicare Advantage plans can cover a range of services including meal delivery, hearing, vision, and even fitness classes. Some plans even include prescription drug coverage!
There may be many MA plans to choose from in your area, and a great way to find out what’s available is to talk to a qualified professional who can help you find the right plan. You won’t lose your Original Medicare coverage if you enroll in a MA plan, and the “extras” your doctor recommends, like physical activity or home health devices, may be covered.
What if I’ve Already Found a Geriatric Medicine Doctor I Like?
Maybe you’ve found a doctor you like, and he or she decides to stop taking your insurance plan. If you have a Medicare Advantage plan, you may have to wait until the Annual Enrollment Period (AEP) to make changes to your plan unless you qualify for a Special Enrollment Period (SEP). If you want to stick with your doctor and are willing to wait until the AEP, which is every year from October 15 to December 7, find out what MA insurance plans your doctor accepts.
Usually, your doctor will give you a list of carriers he or she accepts, and Medicare Plan Finder benefits advisors have access to many different plans and carriers. Your benefits advisor will work with you to find a plan that will allow you to keep your geriatric doctor.
What is the Difference Between a Geriatric Doctor and a Regular Doctor?
Geriatricians provide primary care for seniors who have complicated medical issues. Age is not the only factor that causes people to need geriatricians. For example, an 80-year-old who is active and only takes a couple of medications doesn’t need to see a geriatrician, but a 65-year-old who has diabetes and heart disease does.
Your geriatric care will involve a team of medical professionals that will provide a comprehensive healthcare plan. You’ll work with your primary geriatric doctor, and often times a social worker, physical therapist, and/or a nutritionist depending on your needs.
If a doctor does not specify that they are a geriatric doctor, that does not necessarily mean that they do not work with older patients. However, doctors who do call themselves geriatric doctors typically have studied geriatrics and are more specialized in that area.
Geriatric Doctor
When You Should Find a New Doctor
If you feel like your doctor refuses to answer your questions, it may be time to find a new one. Your doctor has a responsibility to listen to you and answer your questions. If you say you’re concerned about a recommended procedure, your doctor should ask why. Your doctor should be able to ease your concerns and make sure you’re comfortable.
You should also find a new geriatrician if the office staff is unprofessional. If they don’t do their due diligence and provide you with all of the information you need, your health could be at serious risk. Your doctor and the office staff should have great communication skills. Look for a new doctor if your geriatrician doesn’t communicate with the rest of your care team, Your doctor should respond to you within a reasonable timeframe.
How to Find a New Doctor
The first step you should take when looking for a new doctor is to look for recommendations. Ask your friends and family members if they have a doctor that they like. Then, you can call that doctor’s office to verify that they accept your insurance.
If you don’t have any good recommendations, you may want to use an online search tool to find a doctor that accepts your plan.
Your plan might have a search tool of its own. That would be a great place to start because you know for sure that the information will be as up-to-date as possible. You can be sure that the doctors listed there will accept your plan (though it is always a good idea to call the doctor and ask before you set your first appointment).
Medicare.Gov and ZocDoc are two other great tools you can use.
Medicare.Gov’s Physician Finder Tool
Medicare.Gov is a great place to start because it will tell you which doctors accept Original Medicare (Parts A and B). If you have a private plan like Medicare Advantage, be aware that just because a doctor accepts Medicare does not necessarily mean they will accept your private Medicare Advantage plan.
All you have to do is visit medicare.gov/physiciancompare and enter your location and the type of doctor you are looking for.
You may be asked to select exactly which type of doctor you are looking for. Then, you’ll see a list of doctors who accept Medicare near you. You can filter by board certification, group affiliation, male/female doctors, distance, and whether or not they accept Medicare-approved payment (meaning you won’t be billed for more than the Medicare deductible and coinsurance).
ZocDoc is another great online tool for finding doctors near you, and it includes reviews! There is also an appointment scheduling feature so that you can book an appointment without having to call the office.
You can filter your search by the procedure you need as well as by appointment time, languages, gender, hospital affiliations, etc.. To show you how that works, we used our home city of Nashville and “primary care” as an example. Notice how we selected “Medicare” as our form of insurance.
Having the right geriatric team and insurance plan is paramount to having the best overall health possible. The team at Medicare Plan Finder can help you navigate the Medicare plans out there and find the best fit. Call us at 800-691-0473 or contact us here today.
Contact Us | Medicare Plan Finder
This blog was originally written on May 17, 2019, by Troy Frink and updated on September 19, 2019, by Anastasia Iliou.
How to Get Help Paying Medicare Premiums
The National Council on Aging (NCOA) says that over 25 million Americans age 60 and older “struggle with rising … healthcare bills.” Thankfully, federal and state governments have assistance programs for people who need help paying Medicare premiums and other costs.
What Are Medicare Premiums?
A premium is an amount you pay every month for insurance coverage. Original Medicare is health insurance that provides coverage for specific services.
You can qualify for Medicare either by turning 65, or sooner if you have ALS, ESRD, or you’ve received SSDI for at least 25 months.
Medicare premiums can seem expensive, especially if you have a limited income. For example, many people don’t have to pay a Medicare Part A (hospital insurance) premium, but they might still have to pay the Medicare Part B (medical insurance) monthly premium (standard is $144.60 in 2020).
You might not have to pay a Part A premium if you or your spouse has worked 40 or more quarters and paid Medicare taxes or you otherwise qualify for premium-free Part A. You could pay up to $458 per month in 2020 if you don’t qualify for premium-free Part A.
On top of that, Original Medicare (Part A and Part B) doesn’t cover everything. If you want extra benefits such as prescription drug coverage, you’ll need to enroll in Medicare Part D, or a Medicare Advantage plan with a prescription drug benefit. Either option may come with a separate premium. Luckily, you may be able to receive help paying Medicare premiums.
What Should I Do If I Need Help Paying My Medicare Premiums?
How to Get Help Paying Medicare Premiums | Medicare Plan Finder
If you need help paying Medicare premiums, you can apply for several assistance programs called Medicare Savings Programs (MSPs). You may need to provide certain legal documents such as a Social Security card, Medicare Card, and proof of income and address to apply. You may even qualify for several different benefit programs at the same time!
Medicare Savings Programs
There are four types of Medicare Savings Programs (MSP). Each one has its own set of income limits. Your state may have different limits for annual income, too.
In 2019, the total asset limits for most MSPs are $7,730 for an individual, and $11,600 for a couple. These limits are only federal guidelines. Your state may have different limits.
Qualified Medicare Beneficiary Program (QMB). Can help pay premiums for Part A and Part B, as well as copays, deductibles, and coinsurance. An individual may qualify in 2019 with an income up to $1,061 per month or $1,430 per month for a couple. If you qualify for QMB, you may also be eligible for Extra Help (LIS) paying for Part D prescription coverage.
Specified Low Income Medicare Beneficiary Program (SLMB). Can help pay premiums for Part B. A single person may qualify in 2019 with an income up to $1,269 per month or $1,711 per month for a couple. If you qualify as a SLMB, you’re may be eligible for LIS paying for Part D prescription coverage.
Qualified Disabled and Working Individuals Program (QDWI). Can help to pay Part A premiums. This MSP is for disabled people who lost their premium-free Medicare Part A when they went back to work. The income limits for QDWI are $4,249 per month for an individual, and $5,722 for a couple in 2019. The asset limit is $4,000 for an individual and $6,000 for a couple.
Medicare Savings Program Application and Eligibility
The best way to find out if you qualify for MSPs is to apply and let your state determine eligibility. However, Benefits.gov has a tool that uses multiple choice questions to find out if you may be eligible.*
Your state’s Medicaid office can provide information about how to apply and where to send your application.
After you apply, you should receive a “Notice of Action” within 45 days detailing what programs you qualify for, and you should be automatically enrolled in the program that most aligns with your qualifications.
Low Income Subsidy (LIS)
Low Income Subsidy (LIS) or Extra Help is a federally-funded program that helps Medicare beneficiaries save on prescription drugs. LIS can help cover your Part D premium, deductibles, coinsurance, and copays.
The program can provide huge savings! For example, you won’t pay more than $3.40 for generic drugs or $8.50 for brand-name drugs in 2019 according to the Social Security Administration (SSA).
To qualify for LIS, you must have a monthly income of less than $1,405 for an individual or less than $1902 for a couple in 2019. You must also
Have Original Medicare (Part A and Part B) coverage
Have prescription drug coverage (either a Medicare Part D plan or a Medicare Advantage plan with prescription drug benefits)
Have American citizenship
Not have savings, investments, and real estate valuing more than $28,150 if you are married or $14,100 if you are single
You may also qualify for Extra Help if you have Supplemental Security Income (SSI) or if you have both Medicare and Medicaid insurance. If you think you meet the eligibility requirements, click here to apply for LIS or ask your insurance agent to help you.
If you qualify for a DSNP, you may also qualify for a Special Enrollment Period (SEP), which can give you the freedom to make one change per quarter to your plan*. This is a huge cost-saving benefit to DSNP enrollees because it means you can enroll in a plan that best suits your needs.
For example, if your doctor stops accepting your insurance plan, but he accepts another DSNP in your area, you can switch plans to stay with your doctor. You won’t have to enroll in a different plan with a potentially higher premium.
*For the first three quarters of the year as long as you qualify for both Medicare and Medicaid.
How to Save Money on Premiums With Private Medicare Insurance Plans
Some people may not qualify for Medicaid, MSPs or LIS. However, you may still be able to save some money. If you have Original Medicare, you can enroll in private plans such as Medicare Advantage or Medicare Supplements. Note: You must choose one because you cannot be enrolled in both at the same time.
Medicare Advantage Plans
Medicare Advantage (MA) plans help cover medical services. These plans can offer additional benefits such as prescription drugs, vision, hearing, dental, and even fitness classes! Most MA plans have monthly premiums (the average is $23 in 2019) and some MA plans have $0 monthly premiums*.
*You must continue to pay the Part B premium in addition to a Medicare Advantage premium.
If you stick with Original Medicare, you could end up spending more money in premiums and other monthly dues. For example, if you have a gym membership, you likely have to pay dues. That’s one expense. If you have private dental insurance to cover routine cleanings, that’s another. Add vision insurance to that, and that’s three monthly expenses.
Alternatively, you might be eligible for a Medicare Advantage plan that includes dental, vision, and fitness supplemental benefits!
Medicare Supplement Plans
Medicare Supplement (Medigap) plans help pay for financial items such as coinsurance. In 2020, there eight different Medigap plans that offer different levels of coverage. Basically, the more services the plan covers, the higher the premium. Depending on your needs, you can save money on premiums by selecting a plan that covers fewer services.
2020 Medigap Comparison Chart
Find Help Paying Medicare Premiums
If you’re struggling to pay your monthly Medicare premiums, a licensed agent with Medicare Plan Finder may be able to help. Our agents are highly trained and can help you find a plan that suits your budget needs. To set up a no-cost, no-obligation appointment call 844-431-1832 or contact us here to learn more today.
Find Medicare Plans | Medicare Plan Finder
What Is MOOP Medicare and TrOOP and Why Does It Matter?
Medicare is a resource that many people use to help with healthcare costs, but it can be expensive. Depending on your condition or what procedures you need, you could spend thousands of dollars on healthcare costs throughout the course of a year.
However, there are limits on how much you’ll be required to spend out-of-pocket. Both MOOP Medicare and TrOOP are protections that limit your spending if you have a Medicare Advantage plan, and/or a Medicare Part D plan. Original Medicare does not provide the same protections.
Medicare MOOP
Doctor and Patient Discussing Medicare-Covered Services | Medicare Plan Finder
Maximum out of Pocket Medicare Advantage Costs
The Centers for Medicare and Medicaid (CMS) regulates Medicare Advantage plans. In 2019, the Medicare Advantage MOOP is $6,700 for in-network services. If you combine in- and out-of-network limits, MOOPs for some plans can be up to $10,000.
Be aware that not every cost you receive will count toward your MOOP limit. For example, if you have a Medicare Advantage Prescription Drug plan, your monthly premiums and prescription costs may not count toward your MOOP. Also, your plan may not cover out-of-network services even after you reach the out-of-pocket spending limit.
What Happens When You Hit Your Limit?
Once you hit your max out-of-pocket spending limit, your Medicare Advantage plan should pay for the rest of your out-of-pocket expenses for qualifying services.
Note: Look at your plan’s Evidence of Coverage (EOC) document for specific details about qualifying covered services.
Let’s look at a real-world example of this. Let’s say your doctor recommends a hip replacement and your Medicare Advantage plan has a $6,700 MOOP. The average hip replacement surgery is $39,000, which is much more than your MOOP.
In this example, you haven’t had any MOOP-qualifying costs, so your total out-of-pocket expenses will be $6,700. That means that your insurance carrier will pay more than $32,000.
Medicare TrOOP
Calculating Healthcare Costs | Medicare Plan Finder
TrOOP stands for True Out-Of-Pocket costs. While it may sound similar to MOOP, it is not the same thing. While MOOP applies to Original Medicare-covered services with Medicare Advantage Plans, TrOOP applies to prescription drug coverage, whether that’s from Medicare Advantage Prescription Drug plans or stand-alone Medicare Part D plans.
How Does the TrOOP Work?
The TrOOP starts when you reach the annual out-of-pocket threshold after you’ve left the donut hole. In order for your costs to count, they must meet the following conditions:
Your generic or brand-name prescriptions are on your Medicare Part D plan’s formulary or list of prescription drugs.
One exception to the “formulary rule” is if Medicare and your plan approves your drugs even if the prescription drugs aren’t on your plan’s formulary. In this case, your medications will still count toward TrOOP because both Medicare and your plan approved the formulary exception.
You purchased your approved medications at one of your Medicare plan’s in-network pharmacies.
Note: Medicare Part D plans vary by location and coverage policies can depend on the individual plan.
Other Costs That Count Toward TrOOP
Other Medicare Part D costs can count toward TrOOP including:
Your Annual Initial Deductible: If your plan has an initial deductible, this is the amount you’ll pay before your Medicare Part D coverage “kicks in.” This means that you’ll pay 100 percent of your prescription costs until you reach that initial deductible*.
Cost-Sharing Costs After You’ve Met the Initial Deductible: If your plan requires you to pay a copay or coinsurance, those costs will go toward your TrOOP. For example, if your plan requires a $10 copay for a medication, that money will go toward your out-of-pocket limit.
Payments While You’re in the Donut Hole: This is where things may get a little confusing. According to CMS, the manufacturer discount on “applicable drugs” is 70 percent, your cost is 25 percent, and your plan pays the remaining five percent. The five percent your plan pays does not count toward TrOOP, meaning that only 95 percent of the total drug cost counts*.
State Pharmaceutical Assistance Programs (SPAPs): Some, but not all states have assistance programs called SPAPs that work with your Medicare Part D plan. In qualifying cases, the SPAP program may help pay for your Part D premiums, deductible and copays. If the SPAP program assists with your plan costs, those payments may count toward TrOOP.
*If you receive income-based subsidies or other assistance, you may pay a different amount depending on your needs-based program.
Free Prescription Discount Card
What Is the Medicare Donut Hole?
The “donut hole” is a gap in coverage that some Medicare enrollees will see in their prescription drug coverage. It works like this: In 2019, Medicare Part D has a $415 deductible (some plans may be less) and a $3,820 initial coverage limit for total out-of-pocket costs. The donut hole is the gap between the initial coverage limit and the annual out-of-pocket-threshold ($5,100 ).
The donut hole will effectively be going away in 2020. This means that you’ll pay 25 percent of both generic and prescription drug costs after you reach the initial coverage limit.
According to CMS, the 2020 Part D deductible will be $435, the initial coverage limit will be $4020, and the out-of-pocket threshold will be $6,350.
What Doesn’t Count Toward TrOOP?
Not all the money you spend on your prescriptions counts toward your out-of-pocket limit. For example, the amount your plan covers does not count.
For example, let’s say your prescription costs $50. Your copay is $15 and your insurance policy pays $35. Only the $15 you pay for your prescription goes toward your limit. Other items that don’t count include monthly premiums and excluded drugs.
CMS considers excluded drugs to be optional, and are therefore not covered. According to the Center for Medicare Advocacy, excluded drugs include:
Drugs to promote weight loss or weight gain, even if they cosmetic use, such as to treat morbid obesity. One exception is that that drugs to treat AIDS wasting are not considered to be for cosmetic purposes and are therefore NOT excluded.
Fertility medications
Erectile dysfunction drugs, except when medically necessary and when they aren’t used to treat sexual dysfunction
Hair growth and other cosmetic drugs. Note that drugs to treat acne, psoriasis, rosacea and vitiligo are not considered cosmetic drugs.
Foreign drug purposes
Vitamins and minerals, except niacin, Vitamin D supplements (when used for a documented medical reason), prenatal vitamins and fluoride
Consult your formulary if you have more questions about what medications are included in your plan.
Let Us Help You Navigate MOOP Medicare and TrOOP
Medicare may seem complicated, and Medicare Plan Finder is here to help. Our licensed agents are highly trained and can help you determine what plan will save you the most money. Call 844-431-1832 or contact us here to set up a no-cost, no-obligation appointment to learn more.
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5 Ways to Boost Brain Health for Seniors
It’s perfectly natural to lose some mental “processing speed” as we age. This process is called cognitive aging and usually starts as soon as we reach adulthood. While certain brain functions like vocabulary might even improve as we get older, others will gradually decline. A common list of cognitive changes in elderly people typically includes slower problem solving, diminished spatial awareness, and a decline in perceptual speed and memory.
Most of these aging brain symptoms are entirely normal but the rate of this decline may increase, leading to MCI (mild cognitive impairment) or even dementia. However, scientific research has uncovered several methods proven to help maintain elderly brain health and most of them are simple things you can do in your day-to-day life!
Staying Active At Any Age
The connection between exercise and brain health for seniors has long been established. But new studies are suggesting that staying active may be the best way to prevent memory loss in old age! While it might be most effective before severe memory loss begins, it also appears to benefit those with advanced conditions like Alzheimer’s or vascular dementia.
Seniors who exercise regularly can experience reduced inflammation, improved blood flow, and even increased growth of new blood vessels in the brain. An active lifestyle can also improve the quality of sleep, which we will see later is another crucial factor in maintaining brain health. In fact, sustaining a moderate regimen of low impact exercises from six months to a year has even been associated with increased volume in the prefrontal and medial temporal cortices, the parts of the brain responsible for memory and critical thinking!
Medicare Fitness Programs
Unfortunately, the research also indicates that exercise must be a regular commitment in order to see some of these amazing benefits. But dedicating at least three hours a week can be difficult for seniors who don’t have access to a gym. This is where Medicare plans that include fitness programs can help. Plans can include Medicare fitness programs Programs like SilverSneakers® and Silver&Fit® that are designed specifically for seniors and can provide access to fitness and exercise centers. Some may supply their less mobile members with home fitness kits.
Many of us probably remember our mothers extolling the virtues of “brain food.” Turns out she was right! A diet consisting of mostly fruits, vegetables, nuts, beans, and fish has been closely linked to brain health and a lower risk of dementia. This “Mediterranean diet” is also often touted for its positive effects on heart health and cardiovascular risk factors, which can indirectly influence the health of the brain.
In addition to a more healthy diet, many seniors take supplements to get a higher dose of these crucial ingredients than can be found in the foods themselves. Some of the most popular include fish oils like omega-3 fatty acids, antioxidants such as resveratrol, as well as creatine and even caffeine.
Companies have begun producing memory supplements targeted at seniors. Some of these include:
Brainol (includes 19 ingredients for improved cognition, like B-Vitamins, Huperzine A, L-Theanine, and DMAE.
Neurofuse (includes B-Vitamins, L-Theanine, DMAE Bitartrate, and Huperzine A.)
Irwin Naturals Brain Awake (includes Vitamin B6 and L-Theanine)
BriteSmart (includes Huperzine A)
While memory supplements are not typically covered by Medicare, some Medicare Advantage plans might have an OTC (over the counter) allowance benefit which would allow you to purchase supplements. Click here to read more about OTC benefits in Medicare.
One of the easiest methods for seniors to maintain mental acuity is daily brain training. This interactive practice can take on many forms, from crossword puzzles to arts and crafts. And now more than ever, there are services and applications specifically designed to give you your daily dose of critical thinking.
Activities for Alzheimer’s Patients at Home
There are countless ways for seniors to get their brains engaged on a daily basis. Many are things you might already enjoy, including puzzles or card games. In the technological age, of course, many of these activities can be done on a computer or smartphone.
In addition to these traditional games, there are many apps that are designed specifically as activities for seniors with dementia and Alzheimer’s. Apps like Lumosity are great for challenging your brain on a daily basis and some, such as Mindmate, even include exercise and nutrition tips. A cursory Google search may also help you find other free brain games for seniors.
Some doctors suggest that one of the best ways to retain memory and cognitive functioning is to remain engaged with a social group. Many seniors use social media to stay in touch with family and friends and there are even apps like Timeless that are designed to help people with dementia or Alzheimer’s stay social.
Clear Your Mind (And The Rest Will Follow)
The importance of everyday factors like stress and sleep on brain health for seniors shouldn’t be overlooked, especially for the elderly. A good night’s sleep will clear the brain of toxins that accumulate throughout the day like beta-amyloid, a protein which is also commonly found in Alzheimer’s patients. Stress can also play a huge role in how the brain functions by introducing high levels of cortisol and even possibly reducing the size of the prefrontal cortex, the part of your brain that governs memory and learning.
Meditation and Aging
Meditation has been shown to increase the thickness of the hippocampus and decrease the volume of the amygdala, which is responsible for stress and anxiety. Research into mindfulness meditation has even indicated an effect on the process of aging itself. A 2017 UCLA study showed that the brains of people who meditate regularly actually declined at a slower rate than those who did not.
Natural Sleep Remedies For The Elderly
We know that sleep is essential for overall brain health for seniors, but many older adults experience trouble sleeping. Some practices for getting better sleep include turning off screens and lights, regular exercise, reducing sugar intake, and keeping a consistent sleep schedule with naps no longer than 20 minutes. If something more serious is causing you to lose sleep, you might need to consult a physician to test for sleep apnea or to evaluate any medications you might be taking.
Medicare Annual Wellness Visit
If the decline in cognitive functions persists or accelerates, you may need to seek professional help as a preventive measure. As part of your Medicare benefits, you may be entitled to a paid Annual Wellness Visit with your primary care provider to develop a personalized prevention plan that takes into account your lifestyle and risk factors.
In addition to checking physical factors like height, weight, and blood pressure, they can perform a cognitive assessment and screen for various forms of dementia or cognitive impairment. Additionally, a Special Needs Plan might be used to supplement your Medicare benefits. These plans are Medicare Advantage products specifically focused on providing care and coverage for patients with dementia.
Prescription Drug Plans for Alzheimer’s
If your condition or that of a loved one develops into Alzheimer’s or another form of dementia, Medicare Part D may cover the cost of prescription drugs to treat the symptoms. These medications include brands like Aricept and Exelon. Though they are not cures for the disease itself, they are effective at temporarily improving common symptoms of dementia, such as confusion or aggression.
Memory Care Through Medicare
Some severe cases of dementia and Alzheimer’s can make it nearly impossible to handle all the daily duties that come with living alone. In these cases, Medicare may help pay for nursing home care for a period of up to 100 days but will not cover such a solution in the long-term. However, some Medicare Part C plans may help cover the high costs of a nursing home or memory care facility.
For help enrolling in a Medicare plan that covers memory care and other brain health services, call us at 844-431-1832 or click here.
How to Choose the Best Type of Medicare Plan for You
When it’s time to choose a Medicare plan, it’s easy to get overwhelmed. There are quite a few different types of Medicare plans to choose from. Once you choose what type you want – you still have to choose a plan! Making the right choice is important because it may not be easy to change plans if you change your mind.
The Annual Enrollment Period (October 15 through December 7) is when anyone can make changes, and for some people, it’s the only time. If you make the wrong choice, you might have to wait a whole year before you can change again (unless you qualify for the OEP or have a SEP).
Which Types of Medicare Plans are Best for Me?
To figure out which Medicare plan is best for you, ask yourself the following questions:
What specific medical services do I need coverage for (ex: lab tests, blood work, surgery, chemotherapy, dental, etc.)?
How much room do I have in my budget? Am I able to pay a little more to have more benefits?
Would I rather pay more on a monthly basis and pay very little when I visit the doctor, or is it better to pay a small amount every month but risk having higher copayments?
Who are the doctors and other providers who I want to be covered in my plan?
There are four main types of Medicare plans to consider when you begin your Medicare plan search. Start by comparing Original Medicare, Medicare Advantage, Prescription Drug Plans, and Medicare Supplements.
Keep in mind that you cannot have Medicare Advantage and a Prescription Drug Plan at the same time. You also cannot have Medicare Advantage and a Medicare Supplement plan at the same time.
Which plan or combination of plans works best for you?
Medicare Advantage: A private plan that you can purchase once you have Original Medicare. Can add additional benefits such as hearing, vision, dental, fitness, etc. Can include a prescription benefit.
Prescription Drug Plans: Another type of private plan that you can purchase once you have Original Medicare. Usually only includes a prescription benefit.
Medicare Supplements (Medigap): Another type of private plan that you can have in addition to Original Medicare. Adds more financial coverage, like for copayments and deductibles. This type of plan would also require you to have a stand alone part D drug plan.
Different Types of Medicare Plans
Choosing a Medicare Advantage Plan
So, did you decide to go with Medicare Advantage? Great! Now, there are a few types of Medicare Advantage plans that may be available for you. First, ask yourself whether or not you need a large network and whether the freedom to see any doctor is important to you. Then, read through these important differences:
HMO Plans (Health Maintenance Organization) – You’ll select one primary physician. In some cases, you may only receive coverage for that one doctor (unless he or she refers you to a specialist). Requirements may vary based on your plan.
HMO-POS Plans (Point-Of-Service) – You’ll select one primary physician, but you’ll have the freedom to visit any specialist in your network for your other needs. You will be charged a fee for visiting specialists.
PPO Plans (Preferred Provider Organization) – You can see any doctor, but your costs will usually be lower if you choose one that is in your network.
PFFS Plans (Private Fee-For-Service) – You will not need referrals or a primary physician, but you’ll have to pick a doctor that accepts your PFFS plan.
SNP (Special Needs Plans) – Designed for those who are eligible for both Medicare and Medicaid, live in a nursing home, or have a chronic illness or disability.
MSA (Medical Savings Account) – Works like a tax-free savings account for your medical bills. Medicare will deposit money into your HSA. You can use that account to pay for medical expenses.
How do I Pick a Medicare Supplement Plan?
If you’ve decided that you want a Medicare Supplement plan, you’ll want to start by selecting the plan letter that corresponds with the coverage you need. Use the chart below for reference.
Once you’ve made that decision, you may have a few different carriers available in your area to choose from (some smaller cities may not have several options available).
Finding Medicare Plans in your area just got easier. Our Medicare Plan Finder tool can help you not only see what is available, but see which options may be best for your unique needs.
You can enroll by yourself, or you can meet with a licensed agent (for free) who can walk you through the process to make sure you don’t make any mistakes. The licensed agent can also talk to you about a variety of different types of plans in your area and answer all your questions.
This unbiased approach is a great way to get the help you need when selecting a Medicare plan.
To set up your free meeting with a Medicare Plan Finder licensed agent, call 844-431-1832 or click here.
Medicare Advantage vs. Medicare Supplement
Medicare Advantage and Medicare Supplements (also called Medigap) are very different insurance plans with distinct benefits. The answer to the question “is Medicare Advantage better than Medigap?” depends on your circumstances and needs.
What is Medicare Advantage?
Medicare Advantage plans are private plans (not owned by the federal government) that can offer additional health benefits. To have Medicare Advantage, you have to enroll in Original Medicare first. You may have to continue to pay your Medicare Part B premium even if you have Medicare Advantage (MA), but MA premiums can be as little as $0.
Medicare Advantage plans are not all the same, but they can provide benefits like (click on the links to learn more about each one):
There are many different types of Medicare Advantage plans, although not every plan type may be available in your area.
A health maintenance organization (HMO) is a network of health-care providers and facilities where you choose a primary care physician to coordinate your care.
A preferred provider organization (PPO) is also a network of health-care providers and facilities but typically you do not need to select a primary care physician, and you have more flexible options regarding out-of-network care.
A private fee-for-service (PFFS) plan is a mode of benefit delivery where you are not limited to a network. However, there are no guarantees that your doctor or hospital will accept the plan. If you choose to receive your Medicare health coverage through a private Medicare Advantage plan, you must continue paying your Part B premium regardless, because you remain enrolled in Original Medicare (Part A and Part B), even after joining a Part C plan.
What is Medigap?
Medigap is more different from Medicare Advantage than you might think. While Medicare Advantage plans are able to offer health benefits, Medicare Supplement plans (also called Medigap) offer financial benefits. For example, some Medigap plans can cover your Part B premium.
The chart below explains the differences between available Medigap plans in 2020. You can also use our Medicare Plan Finder search tool to compare plans in your area.
2020 Medicare Supplement Comparison Chart
Comparing Medicare Advantage vs. Medicare Supplement plans
Let’s look at Medicare Advantage vs. Medigap. In short, the difference between Medicare Advantage and Medicare Supplement plans is that one can supply health benefits while the other can supply financial coverage.
Medicare Supplement Insurance is a policy that’s added to Original Medicare, Part A and Part B, to provide additional financial coverage. Medicare Advantage is a private plan option that may provide you with other health benefits that Original Medicare does not cover (like dental, vision, fitness programs, etc.).
You cannot have both Medicare Advantage and Medigap at the same time.
Medicare Advantage vs Medicare Supplements | Medicare Plan Finder
A given plan type (e.g., Plan F) has the same benefits regardless of the insurance company that provides the policy, or the state in which you reside. This is not true of Medicare Advantage plans, however, because coverage details may vary by plan.
Excluding prescription drug coverage, any standard Medigap plan with Part A and B will have more benefits than a standard Medicare Advantage plan. However, as mentioned above, some Medicare Advantage plans offer benefits beyond those found in Part A and Part B.
Some Medicare Advantage plans offer prescription drug coverage (often for an additional monthly cost). With a Medigap plan, in contrast, you would need to enroll in a separate prescription drug plan. When comparing plan options, consider your costs for drug coverage. In some cases, Medigap with a stand-alone prescription drug plan has lower total costs than a Medicare Advantage plan with drug coverage. In other cases, the reverse might be true.
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Real-Life Examples: Medicare Advantage vs. Medicare Supplements
Let’s take a look at some real-life examples to help you decide whether Medicare Advantage or Medicare Supplements are right for you.
If you have Medicare Parts A (hospital coverage), B (medical coverage), and D (prescription coverage) and you are hospitalized for cancer treatments for 90 days, you may have out of pocket costs. The Part A deductible means you would pay well over $1,000 first. Once you meet your deductible, your costs will go down. However, after day 60, you’ll be responsible for a portion of every day that you stay there.
If you have Medigap Plan B, your deductible and many of your other hospital costs will be covered. This plan would be in addition to your Part B coverage, so it would all work together to provide extra coverage.
If you have Medicare Advantage, you may have additional health benefits. You’d still likely be responsible for some of those out-of-pocket hospital costs, but your plan might provide a home healthcare benefit, meaning you can get a private in-home nurse when you are released from the hospital. You might also have coverage for medical equipment, such as bathroom safety equipment or a walker.
Comparison is key: Medicare Advantage vs. Medicare Supplements
When choosing between a Medigap plan and a Medicare Advantage plan, take the time to do your research. Read the benefit descriptions of every Medigap and Medicare Advantage plan you are considering. Be certain to look at:
Monthly premium
Deductibles
Doctor and healthcare facility restrictions
Benefits
Anticipated plan costs given your typical use of health-care and hospitalization services
Prescription drug coverage cost sharing as it relates to your medication usage
In the end, your decision is going to be the one that you feel the most comfortable with. The challenge is often wading through all the material to get to the bottom line. Want to make that a little easier? Give us a call at 844-431-1832.
This post was originally published on October 23, 2018, and was last updated on August 29, 2019.
What Can You Do During the Medicare Annual Enrollment Period?
Watch this brief video first!
Annual Enrollment Period… Explained
Did you know that there are five different Medicare enrollment periods throughout the year? Not everyone will be eligible for every period, but everyone who has Medicare is eligible for the Annual Enrollment Period.
Be sure to keep track of each enrollment period so that you know when it’s your turn to make changes. Don’t go months with a bad plan just because you missed your enrollment period!
What/When is the Annual Enrollment Period?
The Annual Enrollment Period runs from October 15 through December 7 of each year. This is the time when all Medicare beneficiaries are eligible to make changes, which will go into effect on January 1 of the following year. It does not apply to people who have not yet enrolled in any form of Medicare coverage. If you’re enrolling for the first time, you’ll have an “Initial Enrollment Period.” You can use the AEP later to make changes if you don’t like the choices you made during your IEP.
Changing Medicare Plans After the Annual Enrollment Period
There are a few other times throughout the year when you may be eligible to make changes.
The Initial Enrollment Period (IEP) is for those enrolling in Medicare for the first time. If you are aging into the program, this will begin three months before your 65th birthday and end three months after. If you become eligible due to disability, your IEP will depend on your disability status or diagnosis.
The General Enrollment Period (GEP) is for those who missed their IEP. It runs from January 1 through March 31. If you enroll during the GEP, your coverage will begin on July 1. You may face a late enrollment penalty fee for not enrolling during your IEP. If you want to enroll in Medicare Advantage during the OEP, you can do that between April 1 and June 30, or you can wait for the AEP.
The Special Enrollment Period (SEP) is not one specific time frame. You may qualify for a “temporary” SEP if you have a special circumstance that results in a loss of coverage, such as losing a job with coverage or moving to an area where different plans are available. You will likely have 30 days following the event to make a change. Some circumstances, like having a disability, can make you eligible for a different type of SEP. If you are disabled or have low-income and have a special needs plan, you can change plans once per quarter for the first three quarters of the year.
Medicare Enrollment Periods
How can I get a SEP for Medicare?
To qualify to change plans once every quarter for the first three quarters of the year, you must:
Be a member of a Medicare Savings Program or Medicaid
Be part of SPAP (State Pharmaceutical Assistance Program)
During AEP, you can make a number of different changes to your coverage, like:
Enroll in a Medicare Advantage plan
Switch to a different Medicare Advantage plan from what you had
Drop your Medicare Advantage plan and have only Part A and Part B
Add a Part D prescription drug plan
Change to a Medicare Advantage plan with a prescription drug benefit
Change from a MAPD (Medicare Advantage Prescription Drug Plan) to a Medicare Advantage plan without prescription coverage
Change from one Part D plan to another
Drop your prescription drug coverage and return to Original Medicare only
You can also add or remove Medicare Supplement (Medigap) coverage, but keep in mind that you can enroll in Medicare Supplements during any time of year. Enrollment periods to not apply to Medicare Supplement plans. However, if you enroll in Medigap any time past your Initial Enrollment Period, underwriting may apply, leaving you with higher costs than you could have had if you enrolled sooner.
The ability to make these changes every year is more important than you may realize.
Even if you think you’re happy with your plan, plans are allowed to change their benefits and costs every year. Your plan can add or remove benefits and make cost adjustments as they need to. At the same time, new plans are continually entering (and leaving) the market. It’s a good idea to take a look and see if there is a better plan for you each year.
Licensed agents are required to go through a training and certification process before they can sell to you. They are usually trained on what’s going on in the area that they sell in. They may be able to tell you about plans that you haven’t even heard about before, and they can help you sort through your options. It does not cost anything to meet with a Medicare Plan Finder licensed agent.
Can you Auto-Renew Medicare?
In most cases, you do not have to renew your plan each year. Your Medicare coverage will automatically continue as long as you want. The only reason your plan wouldn’t renew is if that specific plan itself leaves your service area or leaves Medicare.
However, that does not mean that you shouldn’t review your coverage each year. Have your finances or your healthcare needs changed? Has your plan changed its benefits or costs? Ask these questions every year to make sure you’re still getting the coverage you need.
New to Medicare
What’s new in 2020?
There are a few 2020 Medicare changes that may affect what you want to enroll in this year:
As of 2019, you may be able to change your Medicare Advantage plan during the OEP
How to Make Medicare Plan Changes
You can enroll in a new Medicare Advantage plan by getting help from a licensed agent. If you haven’t enrolled in Original Medicare yet, be sure to do that first by contacting Social Security either online or at 1-800-772-1213. You can also visit your local Social Security office.
To get in touch with a licensed agent in your area, click here or call 844-431-1832 (TTY 711). You can also go straight to our Medicare Plan Finder tool.
7 Common Medicare Mistakes to Avoid
Choosing the right Medicare plan for you can seem daunting. You may be confused about what plan to buy or frustrated that you can’t find the information you need to make a sound choice.
You don’t want to potentially be stuck paying huge penalties or have a plan that doesn’t work for you. However, if you have the right knowledge, you can steer clear of the hassle that comes with these seven common Medicare mistakes to avoid.
1. Waiting Until It’s too Late to Sign up for Medicare
Medicare Late Enrollment Penalty | Medicare Plan Finder
If “timing is everything,” that goes double for Medicare enrollment. One of the most common Medicare mistakes to avoid is putting off enrollment until it’s too late. Many people know that you can enroll in Medicare when you’re 65, but what they might not know is that you can actually start the process when you’re 64. The three months before your 65th birthday, the three months after your birthday, and your birthday month is what’s called the Initial Enrollment Period (IEP).
You can avoid costly penalties if you sign up during your IEP. If you sign up to late your Medicare Part B premium may go up 10 percent for each year that you could have been covered but didn’t enroll.
The IEP doesn’t apply to everyone. For example, people with certain chronic conditions or people who’ve received SSDI benefits for at least 25 months may be eligible for a lifelong Special Enrollment Period (SEP). If you qualify, your lifelong SEP will allow you to make changes to your coverage once per quarter for the first three quarters of the year.
People who go through certain life changes such as losing coverage upon retirement or losing a spouse’s coverage can sign up for Medicare during a temporary SEP, which allows you to enroll late without paying a penalty. However, a circumstantial SEP is only for eight months after you stop receiving employer coverage, so it’s crucial that you enroll during that time frame.
3. Thinking You’re Covered Just Because Your Spouse Has Coverage
Employer insurance plans usually come with an option that covers you and your spouse. Medicare does not work that way. You and your spouse each need an individual plan.
This is actually a good thing. When you were younger, it probably made more sense to not deal with multiple insurance carriers. However, as you age, you become more susceptible to certain illnesses, and you may have different needs than your spouse. You may need more or less covered services.
For example, you might only need to visit your doctor every once in a while for wellness exams or the occasional sickness. However, your spouse may need to look into enrolling in a special type of plan called a Chronic Special Needs Plan (C-SNP) because of a chronic illness.
4. Not Using the AEP to Make Changes or Enroll in New Plans
If you don’t take advantage of the Annual Enrollment Period (AEP), which is October 15 – December 7, you could be stuck with a plan that doesn’t fit your needs for another year.
For example, if you only have Original Medicare and you want to capitalize on the supplemental benefits Medicare Advantage plans can offer, AEP is your window of opportunity.
5. Assuming Medicare Is Unaffordable
Some people may put off enrolling in Medicare because they think they can’t afford it.
While Medicare isn’t free, many people can get premium-free Medicare Part A. You will not owe a Part A premium if you or your spouse has worked and paid Medicare taxes for more than 40 quarters.
Even though you may have to pay premiums for Part B and other Medicare coverage, there is help available. If you have a limited income, you may be able to find assistance through certain Medicare programs such as Medicare Savings Programs, Low Income Subsidy Extra Help, and state Medicaid programs.
Medicare Savings Programs (MSPs): These programs can help pay the Part B monthly premium and help out with coinsurance fees, depending on the program. (There are currently three types of MSPs).
Low Income Subsidy (LIS) Extra Help: This federal program can help pay for the costs associated with Medicare Part D prescription drug coverage.
State Medicaid Programs: This program is funded by both federal and state resources. Medicaid provides medical assistance for people with low incomes and few assets. All Medicaid programs provide certain coverages such as prescription drugs.
Free Prescription Discount Card
People who qualify for MSPs or LIS may also qualify for Medicaid. If you’re eligible for both Medicare and Medicaid, you can enroll in what’s called a Dual Special Needs Plan (DSNP). A DSNP may help pay for most or all of your healthcare costs.
6. Thinking Medicare Covers Everything
Common Medicare Mistakes to Avoid | Medicare Plan Finder
Original Medicare (Part A and Part B) is a great resource for helping out with healthcare costs, but it doesn’t cover everything. Medicare Part A covers inpatient services at hospitals. Medicare Part B covers outpatient services such as doctor’s appointments. Even with those services, you’ll still owe your monthly premium and coinsurance if you see your doctor. For example, the fee for Part B services is usually 20 percent of Medicare-approved costs.
Original Medicare doesn’t cover many services people need such as vision, hearing, and dental care. The Centers for Medicare and Medicaid (CMS) allows private insurance plans called Medicare Advantage (MA) plans to provide those services.
Not every plan in every location offers those extra services, so it’s a good idea to talk to someone who can help you find the plans available in your area if those services are important to you. A licensed agent with Medicare Plan Finder can help you determine what type of Medicare plan is right for you.
For some people, Medicare Advantage plans may not make sense, but they still need more coverage than Original Medicare provides. Some people may only need help with financial items such as coinsurance fees. Those people might benefit most from a Medicare Supplement (Medigap) plan. While MA plans help cover healthcare services, Medigap plans only cover costs.
Find Medicare Plans | Medicare Plan Finder
7. Not Understanding What You Have to Pay out of Pocket
Even if you enroll in a Medicare Advantage or Medigap plan, you may still owe monthly premiums. That means that even though your Medicare Advantage plan may have a $0 premium, you may also have to pay the Part B premium, which is $144.60 in 2020 (unless you have high income).
2020 Medicare Part B Premiums
You may also have to pay a deductible before your coverage starts. The Part B deductible in 2020 is $198. Your MA or Part D plan may also require you to pay a deductible.
You may also have to pay copays or coinsurance. You may owe a copay, which is a fixed amount you pay for services such as doctor’s appointments with many MA plans. Coinsurance is a percentage of covered services. Original Medicare pays about 80 percent of approved costs and you are responsible for the other 20 percent. Your cost sharing for covered services may be different if you’re enrolled in a MA or Medicare Supplement plan.
Let Us Help You Avoid Common Medicare Mistakes
Medicare can be confusing. You might not know what coverage you need or what type of plan fits your budget and lifestyle. A licensed agent with Medicare Plan Finder can show you what’s available in your area and help you choose the best plan for you. Your agent is familiar with the common Medicare mistakes to avoid and help you take the right steps. To schedule an appointment, call 844-431-1832or contact us here today.
