Sunday, June 2, 2024

How To Get The Most Out Of Medicare

Don't Miss

Social Security Checks Are Based On Your Earnings Peak

Make The Most Out Of Medicare Benefits

While the original premise of Social Security to provide economic security for retiring Americans still stands, there are some misconceptions about what to expect in terms of the dollar figure on your first Social Security check. Your benefit is based on your highest 35 years of earnings, Horgan says. This is important because if you take time out of the workforce to take care of children or an aging parent and youre out of work for three to four years, for example, youll end up with zero in your records. This will lower your retirement benefit and this can be a real issue, especially for women. Open a Social Security account at to see your personal payout estimates.

Related: How Are Social Security Benefits Taxed?

The Pros And Cons Of Medicare Advantage

These popular plans may carry hidden risks. Heres what to know.

If youre one of the 63 million Americans enrolled in Medicare, youre probably being deluged by marketing pitches for Medicare Advantage plans, which offer managed care with low or zero premiums.

Medicares fall open enrollment season starts Oct. 15 and runs through Dec. 7, when you can switch your coverage between Original Medicare and Medicare Advantage, change Medicare Advantage plans, or make changes to your prescription drug plan.

All that marketing seems to be working. Recently, 42 percent of Medicare beneficiaries were enrolled in Advantage plans, up from 31 percent in 2016, according to data from the Kaiser Family Foundation. Those numbers include 50 percent of Black and 54 percent of Hispanic enrollees vs. 36 percent of whites in 2018. By 2025, half of Americans are expected to be in Advantage plans.

Its easy to see the appeal of Advantage. Original Medicare doesnt cover all your medical expenses, while Advantage plans have cost-sharing requirements but then cap your out-of-pocket costs. Plus, you have low premiums and the simplicity of all-in-one coverage.

But there can be hidden risks to Advantage plans, especially for those with major health issues.

Some people in Medicare Advantage end up paying unexpectedly high costs when they become ill or find their network lacks the providers they need, says Tricia Neuman, senior vice president at Kaiser.

How To Get The Most Out Of Medicare For Seniors

Thanks to Medicare, more than 56 million Americans five out of six who are age 65 or older have vital health care coverage. However, seniors and pre-retirees need to understand the finer details of the federally funded program if they want to get the full benefits to which they are entitled.

Here are several ways you or a loved one can get the most out of Medicare:

  • Shopping around for the best plan every year. Parts A and B of original Medicare are straightforward in their coverage. If you have earned 40-lifetime work credits, there is no premium attached to Part A, while there is a monthly premium for Part B.

It is Part D of Medicare where enrollees can truly benefit. Medicare contracts with private insurance companies that offer seniors different coverage options, especially when it comes to prescribed medications. These coverage options, as well as the pricing of plans, often change from year to year. By simply enrolling in your prior plan without considering another plan, you could result in less coverage for your prescription drugs, not to mention higher out-of-pocket payments.

There are similar penalties for failing to enroll in Parts A and B when you turn 65 years old. Unless you enroll during a seven-month period between three months before your 65th birth month to the three months following it you may incur a 10% monthly premium penalty on Part B.

You May Like: What Medications Are Covered By Medicare

Already Enrolled In Medicare

If you have Medicare, you can get information and services online. Find out how to .

If you are enrolled in Medicare Part A and you want to enroll in Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.

You can use one of the following options to submit your enrollment request under the Special Enrollment Period:

  • Fax or mail your CMS-40B, CMS-L564, and secondary evidence to your local Social Security office .
  • Note: When completing the forms CMS-40B and CMS-L564

    • State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
    • If possible, your employer should complete Section B.
    • If your employer is unable to complete Section B, please complete that portion as best as you can on behalf of your employer without your employers signature and submit one of the following forms of secondary evidence:
      • Income tax form that shows health insurance premiums paid.
      • W-2s reflecting pre-tax medical contributions.
      • Pay stubs that reflect health insurance premium deductions.
      • Health insurance cards with a policy effective date.
      • Explanations of benefits paid by the GHP or LGHP.
      • Statements or receipts that reflect payment of health insurance premiums.

    Some people with limited resources and income may also be able to get .

    Are You Taking Prescription Drugs

    How to Get the Most Out of Medicare

    Talk to your doctor now and check if any changes need to be made to your medications. In addition, check the cost of your prescriptions with your Medicare Plan, and consider ordering your medications by mail. Some Medicare plans will lower the cost of your prescriptions if you order a 3-month supply by mail.

    Make your health a priority and take advantage of all the coverage your plan offers. Find out how often your plan allows you to see your different doctors and dentists a year, and set recurring appointments in advance. If youre not sure what other benefits your Medicare plan includes, you can contact your agent or Caress Insurance Agency. We work with Scripps Affiliated Medical Groups to help answer all your Medicare questions.

    Not sure if you have the best plan for you? Try our an online tool to easily compare plans, get a custom quote, and speak to one of our agents: !

    • 550 Washington St., Suite 841San Diego, CA 92103

    Also Check: Does Aetna Medicare Cover Home Health Care

    Why Medicare Advantage Plans Can Fall Short

    For many older Americans, Medicare Advantage plans can work well. A JAMA study found that Advantage enrollees often receive more preventive care than those in traditional Medicare. Advantage plans are competing not just on cost but on delivering quality care, says Kenton Johnston, PhD, associate professor of health management and policy at Saint Louis University, co- author of the study.

    But if you have chronic conditions or severe health needs, you may want to think twice about Medicare Advantage because of the requirements for pre-authorization and staying in-network, says Melinda Caughill, co-founder of 65 Incorporated, a firm that provides Medicare enrollment guidance to financial advisers and individuals.

    If you need to see multiple specialists, and you have to get referrals for each appointment or fight to overturn denials, it can be really challenging, Caughill says.

    Steven Feld, 65, a retiree in South Pasadena, Fla., struggled to get coverage for an injection to treat his arthritic knee. The treatment, a prefilled injection administered in a doctors office, is deemed a medical device by the FDA, so the plan twice denied the coverage. When I was on my employers group plan, there was no problem getting the injection covered, says Feld, who joined his Medicare Advantage plan in May.

    You Dont Shop Around For New Plans

    Set it and forget it is the path of least resistance. The truth is, there might be a better plan out there.

    Medicare Advantage plans are competing for your business. They can offer better prices or more benefits than other plans. Take the time to see how they compare costs and choose the one that will save you the most money.

    Recommended Reading: What Is The Best Medicare Supplement Plan In Arizona

    Here’s How To Ensure That You Get Every Cent In Benefits You’re Entitled To

    The benefits of Social Security are readily apparent for seniors. Each and every month, for those who qualify and have filed for benefits, the program pays an average of $1,350 to retired workers. This is a tangible and dependable benefit payment that a majority of today’s retirees count on to help them meet their month-to-month expenses.

    Medicare, which covers some 56 million Americans, 5 out of 6 of which are aged 65 and up, doesn’t have the same tangible benefits feel as Social Security. That doesn’t, however, make it any less important over the long run.

    According to an from the Urban Institute, by the year 2055 the average lifetime benefits paid out by Medicare to a median-earning male will have surpassed the lifetime benefits received from the Social Security Administration. Or in layman’s terms, Medicare is closing the gap with Social Security in terms of importance, and is on track to surpass Social Security in roughly 40 years.

    Get The Most For Your Medicare Dollars

    Are You Getting The Most Out Of Your Medicare Coverage?

    How to get the most from your Medicare dollar is a popular question with close to 100 million responses from a Google search.

    My clients say Why didnt I call you first? You answered all my questions. Never pressured me to buy.

    Turning 65 Medicare Options

    Do you really want to spend time searching the internet for answers? Or allowing strangers in your home. Agents who will try to SELL you something you dont want, dont need and cant afford.

    Here is my pitch. Call. Give me 10 minutes to answer your questions. Any question. Then decided if you want my help or not.

    I call this an offer you cant refuse.

    Don’t Miss: How To Purchase Medicare Insurance

    How Can A Medicare Supplement Insurance Plan Help If A Member Gets Sick Or Injured While Traveling

    Cantu: One great advantage of using traditional Medicare Parts A and B with a Medicare Supplement plan is that your coverage extends to any doctor or medical facility in the U.S. that accepts Medicare. If youâre traveling overseas, many of these plans will also provide foreign travel emergency coverage.

    Your eHealth insurance licensed agent can explain more about what your plan covers and other options that may be available in your area. Call 844-257-7926 Monday through Friday, 8 a.m. to 8 p.m. ET.

    Humana Healthy Foods Card

    This card can be used at participating retailers nationwide to help eligible members get the healthy foods they need. Used just like a credit card, it offers a monthly allowance that can be used to buy approved healthy foods.

    The Healthy Foods Card is only available to members of participating Dual-Eligible Special Needs Plans.

    You May Like: How Much Is Medicare B

    Shop Around Each And Every Year

    Original Medicare, which consists of Part A and Part B is pretty straightforward. There is no shopping around for Part’s A or B since they’re a one-size-fits-all package. Part A, for those who have earned 40 lifetime work credits, has no premium attached, while Part B does have a monthly premium.

    Where consumers need to be diligent with their efforts to shop around is in regard to Part D, also known as Medicare’s prescription drug plan. Medicare contracts with private insurance companies that offer a host of different coverage options for seniors. More importantly, these coverage options, and the pricing of these plans, can and will change from year to year. This means that the plan you’ve chosen in 2016 may not be the best value for you in 2017.

    The worst thing you can do is simply auto-enroll in your prior-year plan without examining what other plans are offering. Doing so could leave you with higher out-of-pocket payments and less coverage for your prescribed medications.

    Image source:

    Can I Get My Health Care From Any Doctor Other Health Care Provider Or Hospital

    Get the Most out of your Medicare Plan
    Original Medicare

    You can go to any doctor or hospital that takes Medicare, anywhere in the U.S.

    In most cases, you don’t need a


    to see a specialist.

    Medicare Advantage

    In many cases, youll need to only use doctors and other providers who are in the plans network . Some plans offer non-emergency coverage out of network, but typically at a higher cost.

    You may need to get a


    You can join a separate Medicare drug plan to get Medicare drug coverage.

    Medicare Advantage

    Medicare drug coverage is included in most plans. In most types of Medicare Advantage Plans, you cant join a separate Medicare drug plan. You can join a separate Medicare drug plan with certain types of plans that:

    • Cant offer drug coverage
    • Choose not to offer drug coverage

    Youll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply:

    • Youre in a Medicare Advantage HMO or PPO.
    • You join a separate Medicare drug plan.

    Read Also: What Is The Average Premium For Medicare Advantage Plans

    How Medicare Advantage Plans Work

    First, it will help to review a few basics. Medicare comes in four parts, with Part A covering inpatient hospital care, and skilled nursing. Theres no premium if you or your spouse have earned at least 40 Social Security credits.

    Part B covers doctor services and outpatient hospital care. You have to pay a monthly premium for this coverage, which is $170.10 in 2022, with a deductible of $233. High earners pay more.

    The other parts of MedicarePart C, aka Medicare Advantage, and Part D, prescription drug coverageare optional and offered by private insurers.

    Medicare Advantage is an all-in-one managed care plan, typically an HMO or PPO. Advantage plans provide the benefits of Part A and B, and most also include Part D, or prescription drug coverage. Some offer extra benefits not available through Original Medicare, such as fitness classes or vision and dental care.

    If you opt for Medicare Advantage, you typically continue to pay your Part B premium as usual, but you will pay little or no additional premiums for your coverage. You generally have copays or coinsurance, but once you reach your out-of-pocket limit, the plan will pay 100 percent of your medical costs covered under Medicare for the rest of the year. The out-of-pocket limit does not apply to prescription drugs or extra benefits.

    With Medigap, youll pay more in monthly premiums compared with Advantage plans . Youll also have a bit more work choosing your Part D plan.

    Tips For Making The Most Of Your Medicare Plan This Year

    Do you enjoy taking advantage of two-for-one deals at the supermarket? Make it a point to confirm discount codes when buying items online? Secretly love the senior discount at your local thrift store? Perhaps part of you feels relieved that pandemic restrictions have cut into your restaurant spending, allowing you to create a rainy-day fund.

    If any of this sounds familiar, you probably consider yourself a savvy consumer who likes to make sure youre spending your money wisely. But have you stopped to consider whether youre applying those same prudent practices to your Medicare benefits?

    Maximizing those benefits can help with more than just saving money. It could help improve your health, as well.

    Here are five tips to help ensure you get the most out of your Medicare coverage this year.

    Tip 1: Learn the difference between Original Medicare and Medicare Advantage.

    Tens of millions of Americans made choices about their Medicare coverage last fall. Some opted for Original Medicare, but more than 40 percent choose Medicare Advantage, which combines Medicare Parts A and B. Many Medicare Advantage plans also offer prescription drug coverage and valuable extras, like dental, hearing and vision care. Whats more, a Medicare Advantage plan can offer home visits to close gaps in care, help identify chronic conditions early, and more. Understanding those additional benefits and features can help you make the most of your plan.

    The bottom line


    Recommended Reading: Can I Enroll In Medicare Online

    Work For At Least 35 Years

    The higher your earnings, the higher your primary insurance amount . This is the amount paid to you as a benefit every month once you retire. Social Security arrives at this amount by taking an average of your indexed monthly earnings over the 35 years during which you earned the most money. Working at least 35 years will ensure that a zero earnings year or lower earning years will not pull down your average earnings. You also increase the likelihood that you will be earning more the longer you work, which will boost your average indexed earnings.

    Especially in the case of one spouse being the sole breadwinner, it is important for the working individual to work up until full retirement age or as close as possible to enhance their benefit. The spouse may have their own earned benefit but will receive either their benefit or half of the higher earners benefit, whichever is higher. This workers earnings and subsequent benefits will also be crucial to any dependent children or dependent parents.

    Survivor benefits grant the remaining spouse the higher of the two individuals earned benefit, which is vital when the household loses one source of income and needs to pay for funeral and burial expenses. To help support a comfortable standard of living, the main earner should work as long as possible to maximize their benefit.

    Tip : Use Network Providers

    Get The Most Out Of Your Medicare Plan

    Medicare Advantage plans typically work with a network of providers, including doctors and hospitals. Plans contract with network providers to provide care to plan members at negotiated prices. This allows for lower out-of-pocket costs for plan members. Some Medicare Advantage plans offer out-of-network coverage, but the member usually pays more than for the same service from a network provider.

    Tip 5: Look for Extra Plan Discounts

    Some Medicare Advantage plans offer discounts on things you already use or need, such as vitamins, hearing aids, fitness programs and alternative medicine services such as acupuncture. Hearing aid benefits alone could save you thousands of dollars a year. And saving money on your daily vitamins and a membership to your local fitness center could be the extra motivation you need to stick to a healthy lifestyle.

    Also Check: How Many Mastectomy Bras Are Covered By Medicare

    More articles

    Popular Articles