A Quartet Of Medicare Enrollment Periods
There are several enrollment periods, in addition to the seven-month initial enrollment period. If you missed signing up for Part B during that initial enrollment period and you aren’t working , you can sign up for Part B during the general enrollment period that runs from Jan. 1 to March 31. Coverage will begin on July 1. But you will have to pay a 10% penalty for life for each 12-month period you delay in signing up for Part B. Those who are covered by a current employer’s plan, though, can sign up later without penalty during a special enrollment period, which lasts for eight months after you lose that employer coverage. If you miss your special enrollment period, you will need to wait until the general enrollment period to sign up.
Open enrollment runs from Oct. 15 to Dec. 7 every year during which you can change Part D plans or Medicare Advantage plans for the following year, or switch between Medicare Advantage and original Medicare. Advantage enrollees also can switch to a new Advantage plan or original Medicare between Jan. 1 and March 31. And if a Medicare Advantage plan or Part D plan available in your area has a five-star quality rating, you can switch to that plan outside of the open enrollment period.
What Do Medicare Supplement Plans Cover
Medigap policies cover the following out-of-pocket costs:4
- Part A coinsurance and hospital costs up to an extra 365 days after Medicare benefits are used up.
- Part B coinsurance or copays.
- Blood .
- Foreign travel emergency .
- Above out-of-pocket limits.
The Part B excess charge is little understood but essential to know. Doctors who accept Medicare assignment agree to rates set by Medicare for covered services. Those who dont can charge up to 15% more than the Medicare-approved amount.
Unless you have a Medigap plan that covers excess charges, you will be responsible for those charges. The alternative? To only use participating doctors, although thats not always easy in an emergency or surgery involving many doctors.
Also, Original Medicare does not cover you outside the U.S. But some Medigap policies do.
When Is The Best Time To Buy A Plan
The Medicare Supplement Open Enrollment period starts on the 1st day of the 1st month in which youre age 65 or older and enrolled in Medicare Part B. In some states, you can buy a plan on the 1st day youre enrolled in Medicare Part B, even if youre not yet 65.
If you meet certain criteria, such as applying during your Medicare Supplement Open Enrollment Period, or if you qualify for guaranteed issue, a company cant use your medical history to determine your eligibility. Rules in some states may vary.
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Choosing My Type Of Medicare Coverage
Your first decision when it comes to health coverage after 65 is between Original Medicare and Medicare Part C.
Original Medicare covers most hospital and doctor expenses. The balance is left to you, with no cap on how high your out-of-pocket costs can go.
Original Medicare allows you to see any doctor in the U.S. who accepts Medicare. It provides excellent flexibility: it has no networks or referral requirements.
Medicare Part C bundles hospital, doctor and drug coverage. It covers most of those expenses, but you pay deductibles, copayments, and coinsurance. Medicare Advantage plans cap out-of-pocket expenses.
Medicare Advantage is all-encompassing, even offering dental and vision coverage . But, you are limited to its doctor network and need referrals to see specialists.
How Does Diabetes Affect My Medicare Supplement Eligibility
When you start filling out an application for a Medicare Supplement , youâll notice that thereâs a section about your health.
In this health section, there are lots of questions about certain diseases and conditions. In sum, if you have any of these conditions, youâre automatically declined.
For many carriers, diabetes is one of these concerns. However, simply having diabetes doesnât automatically decline you.
There is usually a set of specific questions that help the insurer decide how risky you are:
- How much insulin do you take?
- How many total medications do you take?
- Do you have any other conditions, such as high blood pressure?
- How much do you weigh?
All of these questions help the underwriter decide if youâre going to be too expensive to insure. If they find your diabetes to be too risky, theyâll decline you.
So, what are these specific qualifications, and how do you get around them?
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Medigap Guaranteed Issue Rights
You may qualify for guaranteed issue in specific situations outside the Medigap open enrollment period by federal law. For example, if:
- You no longer have coverage because your Medigap insurance company went bankrupt
- Your employer-sponsored supplemental/retiree coverage is ending
- Your Medicare Advantage Plan or PACE withdraws from your area, you moved to a new place not covered by your plan, or you chose to withdraw from a plan during the trial period.
- You choose to drop your Medicare Advantage plan within 12 months of enrolling.
- You choose to drop your Medigap or Medicare Advantage coverage because your insurance company broke rules or misled you.
Some states go beyond the federal requirements regarding Medigap guaranteed issue rights. For example, states such as New York and Connecticut require insurance companies to accept Medigap applications at any time throughout the year insurance companies are not allowed to charge more for a policy due to an applicants health.
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You Continue To Pay For Part B On Medicare Advantage
Now pay attention because Im going to share with you the MOST common misunderstanding about Medicare Advantage plans:
Enrolling in a Medicare Advantage plan does not replace what you pay for Part B.
You must continue to be enrolled in both Medicare Parts A and B before you can join a Medicare Advantage plan in your area. Ive seen a number of people over the years get this wrong. They enroll in Medicare Advantage and then they disenroll from Part B.
Guess what happens?
The Medicare Advantage plan then kicks them out. You must be enrolled in both Parts A and B and live in the plans service area to join a Medicare Advantage plan.
I think what throws people off is that in some areas there are some Medicare Advantage plans with what we call a $0 premium. This means you dont pay for the plan itself, but it doesnt mean you get out of paying for Part B.
How can any plan offer a $0 premium, you ask?
Remember, the plan is being paid by Medicare to deliver your care.to take on your risk. So, the insurance company operating the plan can set the monthly premium at whatever they want. They set the premium as low as possible to attract people like you to their plan.
Even if an insurance company offers a Medicare Advantage plan for $0, it does not mean the plan is free. The insurance company can adjust the plans premium each year. It could be $0 this year and $20/month next year, etc
Do I Need To Do Anything With My Medicare Supplement Plan
Whether youâre entirely new to Medicare or youâve been a Medicare participant for a while, you may have questions about your Medicare Supplement plan, such as âWhat do I need to do with my Medicare Supplement plan this year?â
Medicare Supplements are handled very differently from Medicare Advantage plans, and many individuals donât know this!
Remember that our team of licensed agents is always willing to help you, so please feel free to contact us at any time for individualized help.
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What Health Questions Are Required During The Medicare Supplement Underwriting Process
When seeking a plan, youre required to provide information about your current health problems and past medical history. The insurer is most interested in what conditions youre being treated for now and whether youre likely to undergo medical procedures in the near future. If youre planning to have surgery, for example, an insurer may deny coverage because they dont want to immediately pay for an expensive operation.
You may be required to answer questions about your specific exercise and dietary routine, current medications, whether your conditions require supplemental oxygen use, if you have a heart condition or if you suffer from diabetes. Your age, weight and lifestyle can also influence your chance of being approved for coverage. For example, Medigap plans may require a waiting period before you can receive full benefits if youre a smoker.
The Benefit Of No Health Questions
Medicare Advantage plans have another feature that is attractive. They ask only one health question, so they rarely turn anyone down for coverage. People who suffer from End-Stage Renal Disease are not eligible for Medicare Advantage.
However, you can only enroll in Medicare Advantage plans at certain times of the year.
This prevents people from just waiting until they get sick to get coverage. If you dont enroll in a Medicare Advantage plan during your initial enrollment window, then you will have an annual chance to do so each year in the fall from October 15th December 7th. This is called the Annual Election Period.
If you get sick in February, and you cant get into a Medicare Advantage plan until next year, you could spend a great deal between February and December. So, if you like the idea of Advantage plans, enroll in one before you need it.
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When Should I Apply For A Medicare Supplement Policy
When you elect coverage under Medicare Part B either due to age or disability, you have a 6-month open enrollment for a Medicare supplement policy, which guarantees you coverage with a plan and company of your choice. You may choose from a list of standardized plans listed as A through L. If you do not purchase a plan within your 6-month open enrollment, any company you apply to can deny coverage based on your health conditions. There are some limited additional open enrollment periods available to some persons disenrolling from a Medicare HMO.
How To Increase Your Odds Of Approval
If youre worried about whether youll be approved for a Medicare supplemental insurance plan, there are a few things you can do to increase your chance of finding a policy:
- Enroll in the plan early, when youre still guaranteed acceptance.
- Seek professional medical advice from a licensed health insurance agency to find plans that provide the greatest approval odds.
- Wait until after an upcoming surgical procedure to apply, as your odds of approval increase after youve undergone the procedure and fully recovered.
- Be prepared to provide your medical records and proof that past medical problems have been resolved.
- Quit using products that contain nicotine such as tobacco or vape products.
- Avoid using illicit drugs, as insurers perform blood and urine tests during the underwriting process.
- Consider that some insurers deny coverage to patients using marijuana, even if its legal or used for medicinal purposes.
- Ask how the appeal process works in case youre denied coverage so you can submit an appeal if you wish.
The Medicare-covered services offered by the federal government are often sufficient for most people without major health complications. Make sure you discuss your concerns with your agent if youre new to Medicare and decide whether you really need a Medicare supplement insurance plan. There are some cases where youll save more money without one.
If youre new to Medicare, call to speak with some who can offer the Medicare help you need.
Some Medigap Plans Help Cover Emergency Care When You Travel Abroad
Original Medicare doesnt typically cover emergency care that you receive when traveling outside of the United States.
Some Medigap plans, however, can provide coverage for 80 percent of your foreign travel emergency care costs. This can help give you a sense of security when you take your next trip around the world.
The Medigap plans that include foreign travel emergency care coverage in 2019 are:
- Part B requires an annual deductible of $203 in 2021.
- Part B excess chargesHealth care providers who do not accept Medicare assignment reserve the right to charge up to 15 percent more than the Medicare-approved amount for their services or items.
- Foreign travel emergency careThere are only a few rare circumstances under which Original Medicare provides any coverage for emergency care received outside of the U.S.
High Incomers Pay More For Medicare
If your income is above a certain threshold, you’ll pay more for Parts B and D. These surcharges are based on your adjusted gross income from two years earlier. In 2021, single filers who made more than $88,000 paid a premium ranging from $207.90 to $504.90 per month depending on their income. The standard premium in 2021 was $148.50. The income thresholds, the standard premium and the surcharges haven’t been set yet for 2022.
For Part D coverage in 2021, single filers who made more than $88,000 paid an extra $12.30 to $77.10 per month, depending on their income.
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Why Buy More Insurance
As noted above, Medicare isn’t a blanket insurance policy. This means it does have holes in it. Original Medicare, as the government calls what we now know as Parts A and Band Medicare prescription drug coverage, Part Dpays most of your expenses.
But it’s far from all of the costs you may face if you become seriously ill or get injured. Even routine services come with copayments and deductibles. This is where Medigap insurance kicks in.
The Independent Medicare Insurance Broker
A licensed insurance professional must be licensed in each state they do business, and also appointed to do business by each company they represent. Without going through this process, the insurance professional is not permitted, by law, to show prices or plans of those companies from which they are not appointed and states they are not licensed. The insurance professional that has gone through this process and can offer all Medicare Supplement plans and possibly even Medicare Advantage plans has the ability to represent your best interest. Because they consider your situation and budget then shop all the plans for the best Medigap plan and the best price, they can find and present to you the Medicare Supplement policy and company that is right for you. This is an independent Medicare insurance broker. They do not work for any insurance company. They may work for an insurance agency or for themselves, but their goal is to represent your best interest.
When it comes to shopping for the best plan and best price, the independent Medicare insurance broker represents your best interest. However, they must disclose all pertinent facts to the insurance company. Its that simple.
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How To Find Out If A Medicare Supplement Is Worth It For You
It is better to have some protection when it comes to your healthcare than it is to have no protection. Enrolling in a plan will help give you peace of mind and financial security. Medicare Supplement plans are worth it doctor freedom, low out of pocket costs, and when Medicare pays the claim, your supplemental Medicare plan will pay the rest.
Our team of experts is ready to answer your questions are share the most popular Medigap plans in your area. Call us today to find out if Medicare Supplements are worth it for you!
Is Having Original Medicare Insurance Sufficient
For some people, only having access to Original Medicare may not always be enough. However, for others, having Original Medicare is sufficient, but why? This happens because many low-income Medicare beneficiaries are also eligible for Medicaid benefits. Since many of the Medicare eligibility requirements can be similar to those of Medicaid, applicants are able to fulfill their coverage and cost needs.
For instance, through the dual eligibility coverage, enrollees can cover their coinsurance, copayment and deductible costs while also obtaining coverage for care not granted by Medicare . So, who ends up needing a Medigap plan? Enrollees that only have Medicare assistance are the ones that may require supplemental insurance to fill the gaps of Medicare.
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Why Do I Need To Go Through Medicare Supplement Underwriting To Get A Medicare Plan
Medical underwriting is the process insurance companies use to determine whether they want to insure a new client. During Medicare supplement underwriting, youre required to undergo a physical examination and provide information about your medical history and current health conditions.
The information an insurance company discovers during medical underwriting determines how much risk is involved in providing you with health care coverage.
Medicare supplement insurance, also known as Medigap coverage, is for the purpose of covering your out-of-pocket costs not covered by your Original Medicare or Medicare Advantage plan.
Many people purchase Medicare supplement plans because theyre interested in limiting the potential cost of treating a major health condition or theyd like to protect themselves in the event of an emergency.
If youre new to Medicare or currently looking for affordable Medicare plans, you need to know your guaranteed issue rights so you cant be denied coverage due to your past or current health problems. A licensed insurance agent can help you understand Medicare and review Medicare plans with you to determine whether youre better off with Medicare Part B or an Advantage plan and if a Medicare supplement plan is right for you.