Who To Talk To About Medicare

Senior Speak: Talking To Medicare Clients Age 65 & Older

Medicare Insurance: How to Authorize Someone to Speak to Medicare for You

Lauren Hayden

As an insurance agent who sells Medicare, most of your clients probably fall into the 65 and older population. When you talk to people in this age group, there are several communication doâs and donâts to keep in mind.

The team at Ritter has everything you need to know about having a successful, respectful conversation with your clients who are 65 plus!

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When Should I Call 1

Beneficiaries can call the toll-free Medicare number to:

ask whether certain services are covered,
get detailed information about Medicare health and prescription drug plans in your area, including costs and services,
choose and enroll in a Medicare health or prescription drug plan,

find a Medigap policy in the area,
request a list of Original Medicare physicians, healthcare providers, and suppliers,
request information and forms necessary for filing a Medicare appeal or begin an appeal verbally,

compare quality ratings for skilled nursing facilities, hospitals, home health agencies, and dialysis facilities,
request Medicare publications.

What Information Can I Find At Medicaregov

Medicare.gov contains a treasure trove of contact information and details about Medicare coverage. For contact information, visit the contact page of the website and enter your state or territory then choose the organization or topic from a dropdown menu.

For complete do-it-yourself Medicare access, visit MyMedicare.gov, and set up your own account with a user name and password. Your own MyMedicare.gov account will allow you to:

view and print a copy of your Medicare card,
track Original Medicare claims and your Part B deductible,

register for electronic Medicare Summary Notices ,
update and manage your medical information ,
view the Medicare & You handbook electronically,

update your drug list and pharmacy information,
manage your providers.

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If You Are Under Age 65 And Disabled:

If you are under age 65 and disabled, and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, you will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement. You will not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you about 3 months before your Medicare entitlement date. , you get your Medicare benefits the first month you get disability benefits from Social Security or the Railroad Retirement Board.) For more information about enrollment, call the Social Security Administration at 1-800-772-1213 or visit the Social Security web site. See also Social Security’s Medicare FAQs.

For more information, see Medicare.gov

After We Grant Your Green Card

We issue a Permanent Resident Card to all permanent residents as proof that they are authorized to live and work in the United States. If you are a permanent resident age 18 or older, you are required to have a valid Green Card in your possession at all times.

This page gives you a brief summary of the top actions you may need to do after receiving your Green Card.

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Contacts For Medicare Advantage Medigap And Part D Plans

The Medicare customer service helpline may not have all the answers for Medicare Advantage, Medigap or Part D prescription drug plans. These plans are sold by private insurance companies under contract with Medicare.

You should look for contact information about your plans provider on the card you received from the insurer. Or you may need to look at the information you received about the plan when you first enrolled.

How To Speak To Actual Medicare Customer Service Reps Offline

Applying for Medicare or Medicare Advantage can get confusing, especially for first-timers. While websites can be useful tools, reading through the plethora of information about available plans can be like walking through a maze.

But thereâs no need to fear. If you’re feeling doubtful about reaching Medicare customer service, it’s important to know that real life, in-person help is availableâand much of it is free of cost.

Make an appointment at your local SSA office.

Ground zero for getting started on yourMedicare journey is your local Social Security Administration office, where you can sign up for Part A and Part B in person. Be sure to make an appointment over the phone first. To find your local office, you can call the SSA at 1-800-772-1213 on weekdays from 7 A.M. to 7 P.M. or use the office locator on the official SSA website.

For free help navigating the system, go to your local SHIP.

Your local state health insurance assistance program, or SHIP, provides free in-person counseling to Medicare recipients and their caregivers. A SHIP counselor can help you navigate anything from your rights as a Medicare recipient to your expected out-of-pocket expenses. Whether you need a specific plan for a chronic illness or a special enrollment period because of a big move, your SHIP counselor can help.

To find your local office, call 1-877-839-2675 or visit the official state health insurance assistance programs national network website.

When To Enroll In Medicare If I Am Receiving Retirement Benefits:

If youre already collecting Railroad Retirement Board or Social Security retirement benefits when you turn 65, you will automatically be enrolled Medicare Part A and Medicare Part B if you sign up for Medicare Part B at the time you sign up for retirement benefits.

If you live outside of the 50 United States or D.C. , you will automatically be enrolled in Medicare Part A, but will need to manually enroll in Medicare Part B.

Contacting Medicare On Behalf Of Someone Else

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If youre calling Medicare regarding another persons coverage, youll need to take some additional steps before you even pick up the phone. Medicare can only share a beneficiarys personal health information with authorized entities. The beneficiary can grant you authorization verbally while youre on the line with Medicare, online using their MyMedicare.gov account, or by mailing in a written form. The earlier authorization is granted, the easier it will be for you to help with their Medicare-related matters.

If your loved one becomes incapacitated and has not already authorized Medicare to speak with you, youll need to use your power of attorney to complete the authorization as their personal representative. If your loved one did not name you as POA prior to their incapacitation, you will have to go to court and petition for guardianship in order to access their medical and/or financial information and make decisions on their behalf. This is yet another example of why planning for the future is crucial for seniors and caregivers.

You can download the CMS-10106 Form for 1-800-MEDICARE Authorization to Disclose Personal Health Information here.

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Medicaid Or Medicare Savings Programs

Medicare beneficiaries with limited income or very high medical costs may be eligible to receive assistance from the Medicaid program. There are also Medicare Savings Programs for other limited-income beneficiaries that may help pay for Medicare premiums, deductibles, and coinsurance. There are specified income and resources limits for both programs. Contact your local county Department of Social Services or SHIIP to apply for one of these programs.

What You Need To Have Ready Before Calling Medicare

Before calling Medicare, youll need to have several pieces of information readily available. This will help the customer service representative identify you and quickly address your questions or concerns.

What to Have Ready When Calling Medicare

Your red, white and blue Medicare card.

A pen or pencil and paper to take notes.
The amount you have already paid, if you are calling about a claim.
The date you got a medical service or medical supplies, if youre calling about a claim.

The type of service or supplies you received, if youre calling about a claim.
Your doctors or other providers name, if youre calling about a claim.
Your Medicare Summary Notice, if youre calling about a claim and the MSN is available.

You may also want to have a friend or family member listen in to the call on speakerphone. They should stay quiet but take notes for you so you can concentrate on the conversation with your customer service representative.

Also remember that you can request the information from Medicare in writing. Just ask for it at the end of your call.

How To Cancel Medicare Part C

If you wish to cancel your Medicare Part C plan, here is one option for cancelling your coverage:

The Fall Annual Enrollment Period lasts from each year. During this time, you may disenroll from your Medicare Advantage plan and enroll in a different plan, or you can cancel your Medicare Advantage plan and revert back to Original Medicare coverage.
Starting in 2019, you can take advantage of the Medicare Advantage Open Enrollment Period, which runs each year from .

During this time, you can change from one Medicare Advantage plan to another, whether or not either plan includes prescription drug coverage.

You can also disenroll from your Medicare Advantage plan and switch back to Original Medicare . If you switch back to Original Medicare during this period, you can join a Medicare Part D prescription drug plan.

If you enroll in a Medicare Advantage plan during your Initial Enrollment Period , you can switch to another Medicare Advantage plan or cancel your Medicare Advantage plan and return to Original Medicare at any time during the first three months you have Medicare.

You may be able to cancel your Medicare Advantage plan if you qualify for a Special Enrollment Period .

Choosing The Right Medicare Coverage Can Feel Overwhelming

How to Talk to Your Clients About Medicare

Were here to help. Call our office to schedule an appointment with a Medicare Guide. Heres what youll learn:

Learn how to enroll correctly to avoid penalties
Understand your coverage so you aren’t surprised by unexpected out-of-pocket expenses
Avoid selecting a plan with limited coverage

Save time with our simplified process so you can get back to doing the things you love
Get unbiased advice from an independent guide who works for you, not an insurance company

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What Is The Medicare Advantage Plan Initial Coverage Election Period:

Most beneficiaries are first eligible to enroll in a Medicare Advantage plan during the Initial Coverage Election Period. Unless you delay Medicare Part B enrollment, this enrollment period takes place at the same time as your Initial Enrollment Period , starting three months before you have both Medicare Part A and Medicare Part B and ending on whichever of the following dates falls later:

The last day of the month before you have both Medicare Part A and Part B, or
The last day of your Medicare Part B Initial Enrollment Period.

If youre under 65 and eligible for Medicare due to disability, your IEP will vary depending on when your disability benefits started.

The Problem: You Really Cant Touch This Topic No Matter How Hard You Try

If you cant bring up the subject, youre not alone: 38% of parents never broach the topic, according to Fidelity. And TIAA research found that 1 in 5 parents are completely content to never discuss the issue. But not talking wont prevent stress now .

The fix: Go to a third party. I think some people need that, and its not a bad thing to do, Peck says. There are people who can help you facilitate that conversation, from a financial adviser to a therapist. You have to feel that its someone who has your best interest and someone you have confidence in, she says. Just say, I want to talk to my kids about my finances and Im having trouble. Can you help me? Most people who work in the financial world are comfortable doing that if you ask.

Additional Sources

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When Is Medicare Open Enrollment

Medicare open enrollment also known as Medicares annual election period runs from October 15 through December 7 each year.

During this annual window, Medicare plan enrollees can reevaluate their coverage whether itsOriginal Medicare with supplemental drug coverage, or Medicare Advantage and make changes or purchase new policies if they want to do so.

During the Medicare open enrollment period, you can:

Switch from Original Medicare to Medicare Advantage .

Switch from Medicare Advantage to Original Medicare .
Switch from one Medicare Advantage plan to another.
Switch from one Medicare Part D prescription drug plan to another.

Enroll in a Medicare Part D plan if you didnt enroll when you were first eligible for Medicare. If you havent maintained other , a late-enrollment penalty may apply.

Prior to 2021, patients with end-stage renal disease were unable to enroll in Medicare Advantage plans unless there was a Medicare Special Needs plan available in their area for ESRD patients. But that changed as of 2021, under the terms of the 21st Century Cures Act. People with ESRD gained the option to enroll in Medicare Advantage as of 2021, and CMS expected more than 40,000 to do so. This can be particularly advantageous for beneficiaries with ESRD who are under age 65 and living in states that dont guarantee access to Medigap plans for people under the age of 65.

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Talking Health: Medicare Questions and Answers

DrGail Work & Money 6 users marked this as a favorite basalganglia 2:44 PM This article from Newsweek FencingGal 3:36 PM mightshould 3:45 PM SPrintF 4:09 PM DrGail 4:12 PM this summary fuzzy.little.sock 5:08 PMAs a doctor, my heart sinks when I see a patient has Medicare Advantage, because I know there’s going to be at least one denial of a medically necessary test or treatment in their near future.holgate 5:29 PM KayQuestions 6:06 PM AlexiaSky 9:31 AM the supplemental insurance is allowed to hold pre-existing conditions against you.

Once youve returned to Original Medicare, you can apply for a Medicare Supplement plan anytime you want but your acceptance into a plan isnt always guaranteed. For example, if you have health problems, the insurance company can base its decision on your health history in a process known as medical underwriting. The company can decide not to sell you a plan, or to charge you more because of your health condition.

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Should I Take Medicare Part B

You should take Medicare Part A when you are eligible. However, some people may not want to apply for Medicare Part B when they become eligible.

You can delay enrollment in Medicare Part B without penalty if you fit one of the following categories.

Employer group health plans may cover items normally not covered by Medicare Part B. If so, and you meet one of the categories above or below, then you may not need to enroll in Medicare Part B and pay the monthly premium.

If you are:

a spouse of an active worker
a disabled, active worker
a disabled spouse of an active worker

and choose coverage under the employer group health plan, you can refuse Medicare Part B during the automatic or initial enrollment period. You wait to sign up for Medicare Part B during the special enrollment period, an eight month period that begins the month the group health coverage ends or the month employment ends, whichever comes first.

You will not be enrolling late, so you will not have any penalty.

If you choose coverage under the employer group health plan and are still working, Medicare will be the “secondary payer,” which means the employer plan pays first.

If the employer group health plan does not pay all the patient’s expenses, Medicare may pay the entire balance, a portion, or nothing. An employer group health plan must be primary or nothing.

When Can I Enroll In Medicare If I Am Not Receiving Retirement Benefits:

If you are not yet receiving retirement benefits and are close to turning 65, you can sign up for Medicare Part A and/or Part B during your IEP. If you decide to delay your Social Security retirement benefits or Railroad Retirement Benefits beyond age 65, there is an option to enroll in just Medicare and apply for retirement benefits at a later time.

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How To Stop Social Security Check Payments

The SSA can not pay benefits for the month of a recipients death. That means if the person died in July, the check received in August must be returned. Find out how to return a check to the SSA.

If the payment is by direct deposit, notify the financial institution as soon as possible so it can return any payments received after death. For more about the requirement to return benefits for the month of a beneficiarys death, see the top of page 11 of this SSA publication.

Family members may be eligible for Social Security survivors benefits when a person getting benefits dies. Visit the SSAs Survivors Benefits page to learn more.

Do You Need To Renew Medicare Part A

How to talk to your doctor about Medicare

For most people, Medicare Part A hospital insurance is premium-free and once you have it, you wont have to do anything to keep it. If you are already getting Social Security when you turn 65, youll be enrolled automatically. If you arent getting Social Security, you can use Social Securitys website to enroll.

There are a few good reasons not to sign up for Medicare Part A hospital insurance when you turn 65. Most of them are related to having insurance from your employer or spouses employer. Before you reject Part A, talk to a benefits counselor for your employer and make sure you understand that you are doing the right thing for you. If your situation changes and you want to enroll in Part A, do it cautiously but quickly. You can get more information to help you understand Part A rules and how they affect you.1

Grass May Be Greener on the Other Side

Dont take for granted that there isnt something better. Medicare is a big program with lots of options.

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