10 Common Medicare Mistakes to Avoid

10 Common Medicare Mistakes to Avoid

Missing out on deadlines, postponing enrollment, or selecting the wrong plan can cost you a package for Medicare. Below’s a checklist of 10 usual blunders new Medicare enrollees make and also just how to prevent them, according to the Medicare Rights Center, a detached, not-for-profit customer service company.

1. Not signing up for Medicare at the right time

It’s especially important when it comes to enrolling in Medicare. As you approach 65, you’ll want to join during what the government calls your initial enrollment period (IEP).

If you don’t subscribe throughout your IEP, you will get an additional possibility to enlist throughout Medicare’s annual general registration period, from January 1 with March 31 of every year. If you enroll at that time, your coverage won’t begin until July. Also, because you enlisted late, your regular monthly costs for Medicare Part B, which covers your physician checkouts and various other outpatient services, will likely cost you much more.

2. Blowing the unique enrollment duration

If you are 65 or older, when you quit working as well as lose your medical insurance protection or when the insurance coverage you have with your partner ends, you’ll need to sign up for Medicare. Medicare has created a unique enrollment duration (SEP) that lets you do that without dealing with a late registration penalty.

Again, timing is every little thing. Many people do not recognize that you can only utilize this SEP either while you are covered by a job-based insurance policy or for eight months after you no longer have job-based insurance.

Note: Medicare does not count retiree health insurance or COBRA as job-based coverage. So, if that’s the insurance you have, you’ll require to reread blunder top as well as sign up when you transform 65 or face that late enrollment.

3. Postponing registration when your task insurance policy is 2nd inline

When you have a job-based insurance policy, some companies, depending upon their dimension, can designate Medicare as your primary health and wellness insurance coverage when you turn 65. And if you have retiree insurance coverage or COBRA, those are considered secondary protection.

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If your other or job-based exclusive insurance considers that you will receive additional insurance coverage, it will only spend on a clinical insurance claim after Medicare has paid its share. If your job-related insurance becomes your secondary coverage, it’s essential to sign up for Medicare. If your job-based insurance is primary, then Medicare becomes your secondary coverage.

The way to find out if your job-based insurance is considered primary or secondary is to ask your benefits manager or human resources department or seek Help from 800-MEDICARE.

4. Not understanding Part B and Part D late enrollment penalties

For every 12 months, you delay enrolling in Part B. Your monthly Part B premium may be 10 percent higher. If you have job-based insurance or are still under your particular enrollment period, the penalty won’t apply.

For every 12 months you delay signing up for a Part D plan, your monthly premium may be 1 percent higher. Part D plans cover prescription drug costs. If you can show Medicare that you have drug coverage as good as that provided by a Medicare Part D plan, you won’t have to pay the Part D penalty.

Keep that letter so you can show Medicare you did have Part D-comparable prescription drug coverage when the time comes to enroll in Part D.

Note: Usually, these penalties last for as long as you have Medicare. If you are paying this penalty and qualify for and enroll in a Medicare Savings Program or the Extra Help program– which helps low-income older adults pay for Medicare out-of-pocket costs– you will no longer have to pay the penalty.

5. Not thoroughly comparing original Medicare with Medicare Advantage plans

You can decide to get your benefits through Original Medicare or a Medicare Advantage plan if you are eligible for Medicare. The type of Medicare coverage you choose depends on your health care needs, the insurance your doctors accept, where you live, whether you often travel, and your financial situation.

Original Medicare is the traditional program offered directly through the federal government. It comprises Part A, which covers hospital costs, and Part B includes doctor visits and other outpatient services. The vast majority of doctors in the country take this insurance. To help pay for your out-of-pocket costs, you can buy a Medigap policy with its separate monthly premium. Original Medicare does not include Part D (prescription drug coverage), so you must sign up for a stand-alone Part D plan if you do not have other drug coverage. Original Medicare does not have a limit on your annual out-of-pocket costs.

Medicare Advantage (MA) is a private insurance alternative to original Medicare. These plans provide Part A, Part B, and usually Part D benefits. They may also offer certain benefits that original Medicare does not cover, such as dental or vision care. Some MA plans may also provide some nontraditional services, such as paying for wheelchair ramps, meals delivered to beneficiaries’ homes, and transportation to medical appointments. These plans may also have different costs and rules than Original Medicare. For example, an MA plan can require you to get a referral from a primary care physician before it covers a specialist’s care. If you see an out-of-network provider (except in emergencies), and Medicare Advantage plans generally have providers in your geographic area and may not cover care. MA plans have an annual out-of-pocket limit, and you can not buy a Medigap policy when you enroll in Medicare Advantage.

6. Delaying buying a Medigap policy

Medigap are supplemental health insurance policies that work with original Medicare. If you have a Medigap policy, it pays Part or some of the out-of-pocket costs that Medicare doesn’t cover, such as your Part A hospital deductible or the 20 percent coinsurance in Part B. Depending on where you live, you can choose from as many as ten different Medigap plans. Each policy has a different letter name (Plan A) and offers a different set of standardized benefits. Programs with the same letter name offer the same benefits, but premiums can vary from company to company.

iRemedyThe best time to buy a Medigap policy is during your Medigap open enrollment period. That six-month window starts when you turn 65 years old and have enrolled in Medicare Part B. It’s essential to register then because during that time the insurance companies that sell Medigap policies can not deny you coverage if you have a preexisting condition, and they have to sell you a plan at the best available rate. If you try to buy a program outside of this window, companies may refuse to sell you a policy or deny you coverage for your existing health problems.

Some states have their own rules governing Medigap policies, so if you made this mistake and didn’t sign up during your enrollment period, check with your State Health Insurance Assistance Program (SHIP) at shiptacenter.org to ask about state-specific Medigap rights.

7. Not understanding your out-of-pocket costs

Although Medicare pays the lion’s share of the medical expenses for its enrollees, you need to prepare yourself for sometimes substantial out-of-pocket costs. Here’s a rundown:

Premium: Each Part of Medicare may have its monthly premium. If you enroll in a Medicare Advantage (MA) plan or a Part D plan, you may also owe a monthly premium, depending on the plan you select.

Deductible: Before Medicare starts paying for the cost of your care, you may have to pay a flat amount, called a deductible. Parts A and B in original Medicare have annual deductibles, and some MA and Part D prescription drug plans also have deductibles. Medigap policies often cover individual Medicare deductibles.

Copayment: This is a fixed amount you pay for specific services. Under MA plans, you may have a copay– usually around $25– every time you see a doctor or get another medical facility.

If you have original Medicare, you will owe 20 percent of the cost of the service. If you get a blood test that costs $100, Medicare will pay $80, and you’ll be responsible for $20.

Note: If you have original Medicare, you should make sure the health provider you see accepts Medicare and takes what is called “assignment.” That means the provider is willing to accept the amount of payment on Medicare’s fee schedule for the service they perform. If you see nonparticipating providers, they can charge you up to 15 percent more than Medicare’s approved rate. If you have an MA plan, you should try to go to a network provider because some MA plans won’t cover out-of-network care, and others will spend less if you go out of the system.

8. Choosing a Medicare Advantage plan that doesn’t include your health care providers

Each type of Medicare Advantage plan has different network rules. Most programs are either health maintenance organizations (HMOs), which often require referrals to specialists and rely on primary care physicians to coordinate a patient’s care, or preferred provider organizations (PPOs), which have networks of doctors, hospitals and medical facilities that contract with a plan to provide services. Your costs are typically lowest when you use in-network providers and facilities, regardless of your treatment.

If you decide to enroll in an MA plan, check with your providers to learn which plans they accept. Contact your contact for more information if you have questions. If your providers are not in the plan’s network, check to see how much, if anything, the program will pay for their services.

9. Choosing drug coverage that doesn’t fully and affordably cover your prescriptions

Whether you’re planning to get your prescripts covered through a stand-alone Part D plan or under a Medicare Advantage plan, take some time to learn about the rules, what drugs are included, and your costs.

Make sure your plan covers your needed drugs. Each Part D plan has a list of covered drugs, called a formulary. If your medicine is not on your plan’s formulary, you may have to request an exception, pay out of pocket for the cost, or file an appeal.

Find out whether your plan places any restrictions (sometimes called utilization management strategies) on coverage. Another example of a coverage restriction is step therapy, which means your program requires you to try other, less expensive drugs before it covers a more expensive medicine that you may need.

You should also look at whether the plan you’re considering will give you a good deal at the pharmacy of your choice– or through mail order. Each Part D plan has a network of pharmacies that include both non-preferred and preferred pharmacies. You typically pay less for your prescriptions at selected pharmacies.

10. Assuming you can’t afford Medicare

If you have a limited income, you may be able to get assistance with your health costs through specific programs.

Medicare Savings Programs (MSPs) Help pay the monthly Part B premium and may help with Medicare cost-sharing, depending on the program (there are three types of MSPs). Contact your SHIP at shiptacenter.org to learn if you are eligible for an MSP.

Extra Help is a federal program that helps pay for some to most of the costs of Medicare Part D prescription drug coverage. Contact the Social Security Administration at 800-772-1213 or visit ssa.gov to learn if you are eligible for Extra Help and to start an application.

State Pharmaceutical Assistance Programs (SPAPs) are offered in some states to help eligible individuals pay for prescriptions. Contact your SHIP at shiptacenter.org to learn if there is an SPAP in your country.

You won’t have to pay the Part D penalty if you can show Medicare that you have drug coverage as good as that provided by a Medicare Part D plan.

Keep that letter so you can show Medicare you did have Part D-comparable prescription drug coverage when the time comes to enroll in Part D.

Note: Usually, these penalties last for as long as you have Medicare. If you are paying this penalty and qualify for and enroll in a Medicare Savings Program or the Extra Help program– which helps low-income older adults pay for Medicare out-of-pocket costs– you will no longer have to pay the penalty.

Medicare Advantage (MA) is a private insurance alternative to original Medicare. If you join in a Medicare Advantage (MA) plan or a Part D plan, you may owe a monthly premium, depending on the method you select.

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