JustCare

Category: Medicare

  • Two questions to ask before enrolling in Medicare if you have FEHB, federal employee health benefits

    Two questions to ask before enrolling in Medicare if you have FEHB, federal employee health benefits

    If you worked for the federal government, you may be entitled to federal employee health benefits (“FEHB”) even after you retire. People who qualify for FEHB receive the same benefits at the same price as people who are actively working. The question becomes should you enroll in Medicare?

    Whether to enroll in Medicare depends upon the kind of health care coverage you want and the amount you are willing to spend for coverage. Here are three questions to ask:

    1. Do you want access to care from most doctors and hospitals in the United States at little or no cost? If you’re enrolled in a fee-for-service FEHB plan and sign up for traditional Medicare, Medicare will pay first and the FEHB plan will wrap around Medicare, paying most out-of-pocket costs, including deductibles and coinsurance.
      • Can you afford to pay the premiums for both Medicare and your FEHB plan?
      • If you decide not to enroll in Medicare now but think you may want to enroll in Medicare at a later date, are you prepared to pay a premium penalty for late enrollment?
    2. If you’re in a FEHB HMO, is it meeting your current health care needs? If so, you might choose not to enroll in Medicare and save money on the Medicare premiums.

    For more information on FEHB and Medicare, read this booklet from the federal government or contact the National Association of Retired Federal Employees (NARFE) at 800-627-3394.

     

  • Do you need Medicare if you live abroad?

    Do you need Medicare if you live abroad?

    Medicare generally only covers care in the United States. And, Medicare premiums can add up quickly. So, if you plan to live abroad, do you need Medicare? The answer is a qualified yes. It depends largely on whether you plan ever to return to the United States and where you are planning to live abroad. You should always contact Social Security to fully understand your options. Here are a few key points:

    You should keep your Medicare coverage:

    • If you plan to live in Puerto Rico, the Virgin Islands, Guam, American Samoa, or the Northern Mariana Islands. Medicare will cover your care in all of these places.
    • If you plan to spend time in the United States at any time after you move abroad. Medicare will likely not cover your care abroad, but whenever you are in the United States you will be sure to be covered. If you stop paying your Part B premium while you are abroad, you will need to wait until the Medicare open enrollment period to regain coverage. And, you will pay a 10 percent premium penalty for every year you did not have coverage.

    If you’re enrolled in a Medicare Advantage plan or a Medicare Part D plan:

    • You should switch out of your Medicare Advantage plan and into traditional Medicare. You are not eligible to be enrolled in a Medicare Advantage plan if you do not live in its service area. You are eligible for traditional Medicare, so long as you pay your Part B premium.
    • You should drop your Medicare Part D plan. You are not eligible to be enrolled in a Part D drug plan if you do not live in its service area.
    • So long as you keep paying your Part B premium, if you move back to the United States you will have a special enrollment period to enroll in these plans if you so choose, without penalty.

    If you’re enrolled in a Medigap or Medicare supplemental insurance plan:

    • You should call the Medigap plan to understand the rules for reenrolling and the premiums you will pay. It could be costly or hard to get a Medigap plan once you drop it.

    For more detailed information about Medicare coverage if you live outside the United States, visit Medicare Interactive.  For information on what to think about before enrolling in Medicare, click here.  And, here are two questions to think about during the Medicare Open Enrollment period.

  • Health caring for mom: Three ways to let your mom know you love her on Mother’s Day

    Health caring for mom: Three ways to let your mom know you love her on Mother’s Day

    Mother’s Day is the time to show your mom some serious love. But how? Most of us love flowers and chocolate. So, consider getting mom a little of both. What we really treasure, though, is the priceless gift of time together and conversation. And there are few things more important to talk about than your mom’s health.  So here are a few priceless gifts for mom on her special day:

    1. Make sure your mom is safe and healthy.  Talk to her about all of the drugs she’s taking, both over the counter drugs and painkiller prescriptions. If your mom has a chronic condition like asthma or diabetes, find out whether her primary care doctor is doing a good job of coordinating her care. Click here to learn how your mom’s primary care doctor can help her. And, if your mom wants to stop smoking, lose weight or change another unhealthy behavior, here are some tips for motivating her to do so.
    2. Talk to your mom about planning for her future health care needs. Who would she want to take care of her when she cannot take care of herself?  Would she like to remain at home as long as possible? What are the tradeoffs she would like to make? And, make sure your mother has a reliable health care proxy and a living will. (You should have those too!)  Click here for free help with these advance directives.
    3. Double check that your mom is getting the preventive care services she needs.  She should get regular pap tests, pelvic exams and breast exams. If she’s over 60, she should get a shingles vaccine.  Medicare and most insurance cover all these tests in full. Next time she’s headed to the doctor, consider tagging along. Mom, like all of us, could use a health care buddy to ask the questions she might not ask.

    These are important conversations. Most of us know we should talk to our mothers about their health, but we never quite get around to having the actual conversation. Why not use Mother’s Day as a reason to get serious about your mom’s health? Just talking to your mom about these issues can be healthy for her.

  • Three preventive care exams that every woman should get

    Three preventive care exams that every woman should get

    Cancer rates are falling and fewer people are dying of cancer. To help detect cancer early, it’s important for women to get three cancer screenings regularly. And, because older adults are more likely to get cancer than younger adults, older women should continue getting screenings throughout their lives. Medicare and health insurers cover three preventive care exams that every woman should get: Pap smears, pelvic exams and physical breast exams.

    Each of these exams can detect different types of cancer. Early diagnosis is important because it increases the chance that treatments will work. Medicare covers the full cost of these tests performed together every two years for women at low risk for vaginal or cervical cancer. Health insurers also cover these tests in full.  The Affordable Care Act requires insurers to cover an annual well-woman preventive care visit and any additional needed visits in order for adult women to obtain recommended preventive services. 

    • Pap smears are important for detecting cervical and vaginal cancer in their early stages. Pap smears can also reveal other genital problems, fibroids and sexually transmitted diseases. For this test, the medical professional scrapes cells from the cervix and vagina.
    • Pelvic exams help detect fibroids and ovarian cancer. The doctor checks the uterus, ovaries, vagina and rectum for changes in shape or size.
    • Clinical breast exams detect the possibility of breast cancer. For this procedure, the medical professional checks the breasts and underarms for lumps which can be a sign of breast cancer.

    For more information, visit Medicare Interactive.

  • Should you enroll in Medicare if you have employer coverage?

    Should you enroll in Medicare if you have employer coverage?

    Should you enroll in Medicare if you have employer coverage?  The answer is less complicated than some would suggest, but it depends.  If you or your spouse is actively working and you get health insurance from that employer, you might not need to enroll. You need not sign up for Medicare if there are at least 20 people employed at the job.

    Before deciding not to enroll in Medicare, speak with your employer’s insurance company and call Social Security at 800-772-1213 to make sure you do not need to enroll.  Keep in mind that COBRA and retiree coverage are not considered employer coverage. To be more specific:

    If you and your spouse are not actively employed: Medicare becomes your primary insurance when you turn 65, even if you have not signed up.  Any health insurance you have, including retiree insurance from your former employer, pays only after Medicare pays and will not pay if you are not enrolled in Medicare. You should enroll in Medicare during the seven-month initial enrollment period beginning three months before your birthday month. If you do not enroll then, you will not be able to enroll until the general enrollment period, between January and March, and you will pay a 10 percent premium penalty for each year you are not enrolled.

    If you or your spouse is actively employed:  Whether you must sign up for Medicare depends exclusively on whether there are 20 or more employees at your or your spouse’s job.

    • Your job coverage remains primary only if there are at least 20 full-time employees actively working at the job; in that case, you (and your spouse if your spouse receives coverage through your job) do not need to enroll in Medicare Part B.  You will get Medicare Part A hospital insurance automatically if you are receiving Social Security benefits, since Part A is free. (Call Medicare at 1-800-633-4227 if you need to sign up for Part A benefits.) Your Medicare Part A coverage will serve as secondary insurance, covering costs for hospital services after your employer coverage pays.
    • However, if there are fewer than 20 full-time employees, Medicare must be your primary coverage, and you must enroll in Medicare during the initial enrollment period. Your job coverage will pay only after Medicare pays.

    You have the right to sign up for Medicare any time after you become eligible so long as you have coverage through your or your spouse’s employer and the employer has 20 or more employees.  Once you retire or decide to drop that coverage, you have an eight-month special enrollment period.

    For a simple overview about what to think about when enrolling in Medicare, click here.

    For more information, visit Medicare Interactive.

     

  • What’s the Medicare premium in 2015?

    What’s the Medicare premium in 2015?

    It wasn’t that long ago that the Medicare premium was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  But back in 2003, Congress decided to impose higher premiums on wealthier people with Medicare. And, today, individuals earning more than $85,000 a year and couples earning more than $170,000, about 6 percent of the Medicare population, pay higher premiums than everyone else with Medicare. So, what’s the Medicare premium in 2015?

    The Medicare premium in 2015 is $105 for almost 48 million people, 25 percent of program costs.  It’s a lot more for the 2.9 million people with incomes over $85,000.  People earning between $85,000 and $107,000 pay $147 a month in premiums or 35 percent of program costs.  And people earning more than $214,000 pay $336 in monthly Part B premiums, 80 percent of program costs.

    People with incomes up to 135 percent of the federal poverty level, ($1,345 in monthly income for an individual and $1813 for a couple) are eligible for help paying their premiums through Medicaid or a Medicare Savings Program.  For more information visit Medicare Interactive.

    Click here for the Medicare premium in 2016.

     

  • Four things to think about before moving into a nursing home

    Four things to think about before moving into a nursing home

    Before moving into a nursing home, it’s important to do your homework and understand your rights and options.

    1. Care: You have the right to receive whatever care you need to reach the highest reasonable level of functioning or so that your condition does not deteriorate.  Medicaid patients have exactly the same rights to these services as everyone else in the nursing home so long as the nursing home accepts Medicaid patients. And all patients and their families have the right to help develop the care plan so that it is tailored to the resident’s needs
    2. Choice: The nursing home must accommodate the resident’s preferences, whether they be to wake up late in the morning, to participate in an activity, to change schedules or to have family visit any time of the day or night.
    3. Costs: Only the resident is required to be financially responsible for his or her care.  The nursing home cannot force a family member to take responsibility.  Medicare should pick up the costs for residents needing daily skilled nursing or therapy care who have been hospitalized for three days in the 30 days prior to admission, so long as the nursing home is Medicare-certified.  If the nursing home says Medicare won’t pay, you still should insist that it submit the bill to Medicare.
    4. Help: Every state has a long-term care ombudsman program to help ensure the nursing home provides you with the benefits and protections to which you are entitled free of charge. There are also websites where you can find nursing home ratings, but read them with caution.
    For more information from the National Senior Citizens Law Center, click here.
  • A crash course in 5 important health insurance terms

    A crash course in 5 important health insurance terms

    As if you didn’t already have enough to think about, you need to understand a sea of insurance concepts to keep your health care costs down. Here are five terms you should definitely know.

    1. Premium—what you have to pay each month for your health insurance.
      • If you have Medicare and are receiving Social Security benefits, the government will take your Part B premium out of your Social Security check—nothing to think about there.  But, if you have Part D drug coverage, you’ll likely have to pay that premium by check directly to the insurance company.  And, if you’re buying your own supplemental insurance, you’ll need to pay that premium as well.
      • If you’re in a Medicare Advantage plan, you’ll probably need to pay an additional premium to the insurance company offering that plan.
      • If you have coverage through the Affordable Care Act (ACA), you’ll have to pay that premium but may be eligible for a government subsidy based on your income.  Use this tool from the Kaiser Family Foundation to calculate the amount of your premium that the government will pay for.
    2. Deductible—what you have to pay out-of-pocket for your care before the insurance starts paying. 
      • If you have traditional Medicare, there is a small deductible for your Part B coverage for medical services and a large hospital deductible as well, both of which you’ll have to pay unless your supplemental coverage picks those up.
      • If you’re in a Medicare Advantage plan, an ACA plan, or an employer HMO or PPO, you’ll need to check on deductibles.  Often, insurers charge a deductible for in-network care and a separate deductible for out-of-network care.  And, if you’re premium is very low, your deductibles could be very high.
    3. Copay—a fixed fee that you pay for a particular service.
      • If you’re in a Medicare Advantage plan or an ACA or employer plan and seeing an in-network doctor, your copay will be a set amount of money that represents your share of the doctor’s charge.
    4. Coinsurance—a fixed percentage that you pay, based on the amount your insurer pays. 
      • If you have traditional Medicare and supplemental insurance, the supplemental insurer will pick up the coinsurance for all the services it covers.
      • If you are in a Medicare Advantage plan or an ACA or employer plan and seeing an  out-of-network doctor, your coinsurance will be a percentage of the doctor’s bill.
    5. Covered services: Insurers only pay for the services they cover.  Before you see a doctor, go to a hospital or use an ambulance, check to make sure that the insurer covers services from those providers and under what conditions.
      • Traditional Medicare covers services from most doctors and hospitals anywhere in America.
      • But, if you are in a Medicare Advantage plan or an ACA HMO or PPO, your coverage for routine care may be limited to your providers in your community. Sometimes, you will need prior approval from the insurer or a referral from your doctor in order for your services to be covered.
    If you like this, you might like these:
    Many Americans do not have a good understanding of how their health insurance works 
    How to keep your out-of-pocket costs down if your income is low and you have Medicare
    How to choose between traditional Medicare and a private Medicare Advantage plan
    What’s your Medicare Part B premium and deductible?
    What’s your Medicare Part A deductible?
  • Two ways to make sure Medicare covers ambulance services

    Two ways to make sure Medicare covers ambulance services

    Medicare covers ambulance services when they are medically necessary. Here’s how to ensure Medicare will pay:

    1. Be prepared. Identify an ambulance company to use. Confirm with your local ambulance service that it is Medicare-certified. If you are enrolled in a Medicare Advantage plan, find out which ambulance is in the health plan’s network.
    2. Only use an ambulance if you have an immediate health risk or are bed-bound and require constant monitoring.  And, make sure that the ambulance will take you to the hospital you want to use if there is more than one hospital in your area.  Under the law, the ambulance generally must take you to the nearest hospital.

    If you want Medicare to pay for ambulance services, do not use an ambulette. Medicare will not cover it. For more information, visit Medicare Interactive.

  • Two questions you should answer during the Medicare Open Enrollment Period

    Two questions you should answer during the Medicare Open Enrollment Period

    For anyone on Medicare and many caregivers, Medicare’s Open Enrollment Period is a time to reconsider coverage options. The open enrollment period runs between October 15th and December 7th this year. Here are two questions you should answer during the Medicare Open Enrollment Period:
    1. Is your Medicare doctor and hospital coverage meeting your needs?
    • If you’re in traditional Medicare and have supplemental coverage, you might be paying a little more than if you are in a private Medicare Advantage plan, but you have the widest choice of hospitals and doctors. And, you have good protection against health and financial risk.
    • If you’re in a private Medicare plan, you might save some money upfront, but you have a limited group of doctors and hospitals you can use. If you end up needing a lot of health care, it’s hard to know whether the doctors or hospitals in the health plan’s network will meet your needs. If you use out-of-network doctors and hospitals, you will likely spend a lot out of pocket for that care, more than your costs in traditional Medicare with a Medicare supplemental plan. Also, if you will be traveling out of area and you need care, it’s not likely your care will be covered, except in emergencies or urgent care situations.

    2. Is your Medicare (Part D) drug coverage meeting your needs? If you have Part D drug coverage, you should consider your options and not assume that the plan you have is still the one that you want or will cover the same drugs with the same cost sharing next year. The Part D plans often change the drugs they cover and the terms under which they cover drugs from one year to the next, as well as midyear sometimes. What makes sense this year may not make much sense at all next year. In 2015, the average monthly premium nationally is $32.

    To compare Medicare plan benefits and cost, visit the Open Enrollment Center page on the Medicare website.