JustCare

Tag: Enrollment

  • Medicare Advantage: Disenroll between January 1 and February 14

    Medicare Advantage: Disenroll between January 1 and February 14

    Editor’s note: As of January 1, 2019, you can disenroll from a Medicare Advantage plan between January 1 and March 31 of each year.

    Many people enroll in a Medicare Advantage plan, (a commercial health plan that offers Medicare benefits,) without fully understanding how their health care coverage will work under that plan. Once they learn that they are only covered for care from doctors and hospitals in the health plan’s network, or that the network will not cover their care out of state except in emergencies, or that their out-of-pocket costs could be astronomical, they often want to switch to traditional Medicare. If you want to disenroll from your Medicare Advantage plan, you have the right to leave the health plan during the Medicare Advantage Disenrollment Period, any time between January 1 and February 14.

    Why would you want to disenroll from a Medicare Advantage plan? 

    1. You are not covered for care from doctors and/or hospitals that you know and trust.
    2. You discover that you have long waits to see the health plan’s in-network doctors or those doctors are no longer seeing patients enrolled in the health plan. Don’t trust the health plan’s provider directory.
    3. You do not want to deal with the headache of receiving treatment from out-of-network doctors if you are hospitalized, along with surprise medical bills.
    4. Your out-of-pocket costs for the deductible, if there is one, and copays could be as high as $6,700 for in-network care alone, more than double the cost of Medicare supplemental insurance (“Medigap”) coverage.
    5. Your out-of-pocket costs for care could be astronomical if you need to use out-of-network doctors and hospitals–there is no limit at all on your costs–either because they offer the specialty care you need and that you cannot get from in-network doctors or because you have moved outside of the area your Medicare Advantage plan covers–e.g., a winter or summer home, a family member or friend’s home.

    How do you disenroll from a Medicare Advantage plan?

    1. Notify your Medicare Advantage health plan in writing as soon as possible before February 14th, ideally in January. Call the health plan as well. You will be officially disenrolled on the first day of the following month.
    2. You will be automatically enrolled in traditional Medicare on the first day of the following month, but you will need to sign up for a Medicare Part D drug plan as soon as possible, along with a Medicare supplemental insurance policy, so that you have coverage to fill gaps in Medicare and drug coverage beginning the following month.
    3. You want to be sure you can get Medicare supplemental coverage either through Medicaid or through a private Medicare supplemental insurance plan before you drop your Medicare Advantage plan. Under federal law, Medicare supplemental insurance (“Medigap”) companies do not have to sell you a policy except during your Medicare initial enrollment period at 65 or during your Medicare special enrollment period if you sign up for Medicare after 65.  However, four states–Connecticut, Maine, Massachusetts and New York–require Medigap companies to sell you coverage at any time. And some insurers may sell you coverage even if not required to under the law.  Call your State Health Insurance Assistance Program (SHIP) to learn whether you can buy a Medicare supplemental insurance policy in your state. 

    Tip: You can disenroll from your Medicare Advantage plan at any time if you were misled into enrolling or signed up by mistake or otherwise did not intend to be in the Medicare Advantage plan. Call 1-800-633-4227 (1-800-MEDICARE) to ask to be disenrolled from your Medicare Advantage plan. You can be disenrolled retroactively if you saw an out-of-network doctor because you thought you were enrolled in traditional Medicare. If you have not received any services through the Medicare Advantage plan, you can ask for a special enrollment period to enroll in traditional Medicare, a Part D plan, and a Medicare supplemental insurance (Medigap) plan.

    Here’s more from Just Care:

  • No projected 2018 increase in standard Medicare premium

    No projected 2018 increase in standard Medicare premium

    [Editor’s note: Medicare 2018 premium information released, November 20, 2017.]

    The July annual report of the Medicare Trustees to Congress on the financial state of the program shows no projected 2018 increase in the standard Medicare premium, which is $134 today; indeed, the Part B premium may fall. But, two groups of people with Medicare are projected to pay a higher 2018 Part B premium. People with 2017 Medicare monthly premiums of $109 are likely to pay higher premiums in 2018 because their Social Security benefits are projected to increase. And, some people with annual incomes above $85,000 also will likely pay higher premiums because the income level for paying more than the standard 25 percent of income contribution will be adjusted downward in 2018.

    A projected 2 percent increase in people’s Social Security checks–an average monthly increase of $27.20–means that people paying the standard 2018 Medicare monthly premium of $134 will likely see a reduction in their Part B premium. But, the 70 percent of people with Medicare who have paid a lower premium because their Social Security benefits have barely increased over the last two years–people who have been paying an average monthly premium of $109–will likely see an increase in their Part B premium.

    The income adjustment for calculating the Part B premium in 2018 for people with annual incomes above $85,000 stems in part from increasing costs in Part B, which covers doctors visits, durable medical equipment, outpatient therapy and other outpatient care. In 2016, Part B spending was 2.1 percent of GDP.  The Trustees project it to increase to 3.4 percent by 2037.

    The Trustees report shows intermediate projections that in both 2018 and 2019 individuals will pay a standard monthly premium of:

    • $134.00 if their income is $85,000 or less
    • $187.50 if their income is between $85,001 and $107,000
    • $267.90 if their income is between $107,001 and $133,500
    • $348.30 if their income is between $133,500 and $160,000
    • $428.60 if their income is more than $160,001

    You can calculate the premium amounts for higher-income couples by doubling the incomes listed.

    Beginning in 2007, people with annual incomes above $85,000 (couples more than $170,000) pay Part B premiums that are far higher than people with annual incomes below $85,000. About one in 16 people with Medicare (6 percent) have annual incomes above $85,000. That percentage is projected to grow to 8.3 percent by 2019, according to the Kaiser Family Foundation.

    People with Medicare are notified of 2018 Part B premium changes in the fall, before the Medicare open enrollment period from October 15 through December 7. The annual Part B deductible is expected to remain at $183. The Medicare Part D premium is projected to drop by about $1.2o a month.

    The Medicare Trustees estimate that Part B and Part D out-of-pocket costs, including premiums and copays, account for about 25 percent of a typical individual’s Social Security benefits in 2017.

    The Medicare Trustees now project the Medicare hospital insurance trust fund (Part A of the program) to be insolvent by 2029, one year later than the Trustees projected last year. The Trustees project lower hospital insurance spending than they projected last year, because of lower inpatient hospital utilization assumptions and lower than expected spending in 2016.

    Here’s more from Just Care:

  • Overwhelming majority of people newly eligible for Medicare enroll in traditional Medicare

    Overwhelming majority of people newly eligible for Medicare enroll in traditional Medicare

    A January 2015 Kaiser Family Foundation study shows that the overwhelming majority of people newly eligible for Medicare enroll in traditional Medicare. About 70 percent of people with Medicare are enrolled in traditional Medicare.

    Traditional Medicare offers coverage from more than 90 percent of doctors and virtually every hospital in the United States.  Not surprisingly, fewer than five percent of these people switched into a Medicare Advantage plan in any year between 2006 and 2011. Medicare Advantage plans restrict access to doctors and hospitals.

    Traditional Medicare has greater upfront costs than most Medicare Advantage plans because you need supplemental coverage in order to be protected from financial risk.  That supplemental coverage can be expensive if it is not through Medicaid or a generous employer retiree plan.  But, for anyone with substantial health care needs, deductibles and copays in a Medicare Advantage plan can end up costing a lot more.

  • Turning 65? Make sure you’re not involuntary enrolled in a Medicare Advantage plan

    Turning 65? Make sure you’re not involuntary enrolled in a Medicare Advantage plan

    An increasing number of people first going on Medicare are being involuntarily enrolled in Medicare Advantage plans when they turn 65. The Centers for Medicare and Medicaid Services, CMS, has given their health insurers the right to enroll them in the insurers’ Medicare Advantage plans–commercial insurance plans that offer Medicare benefits under special conditions–without their permission. If you’re turning 65, make sure you’re not involuntary enrolled in a Medicare Advantage plan.

    To date, CMS already has approved proposals from 27 insurance companies to “seamlessly enroll” their Medicaid and commercial members in their Medicare Advantage plans once they become eligible for Medicare. Aetna, UnitedHealth Group, Health First, Anthem and Blue Cross Blue Shield of Michigan are among the companies with permission. For the full list, click here.

    These insurers have permission from CMS to enroll their members who become eligible for Medicare in their Medicare Advantage plans without signed authorization from their members. These enrollments should be described as “troubling,” not “seamless.” The insurers’ Medicare Advantage plans generally have different doctor and hospital networks and different cost structures from the pre-Medicare health plans they offer members.

    This automatic and troubling Medicare Advantage enrollment undermines people’s choice and jeopardizes their continuity of care, leaving them at significant financial and health risk. Indeed, traditional Medicare is the only choice that maximizes the likelihood of that continuity of care.

    People who turn 65 should be able to assume they are enrolled in traditional Medicare, which has been the case. Historically, people who don’t affirmatively choose to enroll in a Medicare Advantage plan by signing up with one are enrolled in traditional Medicare. If they are enrolled in a Medicare Advantage plan without their knowledge, it can wreak havoc on their lives.

    When people believe they are enrolled in traditional Medicare–and they are not–they will use whichever doctors and hospitals they please. Since these providers are likely not in the Medicare Advantage plan’s network into which they have been involuntarily enrolled, they can get hit with huge out-of-network charges.

    CMS does not notify the people who are involuntarily enrolled in their health plans’ Medicare Advantage plans that they are no longer in traditional Medicare. CMS relies on the insurers to notify their members. But, people may not read mail from their insurers once they’ve signed up for Medicare. Instead, they may assume they are enrolled in traditional Medicare, seek care, and rack up huge costs from out-of-network providers.

    By allowing the insurers to automatically involuntarily enroll people in their Medicare Advantage plans, CMS is working against the interests of people with Medicare; it is disregarding its own advice to people choosing a Medicare plan to compare their options carefully. People are only protected if they receive and read the required health plan notification informing them of their automatic enrollment and their right to opt out within 60 days.

    Enrollment in a Medicare Advantage plan must be voluntary. So, if you or anyone you know is enrolled in Medicare Advantage plan involuntarily and unknowingly racks up bills from out-of-network doctors and hospitals, call your local State Health Insurance Assistance Program or SHIP for assistance disenrolling.

  • New law would reduce Medicare enrollment mistakes

    New law would reduce Medicare enrollment mistakes

    These days, many people who turn 65 are still working.  Many are also holding off claiming Social Security benefits until their full benefits kick in. But, many are also delaying claiming Medicare benefits, mistakenly thinking they don’t need it. They do not understand that a decision not to enroll in Medicare can leave them without any coverage and with a premium penalty when they do enroll. The Beneficiary Enrollment Notification and Eligibility Simplification Act, a bi-partisan bill in Congress, would require the government to explain to them when they should enroll in Medicare and reduce Medicare enrollment mistakes.

    Even if you or your spouse has employer coverage, you may need to enroll in Medicare Part B when you turn 65 for a variety of reasons. You can read about the rules regarding enrollment in Medicare on Just Care here.

    Because people not claiming Social Security benefits at 65 do not receive a notice from the government explaining Medicare enrollment rules, they may mistakenly assume their current health coverage will continue and allow them to enroll in Medicare at a later date. But, that’s often not the case. In 2014, there were 750,000 who were paying 29 percent higher Medicare Part B premiums, on average, than they otherwise would have paid, because they had failed to enroll in Medicare when they should have.

    Former Medicare heads as well as more than 70 consumer groups and trade associations support the BENES Act.  If passed, the government would be required to send a notice about Medicare eligibility to people when they turn 65 that helps them understand when they become eligible for Medicare, whether they need to enroll in Medicare to ensure no gaps in their health care coverage and what will happen to their current health care coverage when they turn 65.  It also will explain the risks of delaying enrollment in Medicare in certain situations.  

    The BENES Act goes further still and would direct people to a government web site that enables them to enroll in Medicare.

    In a letter to Congress, the former heads of the Centers for Medicare and Medicaid Services explain that “Many of the problems addressed by the BENES Act did not exist when most of us were in the government, but the decoupling of eligibility ages for Medicare and full Social Security benefits, revisions to Medicare Secondary Payor law, and the growing number of Americans working past the age of 65 have, together, substantially complicated the decision making process for eligible individuals and couples in deciding when and how to enroll in Medicare.”  

    Tell your member of Congress to co-sponsor the BENES Act to help the 10,000 people aging into Medicare each day avoid costly enrollment mistakes. Take action today!

    Here’s more from Just Care:

  • Is involuntary enrollment in Medicare Advantage plans the new norm?

    Is involuntary enrollment in Medicare Advantage plans the new norm?

    It has been the norm that when people first go on Medicare, they are automatically enrolled into traditional Medicare unless they affirmatively choose a Medicare Advantage plan. In recent years, however, involuntary enrollment in Medicare Advantage plans has become the new norm for a small but growing number of people.  Automatic Medicare Advantage enrollment undermines people’s choice, placing millions of people with Medicare at significant financial and health risk.

    Susan Jaffe reports for Kaiser Health News that, when you first become eligible for Medicare, your health plan, under some circumstances, has the right to automatically enroll you in its Medicare plan (a commercial health plan like Aetna or Human that typically only covers care from doctors and hospitals in its network).  Here’s how it appears to work.

    Under this “seamless conversion” policy, health insurers have access to data that lets them know when their members enroll in Medicare. At that time, so long as  the Centers for Medicare and Medicaid Services (CMS) approves, they have the  right to move their members from a state health exchange plan or other health plan into their Medicare Advantage plan.

    However, CMS does not notify the people who are involuntarily enrolled in their health plans’ Medicare Advantage plans that they are no longer in traditional Medicare. It relies on the insurers to notify their members. Of course, people may not read their mail, particularly mail from insurers they thought they were moving on from once they enrolled in Medicare. As a result, they may assume they are enrolled in traditional Medicare, seek care, and end up racking up tons of bills from out-of-network providers.

    By allowing the insurers to automatically involuntarily enroll people in their Medicare Advantage plans, CMS is working against the interests of people with Medicare; it is disregarding its own advice to people choosing a Medicare plan to compare their options carefully. People are only protected if they receive and read the required health plan notification informing them of their automatic enrollment and their right to opt out within 60 days.

    Insurers’ Medicare plans may have networks different from the networks available to their members pre-Medicare eligibility. They are also likely to have very different copays and deductibles. And, they are likely not to be a smart choice for people who want to continue to see the doctors they know and trust. Indeed, traditional Medicare is the only choice that maximizes the likelihood of that continuity of care.

    Shockingly and inexplicably, CMS was not willing to tell Jaffe, the reporter, how long this practice has been in effect or which insurers had approval to use this “seamless conversion” process. As disturbingly, neither Cigna, Anthem or Blue Cross would tell Jaffe whether they were automatically enrolling people in their commercial Medicare plans.

    Jaffe learned that Aetna is about to launch the process in parts of Florida. Humana and United Healthcare said that they plan to automatically enroll people as well.

    Congresswoman Jan Schakowsky is looking into the possibility of an “opt-in” for people, rather than an opt-out, so that people consciously enroll in a Medicare Advantage plan only if that’s what they want to do. Until that happens, CMS could protect people if it automatically disenrolled them from a Medicare Advantage plan if they sign up for a Medicare supplemental policy. Since only people with traditional Medicare need such a policy, enrollment in a supplemental policy is a good indicator that they do not want to be enrolled in a Medicare Advantage plan.

    Enrollment in a Medicare Advantage plan must be voluntary. So, if you or anyone you know is enrolled in Medicare Advantage plan involuntarily and unknowingly racks up bills from out-of-network doctors and hospitals, call your local State Health Insurance Assistance Program or SHIP for assistance disenrolling.

    Here’s more from Just Care:

  • Three things to think about when enrolling in Medicare

    Three things to think about when enrolling in Medicare

    When it’s time to sign up for Medicare, information can be confusing.  Before enrolling in Medicare, here are three things you should know:

    1. Timing: If you are not actively working and getting health insurance from your job–even if you have retiree coverage–you will want to enroll in Medicare in the three months before you turn 65, so that you have Medicare beginning on the first day of your birthday month. If you are getting coverage through your or your spouse’s current job and there are at least 20 employees, you can enroll in Medicare without penalty after you or your spouse stops working.
    2. Enrollment: Enrollment in Medicare Part A (hospital insurance) and Part B (medical insurance) is automatic if you are signed up for Social Security.  You do not need to pay anything for Part A if you or your spouse has worked and paid into Medicare at least 10 years. Your Part B premium is deducted from your Social Security check unless your income is low and you qualify for Medicaid or a Medicare Savings program. If you are not signed up for Social Security, call Medicare at 1-800-633-4227.
    3. Additional coverage: Medicare only covers about half of your health care costs.  If you have traditional Medicare, you will need extra coverage, either through: a former employer; or, Medicaid, if your income is low; or, through a private insurer (“Medigap” or Medicare supplemental insurance).  If you are enrolled in a Medicare Advantage plan, a commercial insurance plan that contracts with Medicare, you cannot buy insurance to fill gaps in coverage. Depending on the plan you choose, your out-of-pocket costs could be as high as $6700 a year for your in-network care and much higher if you use out-of-network doctors and hospitals.

    Here’s more from Just Care:

     

  • Health plans may discriminate against people with costly conditions

    Health plans may discriminate against people with costly conditions

    One great advantage of Medicare is that it has one risk pool that includes people with fewer health care needs and people with more needs. And, everyone pays the same premium. It does not discriminate against people with costly conditions because everyone is at risk of needing substantial care.

    But, people in the health exchanges are forced to choose between plans with different levels of benefits. Those who are healthy pick the less comprehensive plans and those who are sick choose the more comprehensive plans. Forcing people to make a choice between more and less comprehensive coverage can end up making health care very expensive for healthy people who choose lesser coverage when they get really sick.

    Moreover, multiple levels of coverage allows the health plans to game the system and discriminate against people with costly conditions. Kaiser Health News reports that some of the biggest health insurers offering coverage in the state exchanges are doing what they can to avoid enrolling people with costly conditions. They are keeping their brokers from selling policies to high-cost enrollees and not paying commissions for the sale of their most comprehensive health plans.

    Aetna, Cigna and Anthem are cutting back on sales commissions for customers who are eligible for coverage outside the standard enrollment period because these enrollees tend to need more care and cost the health plans more. Cigna and Humana no longer pay brokers to sell gold plans because they are less profitable than bronze plans, which offer lesser benefits.  The insurers have determined that the sickest patients needing the costliest care buy the gold plans.

    The Affordable Care Act prohibits this discriminatory marketing behavior by the health plans.  The health plans, however, deny that their behavior is discriminatory.  They claim it is the only way they can afford to remain in the exchanges. At the same time, because of this behavior, experts claim that fewer people are enrolled in the exchanges than would otherwise be.  Though people can enroll in these plans online, brokers are a critical resource to ensure that as many people as possible eligible for coverage enroll.

  • 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.

  • 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.