JustCare

Tag: Medicare supplemental insurance

  • People with Medicare increasingly going without private supplemental coverage

    People with Medicare increasingly going without private supplemental coverage

    A new report from the US Census Bureau reveals that an increasing number of people with Medicare are going without private supplemental coverage. While the report does not look into why this is the case, more people with Medicare are opting for Medicare Advantage plans, which don’t allow people to have supplemental coverage. In addition, more people in Traditional Medicare are not buying supplemental coverage, either because it is not available to them or it is unaffordable.

    While the Census Bureau does not explore the risks of people with Medicare not having supplemental coverage, the risks are significant. Without supplemental coverage, out-of-pocket costs in the form of deductibles and copays are often unaffordable. People of color, people with low incomes and people in poor health are particularly at risk.

    People enrolling in Medicare Advantage plans often mistakenly believe they are saving money over enrolling in traditional Medicare, when in fact they can easily spend a lot more on their care in Medicare Advantage than in traditional Medicare with supplemental coverage. Comprehensive Medicare supplemental coverage costs around $2,500 a year, while out of pocket costs in Medicare Advantage for people who need a lot of care can easily be $5,000 a year for in-network care alone. Unfortunately, we can’t predict when we will be diagnosed with a costly condition or be hit by a car and need costly care.

    People in traditional Medicare without supplemental coverage pay about 16 percent of the cost of their care; they have no out-of-pocket cap. That can be prohibitively expensive for most people, leading them to opt not to get care. Traditional Medicare should have an out-of-pocket cap.

    The maximum out-of-pocket cap in Medicare Advantage can be as high as $8,850 this year for in-network services. Beyond this out-of-pocket limit, because Medicare Advantage plans too often inappropriately delay or deny care or have restricted networks that will not allow you to see the doctors you need to see, you can be liable for the full cost of care you need. So, whether you are in traditional Medicare or a Medicare Advantage plan, out-of-pocket costs can be thousands of dollars without supplemental coverage. Most people with Medicare delay or forgo care when their costs are unaffordable.

    The Census Bureau report shows that in the five years between 2017 and 2022, the rate of people with Medicare with supplemental coverage fell more than 8 percent from 47.9 percent to 39.6 percent.

    Medicare should have far lower out-of-pocket costs, both to promote health equity and to ensure every older adult and person with a disability has access to the care they need, regardless of their ability to pay for it.

    Here’s more from Just Care:

  • How to switch to Traditional Medicare from Medicare Advantage?

    How to switch to Traditional Medicare from Medicare Advantage?

    For years, I’ve been advising people to enroll in Traditional Medicare for easy access to medically reasonable and necessary care. And, I continue to believe that anyone who can afford the upfront costs of Traditional Medicare with supplemental coverage should enroll in Traditional Medicare. Medicare Advantage plans save you money, so long as you’re healthy; but your health care coverage should cover the care you need when you’re sick and you can’t count on a Medicare Advantage plan to do that. So, one Just Care reader asks, how easy is it to switch from a Medicare Advantage plan to Traditional Medicare?

    First things first: Twice a year, during the annual Medicare Open Enrollment period between October 15 and December 7 and during the Medicare Advantage Open Enrollment period between January 1 and March 31, you have the right to disenroll from Medicare Advantage and switch to Traditional Medicare. The issue becomes getting supplemental coverage to fill gaps in traditional Medicare if you don’t have Medicaid or retiree coverage that fills those gaps.

    Here are the benefits of enrolling in Traditional Medicare, along with the challenges of doing so, and your rights.

    The benefits of enrolling in Traditional Medicare:

    • You will have easy access to the medical and hospital care you deserve, without the need for prior authorization or a referral from your doctor to a specialist; you won’t need to go through hoops to get care, nor will you face care delays or denials of care your treating physician says you need.
    • You and your doctor decide the care you need, not an insurance company that profits from denying you care.
    • You will be covered for care from virtually any doctor or hospital in the US; you will not be limited to coverage from a narrow group of physicians in your community.
    • With supplemental coverage, either through Medicaid, your former employer or union or a Medigap plan that you buy in the individual market, you are likely to have almost all your care covered without having to pay out of pocket for that care.

    The challenges of switching to Traditional Medicare:

    • With certain exceptions, if you want to sign up for Traditional Medicare after you’ve been in a Medicare Advantage plan for more than a year, you have no guaranteed right to buy supplemental coverage in all but four states, New York, Massachusetts, Connecticut and Maine. And, because Traditional Medicare has no out-of-pocket limit, you could have higher out-of-pocket costs in Traditional Medicare than you would in a Medicare Advantage plan, which tends to limit your out-of-pocket expenses for medical services to an average of $5,000 for in-network care but could cap those costs as high as $8,700 in 2024.
    • Even if your Medicare Advantage plan is not covering the care you need from the providers you need to see, you can only switch to Traditional Medicare during the Medicare Open Enrollment Period between October 15 and December 7, effective January 1 of the following year and during the Medicare Advantage Open Enrollment Period between January 1 and March 30, effective the month after you disenroll from your Medicare Advantage plan.
    • If you are able to switch to Traditional Medicare and you don’t have Medicaid or a union or employer retiree plan to provide supplemental coverage, supplemental coverage could cost a lot, easily $200 a month or more. Medigap Plans K and L tend to be lower cost and cap your out-of-pocket expenses.

    Your rights to buy a Medigap without medical underwriting or a waiting period:

    • When you first enroll in Medicare, you have a guaranteed right to buy Medigap coverage to fill gaps in Traditional Medicare during a six month open enrollment period beginning the month you turn 65.
    • If you enrolled in a Medicare Advantage plan when you were first eligible for Medicare and disenroll within 12 months, you have a guaranteed right to buy Medigap coverage.
    • If you move out of your Medicare Advantage plan’s service area, you have a right to switch to Traditional Medicare and a guaranteed right to buy Medigap coverage.
    • If you had supplemental coverage from your employer or union and that coverage ends, you have a guaranteed right to buy Medigap coverage.
    • If your Medicare Advantage plan ends its coverage or commits fraud, you have a guaranteed right to buy Medigap coverage.

    Insurers still might sell you Medigap coverage even if none of the above federal rights apply to your situation:

    You still might be able to buy a Medigap policy in your state if you want to switch from a Medicare Advantage plan to Traditional Medicare and none of the above guaranteed federal rights to buy Medigap apply. Contact your State Health Insurance assistance Program or SHIP for free help. Or call your state department of insurance to see if you can buy a policy. Some Medigap plans have out-of-pocket limits like Medicare Advantage and cost much less than more comprehensive Medigap plans.

    Here’s more from Just Care:

  • Your right to buy a Medigap policy when you enroll in traditional Medicare

    Your right to buy a Medigap policy when you enroll in traditional Medicare

    Between October 15 and December 7, it’s the Medicare Annual Open Enrollment Period, during which time you have the right to enroll in traditional Medicare and disenroll from your Medicare Advantage plan. But, depending upon the circumstances surrounding your enrollment in traditional Medicare and the state you live in, you might not have the right to buy a “Medigap” policy, insurance that fills gaps in traditional Medicare. And, since traditional Medicare does not have an out-of-pocket limit, without supplemental coverage, you put yourself at grave financial risk.

    To be clear, unlike Medicare Advantage, which has an annual out-of-pocket maximum, traditional Medicare has no maximum. But, unlike Medicare Advantage which requires you to pay copays that can total thousands of dollars a year in order to get care, with traditional Medicare you can protect yourself financially through supplemental insurance that fills gaps. You can get supplemental insurance from a former employer or Medicaid, or from a an insurance policy you buy in the individual market, which is sometimes called a Medigap policy.

    However, if you don’t buy a Medigap policy when you first enroll in Medicare, you could end up locked into a Medicare Advantage plan.

    What are your rights to buy a Medigap policy?

    • When you first enroll in Medicare at 65 or later, you have the right to buy a Medigap policy of your choosing, regardless of your age or health, for six months during your initial enrollment period. You should buy the policy when you enroll in traditional Medicare to minimize your out-of-pocket costs.
    • If you enroll in a Medicare Advantage plan when you are first eligible for Medicare at 65 or later, you have the right to buy a Medigap policy if you switch to traditional Medicare within 12 months, up to 63 days after you leave your Medicare Advantage plan.
    • If you are enrolled in traditional Medicare with a Medigap policy and drop that policy to enroll in a Medicare Advantage plan, you have the right to get that Medigap policy back if you disenroll from your Medicare Advantage plan within 12 months of joining, but you must apply for coverage no later than 63 days after you leave your Medicare Advantage plan.
    • If you live in Massachusetts, Minnesota or Wisconsin, you always have the right to buy a Medigap policy but the insurer can charge you more based on your health status if you are not buying the policy during your initial enrollment period.
    • In Massachusetts, Maine, Connecticut and Vermont, you always have the right to buy a Medigap policy and the insurer cannot charge you more based on your health status.
    • If your Medicare Advantage plan leaves or you leave the area and you switch to traditional Medicare, you have a guaranteed right to buy a Medigap policy so long as you do so within 63 days of your Medicare Advantage plan coverage ending.
    • If you have retiree coverage from a former employer that fills gaps in traditional Medicare and that coverage end, you have a guaranteed right to buy a Medigap policy.
    • If your Medicare Advantage plan is found not to comply with its legal obligations or somehow misled you, you have a guaranteed right to buy a Medigap policy.
    • If you are under 65 and have Medicare because you are receiving Social Security Disability Income, you have no guaranteed right to buy a Medigap policy under federal law.

    There are a variety of standardized Medigap plans, some of which fill more gaps in coverage than others. To learn more about your Medigap options and how to choose a Medigap plan, click here.

    Here’s more from Just Care:

  • Medicare open enrollment: Can you buy supplemental insurance?

    Medicare open enrollment: Can you buy supplemental insurance?

    Harris Meyer writes for Kaiser Health News about the confusion surrounding the purchase of Medicare supplemental insurance for people who opt for traditional Medicare during the Medicare annual open enrollment period, which began October 15 and goes through December 7. Can you buy supplemental insurance? Whatever you do, don’t trust an insurance agent to advise you; rather go to your local State Health Insurance Assistance Program or SHIP, for free unbiased advice.

    If you have traditional Medicare, having supplemental insurance is necessary if you want to protect yourself from unlimited out-of-pocket costs. But, many people do not understand that or, if they do, might not be able to buy supplemental insurance. Supplemental insurance, which fills gaps in traditional Medicare, comes in three forms–retiree coverage from your former employer, Medicaid or an insurer in the individual market.

    Medicare supplemental insurance or “Medigap,” which you buy in the individual market, picks up a lot of the coinsurance costs and deductibles that people with traditional Medicare would otherwise have to pay. With it, you can sleep at night without worrying about out-of-pocket costs if you need hospital or medical care. You have the right to buy Medigap insurance during the six months after you first enroll in Medicare Part B.

    There are a series of standardized Medigap plans labeled A through N. They all cover the basic coinsurance costs for medical services. But, some also cover coinsurance for nursing home care and others pick up some of the hospital deductible as well. Some Medigap plans have lower premiums because they require you to pay a high deductible before coverage kicks in. Premiums differ depending upon the type of plan and insurance company offering it you choose.

    If you are in a Medicare Advantage plan and want to move to traditional Medicare, it is sometimes not possible to buy Medigap insurance. A lot depends on the state you live in. Some states guarantee you the right to buy Medigap coverage, no matter your age or health status–New York, Massachusetts, Connecticut and Maine. And, eight states, including those four, do not allow Medigap insurers to charge you more based on your health status or age.

    In most states, the Medigap premium charged and whether you can even buy Medigap coverage at all, depends on your health status. Medigap insurers are not likely to sell you insurance if they don’t have to and the insurance company believes you will incur large health care costs.

    There are a few other situations in which you can buy Medigap insurance, some under federal law and some under state laws. For example, you always have the right to buy a Medigap plan if you sign up for Medicare Advantage when you first enroll in Medicare and then decide you want to switch to traditional Medicare within 12 months. Many states also guarantee you the right to buy a Medigap plan if you lose your retiree supplemental coverage.

    Medigap premiums can easily be $1,500 or more a year and, if you are able to buy a policy after your initial enrollment period, the insurer can charge you more in most states, depending upon your health status. But, if you see a doctor or go to the hospital during the course of the year, you might spend less for the Medigap policy than you would for deductibles and copays in Medicare Advantage.

    Medicare Advantage plans, unlike Medigap plans in most states, cost the same for everyone, no matter their health status or age. That said, Medicare Advantage plans can charge you up to $7,550 a year out of pocket for in-network care alone, excluding prescription drugs.

    If you qualify for Medicare because of a disability, you have no right to buy Medigap coverage under federal law. Most states do require insurers to sell you a Medigap policy. But, 19 states do not. And, if you have end state renal disease–kidney failure–only 14 states give you the right to buy a Medigap plan.

    Contact your state health insurance assistance program or SHIP for guidance on buying a Medigap policy in your state. You can call 1-800-677-1116 for the phone number of your local SHIP.

    Here’s more from Just Care:

  • Four things to think about when choosing a plan to fill gaps in Medicare, a “Medigap” or Medicare supplemental insurance plan

    Four things to think about when choosing a plan to fill gaps in Medicare, a “Medigap” or Medicare supplemental insurance plan

    While people with Medicare have the choice of public health insurance, government-administered traditional Medicare, or private health insurance, a commercial Medicare Advantage plan that provides Medicare benefits, most people opt for traditional Medicare. Traditional Medicare gives them easy access to the doctors and hospitals they know and trust anywhere in the U.S. Moreover, with traditional Medicare, you can  protect yourself against high out-of-pocket costs.

    With a Medicare Advantage plan, each year, depending upon the plan you join, you can incur up to $7,550 in annual out-of-pocket costs, including deductibles and copays for medical and hospital care. On top of that you have deductibles and copays for your drugs, for which you cannot budget.

    There are three ways to fill gaps in traditional Medicare: A “Medigap” policy, sometimes called Medicare supplemental insurance, that you buy in the individual market, Medicaid (including Medicare Savings Programs administered through Medicaid) or retiree coverage, if it’s available to you from a former employer.

    Here are four things to think about when choosing a Medigap plan:
    1. Enrollment: To avoid what could be high out-of-pocket costs if you need care, you should sign up for a Medigap plan at the same time you enroll in traditional Medicare. You will then be fully covered for medical and hospital care.  (Your local area agency on aging, www.eldercare.gov, can provide you with a list of private insurers that sell Medigap policies in your state. You also can call your local State Health Insurance Assistance Program (SHIP) for free assistance choosing a Medigap policy. And, you can go to Medicare.gov for Medigap options in your state.) If you wait to buy Medigap insurance, you might not be eligible to get it right away and, in many states, your premium will be based on your health status. (N.B. You cannot buy a Medigap plan to fill gaps in coverage in a Medicare Advantage plan,)
    2. Choice: You have a choice of many different Medigap plans lettered A through N. Every plan covers basic gaps in traditional Medicare coverage, including gaps in medical and hospital coverage and 365 days of additional hospital coverage. Plan A is the most stripped down of the plans but covers the basics, including the 20 percent coinsurance for doctors’ services. Plans D, covers almost all your basic needs. Plan G is also popular and covers a little more. (As of 2020, if you are new to Medicare, you can no longer buy Plans C or F).
    3. Standardization: With Medigap coverage, the gaps filled by plans A, B, C, D, F, G, K, L, M, N, will be the same no matter which insurer you buy the coverage from.  (Keep in mind that these lettered plans are different from Medicare Parts A, B, C and D.) These plans can be compared on price alone.
    4. Premiums: Premiums can be based on the age at which you buy the policy (issue-age rated), your current age (attained age-rated) or the cost of providing the coverage to everyone in your area (community-rated).  Community-rated premiums will be the same for everyone in your area no matter what age you buy the policy, so they tend to cost more at 65 and less later in life. The lowest priced policy at 65–usually the age-rated policy–will likely not be the lowest priced policy over time.

    Choose your Medigap plan carefully. The cost of a policy can vary considerably, depending upon the insurer from whom you buy the policy and how the premium is calculated. And, if you are considering a switch to Medicare Advantage, for which you do not need a Medigap plan, keep in mind that depending upon where you live and your health status, you might not be able to switch back to traditional Medicare and buy a Medigap plan. Only four states require companies to sell people Medigap policies regardless of their health condition: New York, Connecticut, Massachusetts and Maine.

     Here’s more from Just Care:
  • Enrolling in Medicare? Here’s a checklist

    Enrolling in Medicare? Here’s a checklist

    Most people get Medicare just before they turn 65 (though people with disabilities get Medicare after they receive SSDI for 24 months and people with ALS get Medicare the first month they receive SSDI). As a general rule, you are way better off with Medicare, public health insurance, than with private health insurance. But, figuring out when to enroll in Medicare and what to do can be daunting. And, each fall, you need to revisit your options because they can change significantly from one year to the next. Here’s a checklist:

    • Do you have health care coverage from a current job, either yours or your spouse’s?
      • If you do not, you likely want to sign up for Medicare in the three months before your 65th birthday month, so that your Medicare coverage begins on the first day of your birthday month.  (Your current health insurance in most cases will no longer be your primary coverage after your birthday month.)
      • If you have health care coverage from either your or your spouse’s current job, click here for advice on whether you should sign up for Medicare. Depending upon the job, you may need to enroll in Medicare in order to avoid penalties. Note: COBRA does not count as insurance from your job.
    • Have you already signed up for Social Security?
      • If not, you can sign up for Medicare online through the Social Security Administration. You do not need to sign up for Social Security to enroll in Medicare. Keep in mind that when you sign up for Social Security affects the amount of your monthly check. Click here for advice on when to claim Social Security benefits.
      • If you’ve already signed up for Social Security, you will get Medicare automatically. You should receive a notice in the mail about your automatic enrollment in Medicare Part A (hospital insurance) and Part B (medical insurance), both of which you need whether you enroll in traditional Medicare or a commercial Medicare Advantage plan. The Medicare Part A premium is fully paid for if you or your spouse worked for at least 40 quarters and paid taxes; if not, there’s an additional premium. The Medicare Part B premium, which you must pay no matter which Medicare plan you choose, will be deducted from your Social Security check automatically.
        • You will be automatically enrolled in traditional Medicare, government-administered insurance.
        • You can choose to join a Medicare Advantage plan (Part C), instead of traditional Medicare, by signing up with a Medicare Advantage plan; you will be automatically switched out of traditional Medicare.
    • Key differences between traditional Medicare and Medicare Advantage commercial health plans
      • A Medicare Advantage plan, commercial insurance that contracts with Medicare to offer benefits, is often a lot more expensive and a lot more complicated than it at first may seem. Deductibles, coinsurance and copays can be extremely high, and you cannot buy supplemental coverage to cover these costs as you can with traditional Medicare. At the same time, unlike traditional Medicare, Medicare Advantage plans limit your choice of doctors and hospitals to their network. Your annual out-of-pocket costs for in-network care can be as high as $6,700 and, if you need to go out of network, your costs can be far higher. Here are four key differences between traditional Medicare and a Medicare Advantage plan.
      • If you choose traditional Medicare, as 70 percent of people do, Medicare will cover your care from almost all doctors and virtually every hospital in the US. You will want supplemental insurance to fill gaps in traditional Medicare and prescription drug coverage. With that, all or nearly all of your costs for medical and hospital care should then be covered, so you can budget for your care. And, it will be simpler to access care when you need it.
    • What do you need to consider each Fall, during the Medicare open enrollment season?  Each Fall, you will be able to switch Medicare plans. Because Medicare Advantage plans and Part D drug plans can change significantly from one year to the next, you will likely be better off if you do some homework. Here are two questions you should answer during the Open Enrollment Period.
      • If you’re in traditional Medicare, you can assume your coverage will remain the same in terms of access to doctors and hospitals. So, no homework there. But, you will need to check into your Medicare Part D drug plan options, which can change dramatically from one year to the next. (Here’s a Medicare tool to help you choose.)
      • If you’re in a Medicare Advantage plan, you cannot assume your coverage will remain the same each year. The network doctors and hospitals can change at any time, and the premiums, copays and deductibles can change each year. You will need to do some research around costs and to ensure you are in a Medicare Advantage plan that allows you to see the doctors and hospitals you want to use. You can switch to traditional Medicare. But, if you do not have Medicaid or retiree coverage to fill gaps, you will need a Medigap policy.

    For more about Medicare benefits, Medicaid, Social Security and long-term services and supports, click here. 

    To understand when Medicare is the primary payer and when it is secondary, click here. 

    If you have Veterans’ or other military benefits, learn how they work with Medicare.

  • Your Medigap options in 2020

    Your Medigap options in 2020

    As of 2020, if you are enrolled in traditional Medicare and need to buy Medicare supplemental insurance (Medigap), you have new Medigap options. If you are enrolled in a Medicare Advantage plan and you think you might want to switch to traditional Medicare down the road, find out about your rights to buy Medigap insurance. Your rights are limited.

    Medigap options now include plans D and G, which offer the most comprehensive coverage that fills gaps in traditional Medicare. However, neither plans D or G cover the Part B deductible. You no longer can buy Medigap plans C or F, which had offered the most comprehensive coverage. If you already have plan C or plan F, you can keep it.

    If you would prefer to spend less on Medigap, Medigap plan A will cap your out-of-pocket costs and ensure your medical and hospital care is covered in full, so long as you see Medicare participating providers. You will be responsible only for the Part A and B deductibles. Medigap plan B covers the Part A deductible.

    You can switch to traditional Medicare each year during the Fall Open Enrollment Period, between January and March during the Medicare Advantage Open Enrollment Period, if your Medicare Advantage plan is terminated, and if you move. However, your federal right to buy Medigap insurance is limited. Your state might offer you additional rights. For information on your Medigap rights from Just Care, click here.

    Here’s more from Just Care:

  • Medicare covers physical, speech and occupational therapy

    Medicare covers physical, speech and occupational therapy

    Whether it’s because of an illness or an injury, or simply to improve balance, at some point in our lives, many of us will need therapy to regain or maintain our ability to function. Medicare covers physical, speech and occupational therapy in a variety of settings. Talk to the doctor about whether therapy would benefit you or someone you love.

    Medicare offers several outpatient therapy options. You can receive outpatient therapy services at a Comprehensive Outpatient Rehabilitation Facility, hospital, public health agency or from a private therapist, so long as the provider is Medicare-certified and you qualify for coverage. You can also receive outpatient therapy services from a Medicare-certified home health agency, so long as you qualify for the Medicare home health benefit.

    For Medicare to cover outpatient therapy, you must meet the eligibility criteria:

    • Therapy must be a safe and effective treatment for you.
    • A therapist must deliver the services or direct the delivery of the services.
    • Your doctor must certify you need the therapy to regain or maintain your ability to function and set up a plan of care for you in advance of your receiving services. And, if you need ongoing therapy, your doctor must review it and recertify your need.

    Medicare now covers as much outpatient physical, speech and occupational therapy as people need.

    Traditional Medicare pays 80 percent of the cost of these covered services. Supplemental coverage, such as Medicare supplemental insurance or “Medigap,” retiree coverage or Medicaid,  should pay the rest.

    Medicare also offers several inpatient therapy options. It covers physical, speech and occupational therapy in a nursing home as well as in a rehabilitation hospital. Coverage is limited. If you want inpatient care in a nursing home, you will need to have been hospitalized as an inpatient for at least three days in the 30 days prior to admission. You must receive care in a Medicare-certified skilled nursing facility. (Note: You can spend three nights at a hospital and the hospital may still deem it an outpatient stay.)

    If you simply need rehabilitation services–be it nursing, therapy, social worker help or psychological services–Medicare will cover care in a rehabilitation hospital under its hospital benefit.

    Medicare also covers cardiac rehabilitation care.  Click here to read more about this coverage.

    Here’s more from Just Care:

  • Many people find themselves locked into their Medicare Advantage plans

    Many people find themselves locked into their Medicare Advantage plans

    If you’ve just joined a Medicare Advantage plan this open enrollment period, you have until December 7, and than again between January 1 and February 14, to reconsider. Here’s what you need to know: Once you’re enrolled in a Medicare Advantage plan, you could find yourself locked in. Medpage Today reports that many people mistakenly think they can leave their Medicare Advantage plan.

    In all but four states, however, switching to traditional Medicare is effectively impossible for people with a health condition. Yes, no matter where you live, you can technically switch to traditional Medicare. But, traditional Medicare has no out-of-pocket cap; you need Medicare supplemental insurance to fill coverage gaps and protect yourself financially.

    Except in limited situations, you have no right to buy Medicare supplemental insurance. Without Medicare supplemental insurance, your out-of-pocket costs in traditional Medicare if you have a serious health condition could be tens of thousands, if not hundreds of thousands of dollars. With Medicare supplemental insurance, your costs are minimal.

    Medicare Advantage plans, in contrast, have an out-of-pocket cap. Still, people are often stuck with huge out-of-pocket costs; you could end up spending as much as $6,700 a year out of pocket for in-network care alone. Many people who join and need costly health care only learn how expensive a Medicare Advantage plan can be after they have joined. Moreover, they may discover that their health plan does not cover care from the doctors and hospitals they want to use. Or, they may find that their health plan unduly delays or inappropriately denies them access to the care their doctors say they need.

    Even if you find doctors in the Medicare Advantage plan that you like, those doctors can leave the plan at any time. Or, the plan might raise premiums and deductibles significantly. You can’t rely on the plan for your health and financial well-being.

    Understandably, the data show that people with costly conditions often want to switch to traditional Medicare. If they have Medicaid as well as Medicare, it’s an easy switch. Medicaid picks up the out-of-pocket costs in traditional Medicare. But, if they don’t, Medicare supplemental insurers who sell “Medigap” policies to fill gaps in traditional Medicare coverage are likely to refuse to sell them insurance or charge them exorbitant premiums.

    You do have limited rights to buy Medigap coverage. You are guaranteed Medigap coverage in the first six months of enrolling in Medicare. And, if you join a Medicare Advantage plan, you are also guaranteed Medigap coverage if you switch to traditional Medicare within a year and sign up no later than 63 days after your Medicare Advantage plan coverage ends.

    MedPage Today reports on one man enrolled in a Medicare Advantage plan, who, after surgery to repair a mitral valve and suffering a stroke, ended up with hundreds of dollars a month in copays for his medical services and drugs as well as $295 a day for his hospital stay. He was stunned. Neither the Medicare Advantage ads nor the insurance brokers tell people about these costs or about the difficulty of switching to traditional Medicare and buying Medicare supplemental insurance.

    The American Medical Association, which is working hard to oppose Democratic health care reform proposals, knows well the risks of Medicare Advantage plans. It passed a resolution in 2018 recognizing that “seniors are lured to these advantage plans by misinformation and confusing sales techniques.” The AMA also recognizes that these corporate health plans can delay access to care and can deliver poor service.

    Many people understandably can’t afford the cost of Medicare supplemental insurance and join a Medicare Advantage plan thinking they will save money. They might. But, you should know that you could spend a lot more in a Medicare Advantage plan if you become seriously ill and need costly care. People who get sick too often go bankrupt or forego needed care. The Medicare Plan Finder tool won’t tell you this.

    Here’s more from Just Care:

  • Ready to quit smoking? Medicare will help you

    Ready to quit smoking? Medicare will help you

    It’s never too late to quit smoking and improve your health. If you smoke and are ready to try quitting, Medicare will cover smoking-cessation counseling sessions. Medicare covers up to four sessions twice a year. During these sessions, a counselor will work with you one on one. (Medicare also covers a host of other valuable preventive care services.)

    Medicare’s coverage depends upon whether you have a health condition related to or caused by smoking.  If you have Original Medicare (also called traditional Medicare) and you do not have a smoking-related condition, Medicare will cover the full cost of your smoking cessation sessions so long as you visit a Medicare-certified provider. Smoking-cessation is one of many preventive care services that Medicare covers in full.  If you have a corporate Medicare plan, sometimes called a Medicare Advantage plan, will cover the full cost from an in-network provider.

    If you have a smoking-related condition, Medicare will cover 80 percent of the cost of the sessions from a Medicare-certified provider. You will first need to meet your deductible. Supplemental insurance, such as a Medigap plan, retiree coverage or Medicaid, will generally fill these coverage gaps.

    Medicare will also cover prescription drugs to help you quit smoking through the Part D prescription drug benefit. Medicare will not cover nicotine patches, gum or other over-the-counter treatments to quit smoking,  It will also not cover hypnosis.

    The folks at the tobacco companies are the only people who think you should keep smoking. This John Oliver video shows you what lengths they will go to to promote smoking around the world.  It’s horrifying and really worth watching.

    (This article was originally published on September 23, 2015 and has been updated.)

    Here’s more from Just Care: