JustCare

Tag: SHIP

  • 2023: Four things to know if your income is low and you have Medicare

    2023: Four things to know if your income is low and you have Medicare

    Today, 12.3 million older adults and people with disabilities are enrolled in both Medicare and Medicaid.  Almost three out of four of them (71.1 percent) are eligible for full Medicaid benefits, the remaining 28.9 percent are enrolled in a Medicare Savings Program. While Medicare is an earned health care benefit for people over 65 and people with disabilities, Medicaid is a means-based benefit for people with limited incomes and savings. Medicare and Medicaid work together to provide a more comprehensive set of benefits for people with low incomes.

    1. Medicaid picks up many health care costs that Medicare does not cover: Depending upon your income and assets, along with which state you live in, you might qualify for full Medicaid benefits in addition to Medicare. Medicaid would be your secondary insurance, paying after Medicare.  It generally covers the gaps in Medicare, including the Part B premium, the Part D drug premium, deductibles and coinsurance. It sometimes covers routine dental care and travel to and from the doctor’s office and some long-term care. No matter where you live, if you meet state-specific criteria, you will have coverage for nursing home care.  Depending which state you live in, and your care needs, you might also be eligible for home or community-based care.  In addition, there are several Medicaid/Medicare demonstration projects underway testing new ways to deliver home care for people with Medicare, in one project with the help of therapists, nurses and handymen.
    2. Your state Medicaid office or SHIP program can help you know whether you qualify for full Medicaid or other low-income assistance.  Even if your income or assets are over the limit, many states have what are called “spend-down” programs that allow you to qualify for Medicaid after you have spent some of your own money for health care.  If you own a home, Medicaid does not count your home as an asset. To contact your state Medicaid office, click here and to learn about free and low-cost resources, including the State Health Insurance Programs (SHIP), click here.
    3. Some states enroll people with Medicaid and Medicare in commercial managed care plans: These Medicare Advantage plans might create obstacles to care through limited networks and inappropriate delays and denials of care. But, no matter what state you live in, you should have the right to disenroll and switch to traditional Medicare if you’d like. If you have both Medicare and Medicaid, your out-of-pocket costs in traditional Medicare should be very little or nothing. Contact your state Medicaid office to learn about options in your state.
    4. Even if your income or assets are too high to qualify for full Medicaid benefits, Medicare Savings Programs, (administered by state Medicaid programs), may cover some of the gaps in Medicare. Four different Medicare Savings Programs fill different Medicare coverage gaps, depending upon your income and assets. For example, in 2023, the Qualified Medicare Beneficiary Program, QMB, picks up the cost of Part A premiums; Part B premiums, deductibles, coinsurance, and copayments. To qualify, your individual monthly income cannot exceed $1,235 (married $1,663) and assets $9,090 (married $13,630) plus $1,5oo for burial funds. To learn more about these programs and which health care costs they pick up, click here.

    In addition to Medicaid and Medicare Savings Programs, there are thousands of government and charitable programs that provide free and low-cost services across the country.

    Here’s more from Just Care:

  • Congress must stop the Medigap madness

    Congress must stop the Medigap madness

    On one hand, “Medigap,” health insurance coverage that supplements traditional Medicare, is an incredible product. It usually picks up all but a little of people’s out-of-pocket Medicare costs. On the other hand, people must choose among a sea options they are hard-pressed to understand. And, they must pay a lot of money for Medigap, in order not to worry about their out-of-pocket health care costs. Congress needs to stop the Medigap madness.

    Jake Johnson reports in Common Dreams about  Sen. Elizabeth Warren‘s recent report on how insurance companies encourage insurance agents through money and prizes to upsell people Medigap plans. Even though Medigap is regulated by the federal government, both state and federal governments allow the insurers offering Medigap to run away with the store, scamming “millions of seniors …, offering agents lavish vacations to steer unknowing beneficiaries into more expensive plans,” according to Senator Warren.

    The insurance companies offering Medigap profited handsomely off the $16 billion in premiums they collected last year alone. Older adults are “getting fleeced.” Warren wants federal and state regulators to step in.

    People in traditional Medicare, who don’t have Medicaid or retiree coverage to fill gaps in coverage, need an affordable Medigap plan. They tend to assume that traditional Medicare with Medigap is less affordable than Medicare Advantage, corporate health insurance coverage. But, should you need costly health care services, traditional Medicare plus Medigap can be far more affordable than Medicare Advantage. Medicare Advantage plans typically come with $5,000 in out-of-pocket costs for in-network care alone. Sometimes these costs are higher; Medicare Advantage plans can set our-of-pocket costs for in-network care as high as $8,300 this year.

    Unfortunately, people can’t trust their insurance agents to help them understand the benefits of traditional Medicare over Medicare Advantage. These agents often steer them to Medicare Advantage plans, where they make the biggest commissions. And, when people opt for traditional Medicare, they can’t trust their insurance agents to steer them to the Medigap plan that best meets their needs.

    What you can do: Contact your  State Health Insurance Assistance Program (SHIP) for free unbiased assistance choosing a Medigap plan.

    Warren wants the Centers for Medicare and Medicaid Services, which oversees Medicare, to step in. But, it’s hard to see how additional regulations would help much to protect people from predatory sales agents. The only truly non-predatory solution would be for the government to sell people a government-issued Medigap policy or, better still, cap or eliminate out-of-pocket costs in Medicare.

    If Congress were to add an out-of-pocket cap to traditional Medicare, it would reduce people’s need for Medigap coverage altogether. That’s what’s needed. And, it would save Medicare money.

    The Congressional Budget Office recently found that a high out-of-pocket cap–$8,500–would reduce Medicare spending. It would also give people the choice of traditional Medicare without having to buy Medigap supplemental coverage.

    Here’s more from Just Care:

  • Roundup: 2022 Medicare benefits and more

    Roundup: 2022 Medicare benefits and more

    We’re already three months into the new year. It seems time to put together all the information you might need to be on top of your Medicare health care costs and how to save money in 2022.

    What are your typical costs? Even with Medicare, health care costs can be quite high. The typical person spends more than $6,000 out of pocket on premiums, deductibles and coinsurance.

    What are the advantages of traditional Medicare and the risks of Medicare Advantage plans?  Unlike Medicare Advantage, traditional Medicare covers your care from most doctors and hospitals in the US without administrative obstacles. The key reason people do not opt for traditional Medicare is that they need to buy supplemental coverage to fill coverage gaps. because traditional Medicare has no out-of-pocket cap. (People with Medicaid and some people with retiree benefits from their jobs have that coverage.) Supplemental coverage can cost more than $2,000 a year. But, once you have Medicare supplemental coverage, your out-of-pocket costs are quite small. Medicare Advantage has an out-of-pocket cap, but depending upon the plan you choose, you could be responsible for as much as $7,550 out of pocket, posing a serious financial barrier to care. You can’t buy supplemental coverage to fill gaps in Medicare Advantage and generally are limited to coverage for care from a restricted network of doctors and hospitals.

    How to save money on care Medicare does not pay for?

    How to save money on drugs?

    How to save money on emergency care?

    Who to call with questions about Medicare? Avoid agents and brokers, many of whom profit from steering you to coverage that benefits them and might not benefit you. Instead, for free unbiased assistance, call your State Health Insurance Assistance Program or SHIP.

  • Medicare Open Enrollment: Don’t trust insurance agents

    Medicare Open Enrollment: Don’t trust insurance agents

    It’s Medicare Open Enrollment season from October 15 through December 7, and you should be reviewing your Medicare plan options to make sure you continue to get the coverage you want at the price you want. A new Commonwealth Fund paper explains why it is risky to trust the advice of Medicare insurance agents. It’s far better to talk to your State Health Insurance Assistance Program or SHIP before you make any final decisions.

    Everyone with Medicare, whether enrolled in traditional Medicare or Medicare Advantage, will see their Medicare Part B premium increase in 2022. But, if you’re enrolled in traditional Medicare, you should see no other changes in your coverage or costs for medical or hospital care. If you’re enrolled in a Medicare Advantage plan, your in-network providers as well as your out-of-pocket costs could change dramatically. Your Medicare insurance agent or broker might be able to tell you about changes, but don’t rely exclusively on the agent’s advice.

    Like all insurance agents, Medicare insurance agents have financial interests that are likely not aligned with your needs. For example, they might want to steer you to a Medicare Advantage plan rather than traditional Medicare, even if it’s in your best interest to enroll in traditional Medicare. They generally are paid a higher commission for enrolling people with Medicare in a Medicare Advantage plan than traditional Medicare with a supplement. They are paid nothing if you are in traditional Medicare and receive a lower amount if you enroll in supplemental coverage, “Medigap,” than if you enroll in a Medicare Advantage plan.

    Moreover, insurers pay insurance agents different rates, depending upon the Medicare Advantage plan you enroll in. There’s little doubt that some will steer you to the Medicare Advantage plan that pays them the highest fee.

    The federal government should not be allowing commission differences between traditional Medicare and Medicare Advantage, nor among Medicare Advantage plans. It leads to outcomes that can threaten the well-being of people with Medicare. It also hurts the traditional Medicare program.

    Right now, the Centers for Medicare and Medicaid Services (CMS) sets a maximum amount for Medicare Advantage and Medicare Part D commissions. Agents receive commissions when they initially enroll people in Medicare Advantage and, then, when people renew. CMS does not set a maximum commission for the sale of supplemental insurance, but that commission is generally significantly lower by a couple of hundred dollars than MA commissions.

    For these reasons, insurance agents cannot be trusted to give unbiased Medicare advice.

    How to get unbiased Medicare advice? Every state has a SHIP, a state health insurance counseling and assistance program, which provides free, unbiased Medicare advice. SHIP counselors do not get paid more based on the advice they provide. You can find the contact information for your local SHIP at shiphelp.org or by calling 877-839-2675.

    That said, if you do not have retiree coverage or Medicaid to fill gaps in traditional Medicare and can afford the cost of supplemental coverage–which can easily be $1,500 or more a year–traditional Medicare will give you far better choice of physicians and hospitals than Medicare Advantage and far easier access to care. Medicare Advantage plans impose financial and administrative barriers to care.

    Unfortunately, it’s not possible to know which Medicare Advantage plans have high denial rates and delays, which have high copays, and which will cover your care from quality providers. So, choosing a Medicare Advantage plan can be a big gamble. It’s why people in Medicare Advantage plans who develop complex conditions tend to switch to traditional Medicare when they can, at disproportionately high rates. But, there’s a problem: They are often locked in. After you first enroll in Medicare, Medicare supplemental insurers do not have to sell you coverage, except in limited circumstances.

    Here’s more from Just Care:

  • If you’re making a Medicare choice, don’t trust the insurance agent

    If you’re making a Medicare choice, don’t trust the insurance agent

    One thing I know from experience: Don’t trust the insurance agentIf an insurance agent who is helping you decide what Medicare choices to make. It is more than possible that the agent is directing you to the Medicare choices that are the most financially lucrative for the agent.  The Commonwealth Fund reports on another issue: Agents generally will not tell you about all your Medicare choices. They might not even tell you about your choice of traditional Medicare. It’s a big problem.

    If you’re deciding between traditional Medicare and Medicare Advantage, read this. If you’re deciding among Medicare Advantage plans you should know that it’s virtually impossible to know which plan to choose. So it’s not at all clear that the limited choice the agent offers is an issue. The issue is which plan will give you the care you need at the best price, when you need it. And, no one can tell you that.

    As the Princeton health economist Uwe Reinhardt once said: To choose a plan, pick two diseases you might have next year, then find the doctors you would want to see to treat you for those conditions, then find the Medicare Advantage plan that covers those doctors. If you can find one, pick two new diseases and run through the exercise again.

    You need health insurance that protects you from unpredictable, unforeseeable health events. Unlike Medicare Advantage, traditional Medicare offers you that protection. It allows you to know that you can see virtually any doctor and use any hospital and your care will be covered. Your insurance agent is not going to be able to tell you that you will be able to see the doctors you want to see for every condition you might develop in any Medicare Advantage plan.

    If you’re making Medicare choices, you first need to think about your needs. Do you spend time in different areas of the country? Do you want to be able to see specialists or use certain hospitals? Do you have any health conditions? Do you take any prescription drugs and, if so, what will your copays be in different Medicare drug plans? Are you prepared to spend money on a Medicare supplemental insurance policy to fill gaps in traditional Medicare? Can you afford to pay out of pocket as much as $7,550 a year for in-network care alone if you enroll in a Medicare Advantage plan?

    The best independent help you can get with these questions is through a State Health Insurance assistance Program or SHIP. SHIPs provide free counseling from impartial people. They do not make money from steering you in one direction or another.

    The Commonwealth Fund recommends that CMS should make it easier for people to use “high-quality” agents and more money should go to SHIPs to provide people with independent guidance. Really? There’s no way to know whether your insurance agent is steering you towards a plan that will meet your needs.

    Much of the available information about Medicare Advantage plans is unhelpful. What people need are good meaningful choices–wide choice of providers without high out-of-pocket costs and other hurdles to getting care. Rather, The Commonwealth Fund suggests some kind of rating of agents that people can access; it also buys into the notion that the Medicare star-ratings are worth paying attention to when even MedPAC–the Medicare Payment Advisory Commission–says they are misleading.

    Here’s more from Just Care:

  • Coronavirus: How to get the vaccine?

    Coronavirus: How to get the vaccine?

    Now that the COVID-19 vaccine has been approved, if you’re like me, you probably called your doctor and your friends to find out how you could ensure that you and the older Americans you love get the vaccine as soon as possible. Here’s what I have learned:

    There’s not a lot of information available on how to get the vaccine. When it is available at a given location, it’s a race to schedule a vaccine appointment, not fun and not fair to people who are not equipped to race. There’s also a question of whether you’re even eligible in your state.

    Most states are making the vaccine available to people 65 and over. The problem is scheduling for people who are aging in place. If you’re not up and ready to go online when appointments become available, you likely will lose out.

    My 98-year old father’s geriatrician told me that she did not know when the vaccine would be available to him. At the same time, she said she wanted him to have it as soon as possible. Even though he seemed safe at home, his caregiver is out and about and a vector.

    My dad got lucky. A couple of days later, the doctor sent all of her patients a link to a website on which we could schedule a vaccine appointment. Her office also called to schedule an appointment for my dad. But, don’t count on your doctor’s office calling you.

    President Biden has said that 100 million vaccines will be administered in his first 100 days in office. Biden plans to increase vaccine supplies, get them out to the states and provide the states with the resources needed to administer the vaccines as swiftly as possible. It’s a pretty straightforward plan that has not been in place during the Trump administration.

    So, the good news is that while supplies are not what they need to be at the moment, if you’re over 65, you should be able to get vaccinated in the next three months. The bad news is that, except at the Mayo Clinic, people with serious health conditions are likely to have the same access to the vaccine as everyone else their age and it’s still a struggle to schedule an appointment.  Here’s what Judith Graham of Kaiser Health News recommends you do:

    • Call your doctor and hospital to see whether there is a way for you to register for the vaccine with them, once it is available.
    • Check on local government health department websites for information about scheduling a vaccine in your state. Every state has a covid-19 hotline. You likely will need to be tenacious and patient. But, you might be able to get someone to schedule an appointment for you over the phone.
    • Call your local pharmacy to see what it recommends. Some pharmacies are administering the vaccine on site.
    • Call your state health insurance assistance program for free help signing up for the vaccine. If you can’t get help from the SHIP directly, the SHIP might be able to refer you to an agency that can help. Click here for the your SHIP’s contact information.
    • If you’re a vet, call the department of Veterans Affairs to see if you can get the vaccine through the VA.
    • The silver lining of not being at the front of the line is that the vaccination process should be smoother than it has been by the time you’re scheduled for a vaccine. Lots of people who have been vaccinated already express worry about being exposed to COVID waiting to get the vaccine. Some sites have not done as good a job as one would like at ensuring social distancing and streamlining the process.
    • Keep in mind that vaccine supplies likely will arrive in batches every several days. So, don’t give up trying if you are not able to schedule an appointment right away or supplies run out in your area.
    • And, when you do go to your appointment or go anywhere else where others are gathered, wear two masks, ideally one K95 or N95 mask. The new strains of the novel coronavirus appear to spread more easily. Cloth masks are better than nothing, but they don’t provide as good protection as the K95 and N95 masks.

    Here’s more from Just Care:

  • Medicare Open Enrollment in 2019

    Medicare Open Enrollment in 2019

    Medicare Open Enrollment begins on October 15 and runs through December 7. Whether you are enrolled in traditional Medicare and have a Part D prescription drug plan or you are in a commercial Medicare Advantage plan, your premiums and other out-pocket-costs and in-network providers are likely changing. So, it’s wise to take a hard look at your Medicare options for next year.

    Medicare Advantage and Medicare prescription drug health plan costs and benefits often change significantly from one year to the next. Although you can’t know whether a health plan will meet your future health care needs, you may be able to save money by switching.

    Before you make your choice, keep these facts in mind. Whichever Medicare plan choice you make, you need Medicare Parts A and B, so you must pay the Medicare Part B premium.

    • Traditional Medicare, the government health insurance option, the Medicare health plan choice for nearly seven in ten people with Medicare
      • Traditional Medicare offers coverage from almost all doctors and hospitals anywhere in the country.
      • Traditional Medicare generally does not require pre-authorization or a referral for medical or hospital services.
      • With traditional Medicare, you can fill most if not all coverage gaps with supplemental insurance—Medicaid, retiree coverage from a job or “Medigap,” a Medicare supplemental insurance plan you can buy–all of which cover most or all of your deductible and coinsurance costs. Supplemental insurance protects you from catastrophic costs and allows you to budget for your health care.
    • Medicare Advantage plans, commercial health plans that contract with Medicare
      • Medicare Advantage plans generally limit coverage to a small group of doctors and hospitals in your community—the provider network–except in emergencies or urgent care situations. The provider network can change at any time with doctors and hospitals leaving and entering the network.
      • Medicare Advantage plans often charge an additional premium (on top of the Part B premium), a deductible (the amount you pay before coverage begins) and a copay or coinsurance, with each health care visit. The copay or coinsurance can be very high and unpredictable, a percentage of your hospital bill, and your out-of-pocket costs for in-network care alone can be as high as $6,700 a year. Your costs can change from one year to the next. You cannot buy insurance to fill these coverage gaps.

    If you need costly Medicare-covered services, so long as you have traditional Medicare and supplemental coverage you should be able to see most any doctor and use virtually any hospital to get the care you need with little or no out-of-pocket costs. With Medicare Advantage plans, you have only restricted access to doctors and hospitals and your out-of-pocket costs can easily reach the $6,700 limit for in-network care. Your costs can be even higher if you are hospitalized and are forced to use out-of-network doctors, a fairly common phenomenon, or if you want to use specialists out of network. FYI: Medicare Advantage won’t release data showing people’s typical out-of-pocket costs. However, we know from the HHS Office of Inspector General that Medicare Advantage plans engage in widespread inappropriate denials of care and coverage.

    Keep in mind that even if you need few health care services today, it’s unforeseeable when you might need a lot of care.

    If you’re in a Medicare Advantage plan now:

    • Check your health plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays. If those are good with you, also call your doctors and check with your health plan to make sure your doctors and hospital are still in the network.
    • Consider your other health plan options, including traditional Medicare. One of those options may better meet your needs. You can call your State Health Insurance Program or SHIP for help sorting through your options. You can also call 1-800-633-4227 (1-800-Medicare) or use this Medicare tool to understand your options.
    • Before making a switch to another Medicare Advantage plan, call the plan to confirm your understanding of costs and network doctors and hospitals.
    • If you want to switch to another Medicare Advantage plan, call 1-800-633-4227 (1-800-Medicare) to let Medicare know about your decision.

    If you have a Medicare Part D prescription drug plan:

    • Check your Part D drug plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays or coinsurance. If those seem good to you, check the costs for the drugs you’re taking.
    • It’s wise to look at other drug plan options. You might find a plan that covers your drugs at lower cost. Medicare offers a tool for comparing drug plans based on your drug needs.

    If you decide to switch plans, your new coverage will begin on January 1. Even if you don’t switch now, after the open enrollment period ends, if you are enrolled in a Medicare Advantage Plan and would like to disenroll and switch to traditional Medicare, you may be able to do so between January 1 and February 14. To learn more and get free advice, call your State Health Insurance Assistance Program at 800-677-1116.

    Here’s more from just Care:

  • Four things to know if your income is low and you have Medicare

    Four things to know if your income is low and you have Medicare

    Today, more than 11.4 million older adults and people with disabilities are enrolled in both Medicare and Medicaid.  Almost three out of four of them (72 percent) are eligible for full Medicaid benefits, the remaining 28 percent are enrolled in a Medicare Savings Program. While Medicare is an earned health care benefit for people over 65 and with disabilities, Medicaid is a means-based benefit for people with limited incomes and savings. Medicare and Medicaid work together to provide a more comprehensive set of benefits for people with low incomes.

    1. Medicaid picks up many health care costs that Medicare does not cover: Depending upon your income and assets, along with which state you live in, you might qualify for full Medicaid benefits in addition to Medicare. Medicaid would be your secondary insurance, paying after Medicare.  It generally covers the gaps in Medicare, including the Part B premium, the Part D drug premium, deductibles and coinsurance. It sometimes covers routine dental care and travel to and from the doctor’s office and some long-term care. No matter where you live, if you meet state-specific criteria, you will have coverage for nursing home care.  Depending which state you live in, and your care needs, you might also be eligible for home or community-based care.  In addition, there are several Medicaid/Medicare demonstration projects underway testing new ways to deliver home care for people with Medicare, in one project with the help of therapists, nurses and handymen.
    2. Your state Medicaid office or SHIP program can help you know whether you qualify for full Medicaid or other low-income assistance.  Even if your income or assets are over the limit, many states have what are called “spend-down” programs that allow you to qualify for Medicaid after you have spent some of your own money for health care.  You should know that if you own a home, Medicaid does not count it as an asset. To contact your state Medicaid office, click here and to learn about free and low-cost resources, including the State Health Insurance Programs (SHIP), click here.
    3. Some states enroll people with Medicaid and Medicare in commercial managed care plans: But, no matter what state you live in, you have the right to disenroll and switch to traditional Medicare if you’d like. Contact your state Medicaid office to learn about options in your state.
    4. Even if your income or assets are too high to qualify for full Medicaid benefits, Medicare Savings Programs, (administered by state Medicaid programs), may cover some of the gaps in Medicare. In 2013, 8.8 million people were enrolled in a Medicare Savings Program. Four different Medicare Savings Programs fill different Medicare coverage gaps, depending upon your income and assets. To learn more about these programs and which health care costs they pick up, click here.

    In addition to Medicaid and Medicare Savings Programs, there are thousands of government and charitable programs that provide free and low-cost services across the country.

    Here’s more from Just Care:

  • Health care costs in retirement average $140,000

    Health care costs in retirement average $140,000

    Arielle O’Shea reports in Forbes that a couple who retires this year should expect to spend $280,000 on health care costs over the rest of their lifetime. Put differently, individual out-of-pocket health care costs in retirement now average $140,000. Not only is the amount extraordinary, but people’s 401(k) savings typically will not even cover their full health care costs.

    A person’s average 401(k) savings is $102,900, not even three-quarters (73.5 percent) of the estimated amount they will need to pay for health care in retirement. To help with retirement expenses, some people are pushing back their retirement date. The Employee Benefits Research Institute says that nearly one in four Americans are now saying they will not retire until age 70. A later retirement means lower health care expenses, more earned income and, usually, more earnings on your savings.

    That said, more than half of people surveyed by Fidelity Investments (56 percent) said that they had retired earlier than expected. If you retire before 65, you will likely have higher health care costs.

    Forbes advises that it is never too soon to plan ahead for health care costs and find ways to lower them. You should question your doctors’ orders and ensure you are not getting costly tests you do not need. Doctors are known to overprescribe tests and medicines. Always make sure you need the services and prescription drugs your doctor is recommending. You should find out whether you can change your diet and behavior to avoid taking prescription drugs.

    Also make sure that the doctors you see are in your health plan’s network.  If you are enrolled in traditional Medicare, you should not have to worry. Almost all doctors take Medicare. But, to keep costs down, you should make sure your doctors take assignment–that means that they accept Medicare’s approved rate as payment in full. If you are enrolled in a Medicare Advantage plan, you need to confirm you are seeing network doctors, especially if you are hospitalized. Many doctors in in-network hospitals who treat you may be out of network. And, make sure that any tests are sent to an in-network lab.

    Find out which preventive care services Medicare covers and talk to your doctor about whether you need them. Check out what the US Preventive Services Task Force has to say about them as well. Some tests may not be recommended. Keep in mind that your doctor may not know about Medicare-covered preventive services.

    If you have questions, Medicare offers free state health insurance assistance programs or SHIPs in every state. The SHIPs can guide you to free local resources and help you navigate Medicare.

    You might also want to have a written financial plan so you are best able to budget for your needs.
    Here’s more from Just Care:
  • 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: