SSI Blog
Sometimes, even when you think you’ve made the right choice in a Medicare Advantage Plan, you review your coverage and need to make changes. Whether it’s because you’re moving out of your plan’s service area, or you simply want to change coverage or return to Medicare, there are rules and enrollment periods regarding when you can.
Annual Enrollment
Annual Enrollment is the time to make changes to an existing plan. During this time, you can add, drop, or switch without any penalty or restrictions. You can also join or drop a Part D Plan, or switch from one plan to another. All changes you make during this period will become effective on January 1. This period isn’t just for Part C or Part D. All Medicare beneficiaries are allowed to make changes to their coverage during this time. This is the time to look at other options in your area to make sure all of your healthcare needs will be met the following year.
Open Enrollment
The Open Enrollment Period extends from January 1 through March 31. This is the time for you to drop your plan and return to Medicare plus a Part D Plan or change from one Part C Plan to another. All changes made during this period will be effective on the first day of the following month.
Special Enrollment
Special Enrollment Periods were created for people who need to make changes at other times throughout the year. New coverage typically begins the first day of the month after you disenroll from a previous plan. You may switch from your current plan and join a new plan at any time during the year if the new plan has an overall performance rating of 5 stars.
References:
Medicare Advantage Disenrollment:
https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html#collapse-3192
5-star enrollment period:
https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/five-star-enrollment/5-star-enrollment-period.html
MUC60-2017-BCBS
SSI Blog
For many Illinois seniors, foreign travel is an exciting part of retirement. Will your Medicare Supplement provide coverage on your journey? Most plans do not provide coverage while traveling outside of the United States. However, some do.
Plans
For all travel outside of the U.S., coverage is provided by plans F, G, and Plan N.
Coverage
With any of the above plans, you have coverage that begins during the first 60 days. The plan will pay 80 percent of the billed charges for necessary services outside of the U.S. after you pay a $250 deductible. There is a lifetime limit of $50,000. Plans are available with no underwriting only during your Initial Enrollment period. If you may be traveling abroad during retirement, prepare ahead by choosing a plan that provides coverage.
In Rare Cases, Medicare Pays
Medicare may pay up to 80 percent for services covered even while you are out of the country. Foreign hospitals are not required to submit claims to Medicare. You will need to submit an itemized bill to be reimbursed.
Medicare Pays for Inpatient Care, Ambulance Services, and Dialysis Treatment
In the United States when a medical emergency occurs and a foreign hospital is closer than a U.S. hospital.
Traveling through Canada en route to Alaska and a Canadian hospital is closer than a U.S. hospital.
On a ship within territorial waters adjoining lands of the U.S. but within 6 hours of a U.S. port.
Live in the U.S. and have a medical emergency, but a foreign hospital is closer than a U.S. hospital.
References:
https://www.medicare.gov/supplement-other-insurance/medigap-and-travel/medigap-and-travel.html
https://www.medicare.gov/coverage/travel-need-health-care-outside-us.html
MUC52-2017-BCBS
SSI Blog
Medicare Advantage is a cost-saving option for seniors in Illinois, providing coverage that helps with the cost and coverage gaps in Medicare. Understanding the differences between the various plans will help you make an informed decision. Factors like cost, referrals, and whether or not you can use hospitals and doctors outside a plan’s network.
Health Maintenance Organizations
An HMO plan typically requires that you select a primary care doctor from the plan’s network of providers. In most cases, you’re required to use doctors, health care providers, and hospitals within the plan’s network, except in an emergency. You may need a referral to see a specialist. Compared to other plans, this plan can be a cost-effective option, but you may pay the full cost of care if you do not follow the rules. Prescription drug coverage is usually covered but individual plans vary.
Preferred Provider Organizations
PPOs tend to be less restrictive than HMOs, but increased flexibility can cost you more. You do have the option to use any doctor, specialist, or hospital you choose, but you will pay less if you stay within the plan’s network. A referral is generally not required to see a specialist. Prescription coverage is often covered, but individual plans vary.
-
Private Fee for Service
The type of plan decides how much it will pay doctors and hospitals, and how much you will pay. If the plan has a network of providers, you don’t need to go to doctors or hospitals on the list. However, not all Medicare providers accept this plan. Typically, with a PFFS, you do not need to get a referral to see a specialist. Prescription coverage may be covered, but plans vary.
-
Special Needs
Membership in a Special Needs Plan is limited to people with specific diseases or who have specialized health needs. If you have a severe chronic condition, live in a nursing home, or receive both Medicare and Medicaid, you may be eligible.
There are also Provider Sponsored Organizations (PSOs), and Medicare Medical Savings Accounts (MSAs). Regardless of the type of plan, all cover all Medicare services. They’re required to offer at least the same benefits as Medicare, but most offer more. Many plans include benefits for dental, vision, and prescriptions, benefits not offered through Medicare.
References:
https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/different-types-of-medicare-health-plans-.html
https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/types-of-medicare-advantage-plans.html
HMO: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/hmo-plans.html
PPO: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/preferred-provider-organization-plans.html
PFFS: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/private-fee-for-service-plans.html
SNP: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/special-needs-plans.html
MSA: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-savings-accounts/medical-savings-account-plans.html
| MUC44-2017-BCBS |
SSI Blog
Medicare is available for certain people with a disability who are under 65. To qualify, you must have received Social Security Benefits for 24 months, or have End-Stage Renal Disease or Lou Gehrig’s Disease.
End-Stage Renal Disease
If you have ESRD, you can sign up for Medicare before 65 if you need regular dialysis, or have had a kidney transplant, and meet one of the following:
Worked the required amount of time under Social Security or Railroad Retirement Board.
Eligible to receive or already receiving Social Security or Railroad Retirement Benefits.
Spouse or dependent child of a person who meets the requirements listed above.
Eligible for Medicare because of ESRD, enrollment is not automatic and you will need to enroll in Medicare by contacting your local Social Security office. Benefits typically start on the first day of the fourth month of your dialysis treatments. If you are covered by an employer health plan, your coverage will still start the fourth month of dialysis treatments. Your group may pay for the first 3 months of dialysis. If you participate in a Medicare-certified training program to learn how to administer dialysis treatments from home and are expected to do so, treatments continue through the waiting period. Medicare will end 12 months after you stop dialysis or 36 months after you have a kidney transplant. Coverage can be extended if you start dialysis or get a transplant within 12 months of stopping treatment, or 36 months after the transplant.
Enrollment
Even if you are under 65, enrollment with a disability is automatic. After receiving Social Security benefits or Railroad benefits for 24 months, you will receive your Medicare card in the mail. Look for the card to arrive three months before your 25th month of disability. If you have Lou Gehrig’s Disease, enrollment is automatic, but benefits are available after your first month of disability. You can opt out of Part B coverage if you choose. Instructions on the back of the card explain the process. If you choose not to accept Part B before age 65, you will automatically be enrolled again when you turn 65.
References:
Medicare with a disability: https://www.medicare.gov/people-like-me/disability/signing-up-for-part-b-disability.html
Medicare with ESRD: https://www.medicare.gov/people-like-me/esrd/getting-medicare-with-esrd.html#collapse-3178
MUC56-2017-BCBS
SSI Blog
At Senior Services of Illinois, we’re proud to be your Independent, Authorized, Exclusive General Agent for Blue Cross and Blue Shield of Illinois, the largest and most experienced healthcare insurance company in Illinois. With reliable products, committed service, and the largest networks of providers anywhere, Blue Cross and Blue Shield of Illinois is a trusted name in senior health insurance and has been for over 80 years. Sometimes our customers wonder why they shouldn’t just deal directly with Blue Cross and Blue Shield of Illinois rather than going through our agency. Here are a few benefits of working with us.
Personalized Attention
One of the biggest advantages of working with our local agents is the personalized attention you receive. To us, you’re a familiar face, not just a number on a spreadsheet who needs a plan. Our agents take time to get to know each client, building relationships along the way with their local community.
Local Access
Over the years, our agents have helped many of our friends and neighbors make important decisions about insurance. Sharing expertise and advice is why we started in the business to begin with, and we never tire of helping those needing assistance to navigate the often-confusing world of Medicare, and even dental insurance. We like to think that we’ve created a one-stop agency for all questions, concerns, or problems associated with finding and securing a quality, affordable medicare plan.
Convenient Location
With our office located in Riverwoods, it’s never been easier to reach us, either in person, online, or by phone to help with your questions. We’re accessible and committed to making the process as easy and convenient for you as possible.
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
MUC56-2017-BCBS
