Tag: Medicare
Whether you are already a Medicare beneficiary, or about to become one, you’re likely to run into some new terms. When it’s time to make informed decisions about your Medicare coverage, you’ll be in a better position to understand the coverage.
Coinsurance
The amount you pay for medical services after you pay your deductible. Coinsurance is typically a percentage. For example, you may have coinsurance equal to 20 percent.
Copayments
The amount you pay for medical services or supplies, like a doctor’s visit, hospital outpatient visit, or a prescription drug. A co-payment is typically a set amount, not a percentage. For example, you might pay $10 or $20 for a doctor’s visit or a prescription drug.
Costs Sharing
The amount paid for medical services or supplies, like a doctor’s visit, hospital outpatient visit, or prescription drug. This can include copayments, coinsurance, and/or deductibles.
Excess Charges
If you have Medicare, and the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount, the difference is called the excess charge.
Extra Help
A program designed to help those with limited income pay for Medicare prescription drug costs, like premiums, deductibles, and coinsurance.
Formulary
The list of medications covered by a prescription plan.
Guaranteed Issue Rights
Rights you have when insurance companies are required by law to sell or offer you a Medicare Supplement Plan. With guaranteed issue rights, an insurance company cannot deny you a policy or charge you more for a policy because of a past or present health problem.
Guaranteed Renewable
An insurance policy that can’t be terminated by the insurance company unless you make untrue statements to the insurance company, commit fraud, or don’t pay your premiums. All policies issued since 1992 are guaranteed renewable.
High-deductible Medicare Supplement
A type of plan that has a high deductible but a lower premium. You pay the deductible before the policy pays anything. The amount can change each year.
In-Network
Doctors, hospitals, pharmacies, and other healthcare providers have agreed to provide members of a certain insurance plan services and supplies at a discounted price. With some plans, you are only covered if you receive care from in-network doctors, hospitals, and pharmacies.
Medicare Part C
A plan offered by private companies that contract with Medicare to provide Part A and Part B benefits. Most Medicare Part C plans offer prescription drug coverage.
Medicare Part D
Part D adds prescription drug coverage to Medicare. Part C may also offer prescription coverage that follows the same rules as Medicare Prescription Plans.
Prescription Tiers
Groups of medications will have different costs for each group. Generally, medication in a lower tier will cost you less than one in a higher tier.
Medicare Supplement Open Enrollment
A one-time-only, 6-month period when federal law allows you to buy any policy you want that’s sold in your state. It starts in the first month that you’re covered under Part B and you’re age 65 or older. During this period, you can’t be denied or charged more due to past or present health problems. Some states may have additional open enrollment rights under state law.
Network Providers
The facilities, providers, and suppliers of your health insurer or plan that are contracted to provide health care services.
Out-of-pocket costs
Health or prescription drug costs that you must pay on your own because they are not covered by Medicare or other insurance.
Late Enrollment Penalty
An amount is added to your monthly premium for Part B or Part D if you don’t enroll when you’re first eligible. You pay this higher amount as long as you have Medicare. There are some exceptions.
Written Referral
A written order from your primary care doctor for you to see a specialist or to get certain medical services. In many HMOs, you need to get a referral before you can get medical care from anyone except your primary doctor. If you don’t get a referral first, the plan may not pay for the services.
References:
https://www.medicare.gov/glossary/c.html
MUC52-2017-BCBS
Tag: Medicare
If you are about to turn 65 in Illinois or already eligible for Medicare, but currently receiving health coverage through your spouse, you may be wondering if you need to enroll in Medicare.
Medicare or Group
The size of your employer decides whether or not you can delay enrollment in Part B without a penalty. In companies with fewer than 20 employees, Medicare becomes the primary insurer, with group secondary. If your current insurance will become secondary, then you should take Part A and Part B when you are first eligible. The reason is that the secondary only pays after the primary pays. If you choose to delay Medicare, you will not have a primary, and your out-of-pocket costs will be costly. If your employer has more than 20 employees and your group will remain the primary with Medicare second, then you may not need to enroll in Part B immediately as your current coverage will cover you.
Current Coverage
Group coverage in Illinois works differently once you become eligible for Medicare. After determining which one pays first, look at your coverage and find out how your current coverage changes once you or your spouse turn 65. Then you can decide if it’s worth having both coverages or delaying enrollment in Part B.
Special Enrollment
If you have group coverage and missed your Initial Enrollment, you can still enroll in Part B without paying a penalty. As long as you have coverage, you qualify for a Special Enrollment. And, you have an additional 8 months after losing coverage to enroll without paying a penalty. You’ll also get a guaranteed right to buy Medicare Supplement Insurance for six months after enrolling in Medicare Part B.
]References:
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/should-you-get-part-b/should-i-get-part-b.html#collapse-5783
MUC64-2017-BCBS
Tag: Medicare
The Annual Enrollment is one of the enrollment periods when you can make changes to an existing Medicare Advantage or Part D Plan. Begins on October 15th and ends on December 7th. If you make changes they will take effect on January 1st.
Annual Notice of Change
You will receive an Annual Notice of Change from your insurance provider before Annual Enrollment. This document provides information on changes in costs and benefits that will impact your current coverage in the upcoming year. If you no longer want to continue with a plan, Annual Enrollment is the time to make a change. If you leave a current Part C plan with prescription coverage and return to Medicare, you will need to purchase a Part D plan.
Review Coverage
You will receive your Annual Notice of Change, before Annual Enrollment. Part C plans often make changes to coverage and benefits. Double-check that the hospitals and providers you use will still be in the network. If the upcoming changes will not fit your needs, you can switch coverage during this time (October 15 – December 7). If your plan isn’t changing, or new changes will not matter, you don’t need to do anything, and you will continue to receive the coverage you have. Part D plans often change the formulary, which could affect the cost of prescription medications you currently take. Check the pharmacy you currently use is still listed in the network of providers.
Changes Allowed
Join, switch, or drop a Part C Plan or D during Annual Enrollment.
Join a new plan and be dis-enrolled from the old automatically when your new coverage starts.
Switch a Part C Plan back to Medicare
Enroll in a Part D plan. Coverage will be effective on January 1st.
References:
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-3190
https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/when-to-join-medicare-advantage-plan.html
MUC63-2017-BCBS
Tag: Medicare
Many seniors want to know the difference between a Medicare Supplement and Medicare Advantage Plans. These two plans have different coverage and benefits to fit each individual’s needs and budget.
Medicare Supplement
Medicare Supplement Plans are offered through private insurance companies in IL. These plans help pay for costs not covered by Medicare, like deductibles, copayments, and coinsurance. There are no networks and you are free to use any doctor or healthcare provider you choose who accepts Medicare.
Medicare Advantage
Part C is offered through private insurance companies approved by Medicare. When you join a plan, you still have Medicare coverage. Part A and B benefits are provided through the insurance company. Many plans offer low or zero monthly premiums. Most plans have additional benefits not provided by Medicare including prescription coverage and dental and vision care.
References:
Medicare Advantage: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html
Medicare Supplement: https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html
Extra: https://www.medicare.gov/supplement-other-insurance/medigap/medigap-and-medicare-advantage/medigap-and-medicare-advantage-plans.html
MUC44-2017-BCBS
Tag: Medicare
We created a checklist to help you be prepared for the Medicare enrollment process.
9 to 12 months before you turn 65
Confirm that you are eligible to receive Medicare by calling the Social Security Administration at 800.772.1213.
Review your current health insurance policy to find out what happens with that coverage when you turn 65.
Research options for coverage to help protect yourself from costs not covered by Medicare.
4 to 8 months before you turn 65
Become familiar with Medicare and its various parts: A, B, C, and Part D.
Ask your doctor if they accept Medicare or participate in other Medicare plans.
Sign up for coverage to help protect yourself from out-of-pocket expenses with Medicare.
1 to 3 months before you turn 65
Enroll in Medicare – if you do not receive your automatic enrollment information in the mail, contact the Social Security Administration at 800.772.1213.
Sign up for Social Security if you have decided to take early Social Security benefits (Note: it usually takes three months after you sign up before you begin receiving benefits).
If your spouse and/or dependent are covered under your employer’s plan, make arrangements for him or her to have coverage after you have Medicare.
Happy 65th Birthday!
If you have not received your Medicare card in the mail, call the Social Security Administration at 800.772.1213.
Make sure your physician’s office has a copy of your Medicare Card and any supplement plan you may have signed up for.
References:
https://www.medicare.gov
MUC25-2016-BCBS
