Frequently Asked Questions about Medicare
01 Does Medicare Cost Me Money?
Yes, Medicare will cost you, but it is still one of the better values in the health-insurance market. You will end up paying a greater number of companies and governments than you are used to under your old health insurance. The program is designed to spread around the risk and services. This is one of the reasons people find Medicare confusing. The Medicare program consists of coordinating many organizations that are delivering benefits to Medicare beneficiaries. One way of delivering benefits is through Original Medicare. This term refers to the way that Medicare was set up in the 1960's. It consists of Medicare Parts A & B. Most people pay no premium for Part A, which covers you while you stay overnight in a healthcare facility. Most people need to pay a Medicare-Part-B premium, unless they are enrolled in certain federal programs like Medicaid. A person needs to have both Medicare Part A and B to enroll in either a Medicare-Supplement or a Medicare-Advantage plan. In 2020, the Part B premium is $144.60 per month ... for most individuals. You may pay more if you have a high yearly income. Generally speaking, Medicare Supplements have a high premium but lower payments when you visit the doctor or go to the hospital. Medicare-Advantage plans can have a $0 premium, but you pay more whenever you go to the doctor or hospital. Visit payments are called co-payments or co-insurance. There is a small distinction between the two terms. A co-payment is a fixed dollar amount to pay to the doctor or clinic for a particular procedure. Co-insurance is a percentage that you pay of the total amount due to the doctor or clinic. The insurance company pays what you do not pay. Co-payments and co-insurance are both forms of cost sharing. Other forms of cost sharing include premiums and deductibles. All Medicare Supplements and stand-alone Prescription Drug Plans (the kind of drug coverage you get if you have a Medicare Supplement) have premiums. Beginning in 2020, all plans have at least some cost sharing above and beyond the premium—unless you purchased Medicare Supplement Plan C or Plan F before 2020. Regardless of how much you pay the doctors and hospitals, you never have to pay your Medicare insurance agent; the insurance companies pay them for helping you both as you enroll and as questions arise after you enroll. Since you do not pay agents, there is no reason that you should not have the best agent available. By working with us, you will learn how to identify and select a good agent--something that you will want to do unless you choose to do your own research and make your own decisions, unless you want to be your own agent. You can do this without getting licensed or certified—qualifications that also cost money but are only required if you want to help someone else enroll and be compensated for it.
02 What Are the Medicare Enrollment Deadlines?
The short answer is that deadlines are a complicated topic. If you want a long answer with all the precise details, call or write us. Here is a short answer for people who are turning 65 and enrolling in Medicare for the first time. Most of the time, you must apply for Medicare online by establishing an online account with the Social Security Administration (SSA). You can do this by navigating to https://www.ssa.gov/myaccount/, by telephoning the SSA, or by going into a local Social-Security office. Your Medicare benefits do not start automatically although your Medicare eligibility is supposed to. The government does not start the program automatically because they would like you to be aware of when they will start collecting your Medicare Part B premium (See Question 01 above). If you continue working after starting Medicare AND are not yet collecting Social Security payments, you will need to arrange to pay Medicare monthly. Once you have enrolled in Medicare Parts A & B (Original Medicare), you will want your former healthcare coverage to end at midnight and your new Medicare coverage to begin at one minute after midnight on the day the Medicare coverage starts for you. This avoids the possibility of a lapse in coverage. You have the legal right to do this during a set period of time either around your 65th birthday or around your retirement date if you keep your group healthcare coverage after your 65th birthday. This period of entitlement is called an ICEP or an IEP. This period of time lasts 7 months. Let's call the month during which you turn 65 or you reitre Month 0; the preceding month is Month -1; the month afterward is Month +1. You can to enroll in Medicare, a Medicare Advantage plan, or a Medicare Supplement any time after the beginning of Month -3. You can enroll without facing a penalty up to Month 3+. If you enroll during the three months prior to the beginning of Month 0, then all your entitlements and plans will start together on the first of the month in which you are eligible. There are many different scenarios that we can explain if your situation is not so straight forward as this. Any agent can explain this to you.
03 What Do I Do First to Get Medicare Coverage?
Whether you are planning on being your own insurance agent or managing an agent who does the research for you, the same reasoning applies. The first step is figure out which options are available to you and which one is in your best interest. There are generally three options: (1) individual Medicare, (2) remaining on your group healthcare if you continue working beyond 65, and (3) enrolling in a Medicare group plan if your employer or union offers one. The way to choose is to figure out which approach will be in your best financial interest. The key to figuring that out is to take into account the cost sharing involved in each option with special emphases on premiums, the rate at which premiums have grown in the past, your chronic conditions like arthritis or diabetes, the cost of medications you take over the long run, whether you have multiple homes, whether you will be traveling a lot, and what is most important to you, low risk or low expense. There are other factors to consider in less straight-forward situations. If you are considering options 2 or 3, then step two is beginning a conversation with your Human-Resource Department or whoever runs the group plans. If you decide on option 1, then the second step is getting enrolled in Original Medicare in preparation for enrolling in a Medicare-Supplement or a Medicare-Advantage plan. If you choose an individual Medicare plan, a Medicare Supplement or a Medicare Advantage plan are the two financially safest ways of enjoying coverage. (See Question 02 above.) Either you or you and your agent will need to weigh the pros and cons of both Medicare Supplement and Medicare Advantage plans in your particular set of circumstances.You can always ask Lift Advocacy for more explanation.
04 What Are the Most Important Aspects of Medicare Coverage?
The most important aspects of Medicare plans are not what most people expect them to be after having been on employer group plans most of their lives. The important aspects are not the insurance company's brand name, the amount of the premium, and your cost-sharing portion like 20%. Under Medicare, the three aspects that plan design and government guidance show us affect beneficiary satisfaction the most are (1) the projected total annual cost for health insurance coverage, (2) the projected annual cost of your prescription drugs, and (3) whether or not the doctors and hospital you already trust are in your insurance plan's network. Recently, a fourth aspect has started to factor into decisions—they are extra or supplemental benefits. These are benefits like dental coverage, hearing aids, acupuncture, and so forth, attached to Medicare Advantage plans. They are causing even Medicare Supplement carriers to reconsider their value propositions. The value of these extra benefits has only been worth noticing the last couple years.
05 Why Would Anyone Want to Work With an Insurance Agent?
Occasionally people do not like working with insurance agents. People may prefer avoiding sales people because they may have hidden agendas, like providing the product with the higher sales commission. If you are like most people, you appreciate sales people in some situations but want to choose those situations yourself. You recognize that good sales people can simplify and improve the quality of your life—if you can manage them correctly. Well-managed agents can free you from having to learn all the rules around enrolling in and maintaining Medicare coverage, and there are many of rules. And those rules have to be re-learned every year since the government has the authority to change them in the public interest. We anticipate that most people will want to work with insurance agents—if they believe that they can manage the agents well because they can reduce your frustration and the demands on your time. You can ask us how to identify and manage a good agent—unless you want to be your own insurance agent.
06 What Is the Difference Between a Good and a Bad Agent?
The primary difference between a good agent and a bad agent is in how they rank your needs compared to their own needs. Do they place your needs for service above their own needs to impose good management ratios on their businesses? Here is the way to tell if you have a good agent. You will be able to contact a good agent and get timely responses, good service, and good explanations. Good agents will either answer your questions right away or will research and get back to you. Good agents will ask you which medications you take and then find out which plan covers them most cost-effectively on an annual basis, and they will do this each and every year. Good agents will ask you which doctors you use and then ensure that those doctors accept the insurance plan you are considering. Good agents will know your circumstances and offer you solutions. Good agents will organize their businesses to accommodate your needs (within reason) rather than requiring you to accommodate their phone tree and service categories.
07 How Many Times May I Contact Lift Advocacy?
You can contact us as many times as you want. You are in the driver's seat. We are here to answer your questions.
08 Which Plans Help Most with Chronic Conditions?
Chronic conditions are things like heart disease, cancer, diabetes, and so on. All plans will manage these conditions, but certain plans will do a better job than others. Sometimes there are specialized plans in your area for chronic conditions. Often, choosing a better plan comes down to how well a plan covers your maintenance medications, your specialists, and the specialized services associated with your condition. Many questions need to be asked before the question of the best plan can be answered. If you do it yourself, you need to know which medications are being prescribed, which doctors and facilities you may want to go to, whether there are plans dedicated to those special needs in the area, and so on. You can ask us how to hone in on the better plans if you want to do it yourself, or you can ask us to help you identify an agent to guide you through the decision-making process.