CDISNM Blog
Many seniors enjoy warm weather living year-round by maintaining a dual residence or living for part of the year in two different states. The dual residence is nothing new, and “snowbirds” have been fleeing to southern states in winter for generations. But how does dual residence impact your Medicare options, will you still be covered if you live in two states?
Original Medicare Benefits Work Anywhere Within the United States
With Original Medicare (Part A and Part B), you can travel anywhere within the United States and still be covered—as long as you choose providers who accept Medicare. This is good news for anyone planning to spend part of the year in one state and part of the year in another. Whether you are in Florida or Michigan, any doctor or hospital that accepts assignments will honor your Part A and Part B benefits.
While in most cases, Medicare does not cover care you receive outside of the country, it does include:
All 50 states
The District of Columbia
Puerto Rico
The Virgin Islands
Guam, American Samoa
The Northern Mariana Islands
Medicare Supplement Insurance Is Not Restricted By Service Networks
Like Original Medicare, Medicare Supplement Insurance, or Medigap, does not rely on service networks, and as long as the doctor or hospital you choose accepts Medicare, you’re covered. As a senior with homes in two states, you can travel freely with the peace of mind and confidence that when you need medical care, you can get it and your Medicare Supplement Insurance plan will be applied. Note: if you are a dual resident considering Medigap, be sure to compare policies offered by each state to learn about any differences that may impact your coverage.
Medicare Advantage and Part D Plans Don’t Always Extend Across State Lines
For Medicare Part C and D, the rules for out-of-state coverage are different and your plan may not cover your care while you travel within the United States. With many plans, you need to be a permanent resident of the state where you originally enrolled and you must live in the service area of your plan. In some cases, you can receive out-of-network care, but it will likely cost you more money. In addition, your plan may have specific rules you need to follow, such as needing prior authorization before receiving care that can impact your coverage. With all Medicare plans, Original Medicare, Medicare Advantage, and Medigap, you are covered in any state if you need emergency medical care or urgent care out of network.
References:
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/switching-plans/switch-medigap-.html#collapse-2514
https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/original-medicare/how-original-medicare-works.html#collapse-3111
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CDISNM Blog
Whether or not you take prescription drugs, you may want to consider your options carefully when it comes to joining Medicare Part D. Unless you have other, creditable coverage offered through work or a union, going without prescription drug benefits may end up costing you money. Do you have to join Medicare Part D to avoid extra fees? Part D coverage is optional, but without the right guidance, you could end up paying a higher premium from a late enrollment penalty. Here’s some information on Part D coverage and what you should know if you are approaching your Initial Enrollment Period.
Avoid the Part D Penalty
Joining Medicare Part D, or prescription drug coverage is optional. However, joining late may trigger a penalty. How do you avoid the Part D penalty?
Join Part D when you are first eligible, during your Initial Enrollment period.
Maintain creditable coverage (other prescription drug coverage) through an employer, union, or other health insurance provider.
If you do not currently have prescription drug benefits through an employer or other source, the best time to join Medicare Part D is when you are first eligible, during your Initial Enrollment period. Even if you do not need medications now, joining during Initial Enrollment ensures you avoid paying a late enrollment penalty.
Not everyone needs to join Medicare Part D when they are first eligible, and many seniors delay enrollment without paying a penalty. Many employer-provided health insurance plans offer drug coverage that is considered “creditable” by Medicare.
If you do have drug benefits, as long as you are covered, you do not need to join Medicare Part D. However, if you lose coverage (employer benefits end or COBRA ends) you only have a certain amount of time to join Part D without penalty.
Your health insurance provider will let you know if your coverage is creditable. Be sure to keep this documentation safe as you will need to show it to Medicare when you are ready to join Part D. Without proof, you may end up paying a late enrollment penalty.
If You are Penalized, Here’s How to Calculate Your Premium
If you go without a Medicare prescription drug plan (Part D) or other creditable coverage for 63 days or more after your Initial Enrollment period ends, you may owe a late enrollment penalty. Penalties are calculated by multiplying the Part D premium amount by the number of full months you went without Part D or creditable drug coverage. Penalties are added to your monthly Part D premium for as long as you have coverage. For example, if you went 6 months without creditable coverage, your penalty would be .06 (for 6 months without coverage) times 35.63 (Part D premium) for a total of 2.13. Medicare rounds to the nearest .10, making your penalty $2.10 added to your Part D premium. Note: penalties are recalculated as annual premiums increase.
References:
Part D Penalty: https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html
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CDISNM Blog
As a Medicare-eligible policyholder, you have the right to know whether or not your current drug coverage meets the standard Medicare prescription drug coverage, and is considered ‘creditable’. If your current prescription drug benefits are provided through an employer, union, or another source, understanding what ‘creditable coverage’ means and how it applies to you will help you make an informed decision—potentially saving you money. The good news? All companies offering prescription drug coverage are required by law to notify you about the status of benefits and whether or not your drug plan meets or exceeds the standard Medicare Part D Prescription Drug plan.
Creditable Coverage
For prescription drug coverage to be creditable, the plan must expect to pay (on average) as much as the standard Medicare prescription drug coverage. How is this determined?
Creditable coverage does the following:
Provides coverage for brand name and generic prescriptions.
Provides reasonable access to retail providers.
Pays an average of at least 60 percent of a participant’s drug expenses.
Satisfies at least one from below:
No annual benefit maximum.
An expectation is that the amount payable by the plan will be at least 2,000 annually.
For integrated coverage: No more than $250 deductible per year, no annual benefit maximum, and no less than a $1,000,000 lifetime combined benefit maximum.
Why It Matters
Of course, there’s a good reason why it makes sense to maintain creditable prescription drug coverage. Medicare beneficiaries who decide not to sign up for Part D prescription drug coverage when they are first eligible, but enter the program late often have to pay more. People signing up late for Medicare Part D without creditable drug coverage may be subject to a 1 percent monthly premium penalty for late enrollment. However, if you have drug benefits through an employer—and it’s creditable—you can stay with your current plan instead of enrolling in Medicare Part D and avoid paying higher prices when you do enroll. In other words, as long as your current drug benefits are as good as Medicare, or ‘creditable’, you can continue to use them and will not pay higher prices when you decide to enroll in Part D at a later date.
What You Should Know
As long as you maintain drug coverage through an employer or union, you should receive a notice by mail each September informing you whether or not your coverage is ‘creditable’. Be sure to keep this documentation—you may need it should you decide to move to a Medicare drug plan later.
References:
https://www.cms.gov/medicare/prescription-drug-coverage/creditablecoverage/index.html
https://www.cms.gov/medicare/prescription-drug-coverage/creditablecoverage/downloads/whatiscreditablecoverage.pdf
https://www.medicare.gov/forms-help-and-resources/mail-about-medicare/notice-of-creditable-coverage.html
MUC55-2017-BCBS
CDISNM Blog
For many seniors, travel is an exciting part of a retirement plan. Whether you’re planning a continuous exploration of faraway lands or a simple one-week trip abroad, foreign travel is a reality for many after leaving the nine-to-five lifestyle behind. But, what about your health care needs? Will your Medicare coverage come with you on your journey?
Medicare Supplement Plans That Offer Coverage
Some Medicare Supplement Insurance plans offer foreign travel coverage—medical benefits as you travel out of the country. The 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa are considered part of the United States—domestic travel, and foreign travel benefits are not necessary.
For all other travel outside of the United States, foreign travel emergency care coverage is provided by six available supplement plans: Plan C, D, F, G, M, and N. If you purchased Medicare Supplement insurance before 2010, and you have plans E, H, I, or J, your foreign travel benefits will still be valid, even though these plans are no longer offered for sale.
What Is Covered
With any of the above plans, you will have foreign travel emergency care that begins during the first 60 days of your trip. Your supplement plan will pay 80 percent of the billed charges for necessary medical care outside of the U.S. after you pay a $250 deductible. There is a lifetime limit of $50,000 for all foreign travel emergency care.
If you’re undecided as to whether or not you should buy coverage, here’s something to think about: Medicare Supplement plans are available with no underwriting only during your Initial Enrollment period. If you think you may be traveling abroad during retirement, you may want to plan by choosing a plan that offers foreign travel benefits.
In Rare Cases, Original Medicare Pays for Foreign Care
Typically, Medicare does not pay for treatment outside of the United States and Medicare Prescription Drug plans do not cover medications purchased abroad. However, in some rare cases, Medicare may pay up to 80 percent for services covered under Original Medicare even while you are out of the country. Note, that foreign hospitals are not required to submit claims to Medicare. More than likely you will need to submit an itemized bill to be reimbursed.
Original Medicare may pay for inpatient care, ambulance services, or dialysis treatment outside of the U.S. if:
You are in the United States when a medical emergency occurs and a foreign hospital is closer than a U.S. hospital.
You are traveling through Canada en route to Alaska and a Canadian hospital is closer than a U.S. hospital.
You are on a ship within territorial waters adjoining lands of the U.S. but within 6 hours of a U.S. port.
You 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
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CDISNM Blog
If you receive health insurance benefits through work, you may have heard about COBRA coverage. COBRA helps people avoid losing their health insurance abruptly during a qualifying event, such as divorce, death, retirement, or leaving a job. With COBRA, you pay for employer-provided health benefits to continue for you, your spouse, and your dependents for some time until other arrangements can be made. If you will soon be eligible for both Medicare and COBRA, which benefits should you take? If you are a spouse not eligible for Medicare, and about to lose employer coverage, can you still take COBRA? Understanding your options is important for ensuring you have the coverage you need when you need it most. Here’s some background on COBRA, along with some facts that can help you make an informed decision regarding Medicare.
What Is COBRA?
Short for the Consolidated Omnibus Budget Reconciliation Act, COBRA was passed by Congress in 1985 to protect qualified beneficiaries—and their dependents—from losing health coverage abruptly should group health insurance stop. COBRA benefits are typically available when a qualifying event occurs, such as a divorce or legal separation, death of a covered employee, retirement, or, in some cases, eligibility for Medicare.
If you have COBRA when you first become eligible for Medicare:
If you’re already receiving COBRA benefits, and become eligible for Medicare during that time, what should you do? While seniors often delay signing up for Medicare Part B if they have comparable health insurance, COBRA is not considered comparable coverage. If you wait to enroll in Part B until your COBRA coverage ends, you will pay a late enrollment penalty. To be safe, if you have COBRA at the time you become eligible for Medicare, sign up for Part B to avoid the late penalty—you can have both Medicare and COBRA. Remember, enrollment in Part B triggers open enrollment rights for Medicare Supplement. If you plan on using Medigap to help pay out-of-pocket costs, you will have six months from the date you enroll in Part B to choose a plan without regard to your current health condition. If you have COBRA before enrolling in Medicare, your COBRA benefits may end on the date you sign up for Medicare. However, your spouse and dependents may be able to keep coverage for up to 36 months. And, you may be able to keep COBRA benefits for services not provided by Medicare. For example, if dental or vision coverage is provided through COBRA, you may be able to continue paying for benefits for as long as you are entitled to COBRA.
If you have Medicare when you become eligible for COBRA
You may have already signed up for Medicare when COBRA benefits are made available to you. You can sign up for COBRA coverage even if you are already enrolled in Medicare. Medicare becomes your primary payer, while COBRA acts as your secondary payer. However, you will be responsible for both the Part B premium and your COBRA premium. When would it make sense to take COBRA coverage with Medicare? Maybe your COBRA benefits include prescription drug coverage or eye care. With Medicare, these services are not included but are extra. You do have the option to turn down COBRA benefits. But, if you have dependents who rely on you for health coverage, be sure to consider your options carefully. In general, COBRA only applies to companies with 20 or more employees. If you are planning on retiring or leaving employment where COBRA is offered, you should receive a letter notifying you of your rights and offering you the option to elect COBRA continuation coverage. Typically, COBRA benefits extend for 18, and in some cases, 36 months.
References:
https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/cobra-7-facts.html
https://www.medicareinteractive.org/get-answers/medicare-and-other-types-of-insurance/understanding-cobra/can-i-have-both-cobra-and-medicare
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