CDISNM Blog
Medicare plan deductibles are charged not at the beginning of the plan year, but at the beginning of each benefit period. Understanding your benefit period and when it is can help you estimate your costs in the event you need care.
Benefit Period
The benefit period is simply the way Medicare measures your use of inpatient hospital and skilled nursing facility (SNF) services. Your period begins the day you’re admitted as an inpatient into a hospital or SNF and ends when you have gone 60 days in a row with no inpatient hospital or SNF care. The benefit period has nothing to do with the calendar year but is based on your medical care needs. It begins on the first day you are admitted into the hospital or SNF and ends 60 days after the last day you receive treatment. For example, if you are admitted into the hospital on May 1 and receive 15 days of treatment, your benefit period would begin on May 1 and end on July 15.
If you need to return to the hospital before the 60 days have expired, you will still be in the same benefit period. However, as soon as 60 days have passed with no care, if you return to the hospital, you will start a new period. While there is no limit to the number of benefit periods you can have or how long each benefit period can last, you must pay the inpatient hospital deductible.
Benefit Period Determines How Much You Pay
When your benefit period begins, you are responsible for paying your Part A deductible. In 2024, Medicare recipients will pay a $1632 deductible for each benefit period. For days 1-60 in the hospital, the coinsurance for each benefit period was $0. That means for the first two months in the hospital, you are covered with no daily coinsurance due. For days 61-90 of a hospital stay, coinsurance is $408 per day. For days 91 and beyond, coinsurance for each “lifetime reserve day” after day 90 for each benefit period is $816. With a skilled nursing facility, coinsurance was $0 for the first 20 days of each benefit period and $204 per day for days 21-100. To find out where you are in your benefit period, refer to your Medicare Summary Notice (MSN). This document details all health care services you received in the past 3 months.
References:
https://www.medicare.gov/glossary/b.html
https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html
https://www.medicare.gov/coverage/skilled-nursing-facility-care.html
https://blog.medicarerights.org/what-is-a-benefit-period/
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CDISNM Blog
Initial Enrollment Period
At the age of 65, most individuals are automatically enrolled in Medicare Part A and Part B. As long as you are eligible to receive Social Security or Railroad Retirement Board benefits, you qualify for Medicare coverage. Everyone who has worked for at least 10 years will receive Part A benefits premium-free. You do not need to do anything at all and you will automatically be enrolled in Medicare Part A coverage. However, Part B is not premium free and you will need to pay monthly. Like Part A, enrollment is automatic – if you choose not to accept Part B coverage, you can “opt-out”. If you are still working at age 65 and receive employer-sponsored health care, you may still enroll in Part B coverage and would need to sign up during your Initial Enrollment Period. If you choose to continue receiving coverage through work, it is acceptable to delay enrollment in Part B benefits. In this case, there is a Special Enrollment Period that typically begins when employer-based coverage ends.
Medicare Enrollment Periods
Initial Enrollment Period:
Medicare offers those who are turning 65 7 months to enroll called the Initial Enrollment Period. Initial Enrollment begins three months before your 65th birthday and ends three months after you turn 65.
General Enrollment Period:
For those who miss the Initial Enrollment Period, there is a General Enrollment Period, which extends from January 1st through March 31st each year. Keep in mind, that enrollment begins on January 1st for coverage that begins on July 1st.
Open Enrollment Period:
Changes can be made during this period to switch from a Medicare Advantage Plan to Original Medicare plus a Part D Plan or to switch from one Medicare Advantage Plan to another. This period is from January 1st to March 31st. Plan changes take effect the month after it is submitted.
Special Enrollment Periods:
Special Enrollment Periods are available for people who are undergoing special life events or circumstances that make it difficult to enroll during designated enrollment periods.
Making Changes to Your Medicare Coverage
Medicare realizes that sometimes people want to change their Medicare plan. An Annual Election Period is available from October 15th through December 7th. During this time, anyone is entitled to do the following:
If you receive Original Medicare:
Leave Original Medicare for a Medicare Advantage plan (with or without prescription drug coverage)
Join or drop Medicare Prescription Drug coverage
Switch between Medicare Prescription Drug plans
If you are enrolled in Medicare Advantage:
Switch to Original Medicare
Switch between Medicare Advantage plans with prescription drug coverage
Switch between Medicare Advantage plans without prescription drug coverage
With all changes to your Medicare plan, as long as your enrollment request is made by December 7th, new coverage begins January 1st of the following year.
References:
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-how-to-sign-up-for-part-a-and-part-b.html
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CDISNM Blog
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MUC42-2017-BCBS
CDISNM Blog
Now that you’ve decided to join Medicare Advantage (Part C) as a way to receive your Medicare benefits, you may be wondering when you can enroll. Medicare only allows you to join, switch, or make changes to Part C at very specific times—when you first get Medicare and during yearly enrollment periods. It’s important to know when these specific deadlines occur to avoid missing them and delaying your health care coverage.
Initial Enrollment Period
When you first become eligible to receive Medicare, you enter your Initial Enrollment Period. This is a 7-month period of time that begins 3 months before your 65th birthday, includes your birthday month, and ends 3 months after. For 7 full months, you are in your unique initial enrollment period and can sign up for Medicare Part C. In most cases, this is the best time to join. However, if you didn’t join and you already have Original Medicare, you can still join a Medicare Advantage plan during other enrollment periods.
Other Enrollment Periods
Annual Enrollment extends between October 15 and December 7. During this time, anyone can join, switch, or drop a Medicare Advantage plan. As long as the plan you are requesting receives your information by December 7, your new coverage will begin on January 1. During Annual Enrollment, you can:
Change from Original Medicare to a Medicare Advantage plan.
Change from a Medicare Advantage Plan back to Original Medicare.
Switch from one Medicare Advantage plan to another Medicare Advantage plan.
Medicare Open Enrollment Period (January 1 – March 31) If you’re interested in dropping your current Medicare Advantage Plan to return to Original Medicare, a specific period has been created for you to do so. The Open Enrollment Period extends from January 1 through March 31. This is the time for you to drop Medicare Advantage and return to Original Medicare plus a Part D Plan or change from one Medicare Advantage Plan to another Medicare Advantage Plan. All changes made during this period will be effective on the first day of the following month. For example, if you drop your Part C plan on January 22, your new coverage will begin on February 1.
Special Enrollment periods were created for people to join and make changes to Medicare Part C when circumstances make it difficult for them to meet regular enrollment periods. For instance, if you move, lose your current coverage, have the opportunity to get other coverage, or meet one of several other special situations, you can usually join, switch, or drop a Medicare Advantage plan. If you are enrolled, but move to a new address with better coverage available, you have 2 months to switch plans. If you were living abroad, but are now back in the United States, you have 2 months to join a plan. Or, if you lose coverage through an employer (COBRA included) you typically have 2 months to join a Medicare Advantage plan.
While many special circumstances may qualify for Special Enrollment, here is a quick summary of the main conditions that meet Special Enrollment criteria:
Move to a new address, move back into the country, or move into or out of a nursing home or assisted living facility.
No longer being eligible for Medicaid or extra help, or losing employer coverage.
Has your current Part C plan been terminated by Medicare or not renewed?
Reviewing Coverage and Switching
When the goal is to spend the least amount of money for the most amount of coverage, you owe it to yourself to get the best deal you can with Medicare Part C. Initial Enrollment is usually the best time to sign up, but once you have coverage, Annual Enrollment (Oct 15 – Dec 7) is a great time to make changes to an existing plan or switch between plans. Even if you think your current Medicare Advantage plan meets your needs, it makes sense to look over new coverage options. Shopping around for better rates and benefits for the upcoming year is a smart way to make sure you’re getting a plan that fits your healthcare needs and your budget.
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
https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances/join-plan-special-circumstances.html#collapse-3198
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CDISNM Blog
With Annual Enrollment just around the corner, seniors everywhere are reviewing their Medicare plans to see if they need to make changes to their coverage. If you’re new to Medicare, you may be wondering where to start, and how to make sure you are enrolled in the right plan to fit your needs and your budget.
Review Costs and Benefits for Next Year
As a recipient of Medicare (Part A and Part B), you should take the time to look over next year’s costs and benefits to see if Medicare will still work for you. Review your Annual Notice of Change, which should arrive by mail in October. If you are not happy with what you see, Annual Enrollment (October 15-December 7) is the time to make changes. Remember, any changes you make during Annual Enrollment will take effect on January 1 of next year.
Check You Prescription Drug Formulary
If prescription medication is a significant part of your medical care, be sure to check the formulary for next year to make sure your needs will still be met. Many times, the list of covered drugs changes from year to year. You need to know if your drug is no longer available or will change tiers and become more expensive. This applies to Medicare Part D, as well as prescription drug coverage you may have with a Medicare Advantage plan.
Review Changes in Networks With a Medicare Advantage Plan
Many times, benefits and costs stay the same with Medicare Advantage, but networks change from year to year. Be sure to confirm that your doctor is still part of your plan’s care network and that any hospitals you use are still available under the plan. Of course, it’s smart to review a few new plans in your area to see if the same coverage is available at a lower cost to you. If your Medicare Advantage plan includes prescription drug coverage, don’t forget to look over next year’s formulary for changes to drugs, dosage amounts, and pharmacy availability.
Annual Enrollment Does Not Apply to Medicare Supplement Plans
If you have Medicare Supplement insurance (a Medigap policy), Annual Enrollment does not apply. Any changes you wish to make to your plan are best made during your unique Medicare Supplement Open Enrollment period. Open Enrollment begins the first month you turn 65 and enroll in Part B. During these six months, you have a guaranteed issue right, meaning no insurance company can turn you down or charge you more for a plan. After your Open Enrollment period ends, insurance companies may refuse to sell you a policy and can charge you more for the same policy. If you have a pre-existing health condition, make changes to your policy during your Open Enrollment, as you may not be able to get a plan after it ends. Luckily, if you miss your enrollment period, there are a few exceptions and you may have a guaranteed issue right in some situations. If, for instance, you move out of your plan’s service area or you have Original Medicare and your employer coverage is ending, you will likely have a guaranteed issue right to buy a new policy.
Resources:
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html#collapse-2283
https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-help-others/Medicare-Open-Enrollment.html
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
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