CDISNM Blog
As a Medicare recipient, you can travel anywhere in the United States and still be covered, as long as you use doctors and hospitals that accept Medicare. However, if you travel outside of the United States, your Medicare coverage is limited. But what about Medicare Supplement Insurance? How does your plan work when you travel in the U.S. and out of the country?
Coverage In the U.S.
Like Original Medicare, Medicare Supplement plans typically do not require that you use specific doctors or hospitals from a network. Medical care you receive anywhere in the U.S. is usually covered. However, there are exceptions. If you have a Medicare Select plan with a defined network, different rules apply, and you may not be able to use your insurance outside of your plan’s network. In addition, some plans with benefits above Original Medicare, like vision and dental, may make these benefits available only in the state where you bought the plan.
Coverage Outside of the U.S.
Depending on the Medicare Supplement plan you choose, you may have coverage for services or medical supplies you need while out of the country. Currently, plans G and N offer foreign travel emergency health care coverage when traveling outside of the United States. With any plan offering foreign travel benefits, care must begin sometime within the first 60 days of your trip, and cannot be covered by Original Medicare. After you meet a $250 deductible, your Medigap plan will pay 80 percent of the billed charges. Note: Foreign travel emergency care provided by plans have a lifetime limit of $50,000.
Resources:
https://www.medicare.gov/supplement-other-insurance/medigap-and-travel/medigap-and-travel.html
MUC60-2017-BCBS
CDISNM Blog
Here’s some good news: if you’re turning 65 soon, you’ll also be eligible to join Medicare – a federally funded program that provides hospital and medical insurance to older Americans. Transitioning to Medicare for the first time can be confusing and you’re not alone if you have a few questions. Here’s a great resource to get you started—important tips and things to think about as you plan for Medicare coverage.
Enrollment In Medicare Is Automatic
If you’re worried about how to sign up for Medicare before your birthday, don’t be. For most seniors, enrollment in Original Medicare (Part A and Part B) is automatic. As long as you receive Social Security or Railroad Retirement benefits, you don’t need to do anything at all and your Medicare card will be sent to you by mail. Expect to receive your card 3 months before you turn 65, with benefits beginning on the first day of your birthday month. If you do not receive retirement benefits, you may need to enroll in Medicare manually through the Social Security Administration or Railroad Retirement Board.
Accepting or Opting Out of Part B
While Part A (hospital insurance) is free for most people, Part B (medical insurance) is not. A monthly premium will be deducted from your Social Security check each month. In 2024, the standard Part B premium is $174.70 (or higher depending on income). However, most people who receive Social Security benefits will pay less than this amount. If you are still working, covered through an employer or a spouse’s employer, you do not need to keep Part B coverage or pay for it. You can choose to opt out of Part B coverage on the back of your membership card.
Important tip: If you opt out of Part B coverage, and do not have comparable coverage through an employer or spouse, you may end up paying a late enrollment penalty when you decide to join.
Initial Enrollment Period
When you first become eligible for Medicare, you enter what is called your Initial Enrollment Period. This is a 7-month period of time beginning 3 months before your birthday month, and extending 3 months after your birthday month. For example, if you were born in July, your Initial Enrollment Period would be April 1 through October 31. This is the time to enroll in Medicare (for those not enrolled automatically) or enhance coverage with additional benefits.
Important tip: If you’re looking to add additional coverage to Original Medicare, your Initial Enrollment Period is the time to do it. If you delay, you may have to wait until the General Enrollment Period (Jan 1- Mar 31) of the following year and may also be charged a late enrollment penalty.
Adding Benefits
Original Medicare covers much of your health care needs, but it doesn’t cover everything. It’s up to you to decide if you want to enhance coverage with extra benefits and how. Understanding your options will make it easier to choose the perfect complement to your Medicare coverage. There are only two ways to receive Medicare: through Original Medicare or Medicare Advantage (Part C). Original Medicare provides Part A and Part B. Medicare Advantage Provides Part A, Part B, and extra benefits. Medicare Supplement (Medigap) insurance and Prescription Drug coverage (Part D) may be added to Original Medicare for additional benefits.
Medicare Supplement – Medigap helps pay the out-of-pocket expenses associated with Medicare, like deductibles, coinsurance, and copays. While there are no benefits for dental, vision, or prescription drugs, some plans provide coverage while traveling outside of the country. You are responsible for paying a monthly premium for Medigap coverage as well as your Part B premium.
Medicare Advantage – Part C extends Original Medicare by delivering all of your Part A, Part B, and additional benefits from one plan. Dental, vision, and prescription drugs are often covered. If you join a Medicare Advantage plan, you’re still enrolled in Medicare, you simply enhance coverage with extra benefits. You are responsible for paying a monthly premium for Medicare Advantage as well as your Part B premium.
Prescription Drug Coverage – Part D Original Medicare does not include benefits for prescription drugs. If you wish to add coverage, there are only two ways to do it: join a standalone Part D plan, or join a Medicare Advantage plan that already includes prescription drug benefits.
Important tip: you cannot combine Medicare Supplement and Medicare Advantage benefits. If you’re looking to extend benefits beyond Original Medicare, you need to decide which makes the most sense for your specific needs—extra medical benefits or help with expenses.
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/supplement-other-insurance/medigap/whats-medigap.html
Cost of Part B: https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html
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CDISNM Blog
Sometimes, even when you think you’ve made the right choice in a Medicare Advantage plan (Part C), you need to make changes. Whether it’s because you’re moving out of your plan’s service area, or you simply want to change plans or return to Original Medicare, there are rules for when and how you can adjust your Part C coverage. While Annual Enrollment in the fall is typically the time when most seniors make changes, there are other times throughout the year when you can change your Medicare Advantage plan.
Annual Enrollment (October 15 – December 7)
Annual Enrollment extends from October 15 to December 7 each year and is the best time to make changes to an existing Medicare Advantage plan. During this time, you can add, drop, or switch Medicare Part C plans without any penalty or restrictions. You can also join or drop a Medicare Prescription Drug Plan, or switch from one Medicare drug plan to another during Annual Enrollment. All changes you make during Annual Enrollment will become effective on January 1.
The Annual Enrollment period isn’t just for Medicare Advantage or Part D recipients. All Medicare beneficiaries are allowed to make changes to their coverage during this time. Some people join Medicare Advantage or enroll in a prescription drug plan for the first time. Even if you are satisfied with your Medicare Advantage plan, Annual Enrollment is the time to look at other options in your area to make sure all of your needs will continue to be met the following year. Comparison shopping is smart and may help you find better coverage at a more affordable price. If you are currently enrolled in a Medicare Supplement plan, you can make changes to Medigap anytime throughout the year, and you are not restricted to the Annual Enrollment period. However, underwriting may apply.
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.
Other Reasons to Change
What happens if you need to make changes to your Medicare Advantage plan outside of the Annual Enrollment or the Medicare Open Enrollment Period? Special Enrollment periods were created for people who need to make changes to Part C at other times throughout the year. For example, if you move out of your current plan’s service area or your plan leaves your area, you can switch to another Part C plan or return to Original Medicare at any time during the year. New coverage typically begins the first day of the month after you disenroll from a previous Medicare Advantage plan.
Another qualifying reason to use the Special Enrollment Period is if you want to join a 5-star Medicare Advantage plan. You may switch from your current Part C plan and join a new plan at any time during the year if the new plan has an overall performance rating of 5 stars. Note: you may only use this Special Enrollment option once during the year.
References:
Switching from Medicare Advantage to Original Medicare https://www.medicareinteractive.org/get-answers/overview-of-medicare-health-coverage-options/changing-medicare-health-coverage/switching-from-a-medicare-advantage-plan-to-original-medicare
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
CDISNM Blog
Medicare Annual Enrollment begins October 15 and runs through December 7. This is your time to review your current health plan, and maybe even select a new plan. Whether you’re looking to sign up for Medicare Advantage or Prescription Drug coverage, make changes to an existing plan, or dis-enroll completely, this is the time it happens. Annual Enrollment can be confusing, and many seniors do nothing at all. But, it’s well-known that both the terms and costs of plans change from year to year. Even if you’re satisfied with your existing plan, reviewing your coverage annually is smart—not only to stay informed but also, because you may be able to save money and improve your coverage with a new plan.
Remember, you only have a few choices:
If you have Original Medicare, you can choose to buy a Medicare Supplement plan (Medigap).
If you have Original Medicare you can choose to buy a Medicare Advantage plan.
If you have a Medicare Advantage plan, you can pick a new one.
If you have prescription drug coverage, you can change your Part D Prescription plan.
You should receive an Annual Notice of Change in the mail, informing you of any changes being made to your current plan’s coverage and costs for the following year. Take a minute and review this document. Then ask yourself the following four questions to ensure you are well prepared for Open Enrollment.
Was I satisfied with my health coverage last year? Before doing anything else, ask yourself if you were happy with your Medicare health plan last year. If the answer is yes, then review your Annual Notice of Change for changes in terms, coverage, or cost that may affect you this year. If your healthcare needs have changed, your existing plan may not fit your needs anymore, and it may be time to look for different coverage.
Is my doctor still in the network? Often, health plans make changes to networks from year to year. Be informed and prepared by looking to make sure your doctor and hospital are still in your plan’s network for the upcoming year. Did the terms change? For instance, do you need a referral to see a specialist?
Will I be taking any different prescriptions? As your healthcare needs change, so may your prescriptions. If you have prescription drug coverage, either as a standalone plan or through a Medicare Advantage plan, you must look for changes in the plan’s formulary. Are the medications you currently take still covered? Can you use the same pharmacy you use to pick up your medicine?
Will my out-of-pocket expenses change? Think about how much money you spent on health care last year. In many cases, if your plan doesn’t meet your needs, picking a new one may save you money. How much will your current plan expect you to pay? Has this amount increased from last year? If so, by how much? Don’t forget to look for changes in deductibles copayments and coinsurance.
Remember, it’s okay to do nothing at all when Annual Enrollment arrives. If you are happy with your current plan, it will roll over—with any current changes intact—and continue for another year.
References:
https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/questions-when-looking-for-a-plan.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
MUC52-2017-BCBS
CDISNM Blog
Understanding the ins and outs of Medicare Supplement insurance can be challenging. So, we decided to put together a list of the top ten most asked questions about coverage. If you need a quick refresher, or you’re simply looking for an answer, you may find it here.
1: Do I have to buy Medicare Supplement insurance to keep my Original Medicare?
A: No. Medicare Supplement insurance is optional insurance designed to help pay for some of the out-of-pocket expenses associated with Medicare, like deductibles, coinsurance, and copays.
2: Can I Combine Medicare Supplement with a Medicare Advantage Plan?
A: Unfortunately, no. It would be nice to combine the extra benefits of an MA plan with the cost-saving benefits of Medigap. However, it is not allowed. It is against the law for private insurers to sell you a Medigap plan if they know you have Medicare Advantage.
3: If I have Part A, but choose to delay Part B, can I still purchase Medicare Supplement insurance?
A: No. You must have both Part A and Part B coverage (Original Medicare) to be eligible for Medigap.
4: Does Medigap cover both my spouse and me?
A: No. Medigap covers one individual at a time. If both you and your spouse wish to have Medicare Supplement coverage, you each need to have your plan.
5: Can my Medigap policy be canceled if my health deteriorates?
A: No. Standardized Medigap policies are “guaranteed renewable”. That means that even if your health deteriorates, as long as your premiums are paid on time, you cannot be forced out of your policy.
6: Do any Medicare Supplement plans include prescription drug benefits?
A: No. In the past, some Medigap policies included drug coverage. However, policies sold after Jan 2006 do not.
7: When should I enroll in Medicare Supplement?
A: The best time to buy a Medigap policy is when you are first eligible, during your Open Enrollment period. This is a 6-month period of time that begins the month you turn 65 and enroll in Part B. If you wait until after your enrollment period, you may not be able to buy a policy, or it could end up costing you more.
8: Medicare Supplement policies are “standardized”. What does that mean?
A: All Medigap policies must follow federal laws. Standardized plans, named for letters of the alphabet, must offer the same basic benefits, regardless of who sells them. For example, a Plan “F” at one company must include the same basic benefits as a Plan “F” at another company.
9: How much does Medicare supplement insurance cost?
A: Cost varies significantly, and insurance companies often charge different premiums for the same policy. The key to getting a good rate is to compare the same policies at a few different companies. Premiums differ between plans, but some states offer the Medicare SELECT option as a way to save money—you agree to use doctors and hospitals in the network in exchange for a reduced premium.
10: What if I travel outside of the country?
A: Plans G, and N include foreign travel emergency benefits. Medigap pays 80 percent of medically necessary emergency care outside the U.S. after you pay a $250 deductible. If you purchased Plan E, H, I, or J before June 1, 2010, you also have coverage.
References:
https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html
https://www.medicare.gov/supplement-other-insurance/medigap/costs/medigap-plan-costs.html
https://www.medicare.gov/supplement-other-insurance/medigap-and-travel/medigap-and-travel.html
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