CDISNM Blog
Almost a third of Medicare beneficiaries receive their coverage through Medicare Advantage (MA), also called Part C. If you enroll in an MA plan, you still have Original Medicare, and you’re still responsible for paying your Part B premium. But there are other costs to consider too, such as deductibles, copayments, and maybe even a monthly premium for your MA plan. If you’re considering your options and would like an idea of what to expect for Medicare Advantage plan costs, here’s a quick breakdown.
Some Plans Charge a Monthly Premium
Luckily, there are many Medicare Advantage plans to choose from, with just as many premium amounts. Some plans offer low, even zero monthly premiums for coverage, while others can charge as much as $150 per month. Generally, with Medicare Advantage, you still need to pay your Part B premium in addition to any premium amount charged by your MA plan.
Deductibles, Coinsurance and Copays
Out-of-pocket costs vary with Medicare Advantage. Some plans require that you pay a deductible for doctor or hospital visits, while others do not. However, most plans do charge you a copayment each time you visit the doctor. This is in place of the 20 percent coinsurance you would be required to pay under Original Medicare. The good news is, that all Medicare Advantage plans are required by law to put a limit on the amount of money you will need to spend out-of-pocket for deductibles and copays for coverage each year.
Out of Network Charges
Unlike Original Medicare where you can receive care in any facility that accepts Medicare, with an MA plan, there are specific networks of providers. As a member of the plan, you agree to use the hospitals, doctors, and pharmacies that are in the plan’s network for your care. You can use providers who are not in the plan’s network or service area but it will cost you more. It’s important to read and understand your plan’s rules. If you don’t, you may be responsible for the full costs of medical services.
In Summary
Your out-of-pocket costs for Medicare Advantage are based on answers to the following questions:
How much is the plan’s monthly premium?
Does the plan pay for any of your Part B premiums?
Is there a yearly deductible?
How much will you have to pay for each visit or service? (copays and coinsurance)
Will you pay more for care received out of the plan’s network?
What is the plan’s yearly limit for out-of-pocket costs for all medical services?
References:
https://www.medicare.gov/your-medicare-costs/medicare-health-plan-costs/costs-for-medicare-advantage-plans.html
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CDISNM Blog
There are many reasons why you may want to switch your current Medicare Supplement Plan. Maybe you’re paying for benefits you don’t need, or, you need more benefits now than when you first joined. Sometimes, you need to change insurance companies or you simply want a less expensive commitment.
Know When You Can Switch
Regardless if you’ve already decided to switch your policy, you can’t unless certain conditions apply. To switch your Medicare Supplement insurance policy, you must:
Have a guaranteed issue right or be eligible under a specific circumstance OR
Be within your Medicare Supplement insurance open enrollment period
Your unique open enrollment period lasts for six months, starting when you first sign up for Part B and are at least 65 years old. During this time, you have a guaranteed issue right to buy any Medicare Supplement policy sold in your state without being turned down or being charged more because of a pre-existing health condition. If you already have a policy and you are within your six-month open enrollment period, you can switch to another plan without any restrictions.
Note: as soon as your open enrollment period ends, your guaranteed issue ends too, and you may not be able to buy another policy. If you have health concerns, be sure to pay close attention to these dates. Your enrollment period is the best time to buy or switch if you are dissatisfied with your current plan.
Guaranteed Issue Rights
There are some exceptions to the rule and other times when you may have a guaranteed issue right to buy or switch a Medicare Supplement insurance policy outside of your open enrollment period. For instance, if your current plan misleads you or isn’t compliant with the law, you can usually switch policies with no restriction. Or, if the insurance company providing your plan declares bankruptcy, you can switch to a new Medicare Supplement insurance policy. In some cases, if you drop a Medicare Supplement insurance policy to buy a Medicare Advantage plan, but don’t like it, you have up to a year to switch back to a Medicare Supplement insurance policy with a guaranteed issue right.
You Can Take a “Free Look”
You have 30 days to decide if you want to keep a new Medicare Supplement insurance policy. This “free look” period starts when you first get your new policy and ends 30 days later. If you wish to exercise your free look, do not cancel your old policy until you are certain you want to keep the new one. You will be responsible for paying both premiums for one month if you choose to take a free look.
Compare Your Old Policy With Your New Policy
Medicare Supplement insurance policies have changed significantly in the past few years. Policies sold before January 1, 2006, included prescription drug benefits. New policies do not. Some plans are no longer offered at all. If you have an older policy and you are looking to switch, know that you may not be able to carry these benefits over to a new policy. There may also be new benefits that may not have been available when you first purchased Medicare Supplement insurance. For example, many new policies are guaranteed renewable or offer lower premiums for similar coverage. Be sure to look closely at benefits and costs if you are looking to switch your Medicare Supplement insurance. Note: if you have an older policy that is no longer available and you decide to cancel it, you cannot get it back.
References:
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/switching-plans/switch-medigap-.html
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights-scenarios.html
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CDISNM Blog
If you’ve done the research and you’ve decided that Medicare Supplement Insurance fits your needs best, great! The right Medigap policy can help you get a handle on costs associated with your health care and can even give you a few extra benefits. However, knowing when to buy is the key to getting a great policy that you can afford. Take a minute to review some important details on when to buy Medicare Supplement insurance, and be prepared when it’s time to make a choice.
When You’re First Eligible
The best time to buy Medicare Supplement insurance is when you’re first eligible, during your open enrollment period. This six-month period of time starts when you are 65 or older and enrolled in Medicare Part B. For most people, enrollment in Part A and Part B is automatic, and Medicare Supplement insurance open enrollment begins at the same time. The reason why this is the best time to buy is simple. During your open enrollment, insurance companies must sell you any Medicare Supplement insurance policy sold in your state at the best available rate—even if you have health problems. If you wait more than six months and miss your open enrollment period, you may not be able to buy a Medicare Supplement insurance policy. Or, if you are accepted, the same policy could end up costing you more.
Guaranteed Issue Right
There are certain times outside of your Medicare Supplement insurance open enrollment where you may have a “guaranteed issue right,” or the same rights to buy Medicare Supplement insurance at a good rate without medical underwriting denying you coverage. For instance, if you chose to delay signing up for Part B because you have group insurance through an employer, that’s okay. Your open enrollment period will also be delayed until you sign up for Part B. But, instead of having six months, you only have 63 days to join Medicare Supplement insurance with the same guaranteed issue right?
Here are some other times when you may have a guaranteed issue right to buy Medicare Supplement insurance.
An employer group health insurance plan is ending.
You joined a Medicare Advantage plan when you were first eligible,
but now, within the first year, you would like to return to Original Medicare.
You dropped a Medicare Supplement insurance policy to join a Medicare Advantage plan for the first time and you’ve been in the plan for less than a year and want to switch back.
Your previous Medicare Supplement insurance policy or Medicare Advantage plan ends through no fault of your own.
You’re in a Medicare Advantage plan, but you move out of the plan’s service area.
Open Enrollment
If you miss your Medicare Supplement insurance open enrollment or do not have a guaranteed issue right for another reason, you may be able to buy a policy during Annual Open Enrollment. However, insurance companies selling during this time are allowed to use medical underwriting as a deciding factor. In other words, they can use your current health status to decide whether to sell you a policy and even to determine how much to charge you.
The key to buying Medicare Supplement insurance during Medicare Open Enrollment is to compare shops. Insurance companies are not required to charge the same for the same plans—and they don’t. Be sure to look closely at not only the benefits but also, the cost of each plan side-by-side before deciding to buy. With good research, you may be able to find the same plan for less offered through another provider.
Switching Plans
If you currently have a Medicare Supplement insurance policy but realize that you’re paying for benefits you don’t need, or need benefits you don’t have, switching policies may make sense. However, to switch to a different policy, you must have a guaranteed issue right or be within your Medicare Supplement insurance open enrollment period.
If you do switch to a new Medicare Supplement insurance policy, you have 30 days to decide if you want to keep the new policy. Your “free look period” starts when you get your new policy. Note: during your 30-day trial, you will be responsible for paying both premiums for one month. And, it is your responsibility to make sure you cancel your old policy.
References:
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/when-can-i-buy-medigap/switching-plans/switch-medigap-.html
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights-scenarios.html
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CDISNM Blog
If you’re looking into your options with Medicare Advantage, also called Medicare Part C, you may have questions about how it works and if all plans are the same. First, you still have Medicare if you join a Medicare Advantage plan. Part C is just another way to receive your Part A and Part B benefits. However, each Medicare Advantage plan is different with different rules about not only which doctors and hospitals you can use, but also, how much you will have to pay for your health care.
Different Types
The most common types of Medicare Advantage plans are:
Health Maintenance Organizations (HMOs)
Preferred Provider Organizations (PPO)
Private Fee-For-Service (PFFS)
There are also Part C plans called Special Needs Plans (SNP), Provider Sponsored Organizations (PSO), and Medicare Medical Savings Accounts (MSAs).
Regardless of the type of plan, all Medicare Advantage plans cover all Medicare services. They’re required to offer at least the same benefits as Original Medicare—but most offer even more. Many Part C plans include benefits for dental, vision, and prescription drugs—benefits not offered through Original Medicare.
Cost, Rules, and Restrictions
Even Part C plans of the same type (an HMO for instance) can be very different, particularly when it comes to cost, rules, and restrictions.
Cost
Every Medicare Advantage plan is required to cover all the services provided by Original Medicare, but they do not have to charge the same. While they cannot charge higher copayments than Original Medicare, they can require you to pay more for certain services, like inpatient hospital care for instance. All Part C plans have an annual limit on how much you will pay out-of-pocket for deductibles and copays.
Plan Rules
Each Medicare Advantage plan has its own set of rules that enrollees must follow. For instance, some plans require you to get permission, or prior authorization from the plan before receiving certain care. With some plans, your doctor may need to get permission from the plan before giving you specific services or drugs.
Plan Restrictions
Some Medicare Advantage plans have restrictions on how you can receive care. For instance, you may be required to go to doctors and hospitals in the plan’s network. Many plans also require that you get a referral from your primary care doctor before seeing a specialist. Medicare Advantage is the right choice for many seniors. If you are healthy and don’t anticipate needing a lot of medical care, Part C may be more cost-effective than Original Medicare. However, it’s important to understand how each plan’s rules and restrictions differ, and how those differences may impact your ability to get the care you need and deserve.
References:
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CDISNM Blog
With the elevated risk for certain types of cancers and high rates of chronic disease, women have unique health requirements. For many women aged 65 and older, Medicare is an important piece of the puzzle, offering screenings and other services designed to identify or treat these conditions at little or no cost. Here’s some information on women’s health and Medicare, and how you can benefit from the program. Medicare covers many preventive services and screening tests designed to identify problems early, allowing treatment to work best. Some of the services women can take advantage of right now include:
Annual wellness visit
Bone mass measurement
Cervical cancer screenings
Mammogram
Cardiovascular screenings
Pelvic Exams and Pap Smears
Medicare covers 100 percent of the costs of a pelvic exam that can help detect fibroids or ovarian cancers. The benefit also includes a clinical breast examination for the detection of breast cancer. Most women are entitled to receive one pap smear every 24 months that helps identify vaginal or cervical cancer. For those at high risk for developing these types of cancers and those who recently received an abnormal pap smear, Medicare pays for a new pap smear every 12 months.
Mammograms and Mastectomy
Medicare Part B pays 100 percent for a screening mammogram once every 12 months and 80 percent for a medically necessary diagnostic mammogram. If a mastectomy is needed, Medicare Part A covers the cost of surgically planted breast prostheses (less Part A deductible and coinsurance) and Medicare Part B pays for external breast prostheses along with a post-surgical bra and breast reconstructive surgery (less Part B deductible and coinsurance).
Women and Heart Disease
Medicare covers many services designed to prevent, diagnose, treat, or manage heart disease in women. A thorough preventive visit and annual wellness check are covered 100 percent, followed by a cardiovascular screening once every 5 years and two diabetes screenings per year along with clinical lab tests. In addition, medical nutrition therapy and diabetes management support are covered by 80 percent.
Bone Mass Measurement and Osteoporosis Drugs
Medicare Part B covers one bone density test every 24 months for qualified women who are at risk for developing osteoporosis. If qualified, you pay nothing for these services. Note: If your doctor or health care provider recommends services beyond what Medicare covers, you may have to pay some or all of the costs. Medicare Part A and Part B pay for an injectable drug designed to treat osteoporosis in women. Some women may also be eligible for a home visit from a nurse to inject the drug (Part B deductible and coinsurance apply to the costs of the drug, but you pay nothing for the home visit).
Resources:
https://www.medicare.gov/coverage/mammograms.html
https://www.medicareinteractive.org/get-answers/medicare-covered-services/preventive-care-services/medicare-coverage-of-pap-smears-pelvic-exams-and-physical-breast-exams
https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html
https://www.medicare.gov/coverage/osteoporosis-drugs-for-women.html
https://www.medicare.gov/coverage/bone-density.html
https://www.medicare.gov/coverage/cardiovascular-disease-screenings.html
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