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. 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.
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
MUC67-2017-BCBS
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:
MUC60-2017-BCBS
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
MUC64-2017-BCBS
CDISNM Blog
After age 50, men have an increased risk of developing certain cancers, like prostate and colorectal cancer. Colorectal cancer is the number two leading cause of cancer-related deaths—and risk only goes up with age according to cancer.org. Men also have higher rates than women for heart disease, diabetes, and stroke, three of the top 10 causes of death. Luckily, regular screening tests are the most effective way to reduce risk. For men on Medicare, being proactive about health is easy, as the program covers many preventive services and screenings at little or no cost. Here’s some information on men’s health and Medicare, and how you can benefit from the program.
Medicare covers a variety of preventive services and tests designed to identify problems early when treatment can work the best. Some of the services men can take advantage of right now include:
Prostate and colorectal cancer screenings
Diabetes screenings
Cardiovascular screenings
Prostate and Colorectal Cancer Screenings Medicare Part B covers a variety of prostate and colorectal cancer screening tests to help identify precancerous growths when treatment is most effective. A digital rectal exam is covered (less deductible and coinsurance) once every 12 months to detect prostate cancer. Medicare also pays for a prostate-specific antigen (PSA) test at 100 percent, at no cost to you. Men who are considered high risk for colorectal cancer can receive a colonoscopy test and enema paid in full every 24 months, or every 48 months for those of average risk. The average risk for developing colorectal cancer means no personal or family history of polyps, inflammatory bowel disease, or hereditary colorectal cancer. In addition, Medicare Part B pays for a multi-target DNA stool test every 3 years and a fecal occult blood test annually. While most screenings are covered 100 percent, if a biopsy or removal is required, you may be responsible for a copay or coinsurance.
Diabetes Screenings Medicare Part B covers the full cost of screenings to check for diabetes at 100 percent. Men who are considered high-risk are eligible for 2 screenings per year. High-risk factors include the following:
High blood pressure
History of abnormal cholesterol and triglyceride levels
Obesity
History of high blood sugar
You may also receive 2 tests per year if any 2 of the following apply to you:
Over 65 years old
Overweight
Family history of diabetes
History of gestational diabetes
Cardiovascular Screenings and Stroke Prevention Medicare Part B also covers screening blood tests for cholesterol, lipid, and triglyceride levels at 100 percent every 5 years. These screenings are an important part of detecting conditions that may lead to a heart attack or stroke. Your doctor may recommend more tests than Medicare covers. Be sure to ask questions to understand why your doctor is recommending services, and if Medicare will pay for them or if you will be responsible for paying all or some of the costs.
References:
https://www.medicare.gov/coverage/colorectal-cancer-screenings.html
https://www.medicare.gov/coverage/prostate-cancer-screenings.html
https://www.medicare.gov/coverage/diabetes-screenings.html
https://www.medicare.gov/coverage/cardiovascular-disease-screenings.html
https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html
MUC64-2017-BCBS
CDISNM Blog
As you approach age 65, you may be worrying about how you will handle unexpected medical costs. Luckily, Medicare can help. Understanding your options, and what is available to you can help you manage your health expenses as you age. There are only two ways to get Medicare coverage for things like doctor visits, outpatient care, and inpatient hospital care—through Original Medicare (Part A and Part B) or a Medicare Advantage Plan. The costs associated with each vary considerably, and the choices you make directly influence how much you will pay out-of-pocket for coverage.
Costs in 2024
The exact amount you pay for Medicare coverage is based on several factors, including your income. Original Medicare typically carries a monthly premium along with a few other out-of-pocket expenses, such as a deductible, coinsurance, and copay. While there are five different income tiers used to calculate costs, Part A is typically free for most people. Part B is not, and carries a standard premium of $174.70 per month. There is also a Part B deductible of $240 per year. Once this is met, you can expect to pay a copay for most doctor services, outpatient therapy, and durable medical equipment equal to 20 percent of Medicare-approved costs.
How You Pay for Medicare
Whether you have Original Medicare or a Medicare Advantage Plan, if you receive Social Security benefits, Railroad Retirement benefits, or Office of Personnel Management benefits, your Part B premium will be deducted automatically each month from your benefits check. If you do not receive these benefits, you will receive a bill for Medicare coverage. Again, in 2024, most Original Medicare recipients pay the standard Part B premium amount, and you can expect $174.70 to be taken from your benefits check. Retirees with higher incomes pay a higher premium, calculated using the modified adjusted gross income on the most recent tax return.
Financial Help Is Available
The good news is, that there are several programs available to help people with limited income and resources get the coverage they need and deserve.
Medicaid is a joint federal/state program that helps pay for medical costs for people with limited income and resources. In many cases, Medicaid offers additional benefits not provided by Medicare, such as nursing home care and prescription drug coverage. Eligibility rules differ by state. Be sure to call your state Medicaid program to see if you qualify.
State Medicare Savings Programs were created to help seniors pay for premiums and out-of-pocket costs like deductibles, coinsurance, copays, and even prescription drug coverage costs. Eligibility is based on income.
The PACE program was created to help elderly seniors in need of nursing home-level care receive services at home or in a PACE center rather than at a nursing home or elder care facility. To qualify, you must be at least 55 years old, live in the service area of a PACE organization, and need nursing home-level care. PACE often covers dental care, prescription drugs, meals, preventive care, emergency services, and more.
If you qualify for Medicaid, you pay nothing for PACE coverage. If you do not qualify for Medicaid, you pay a monthly premium for prescription drugs along with a monthly premium to cover the costs of long-term care. However, there is no deductible or copayment.
Extra Help paying for prescription drug coverage is available for those who meet certain income and resource limits. If you qualify, you may pay a reduced amount for your Medicare drug plan premium and deductible.
References:
Medicaid:
https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicaid/medicaid.html
Medicare Savings Program
https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicare-savings-program/medicare-savings-programs.html
PACE
https://www.medicare.gov/your-medicare-costs/help-paying-costs/pace/pace.html
Extra Help with Part D
https://www.medicare.gov/your-medicare-costs/help-paying-costs/save-on-drug-costs/save-on-drug-costs.html
https://www.medicare.gov/your-medicare-costs/
https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html
https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html
MUC68-2017-BCBS
