CDISNM Blog
Medicare is available for most people age 65 or older, but also for certain people with disabilities who are under age 65. To be eligible, you must have received Social Security Benefits for 24 months, or have End-Stage Renal Disease or Lou Gehrig’s Disease. If you are disabled and wondering if you qualify for Medicare Part A and Part B, here’s some important information that can help.
Medicare With a Disability
Even if you are under 65, enrollment in Medicare Part A and Part B with a disability is automatic. After receiving Social Security benefits or Railroad benefits for 24 months, you will receive your Medicare card in the mail. Look for the card to arrive three months before your 25th month of disability. Note: if you have Lou Gehrig’s Disease, enrollment is automatic, but Medicare benefits are available after your first month of disability. Enrollment in both Part A and Part B is automatic. However, you can opt out of Part B coverage if you choose. Instructions on the back of the card explain how to do so. If you choose not to accept Part B before age 65, you will automatically be enrolled again when you turn 65.
End-Stage Renal Disease (ESRD)
If you have ESRD, you can sign up for Medicare before 65 if you need regular dialysis, or have had a kidney transplant, and meet one of the following:
You worked the required amount of time under Social Security or Railroad Retirement Board.
You are eligible to receive or already receiving Social Security or Railroad Retirement Benefits.
You are the spouse or dependent child of a person who meets the requirements above.
If you are eligible for Medicare because of ESRD, enrollment is not automatic and you will need to enroll in Part A and Part B by contacting your local Social Security office. Benefits typically start on the first day of the fourth month of your dialysis treatments. If you’re covered by an employer group health plan, your Medicare coverage will still start the fourth month of dialysis treatments. Your employer group may pay for the first 3 months of dialysis.
Medicare benefits may start during the first month of dialysis
You participate in a Medicare-certified training program to learn how to administer dialysis treatments from home and are expected to be able to do so. Dialysis treatments continue through the waiting period. Medicare benefits will end 12 months after you stop dialysis treatments or 36 months after you have a kidney transplant. Coverage can be extended if you start dialysis or get a kidney transplant within 12 months of stopping dialysis, or 36 months after receiving a new kidney.
References:
Medicare with a disability: https://www.medicare.gov/people-like-me/disability/signing-up-for-part-b-disability.html
Medicare with ESRD: https://www.medicare.gov/people-like-me/esrd/getting-medicare-with-esrd.html#collapse-3178
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CDISNM Blog
If you are about to turn 65 or already eligible for Medicare, but currently receiving health coverage through your spouse, you may be wondering if you need Medicare. Part A is free for most people, and it doesn’t hurt to sign up even if you have group insurance through an employer. However, there are some things to consider that can help you decide when to enroll in Medicare.
Determine which coverage is the Primary Insurer
The size of your employer often decides whether or not you can delay enrollment in Part B without paying a penalty. In companies with fewer than 20 employees, Medicare automatically becomes the primary insurer, with group insurance secondary. If you learn that your current insurance will become secondary to Medicare, then you should take Part A and Part B when you are first eligible. The reason for this is that secondary insurance only pays after the primary insurer pays, and pays very little. If you choose to delay Medicare, you will not have a primary insurer, and your out-of-pocket costs will be high. On the other hand, if your employer has more than 20 employees and you learn that your group health insurance will remain the primary insurer with Medicare coverage second, then you may not need to enroll in Part B immediately as your current coverage will cover your needs.
Changes After You Become Eligible for Medicare
After determining who will be the primary insurer, look to your benefits. In some cases, group insurance works differently once you become eligible for Medicare. Learn if your benefits will change, and then decide if it’s worth having both types of coverage or delaying enrollment in Part B. Unlike Part A, Part B isn’t free—once enrolled, everyone pays a monthly premium. Find out how your current coverage works once you or your spouse turn 65 and then decide if it makes sense to enroll in Part B or delay enrollment until a later date.
With Group Coverage, You Qualify for a Special Enrollment Period to Enroll in Medicare
The good news is, that if you have group coverage and missed your Medicare Initial Enrollment Period, you can still enroll in Part B without paying a penalty. As long as you have group coverage, you qualify for a Special Enrollment Period. And, you have an additional 8 months after losing group coverage to enroll in Medicare without paying a penalty. You’ll also get a guaranteed right to buy Medicare Supplement Insurance for six months after enrolling in Medicare Part B.
References:
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/should-you-get-part-b/should-i-get-part-b.html#collapse-5783
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CDISNM Blog
The Annual Enrollment Period (AEP), is the one time of year when you can make changes to an existing Medicare Advantage or Prescription Drug plan. You have a few choices. You can join a new Medicare Advantage (MA) Plan or Prescription Drug Plan (PDP), switch between MA plans, or leave a Medicare Advantage Plan to return to your Original Medicare. With many options, the Annual Enrollment Period can be confusing. Here are five frequently asked questions, with answers to help you easily navigate this important time of year.
1: When is Annual Enrollment?
A: Annual Enrollment begins on October 15th and ends on December 7th.
These dates are important to remember. If you make changes at any time during Annual Enrollment, they will take effect on January 1st. Remember, in most cases, Annual Enrollment is the only time you can move to a new Medicare Advantage or Part D plan. Be sure to do research ahead of time and be ready to switch if that’s what you decide to do.
2: I’ve read my Annual Notice of Change (ANOC), and my costs are going up. What can I do?
A: Annual Enrollment is your time to make changes to your Medicare plan.
As a member of a Medicare plan, you should receive an Annual Notice of Change in the mail by the last day of September. This important document includes any changes in costs and benefits that will impact your current plan in the upcoming year. If, after reviewing your ANOC, you no longer want to continue with the plan you have, now is the time to change. During Annual Enrollment, you may make the following changes:
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.
Join a Medicare Prescription Drug Plan.
Switch from one Prescription Drug Plan to another Prescription Drug Plan.
Drop Medicare Prescription Drug coverage completely.
Don’t forget, that Original Medicare does not include prescription drug coverage. If you leave a current Medicare Advantage Plan with prescription coverage and return to Original Medicare, you will need to join a standalone Part D plan. If you do not enroll in a standalone Part D plan, a Part D penalty may apply.
3: Annual Enrollment ended, but I do not like the new Medicare Advantage Plan I joined. What can I do?
A: After Annual Enrollment ends, there is an Open Enrollment Period from January 1st to March 31st.
The Open Enrollment Period was created for people who are dissatisfied with their Medicare Advantage Plan after the Annual Enrollment Period ends. This is another time, in addition, to Annual Enrollment when you can disenroll. During this period, you can switch from a Medicare Advantage Plan to Original Medicare plus a Part D Plan or switch from one Medicare Advantage Plan to another. Any changes take effect the month after it is submitted.
4: Is Annual Enrollment the same as Open Enrollment for the Health Insurance Marketplace?
A: No. Open Enrollment for the Health Insurance Marketplace is not Open Enrollment for Medicare.
The federal health exchanges were created to provide insurance options for underinsured or uninsured Americans in need of health insurance coverage. As a member of Medicare, Annual Enrollment (Oct 15-Dec 7) is for you to change your Medicare plan only.
5: If I want to make changes to my Medicare plan, what do I need to do?
A: Joining, switching, or dropping a Medicare Advantage Plan or Prescription Drug Plan during Annual Enrolment is easy.
To Join a Medicare Advantage Plan, simply enroll in the plan and your old coverage will be discontinued automatically.
To switch between MA plans, simply join the new plan and you will be disenrolled from the old plan automatically when your new coverage starts.
To switch from an MA plan back to Original Medicare, contact your current plan.
To join a Prescription Drug Plan, enroll in the plan you choose and coverage will begin on January 1st.
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#collapse-3190
https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/when-to-join-medicare-advantage-plan.html
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CDISNM Blog
The Medicare Part D Prescription Drug ‘Extra Help’ Program was created by the Social Security Administration to help people with limited income pay for their medication. Recipients of Extra Help pay lower drug premiums, copayments, and deductibles. As a member of Medicare, you are entitled to purchase a Prescription Drug plan. And, if you have limited resources, you may be entitled to receive help paying for monthly premiums, annual deductibles, and copayments. Many people are unaware that they qualify for Extra Help, and could be missing an opportunity for big savings. Here’s how to find out if you qualify, and some important information on how to apply.
Qualifying for Extra Help
The Social Security Administration determines who qualifies for Extra Help by looking at the value of their total savings, investments, real estate, and income.
Resources Bank accounts, stocks, bonds, mutual funds, retirement accounts, and available cash are all considered to determine financial eligibility. While the value of some real estate is considered, your primary residence is not. If you own your home, its value is not considered part of your total resources. In addition to your home, personal items such as jewelry, furniture, and vehicles are not considered. Rental property and life insurance policies are also not included as part of your financial resources.
Applying for and Receiving Extra Help
If you believe you may qualify for Extra Help, you can apply online, by phone, or in person at your local Social Security office. After your application has been reviewed, you will receive a letter by mail informing you if you qualify. To receive Extra Help, you will need to provide proof of your Part D plan. A “Notice of Award” from Social Security is documentation that you qualify and proof of eligibility for Extra Help.
References:
https://www.ssa.gov/pubs/EN-05-10508.pdf
http://medicaretoday.org/wp-content/uploads/2018/09/Medicare-Part-D-Extra-Help-Program-in-2019.pdf
https://www.medicare.gov/your-medicare-costs/help-paying-costs/extra-help/level-of-extra-help.html
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CDISNM Blog
If you’re spending time reviewing your options with Medicare Advantage (Part C) but you’re confused by zero premium plans, you’re not alone. How can some Part C plans offer coverage with no premium, and why wouldn’t everyone sign up for one? At first glance, premium-free Medicare Advantage sounds great. But you need to be careful. Here’s why some Medicare Advantage plans have a zero premium, and why this may not be the least expensive way to go.
How Companies Can Afford to Offer Zero Premiums
Private insurance companies often sell Medicare Advantage plans with low or $0 monthly premiums. How can they afford to do it? Insurance companies selling Part C agree to provide plan recipients with all of their Part A and Part B Medicare benefits. That’s why when you sign up for Part C, you receive your Part A and Part B benefits through your Part C plan, not through Original Medicare. In exchange for providing these benefits, the federal government agrees to make monthly payments to the insurance company to cover the cost. Some companies make deals with hospitals and doctors for reduced rates—savings they often pass on to their members. This is how Medicare Advantage plans can offer additional benefits above and beyond Original Medicare, like dental, vision, and eye care, as well as senior fitness programs.
You Monthly Premium Is Only Part of Your Cost
A Part C plan with no monthly premium may be right for you, but it’s often not the most cost-effective solution. Why? It has to do with other expenses—deductibles, copays, and even out-of-pocket maximums. The monthly premium is only part of your costs and you should look carefully at the specifics of each plan to determine what you will be expected to pay.
Other Factors That Impact How Much You Pay for Medicare Advantage
Despite zero premium plans, most people with Medicare Advantage do pay a monthly premium. Here are some other factors to consider, in addition to premiums, that impact how much you pay for Medicare Advantage.
Whether or not your plan pays your Part B premium.
The amount of your deductible.
How much do you pay for each visit or service (copayment, coinsurance)?
The type of plan you have and if you use in-network providers or go out of network for care.
The plan’s out-of-pocket maximum.
Of course, the type of health care you need and how frequently you receive it also plays a role in how much you ultimately spend for health care with a Medicare Advantage plan.
References:
Medicare Advantage Costs https://www.medicare.gov/your-medicare-costs/medicare-health-plan-costs/costs-for-medicare-advantage-plans.html
CMS.gov https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Fast-Facts/index.html
Medicare Advantage Costs and Facts https://www.medicareinteractive.org/get-answers/overview-of-medicare-health-coverage-options/medicare-advantage-plan-overview/what-is-a-medicare-advantage-plan
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