CDIS Blog
After enrolling in Medicare, you still need to decide how you want to receive your benefits and whether or not you need extra coverage beyond Part A and Part B. The good news is, you have choices. You can stay with Original Medicare and join a Medicare Supplement Insurance Plan for help with out-of-pocket expenses. Or, you can join a Medicare Advantage plan and receive all of your Part A and Part B plus extra benefits through one complete plan. Medicare Supplement plans cannot be combined with Medicare Advantage. Taking some time to understand the differences between the two will help you make an informed decision about your health care.
Medicare Supplement
Medicare Supplement, sometimes called “Medigap”, is offered through private insurance companies to “supplement” Medicare. A Medigap plan can help you pay for costs not covered by Original Medicare, like deductibles, copayments, and coinsurance. There are no networks and you are free to use any doctor or healthcare provider you choose who accepts Medicare.
Plans are standardized. Plans are identified by letters of the alphabet and are standardized by the federal government. That means a Plan A in one state must offer the same minimum benefits as a Plan A in another state. However, they don’t have to charge the same—and they don’t.
Cost varies between plans. You must have Part A and B to be eligible to join a plan. In addition to a monthly premium, you will be responsible for paying your Part B premium.
Plans do not offer prescription drug coverage. If you need drug benefits, you must enroll in a stand-alone prescription drug plan offered through Medicare.
Help with costs. Deductibles, premiums, and copayments can be costly, and the right Medigap plan can shoulder many of these out-of-pocket costs.
Medicare Advantage
Medicare Advantage, also called Part C, is offered through private insurance companies approved by Medicare. When you join an MA plan, you still have Medicare, but receive your Part A and Part B benefits through your Part C plan.
Additional benefits beyond Original Medicare. Medicare Advantage provides additional benefits beyond Original Medicare. While each plan is different, most include prescription drug coverage, and many include benefits for dental and vision care.
An all-in-one solution. Part C coverage is a comprehensive Medicare solution, providing all of your traditional benefits, plus extras in one complete plan.
Each plan is different. Different MA plans have different rules for how you receive your benefits. With some plans, you must use doctors and hospitals within the plan’s network and may need to get a referral to see a specialist.
Cost varies between plans. Comparing plans is the only way to find the perfect combination of cost and benefits. With an MA plan, you will still need to pay your Part B premium, although many plans offer low or zero monthly premiums.
Important to Remember
Both Medicare Supplement and Medicare Advantage can help you secure the benefits you need and deserve. Remember, Medicare Supplement insurance helps with out-of-pocket expenses but does not typically provide coverage for services beyond Original Medicare. If you need dentures or a new pair of eyeglasses, your Medigap plan will not help. Medicare Advantage does provide additional benefits beyond Part A and Part B, but cannot be combined with Medicare Supplement.
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References:
Medicare Advantage: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html
Medicare Supplement: https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html
Extra: https://www.medicare.gov/supplement-other-insurance/medigap/medigap-and-medicare-advantage/medigap-and-medicare-advantage-plans.html
CDIS Blog
Seniors suffering from a debilitating chronic health condition may be eligible to join a Medicare-approved Special Needs Plan (SNP). An SNP provides additional benefits above and beyond Original Medicare, offering seniors with special care requirements the treatment and services they need. What is a Special Needs Plan and who qualifies? The following information can help you understand eligibility requirements and plan details to determine if a Medicare Special Needs Plan is the right choice for you.
Special Needs Plan
Treatment of certain chronic health conditions such as cancer or dementia may require additional services above and beyond that which Medicare provides. For many seniors, the extra cost associated with treatment is a burden and Special Needs Plans address these concerns. Most benefits provided by an SNP are paid in full for recipients who are enrolled in both Medicare and Medicaid. However, for seniors who do not qualify for Medicaid, participating in an SNP costs about the same as enrollment in a typical Medicare Advantage plan.
Eligibility Requirements
To be eligible to join a Medicare Special Needs Plan, you must be enrolled in Medicare Part A and Part B, reside in the plan’s service area, and meet specific medical requirements. Seniors with a disabling chronic condition or who live in a nursing home, require in-home care or currently receive both Medicare and Medicaid benefits may qualify. SNPs may not be available in all states as insurance companies providing benefits decide which counties will offer coverage.
What Qualifies as a Chronic Condition?
Many seniors face chronic health conditions with age. However, to qualify for a Special Needs Plan, seniors must have one or more of the following chronic conditions:
Alcohol or drug dependence
Hematologic disorder
Autoimmune disorder
HIV/Aids
Cancer
Chronic lung disorder
Cardiovascular disorder
Disabling mental health conditions
Chronic heart failure
Neurologic disorder
Dementia
Stroke
Diabetes
End-stage liver disease
Is a Medicare Special Needs Plan Right For You?
Navigating Medicare and available benefits can be challenging, and it’s always a good strategy to learn as much as you can about all programs that may be able to help. If you are suffering from a chronic condition, an SNP may be the right choice. With an increased network of providers who specialize in treating your condition and additional benefits, getting the care you need and deserve may be easier than you realize.
References:
https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/special-needs-plans.html
https://www.medicare.gov/Pubs/pdf/11302.pdf
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CDIS Blog
Medicare Supplement insurance (also called Medigap) offers seniors coverage for out-of-pocket expenses associated with Medicare like copays and coinsurance, and even deductibles. The right Medicare Supplement Insurance plan adds to Original Medicare coverage, giving you peace of mind and confidence that when you need medical care, you can get it.
How Plans Work
Medicare Supplement insurance is a supplement to Medicare Parts A and B, meaning you’re still in the Medicare program, but have coverage for expenses that Original Medicare does not cover, like traditional out-of-pocket costs many seniors struggle with.
Eligibility Requirements
To be eligible to join a Medicare Supplement insurance plan, you must be enrolled in Medicare Part A and Part B. Medigap is a guaranteed issue, during your initial enrollment period, meaning even with medical complications, you cannot be turned down. Plus, if you continue to pay your premium on time, your Medicare Supplement plan is renewable, even if you develop health problems.
Choosing the Best Plan
Medicare Supplement insurance plans in Oklahoma are offered through private insurance companies. Plans are standardized, meaning a plan “A” offered from one company must provide the same minimum benefits as a plan “A” from another company. However, price does not need to be the same and there is great variance between companies on not only cost, but also, trustworthiness, dependability, and reputation. If you’re considering your options with Medigap coverage, be sure to consider reliability and affordability as important factors in choosing a provider.
References:
www.medicare.gov
www.bcbsok.com
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CDIS Blog
If you’re looking to secure a Medicare-approved healthcare plan, do you know when you are eligible to enroll? Take a few minutes to understand your enrollment period, and avoid missing your deadline, or having to pay a penalty.
When You First Join Medicare – 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.
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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CDIS Blog
While the Affordable Care Act (ACA) was signed into law in 2010, there is still confusion, particularly in the senior community about how the healthcare law impacts Medicare coverage. Finding answers about the relationship between the ACA and Medicare is a smart way to ensure you make informed decisions about your healthcare now and in the future. How does the Affordable Care Act affect seniors and will Medicare change under the new healthcare law? Here are some answers that can help.
The ACA Is Not Replacing Medicare Coverage
The new law established a Health Insurance Marketplace (online exchange) where consumers can go to purchase healthcare coverage. Many seniors are concerned that they are now obligated to purchase coverage through the Marketplace. Here are the facts: Medicare isn’t part of the Marketplace. If you are enrolled in Original Medicare or have a Medicare Advantage plan, your coverage will stay the same and you will never need to obtain your benefits through online exchanges. It is against the law for anyone to knowingly sell you a health insurance plan through the Marketplace if you are currently enrolled in Medicare.
Medicare Is “Essential Coverage” – No Additional Health Insurance Is Needed
The individual mandate as described by the ACA can be confusing. While it is true that some people who are uninsured or underinsured will be required to pay a penalty, seniors on Medicare do not have to worry. Medicare is considered “essential coverage” and recipients will not be required to add healthcare coverage to an existing plan. Since most seniors are eligible for Medicare coverage at 65, as long as you are enrolled, you will not be responsible for paying a fee under the Affordable Care Act.
Preventive Care Coverage Under Medicare Has Expanded
Passage of the Affordable Care Act also means more services for seniors on Medicare, particularly preventive care. Medicare is now required to cover a host of services at no additional cost to you, including immunizations, mammograms, colonoscopies, annual wellness visits, and more – all without a co-pay.
Changes to Medicare Prescription Drug Coverage
The coverage gap, also called the “donut hole” that many seniors experience with prescription drug coverage can make it challenging to afford medication. Provisions of the Affordable Care Act require Medicare to pay more, which reduces costs for seniors entering the gap. The ACA plans to eliminate the donut hole by 2020, but until then, seniors enjoy a 55 percent discount on covered brand name prescriptions and a 35 percent discount on generic drugs until out-of-pocket limits have been reached. While prescription drug costs have decreased for most recipients, costs have increased slightly for individuals who earn more than $85,000 and couples earning $170,000 or more.
The Affordable Care Act has made important changes to healthcare and it’s important to understand how the law impacts you and your Medicare coverage.
References:
https://www.medicare.gov/Pubs/pdf/11493.pdf
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