CDIS 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 Medicare Advantage 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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CDIS Blog
There are many reasons why you may want to switch your current Medicare Supplement policy. 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.
When You Can Switch
Regardless if you’ve already decided to switch your policy, you can’t unless certain conditions apply. To switch your 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 insurance 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 Medicare Supplement insurance 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 Medicare Supplement insurance open enrollment period ends, your guaranteed issue right 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 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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CDIS Blog
If you’ve done the research and you’ve decided that a Medicare Supplement Plan fits your needs best, great! The right 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.
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?
Other times when you may have a guaranteed issue right:
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.
During Medicare 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.
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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CDIS Blog
For many women age 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 of a screening mammogram once every 12 months and 80 percent of 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).
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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CDIS Blog
For men on Medicare, being proactive about health is easy, as the program covers many preventive services and screenings at little or no cost. Medicare covers a variety of preventive services and screening 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
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