CDIS 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.
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.
Resources:
https://www.ssa.gov/pubs/EN-05-10508.pdf
https://www.medicare.gov/your-medicare-costs/help-paying-costs/extra-help/level-of-extra-help.html
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CDIS 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.
Private Insurance Companies
Private insurance companies often sell Medicare Advantage plans with low or zero 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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CDIS Blog
Each fall, if you are enrolled in a Medicare Advantage plan or a Medicare Prescription Drug Plan (Part D), you will receive a “Plan Annual Notice of Change” (ANOC) in the mail. If this is your first notice, or you’re unsure what you are supposed to do with this information.
Annual Notice of Change
In late September, members of Medicare Advantage and Part D will receive a “Plan Annual Notice of Change”. The ANOC is sent by your plan to inform you of any changes in coverage, costs, or service area that will take effect in January. All Medicare plans are required to send this document no later than September 30, or 15 days before the start of the Annual Enrollment Period. The ANOC is usually mailed with your plan’s Evidence of Coverage (EOC), or documentation that goes into more detail about all of your plan’s cost, coverage, and benefits—beyond any new changes.
Review Changes
In September, when you receive your ANOC in the mail, you should review any changes to make sure your plan will continue to meet your needs for the upcoming year. Plans often make annual changes to costs and benefits, which means that your copay could change, as well as which providers are in-network or out-of-network. When reviewing be sure of the following:
Providers, services, and prescription drugs you use are still available and covered under your plan.
Any out-of-pocket cost for care and services is understood.
If you decide that upcoming changes to your plan will not fit your needs, you may want to change your Medicare coverage during Annual Enrollment (October 15 – December 7). This is your time to review available plans to find one that meets your individual needs best. Of course, if your plan isn’t changing, or new changes will not affect you, you don’t need to do anything at all and you will continue to receive the covered services and care you have now.
Note: If for some reason you do not receive this document by September 30, contact your plan immediately.
References:
https://www.medicare.gov/forms-help-and-resources/mail-about-medicare/plan-annual-notice-of-change.html
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CDIS Blog
For many seniors, Medicare is a big help. It covers a substantial amount of medical bills. But, it wasn’t designed to pay for everything, and it doesn’t. Unfortunately, if you rely exclusively on Medicare to pay your healthcare bills, you could be facing significant out-of-pocket costs. And that’s why some seniors turn to Medicare Supplement, to help shoulder some of these costs. With several different benefits and plans to choose from, finding one that fits your needs isn’t complicated. But if cutting costs is your goal, the money-saving Med-Select option may be the right choice. Here’s how this option can help you save on Medicare Supplement premiums.
Med-Select Option
Medicare Supplement insurance is offered to anyone with Medicare. While each plan is different, some plans are available in both a “standard” option and a reduced premium version, or a Med-Select option. Both the standard and the Med-Select options offer identical benefits but have different restrictions. With Med-Select, you pay a reduced premium in exchange for agreeing to use one of the hospitals in the Medicare Select Network for all of your treatment. Med-Select plan benefits are the same as standard plan benefits, but premiums cost less. For example, if you choose Plan F, either Med-Select or Standard option, your Part B deductible will still be covered, as will any excess charges.
Protect Yourself From the Bills Medicare Won’t Pay
Medicare Select is available as an option only with certain plans, and companies are not required to offer Med-Select with every available Medicare Supplement standard plan. With the Med-Select option, you agree to use one of the Med-Select hospitals for all non-emergency care. If you do not, then you are responsible for paying the Part A deductible and any other non-covered charges. Only certain hospitals are network providers and it’s important to check with your doctor to see if he or she is included. To qualify for the Med-Select option, you must live within 30 miles of a hospital in the Medicare Select Network.
Resources:
https://www.bcbstx.com/medicare/med_select_option.html
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CDIS Blog
Many seniors enjoy warm weather living year-round by maintaining a dual residence or living for part of the year in two different states. The dual residence is nothing new, and “snowbirds” have been fleeing to southern states in winter for generations. But how does dual residence impact your Medicare options, will you still be covered if you live in two states? Here’s some guidance on Medicare and what you should know if you head south for the winter.
Original Medicare Benefits Work Anywhere Within the United States
With Original Medicare (Part A and Part B), you can travel anywhere within the United States and still be covered—as long as you choose providers who accept Medicare. This is good news for anyone planning to spend part of the year in one state and part of the year in another. Whether you are in Florida or Michigan, any doctor or hospital that accepts assignments will honor your Part A and Part B benefits.
While in most cases, Medicare does not cover care you receive outside of the country, it does include:
All 50 states
The District of Columbia
Puerto Rico
The Virgin Islands
Guam, American Samoa
The Northern Mariana Islands
Medicare Supplement Insurance Is Not Restricted By Service Networks
Like Original Medicare, Medicare Supplement Insurance, or Medigap, does not rely on service networks, and as long as the doctor or hospital you choose accepts Medicare, you’re covered. As a senior with homes in two states, you can travel freely with the peace of mind and confidence that when you need medical care, you can get it and your Medicare Supplement Insurance plan will be applied. Note: if you are a dual resident considering Medigap, be sure to compare policies offered by each state to learn about any differences that may impact your coverage.
Medicare Advantage and Part D Plans Don’t Always Extend Across State Lines
For Medicare Part C and D, the rules for out-of-state coverage are different and your plan may not cover your care while you travel within the United States. With many plans, you need to be a permanent resident of the state where you originally enrolled and you must live in the service area of your plan. In some cases, you can receive out-of-network care, but it will likely cost you more money. In addition, your plan may have specific rules you need to follow, such as needing prior authorization before receiving care that can impact your coverage. With all Medicare plans, Original Medicare, Medicare Advantage, and Medigap, you are covered in any state if you need emergency medical care or urgent care out of network.
Resources:
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/switching-plans/switch-medigap-.html#collapse-2514
https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/original-medicare/how-original-medicare-works.html#collapse-3111
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