But, let’s start somewhere! So, number one can be: “listening to friends, family and others” about what to do for YOUR Medicare selections.
This is always sort of crazy. Medicare is the farthest thing from “one size fits all” but so many people come to us and say “my sister said I should… my friend said… everybody says my card will show up so I don’t have to do anything.”. On and on.
A client once said to me “everybody says this or that will happen if you don’t do this or that. They make you so paranoid to do or not do something. BUT, I don’t even know who THEY are!”
Isn’t that the truth. “THEY” is the world. You have to tune THEY out.
Our suggestion to get past this is pretty basic. Get some lead time (six to nine months before you turn 65), take some time to digest pieces of information , literally write out questions that you have on a piece of paper, schedule a time to talk to our advisors and I can just about promise you that you’ll arrive into the Medicare system less stressed than you would have imagined.
We know that you spend time with friends, family and others that tell you what they’re doing. You’re comparing Medicare plans over cocktails on Friday evening these days. We get it. Take it all with a grain of salt and come to your phone call with us with your list of questions. “My sister said this… I saw this on TV… how can that be free”. With Medicare – understand what you’re doing and why you’re doing it. Why you purchased that plan. How it works. Don’t just listen to the crowds. It’s a really important thing to get right.
Thus, start early. Call us at 64.5 years old.
After you start researching and taking into account what friends and family, temper that with some research and learning of your own…. What often trips people up related to Medicare is not understanding that you have a choice of WHICH PATH you choose to get your Medicare coverage through.
What does that mean? Pull out your 2020 Medicare & You Handbook from the government or use the link here. Go to pages 6 and 7. You’ll see here that, here in the official Medicare handbook, it’s telling you that you have a CHOICE to make.
If you go that route? Medicare is simply your primary insurance company. They will pay 80% of Medicare approved charges. What about the 20%? If you don’t buy a Medigap contract, you will pay the entire 20% (not recommended one iota!) If you purchase a Medigap policy, the bill for the 20% will go to the carrier that you purchased the policy through. Lastly, you’ll add a drug plan (Part D) and that will round out your coverage.
With Original Medicare and Medigap, your network is the entire U.S. That means any doctor, facility, hospital and more that accepts Medicare. Those are the places you can go and physicians you may see. Co-pays, co-insurance, etc? Depends on your plan. With a Plan G you will have an annual $198 deductible. That’s it. After that? You pay zero.
Path Number Two. The RIGHT side of page 6 and 7 in the handbook…. You can enroll into a Medicare Advantage plan.
These are plans that you will re-enroll into annually. You are signing up for an insurance carrier to manage your healthcare and deliver such services to you. They can be “free” plans (yes, zero premium each month). Carriers can add dental coverage (teeth cleanings, for example) and additional benefits into the plan. Carriers must provide at a minimum the services that Medicare’s Part A and Part B cover. After that?
These are the plans that you see advertised on TV as “zero cost to you”.
Understand that you will always pay your Part B premium to the government each month. Very simplistically, the government contracts with an insurance carrier each month to manage your care. This not mean that you will no longer pay for Medicare’s Part B as is commonly misunderstood.
You will have networks, co-pays, co-insurance and more. Annually you must check with your doctors to be sure that they accept your plan for the new plan year. Know your co-pays and co-insurance amounts. You may have to deal with pre-authorizations and such depending on your plan.
Remember, to get a ‘free’ plan, there can be a tradeoff and/or limitations. If you can accept that? Then it could be a good plan for you. It’s important to understand all of the details in these plans.
At the end of the day, the consumer is owed the CHOICE of plans. So hear of agents that do not explain clearly that you may choose between Medigap and Medicare Advantage. Take your time to learn the differences and determine what fits you best.
Often, at our seminars, people come up and say “I’ve never heard the word Medigap before”.
That’s just plain wrong. Finding out later when it may not be available to you, isn’t right. (see #4 re: pre-existing conditions)
This is a big one. Poor timing in regards to enrolling into Medicare’s Part B.
There’s an awful lot of confusion as to WHEN to enroll into Part B. Many people actually become enrolled into Part B and they have no idea that it happened (yes, for real).
When you enroll into Part B of Medicare can have impacts on other areas of your world. Your finances (you are now paying for Part B whether you notice it or not!), your insurability (yes, it can have an impact on product choice and insurability down the road) and more.
NOTE: the only time that a person is automatically enrolled into Medicare’s Parts A and B, is when that person is collecting Social Security benefits prior to turning age 65. Example. You are 63 years old and decide to collect your benefits. A few months before you turn 65 years old, your red, white and blue Medicare card will arrive in your mail. The card will have an identifier number on it for you and will show you a date for your hospital and medical coverage beginning 5/1/2020 for example.
In May, you will then begin seeing a monthly debit of $144.60 (2020 figures) from that social security check. You indeed do have Medicare’s Part A and B whether you realize it or not! We will definitely come across folks that tell us that they do not have Medicare… but they have the ID card and when they check their statements, they are paying “for something”. You have Medicare.
Those not getting Social Security benefits? You have to be proactive about signing up. We help you figure out if you need to go into a Social Security office or can file for benefits online. WHEN you add Part B of Medicare into your world is a big deal kind of decision.
Think of Part B coverage as the medical coverage that it is. It’s simply coverage that you are eligible for from the US government. Nothing super magical; it’s coverage. You can buy it from the government, buy it from a carrier, obtain it through an employer, etc.
Whether you NEED to have Part B coverage is that whole “process thing” that we talk about. Deciding whether you need it, should get it, shouldn’t get it —-> those are truly the big deal types of decisions that we help people with.
There’s too much to discuss here but know this very important part. When a person is NEW to Medicare’s Part B coverage (regardless of age, you can be age 74 and just starting your Part B coverage), that person has a six month window where they can purchase any Medigap plan that they’d like without revealing anything about their health to an insurance carrier. For people with significant pre-existing conditions, this is really important to be aware of.
So, if you went along and just happened to get Part B and didn’t quite realize it… and a few years later you would really like to purchase a Medigap policy but had a cancer diagnosis… depending on what type of coverage you have at the time beyond your Part B starting date… you may not be able to purchase the Medigap contract.
Point being: Call us before you turn 65 so that we can help you do the right thing.
We, as a population, are generally conditioned by the ACA (Affordable Care Act) and employer insurance to believe that pre-existing conditions are not a factor in securing health insurance coverage.
While true during those years, things do change when you are Medicare eligible.
John came to our seminar. He was 68 years old at the time. He’d been enrolled into Medicare for his insurance coverage since age 65. He also had chosen a Medicare Advantage plan. He told us after our seminar that he had never heard of the word “Medigap”. Since he had been dealing with cancer and incurring more costs than he had anticipated, he wanted to purchase a Medigap contract.
He could not do so. He had been on Medicare’s Part B for over six months. He’d been enrolled into a Medicare Advantage plan for over 12 months (special rules apply there as well). It was too late for him to purchase a Medigap contract. See Number Two above. The seminars that John had attended prior to ours and the agent that had enrolled him into his current plan had not been clear that Medigap was another option for him.
We try and help people see that some of the decisions that you make at age 65 can have long term impacts on your choice of coverage.
Now, all 65 year olds have pre-existing conditions. If you take Atorvastatin and Lisinopril? Those are not the pre-existing conditions that we are referring to. Cancer diagnosis, a stent placed 6 six weeks ago, early onset of dementia? You shall be declined.
So, how do you protect yourself? You take your time in learning Medicare. You take this on as a process to get enrolled in the right things at the right time. You find good help to do the above. See Number Five next…
And, number five… If Medicare is such a PROCESS, how in the world do you start and get through it properly?
We’ll tell you that is exactly the question we faced when we created our agency.
We saw that financial advisors, human resources, your friends, family, your CPA, the Social Security office and more didn’t always have the correct answer for you regarding Medicare. Or, they didn’t have ANY answer for you. Your traditional health insurance person didn’t quite have a grasp of the nuances of Medicare. The postcards are flying into your mailbox and the phones are soliciting you like mad. How do you figure out what to do and tune much of the noise out.
Well, all we can say is find the best help that you can (easier said than done; we know)