CDIS Blog
Now that you’ve decided to join Medicare Advantage (Part C) as a way to receive your Medicare benefits, you may be wondering when you can enroll. Medicare only allows you to join, switch, or make changes to Part C at very specific times—when you first get Medicare and during yearly enrollment periods. It’s important to know when these specific deadlines occur to avoid missing them and delaying your health care coverage.
Initial Enrollment Period
When you first become eligible to receive Medicare, you enter your Initial Enrollment Period. This is a 7-month period of time that begins 3 months before your 65th birthday, includes your birthday month, and ends 3 months after. For 7 full months, you are in your unique initial enrollment period and can sign up for Medicare Part C. In most cases, this is the best time to join. However, if you didn’t join and you already have Original Medicare, you can still join a Medicare Advantage plan during other enrollment periods.
Other Enrollment Periods
Annual Enrollment extends between October 15 and December 7. During this time, anyone can join, switch, or drop a Medicare Advantage plan. As long as the plan you are requesting receives your information by December 7, your new coverage will begin on January 1. During Annual enrollment, you can:
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.
Special Enrollment periods were created for people to join and make changes to Medicare Part C when circumstances make it difficult for them to meet regular enrollment periods. For instance, if you move, lose your current coverage, have the opportunity to get other coverage, or meet one of several other special situations, you can usually join, switch, or drop a Medicare Advantage plan.
For example, if you are enrolled in Medicare Part C, but move to a new address with better coverage available, you have 2 months to switch plans. If you were living abroad, but are now back in the United States, you have 2 months to join a Medicare Advantage plan. Or, if you lose coverage through an employer (COBRA included) you typically have 2 months to join a Medicare Advantage plan. While many special circumstances may qualify for Special Enrollment, here is a quick summary of the main conditions that meet Special Enrollment criteria:
Move to a new address, move back into the country or move into or out of a nursing home or assisted living facility.
No longer being eligible for Medicaid or extra help, or losing employer coverage.
Has your current Part C plan been terminated by Medicare or not renewed?
When the goal is to spend the least amount of money for the most amount of coverage, you owe it to yourself to get the best deal you can with Medicare Part C. Initial Enrollment is usually the best time to sign up, but once you have coverage, Annual Enrollment (Oct 15 – Dec 7) is a great time to make changes to an existing plan or switch between plans. If you miss the December 7 deadline, you can still drop your current Medicare Advantage plan and return to Original Medicare during Medicare Advantage Disenrollment (Jan 1 – Feb 14). If you leave your plan and return to Original Medicare, you have until February 14 to join a prescription drug plan. However, you may not switch from Original Medicare to a Medicare Advantage plan or switch between Medicare Advantage plans during this time
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
https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances/join-plan-special-circumstances.html#collapse-3198
MUC56-2017-BCBS
CDIS Blog
Here’s some good news: if you’re turning 65 soon, you’ll also be eligible to join Medicare—a federally funded program that provides hospital and medical insurance to older Americans. Transitioning to Medicare for the first time can be confusing and you’re not alone if you have a few questions. Here’s a great resource to get you started—important tips and things to think about as you plan for Medicare coverage.
Enrollment In Medicare Is Automatic
If you’re worried about how to sign up for Medicare before your birthday, don’t be. Enrollment in Original Medicare (Part A and Part B) is automatic for most seniors. As long as you receive Social Security or Railroad Retirement benefits, you don’t need to do anything at all and your Medicare card will be sent to you by mail. Expect to receive your card 3 months before you turn 65, with benefits beginning on the first day of your birthday month. If you do not receive retirement benefits, you may need to enroll in Medicare manually through the Social Security Administration or Railroad Retirement Board.
Accepting or Opting Out of Part B
While Part A (hospital insurance) is free for most people, Part B (medical insurance) is not. A monthly premium will be deducted from your Social Security check each month you are still working, covered through an employer or a spouse’s employer, you do not need to keep Part B coverage or pay for it. You can opt out of Part B coverage on the back of your membership card.
Important tip: If you opt out of Part B coverage, and do not have comparable coverage through an employer or spouse, you may end up paying a late enrollment penalty when you decide to join.
Initial Enrollment Period
When you first become eligible for Medicare, you enter your Initial Enrollment Period. This is a 7-month period of time beginning 3 months before your birthday month, and extending 3 months after your birthday month. For example, if you were born in July, your Initial Enrollment Period would be April 1 through October 31. This is the time to enroll in Medicare (for those not enrolled automatically) or enhance coverage with additional benefits.
Important tip: If you’re looking to add additional coverage to Original Medicare, your Initial Enrollment Period is the time to do it. If you delay, you may have to wait until the General Enrollment Period (Jan 1-Mar 31) of the following year and may also be charged a late enrollment penalty.
Adding Benefits to Original Medicare
Original Medicare covers much of your health care needs, but it doesn’t cover everything. It’s up to you to decide if you want to enhance coverage with extra benefits and how. Understanding your options will make it easier to choose the perfect complement to your Medicare coverage.
There are only two ways to receive Medicare: through Original Medicare or Medicare Advantage (Part C). Original Medicare provides Part A and Part B. Medicare Advantage Provides Part A, Part B, and additional benefits. Medicare Supplement Insurance and Prescription Drug coverage (Part D) may be added to Original Medicare for additional benefits.
- Medicare Supplement – Helps pay the out-of-pocket expenses associated with Medicare, like deductibles, coinsurance, and copays. While there are no benefits for dental, vision, or prescription drugs, some plans provide coverage while traveling outside of the country. You are responsible for paying a monthly premium for coverage as well as your Part B premium.
- Medicare Advantage – Part C extends Original Medicare by delivering all of your Part A, Part B, and additional benefits from one plan. Dental, vision, and prescription drugs are often covered. If you join a Medicare Advantage plan, you’re still enrolled in Medicare, you simply enhance coverage with extra benefits. You are responsible for paying a monthly premium for Medicare Advantage as well as your Part B premium.
- Prescription Drug Coverage – Part D Original Medicare does not include benefits for prescription drugs. If you wish to add coverage, there are only two ways to do it: join a standalone Part D plan, or join a Medicare Advantage plan that already includes prescription drug benefits.
Important tip: you cannot combine Medicare Supplement and Medicare Advantage benefits. If you’re looking to extend benefits beyond Original Medicare, you need to decide which makes the most sense for your specific needs—extra medical benefits or help with expenses.
Resources:
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/supplement-other-insurance/medigap/whats-medigap.html
Cost of Part B: https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html
MUC47-2017-BCBS
CDIS Blog
With Annual Enrollment just around the corner, seniors everywhere are reviewing their Medicare plans to see if they need to make changes to their healthcare coverage. If you’re new to Medicare, you may be wondering where to start, and how to make sure you are enrolled in the right plan to fit your needs and your budget.
While there are many things to learn as a new Medicare recipient, here’s some help reviewing your coverage before Annual Enrollment.
Review Costs and Benefits for Next Year
As a recipient of Original Medicare (Part A and Part B), you should take the time to look over next year’s costs and benefits to see if Original Medicare will still work for you. Review your Annual Notice of Change, which should arrive by mail in October. If you are not happy with what you see, Annual Enrollment (October 15-December 7) is the time to make changes. Remember, any changes you make during Annual Enrollment will take effect on January 1 of next year.
Check You Prescription Drug Formulary
If prescription medication is a significant part of your medical care, be sure to check the formulary for next year to make sure your needs will still be met. Many times, the formulary (list of covered drugs) changes from year to year. You need to know if your drug is no longer available or will change tiers and become more expensive. This applies to Medicare Part D, as well as prescription drug coverage you may have with a Medicare Advantage plan.
Review Changes in Networks
Many times, benefits and costs stay the same with Medicare Advantage, but networks change from year to year. Be sure to confirm that your doctor is still part of your plan’s care network and that any hospitals you use are still available under the plan. Of course, it’s smart to review a few new plans in your area to see if the same coverage is available at a lower cost to you. If your Medicare Advantage plan includes prescription drug coverage, don’t forget to look over next year’s formulary for changes to drugs, dosage amounts, and pharmacy availability.
Annual Enrollment Does Not Apply to Medicare Supplement
If you have Medicare Supplement insurance (a Medigap policy), Annual Enrollment does not apply. Any changes you wish to make to your Medicare Supplement insurance plan are best made during your unique Medicare Supplement Open Enrollment period.
Medicare Supplement Open Enrollment is not Annual Enrollment.
Medicare Supplement Insurance Open Enrollment begins the first month you turn 65 and enroll in Part B. During these six months, you have a guaranteed issue right, meaning no insurance company can turn you down or charge you more for a Medicare Supplement Insurance Plan.
After your Medicare Supplement insurance Open Enrollment period ends, insurance companies may refuse to sell you a policy and can charge you more for the same policy. If you have a pre-existing health condition, make changes to your policy during your Medicare Supplement Open Enrollment, as you may not be able to get a plan after it ends.
Luckily, if you miss your enrollment period for Medicare Supplement insurance, there are a few exceptions and you may have a guaranteed issue right in some situations. If, for instance, you move out of your plan’s service area or you have Original Medicare and your employer coverage is ending, you will likely have a guaranteed issue right to buy a new policy.
The good news is, if you are happy with your current Medicare coverage, whether it’s a Part D plan, Original Medicare, or a Medicare Advantage plan, you usually are not required to do anything at all. But, it’s always a good idea to take a look and avoid being surprised on January 1.
Resources:
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html#collapse-2283
https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-help-others/Medicare-Open-Enrollment.html
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
MUC67-2017-BCBS
CDIS Blog
If you’ve ever insured a home or vehicle, you’re probably familiar with an insurance deductible. Typically, you pay your deductible once at the beginning of your plan year. With health insurance, for example, you pay for your health care costs until you reach the deductible, and then your health insurance provider pays for any additional care you receive for the remainder of the year. Medicare is slightly different, and plan deductibles are charged not at the beginning of the plan year, but at the beginning of each benefit period. Understanding your benefit period and when it is can help you estimate your costs in the event you need care.
Medicare Benefit Period Explained
The Medicare benefit period is simply the way Original Medicare measures your use of inpatient hospital and skilled nursing facility (SNF) services. Your benefit period begins the day you’re admitted as an inpatient into a hospital or SNF and ends when you have gone 60 days in a row with no inpatient hospital or SNF care.
The benefit period has nothing to do with the calendar year but is based on your medical care needs. It begins on the first day you are admitted into the hospital or SNF and ends 60 days after the last day you receive treatment. For example, if you are admitted into the hospital on May 1 and receive 15 days of treatment, your benefit period would begin on May 1 and end on July 15. If you need to return to the hospital before the 60 days have expired, you will still be in the same benefit period. However, as soon as 60 days have passed with no care, if you return to the hospital, you will start a new benefit period.
While there is no limit to the number of benefit periods you can have or how long each benefit period can last, you must pay the inpatient hospital deductible for each benefit period.
References:
https://www.medicare.gov/glossary/b.html
https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html
https://www.medicare.gov/coverage/skilled-nursing-facility-care.html
https://blog.medicarerights.org/what-is-a-benefit-period/
MUC63-2017-BCBS
CDIS Blog
In addition to Medicare coverage, many seniors carry group insurance through an employer or a spouse’s employer. If you need medical services, which insurance pays first?
Different healthcare plans are called “payers”. You will have a primary payer (the one who pays first) and a secondary payer (the one who pays second). Who pays first and who pays second depends on many things, including, how many employees an employer has if you are retired or still working, and whether or not you are covered under a spouse’s group plan. Understanding how your healthcare coverage works is the key to keeping your out-of-pocket expenses low. Here’s how your Medicare coordinates with other insurance coverage.
If the Employer Has 20 or More Employees, a Group Health Plan Usually Pays First
For companies with over 20 employees, group health coverage typically pays before Medicare. If you are over 65, have Medicare, and are enrolled in coverage through work, your group plan usually pays first. When employer benefits do not cover the entire cost of medical care, the balance is sent to Medicare. Your out-of-pocket costs will vary based on how much of the remaining balance Medicare pays.
If the Employer Has Less Than 20 Employees, Medicare Usually Pays First
If you receive your health benefits through an employer with less than 20 employees, Medicare typically pays first. However, there are instances where your group coverage might pay first if your employer joined with other employers to form a multi-employer plan, and at least 1 employer in the group has 20 or more employees, then group coverage pays first.
If You Receive Retiree Coverage Through a Former Employer, Medicare Usually Pays First
Generally, if you are retired and receiving retiree coverage through a former employer, Medicare pays first and group coverage pays second. However, if you are retired, your spouse is not retired and you are covered under his or her policy with 20 or more employees, group coverage pays first and Medicare pays second.
Additional Things to Consider
Receiving care outside an employer plan’s network can be tricky. In many cases, receiving medical care outside of an employer plan’s network can cause both group coverage and Medicare not to pay. Be careful when considering out-of-network care. Check with your employer plan to ensure they will still pay.
If you do not take your employer’s coverage, coverage through a spouse will pay before Medicare. If you choose not to take employer-offered health care through your work, Medicare will pay for approved services. However, if you have coverage through a spouse, or if your spouse’s employer has over 20 employees, Medicare will not pay first.
If you are receiving COBRA, Medicare typically pays first. Even if you had COBRA benefits before being enrolled in Medicare, Medicare Pays first. If you have Medicare and are 65 or older, and receive COBRA benefits after enrolling in Medicare, Medicare pays first.
Even with a secondary payer, you may have out-of-pocket expenses. The primary payer (whether it’s Medicare or group coverage) doesn’t always pay the full balance owed from medical care. Unfortunately, the secondary payer may not cover all of the remaining costs.
If you choose to delay Part B, group coverage may not be paid until you join Part B. The secondary payer only pays if there are costs the primary insurer doesn’t cover. If you don’t have a primary payer because you chose to delay Part B, group insurance may not pay until you enroll in Part B (to have a primary payer).
References:
https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/which-insurance-pays.html
https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/how-medicare-works-with-other-insurance.html
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