While Medicare helps pay for your health care expenses, it has many guidelines and rules, making it confusing now and then. It turns out that Medicare mistakes are most common in a Medicare member’s first year of coverage. Instead of learning the hard way, you can stay in front of things you shouldn’t do to avoid the common Medicare errors altogether. Here are the 3 costly Medicare mistakes to avoid if you want to make the best decision for your healthcare needs.

Not Enrolling on Time

Delaying Medicare enrollment is one of the most expensive and common Medicare mistakes you can make. As you approach 65, you will want to enroll for Medicare during your Initial Enrollment Period (IEP). This is a 7-month period that starts 3 months before your 65th birthday and extends through the 3 months following your 65th birthday month. You may have to pay late Medicare enrollment penalties for the rest of your life for the failure to sign up for Medicare during your Initial Enrollment Period.

However, it is possible to delay your enrollment if you are eligible for a Special Enrollment Period (SEP). If you fail to enroll during the SEP, you may also incur late fees.

Ignoring Plan Changes

Failing to read your Annual Notice of Change (ANOC) or Evidence of Coverage (EOC) can be costly. These are important documents that Medicare beneficiaries receive in the mail in September if they are enrolled in a Medicare Advantage plan or Medicare Part D prescription drug plan. They state the changes your plan will make to its coverage and cost for the coming year.

Once you have reviewed these documents, you can make the necessary changes during the Annual Enrollment Period (October 15 - December 7). Suppose you are not satisfied with your plan’s changes but fail to use the Annual Enrollment Period to your advantage. In that case, you can be doing more harm than good as you will be sticking with a plan that may cost more and no longer provide the coverage you need.

Receiving Care Outside of Your Plan’s Network

If you opt for the Medicare Advantage plan, you may be required to use the plan’s network of hospitals and doctors to get coverage for your medical expenses. It is vital to make sure your hospitals, doctors, and other providers are covered in your plan annually. You won’t only pay more for seeking healthcare outside of your plan’s networks; all the paperwork will also be your responsibility.

Need Help?

Contact iHealthcare Direct to speak with a licensed and experienced Medicare agent to help address your concerns and find a Medicare plan that fits your coverage and budget needs.

Medicare terms can sometimes seem like an unknown language, but understanding some of the most common Medicare terms can help make it easy for you to navigate through your Medicare options and make an informed decision. We have defined the top 5 Medicare terms you should know as you prepare to choose a Medicare plan that fits your needs.

Benefit Period

This is the set amount of time during which Medicare will pay for Skilled Nursing Facility (SNF) and hospital services. The benefit periods start upon your admission to a hospital or skilled nursing facility. It ends once you have been discharged and didn’t receive any inpatient hospital care for at least 60 days.

In the situation where you are readmitted to a hospital or SNF within the 60-day period, you’ll be in the same benefit period. A new benefit period will start if you are admitted after those 60 days have passed, and you will be subject to the Medicare Part A copays and deductibles.

Cost-Sharing

This refers to the portion of medical services received that you are responsible for paying. Cost-sharing includes a combination of deductibles, copayments, or coinsurance. Medicare Supplement Plans K and L are good examples of cost-sharing plans. Plan K typically covers 50% of out-of-pocket costs, whereas Plan L covers 75%.

Donut Hole

This is also known as the Coverage Gap. This is one drug coverage stage a beneficiary may experience while they are a member of the Medicare Part D plan. This is the period during which there is a gap in the prescription drug coverage provided by Medicare Part D. And you’ll remain in this hole until your out-of-pocket spending meets the predetermined limits.

Formulary

The formulary is referred to as the list of medications that a Prescription Drug Plan covers. The formulary includes both generic and brand name drugs and contains at least two of the most commonly prescribed medications within each drug class.

Initial Enrollment Period

The Initial Enrollment Period (IEP) is the 7-month period you have to enroll in Medicare when you turn 65. The 7-month period starts three months before the month you turn 65 and lasts until three months after you turn 65.  

As you near retirement, you may wish to consult a Medicare professional to become familiar with the Medicare program. This is where we can help. If you have any questions about Medicare, contact iHealthcare Direct today, and we can help you find a plan that suits your needs.

Many individuals have not yet retired when they're eligible for Medicare, so they may still have health insurance coverage. Now that they have hit 65, though, they are also eligible for Medicare as well. Is it possible to have two different health insurances, one of them being Medicare, at the same time?

Yes, it's quite possible to be enrolled in both private insurance and Medicare at the same time. Receiving coverage from both a private insurance company, as well as Medicare, is referred to as a “coordination of benefits.” This coordination of benefits determines if the private insurance provider or Medicare will pay for medical expenses/costs first. The insurance that is required to pay first is the “primary payer.” Medicare can sometimes be deemed the primary payer when it comes to the two insurances. It depends on what type of private insurance coverage you have to fully determine who is the primary payer and who is the secondary payer. 

Once the order of payment is decided, the steps to apply coverage are as such:

• The primary payer, which is sometimes Medicare, pays for any medical services until their coverage limit has been reached.
• Then the secondary payer, which could be the private insurance, finishes up by paying for anything that the primary payer did not cover in the beginning. 

What Different Types Of Coverage Can You Have With Medicare?

If you're still employed but became eligible for Medicare and enrolled during your Initial Enrollment Period, you're allowed to have private health insurance coverage through your employer. You may also still be enrolled on your spouse’s group plan if they're still receiving health insurance from their employer and receive Medicare at the same time.

You're also able to be enrolled in Medicare and COBRA at the same time. COBRA is a plan that allows you, or your spouse, to temporarily keep private health insurance coverage once employment ends. Finally, you can also enroll in TRICARE and Medicare simultaneously. TRICARE is insurance coverage for active military personnel, as well as retired military veterans. It also provides coverage for their dependents. In order to be able to have both TRICARE and Medicare at the same time, you must: 

• Be 65 or older and enrolled in Medicare Part B
• Have a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS), and be enrolled in both Medicare Part A and Part B
• Have Medicare and are a dependent of an active duty service member with TRICARE coverage

Call Us Today

While most individuals that are 65 and older only have Medicare as their primary insurance, there are some who already have insurance but have entered into their Initial Enrollment Period for Medicare and are scared to apply due to active health coverage. But there’s no need to worry! It’s possible to have private health insurance from another provider and still receive health coverage and benefits from Medicare.

To learn more about having other health insurance with Medicare, give us a call today!

Medicare is health insurance that’s primarily made for those 65 and older. It functions as a typical health insurance policy and can save beneficiaries thousands of dollars when it comes to medical costs. Understanding Medicare and the way its coverage works is essential, so let’s go over some of the basics.

There are two main policy options, Medicare Advantage and Original Medicare. Which option you pick will depend on how much flexibility you want your policy to have and the type of coverage you want it to provide. If you want to be able to add additional areas of coverage, then you’ll most likely want to select a Medicare Advantage policy. If you want standardized coverage that includes many basic costs, Original Medicare might be the best choice.

Dual enrollment

Being enrolled in two different health insurance policies, also known as dual enrollment, is entirely possible with Medicare. One of the most common dual enrollments includes both Medicare and Medicaid. This is an excellent option for those that are in a low-income bracket. Eligibility for Medicaid primarily depends on income, while Medicare eligibility primarily depends on age.

Having both policies is a great way to make sure that you’re saving as much money as possible and using your policy to its full extent.

Special Enrollment Periods

Medicare is very specific about enrollment periods. Special Enrollment Periods are granted to those with special circumstances, such as those who have employer health insurance when they would typically enroll in Medicare. Getting a Special Enrollment Period means that you can choose to delay enrollment if that makes the most sense for you.

Maximizing your health insurance policies

Saving money is important, and that’s why Medicare exists. In fact, enrolling in two different policies is one of the best ways to save as much money as possible on your medical bills. Understanding your policies and what they include will help you make educated and intentional decisions to save you as much money as possible.

If you’re curious about ways to maximize your health insurance, it can be helpful to reach out to an insurance agent that can provide you with some answers.

If you’re ready to work with an insurance agent, you can give us a call, and we can set up an appointment. Working with new and existing clients is something we love doing, so we look forward to speaking with you and discussing all of your Medicare options!

Medicare is a federal health insurance program designed to cover medical costs for citizens or legal residents that are 65 years old or older. Some people who are under 65 can also enroll in the program if they meet certain qualifications. 

Medicare consists of various parts. Part A and Part B are known as Original Medicare, while Part C is known as Medicare Advantage. There is also Medicare Part D and Medicare Supplements.

Medicare Part A

Medicare Part A, which is part of what is known as Original Medicare, provides coverage for inpatient hospital services. Beneficiaries who are admitted to a hospital based on a doctor’s order will get coverage for certain hospital costs.

Under Part A, you’ll also get coverage for skilled nursing facility care, hospice care, and some home healthcare services. For beneficiaries who have paid the necessary Medicare taxes while employed, there will also be no premium for Part A.

Medicare Part B

Part B is the second part of Original Medicare. Under Part B, Medicare beneficiaries get coverage for outpatient healthcare services such as preventive screenings, doctor visits, durable medical equipment, and more. Many Medicare enrollees enroll in Part A and Part B to get more coverage for their healthcare expenses. 

In some cases, Part B will also cover certain prescriptions, like immunosuppressants or anticancer drugs.

Medicare Advantage

Medicare Advantage is also called Medicare Part C and covers the same services as Parts A and B. It covers inpatient and outpatient procedures and services like doctor visits, preventive screenings, hospice care, medical equipment, and other medical expenses. 

Most Medicare Advantage plans also include coverage for prescription drugs and extra benefits such as routine hearing, dental, vision, and more. However, to enroll in Medicare Advantage, you must be enrolled in Original Medicare. Also, you must continue to pay your Part B premiums, though some Part C plans may not even have a premium.

Medicare Part D

Medicare Part D provides coverage for at least two drugs in each class or category. These plans are also required to cover most, if not all drugs listed in these specific categories:

• Anticonvulsants
• Antipsychotics
• Anticancer
• Antidepressants
• Immunosuppressants
• HIV/AIDS drugs

Medicare Supplement Plans

Medicare Supplements, also known as Medigap, help to cover the out-of-pocket expenses that Original Medicare does not cover. While each Medigap plan provides different coverage, here is a general idea of what could be covered:

• Coinsurance
• Copayments
• Deductibles
• Excess charges
• Foreign travel emergency care
• Blood transfusions

What Does Medicare Not Cover?

While Medicare does cover quite a bit of services, there are some services that Medicare does not cover, such as acupuncture, cosmetic procedures and medications, and long-term care. This is why it is important to understand what each part covers before you enroll.

To learn more about what each part of Medicare covers and what your options are, reach out to us today by giving us a call at 713-900-1901.