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!

Let’s talk about the top three reasons why so many people choose iHealthcare. We’re at the top of the insurance field and this blog post explains why.

You deserve expert advice from professionals in the insurance field. At iHealthcare, we’re here to make the insurance process easier for you, reducing your stress. If you’re feeling concerned about the insurance process or wanting to learn more, we’re here for you. Feel free to make an appointment to speak with us so we can learn more about your situation and provide you with individualized advice.

We have years of experience

When it comes to insurance, experience is important. It is through the years of experience we have that comes our foundational understanding of various insurance topics. From Medicare to life insurance, we understand policies and can help our clients select the best ones for their individual situations.

You can trust that working with us will lead you down the right path. Insurance can be challenging, so it’s best to work with professionals that understand what they’re talking about.

We specialize in multiple types of insurance

Insurance is a very complicated subject and there’s so much to understand. That’s why we specialize in a wide variety of topics, so that our community has access to the information that they need to make informed choices. Whether you’re looking for health insurance or life insurance, we can help you find the answers that you need.

Our team has professionals that have experience in multiple different areas, so that you can be sure you’re getting the right information. We’re proud of the range of specialties that we have and believe that represents our dedication to our clients and their insurance decisions.

We provide expert advice

When it comes to insurance, we know what you need to know. Our team has the expertise and knowledge to not only answer your questions, but make educated recommendations. This is one of the reasons why so many come to us with their insurance questions. 

If you’re ready to take your insurance to the next step, we’re here to help. Please contact us today to make an appointment so that we can begin discussing which policies might be the right choice for you. Thank you for choosing iHealthcare and working with our team. We look forward to hearing from you and making sure that you have the information you need to continue forward.

Getting health insurance is so important. Making sure that you have the right type of health insurance is one of the best ways to save money and make sure that you have access to the medical care that you need.

Understanding Medicare

Medicare is health insurance that the US government provides. Seniors are the target audience for Medicare, though those with certain disabilities can also apply. Keeping this in mind is important, because Medicare is very specific about eligibility. 

Making sure that you’re eligible for Medicare can be both simple and complex, so it’s best to make sure that you have an insurance agent you can trust. They’ll be able to provide you with further information and make sure that you fill out paperwork correctly. Being able to rely on an insurance agent can greatly reduce your stress and provide you with peace of mind when it comes to enrollment and policy selection.

Medicare is divided up into different parts. Parts A and B are what makes up Original Medicare. Many people choose this option because they want standardized coverage. However, this option does not include prescription drug coverage.

Part D

If someone enrolled in Original Medicare wants prescription drug coverage, then they will need to enroll in Part D. This will provide them with coverage at the pharmacy, which could end up saving individuals thousands of dollars each month. Making sure that you have prescription drug coverage is one of the smartest financial decisions that many people make, so it’s important to keep in mind.

Part D is only available for those that are enrolled in Original Medicare. Medicare Advantage policies typically include prescription drug coverage, so that’s why Part D is not included for that specific type of policy.

Is Part D right for you?

Part D is an extremely important part of Medicare. Many people are relieved to have prescription drug coverage and know that their bills at the pharmacy won’t be too high. If you’re enrolled in Original Medicare and want to choose Part D as well, then speak with an insurance agent who can help you through the enrollment process.

We’re here to provide you with individualized support and make sure that you feel confident about your decisions. Call us today to book an appointment. We look forward to hearing from you and being part of your Medicare journey.