Everyday 10,000 new Americans become eligible for Medicare. Below are five common mistakes that Medicare beneficiaries make. Visit Trusty.care and use one of our helpful tools to check for Medicare eligibility, calculate your initial enrollment period, special enrollment period and penalties.
1. Misunderstanding the Part ABC&Ds of Medicare
Part A — Hospital insurance that pays for inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care. If you or your spouse have worked and paid taxes to Medicare for at least 40 quarters (10 years) Part A will be free. If you do not have enough working quarters, Part A will have a premium you will be required to pay.
Part B — Medicare medical insurance that helps pay for doctors’ services, outpatient hospital care, durable medical equipment, and some medical services that are not covered by Part A. There is a premium for Part B ($183 in 2018). Medicare will typically pay 80% of the Medicare approved cost, and you will pay 20%, unless you have a supplemental insurance policy that helps to cover these out of pocket expenses. There is no cap to your out-of-pocket expenses, so supplemental insurance is important to consider.
Part C — Medicare Advantage plans are sometimes referred to as Medicare Part C and are offered by private insurance companies approved by Medicare. You must be enrolled in both Part A and Part B to join a Medicare Advantage plan. You’ll still be in the Medicare program, but you will receive your benefits through the plan instead of through Original Medicare. These plans are required to cover all of the same services as Original Medicare (Part A and B), but they may charge lower co-pays. Also, at the plan’s discretion, they may offer Part D drug coverage, as well as some extras like routine vision and hearing care. You may pay a monthly premium for a Medicare Advantage plan, in addition to your Part B premium. However some MA plans do not charge premiums of their own. (Medicare Advantage plans may restrict your choice of doctors and other providers, and charge higher co-pays if you receive care out of network).
Part D — helps to pay for prescription medications that you may use at home. This coverage can come in one of two ways: by joining a private stand-alone Part D Drug plan and paying an additional monthly premium OR by enrolling in a MA plan that includes Part D coverage in its benefit package.
2. Medicare is not automatic for most people
Most people think Medicare is automatic…but for most people it isn’t. Understanding the difference between Initial Enrollment Period (IEP) and Open Enrollment Period (OEP) is critical to avoiding lifetime penalties and medical underwriting.
The Initial Enrollment Period is the first chance you have to enroll in Medicare Part B. Your Initial Enrollment Period starts three months before you turn 65, includes your birthday month and three months after (7 months).
Open Enrollment Period is a one-time-only six month period when you can buy any Medigap (supplemental insurance) policy you want that is sold in your state. It starts in the first month that you are covered under Medicare Part B and you are age 65 or older. During this period, you can’t be denied coverage or charged more due to past or present health problems.
3. Understanding “current” employment versus other types of inactive employer coverage as it relates to Medicare Part B enrollment rules
“Current” employment is a status for people who are actively working and receiving employer coverage. People who are not actively working and continue to receive employer coverage (i.e. retirement coverage, COBRA) would not meet the criteria for the Part B Special Enrollment Period (SEP). Part B SEP allows you to sign up for Part B without penalty after your Initial Enrollment Period.
4. Using an out-of-network provider in an in-network facility Calls about denials for physician services comprise 40% of the overall denials of coverage for Medicare Advantage plans. People routinely use in-network facilities only to find that providers are not always in their plan’s network. Despite the protections for people with Medicare who use emergency services, plans continue to deny coverage due to out of network providers. Make sure the physician that attends to you is in in-network even though you are in an in-network facility.
5. Failing to Read Your Plans Annual Notice of Change
Providers of Medicare Advantage and Part D prescription drug plans will mail to beneficiaries an Annual Notice of Change to their plans every September. This notice will list any plan changes in regards to coverage and costs for the next year. You will have the opportunity to compare plans and switch during Open Enrollment (October 15th to December 7th) if you choose.
By Gus Smith Trusty.Care, your trusted partner for all your Medicare decisions
Medicare mistakes can have severe financial and healthcare consequences, especially when you miss a deadline or sign up for the wrong plan. The streamlined Trusty.care platform helps you easily identify and sign up for the right plan, and optimize your health coverage for life.