Joel Mekler | Medicare Moments: ‘I wish I had known; nobody told me’ | Lifestyles


Frank Sinatra may have had too few regrets to mention them. However, this is not the case for Medicare beneficiaries.

I get countless calls from beneficiaries wanting to know more about one thing or another about Medicare. And this is expressed even by people who consider themselves to be otherwise intelligent and knowledgeable. What people don’t know about Medicare can cost them dearly.

In today’s article, I want to go over some of the top things recipients get wrong in hopes that you can learn from their mistakes.

I wish I had researched the pros and cons of zero premium Medicare Advantage plans. When comparing Medicare Advantage (MA) plans, one of the first things most people look at is the monthly premium. And that makes sense. It’s always disappointing to find a good plan that includes all your doctors and medications and offers great added benefits – only to find that its price is way over your budget.

On the opposite end of the spectrum is the $0 Medicare Advantage plan. It sounds like a unicorn, but in reality, about 90% of people have access to a zero-premium Medicare Advantage plan. So, are zero-premium Medicare Advantage plans free? No, zero premium Medicare Advantage plans are not free; they have no monthly premium. Other costs you are likely to incur include:

• Deductibles: This is the amount you must pay out of pocket before your plan starts paying its share. Depending on the plan, you may have separate deductibles for medical care and prescriptions.

• Co-payments: This is a fixed amount that you pay at the time of service. Depending on the plan, you may have higher copayments for different types of care, especially if you have a PPO, which covers out-of-network care for a higher cost.

• Coinsurance: Some Advantage plans charge coinsurance instead of a copayment. The difference is that coinsurance is a percentage of the total cost. So instead of a flat $20 co-payment for a doctor’s appointment, you could pay 20% of the price of the service. (This is part of Medicare’s cost-sharing model.)

• Maximum payout: Also known as MOOP, the annual maximum payout varies by plan but cannot exceed $7,550. (The 2022 average is about $5,100.) There is no MOOP with Original Medicare.

And always remember: you still owe the Medicare Part B premium ($170.10 in 2022), even if your Advantage plan also carries a monthly premium. The insurance company is reimbursed for providing your Medicare benefits, even if your MA plan is premium-free.

The good news is that 90% of people enrolled in an MA-PD have access to a plan with a $0 premium. Interestingly, however, only about 56% of people who had the option chose a no-premium MA-PD plan. The others opted for plans with a monthly premium. It’s not that surprising: I always recommend people look beyond the monthly premium to determine the true cost of a plan and make sure it offers the kinds of benefits you want and need. you need. Remember that free isn’t always free with some Medicare Advantage plans.

I would like to not miss my initial Medicare enrollment period. Medicare has specific enrollment periods that govern when you can enroll in, change, or opt out of certain coverages. There is an initial seven-month enrollment period for people who need Medicare when they turn 65, including three months before age 65, the month of your birthday, and three months after. The window applies to Parts A through D. Keep in mind that in general, you must have Parts A and B before purchasing other types of health insurance.

For example, if your birthday is in September, you can enroll in Medicare anytime from June through December. Please note that your Medicare coverage may still begin within the enrollment window at different times. If you enroll from June to August, your coverage will begin in September. If you register in September, it will start on October 1st. But if you sign up later, there may be longer coverage gaps. In this example, the coverage date is December 1 for October subscriptions, January 1 for November subscriptions, and February 1 for December subscriptions.

If for any reason you missed registering for Part A or B during the initial registration period, there is also a general registration period from January 1 to March 31 each year. However, in most cases, coverage will not come into effect until July 1. Waiting after initial registration could result in lifetime surcharges for late registration in Parts B and D.

The Part B penalty is 10% for each full year of delay; Part D penalty is 1% per month. These are cumulative penalties. Worse, perhaps, than the penalties, late registrations can leave you without primary health insurance for an extended period.

How to avoid these penalties? The first step is to take nothing for granted as you approach your 65th birthday. Suppose you are already collecting social security benefits when you turn 65. In this case, you will automatically be enrolled in Parts A and B and will receive a Medicare card approximately two months before your 65th birthday. At age 65 or older, if you have – yourself or through your spouse or even ex-spouse – an active employer group health insurance policy, you generally do not need register for Medicare Part B. But if you are not receiving Social Security benefits and do not have an active employer group health insurance policy, you must register for Medicare benefits with Social Security Administration.

I wish I didn’t miss the annual Medicare Open Enrollment Period. Open enrollment, which runs between Oct. 15 and Dec. 7 each year, is the annual equivalent of a Medicare overhaul. Ideally, consumers can roll up their sleeves to compare products and make changes to get the best prices and coverage. But a new study from the Kaiser Family Foundation found that 57% of people don’t review or compare their coverage options every year, including 46% who “never” or “rarely” review their plans. Surprisingly, two-thirds of beneficiaries age 85 or older do not review their coverage every year, and up to 33% of this age group say they never do. People with poor health or low income or education are less likely to shop.

This indifference cannot be attributed to a lack of information. Each September, Medicare sends an Annual Notice of Change document (by mail or email), which lists changes to a person’s current coverage for the coming year, such as premium and co-payments. Medicare also sends out a thick manual, “Medicare & You,” with detailed information about plan options. Insurance companies flood the airwaves and mailboxes with advertisements and brochures.

Why don’t the beneficiaries do it? Complexity is a crucial issue. Kaiser found that 30% of enrollees said the Medicare program was either “fairly difficult” or “very difficult” to understand, and these percentages were higher among Medicare beneficiaries with disabilities. Once you enroll in Medicare, you can’t afford to “set it and forget it.” If you’re not comfortable using the internet to look up plans or don’t have internet access, the PA-MEDI (formerly APPRISE) is here. PA-MEDI is administered by the Pennsylvania Department of Aging and provides free individual Medicare counseling and assistance in every state and county.

I would like to know that Medigap insurers may not have to sell you a policy if you do not purchase one the first time you are eligible. If you’re starting with Medicare Advantage and want more choices later, you can technically upgrade to Original Medicare. But you’ll likely encounter a problem that will make it impractical or impossible if you have a serious illness or pre-existing condition.

The best time to purchase a Medigap policy is during your six-month Medigap open enrollment period. This is when you usually get better prices and more font choices. You can buy any Medigap policy sold in your state during this time, even if you have medical conditions. The period automatically begins the first month you receive Medicare Part B and are age 65 or older. It cannot be modified or repeated. After this enrollment period, you may not be able to purchase a Medigap policy, or if you are able to purchase one, it may cost more due to past or present health issues.

(Joel Mekler is a Certified Senior Counselor. Send your Medicare questions to him at [email protected])


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