Ask the Medicare Expert

Fact Checked

Ron Elledge is a Medicare agent, planner, and author. For more than 12 years, Ron has been a seniors’ market insurance agent in Arizona and New Mexico.

Ask Ron Your Medicare Questions

If you’re struggling to understand Medicare benefits, we can help. Ask Ron about how to navigate Medicare and maximize your benefits.






    What’s your Medicare question?

    Note: Questions and answers may be published with your first name. Your email, phone, and location will remain confidential.


     

    The Latest Medicare Questions and Answers

    Accessing Medicare Online

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    Are Aetna’s claim details available through the computer? If so, how do I gain access to this? -Rose

    Hello Rose, there are two options for members to view Medicare claims information: Medicare.gov or Aetnamedicare.com, and both require a personal account. For Aetna-specific claims details log onto the second link and select Login in the upper right corner. Choose the type of Aetna plan you have: Medicare Advantage (MA), Prescription Drug Plan (PDP), or Supplement, and either log in to an existing account or register for a new one. When registering you will be asked for your Aetna member number and some personal information. Once you log in to your personal account you will be able to view previous and current claims details.

    You may also log in to your personal Medicare account (first link above) and view your claims history.

    Medicare is Awesome! Ron

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    Where can I locate my claims on the Medicare website? Thanks. -Diane

    Hi Diane. You must have an account on mymedicare.gov; sign up for one if you do not have one. Once you have logged in to your account, there is a large button “View My Claims” in the top right corner just below the green bar with your information and messages. Click on that button and it will take you to your claims history.

    Ron

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    I have a Medicare ID, but I cannot recall, nor did I bookmark, the Medicare login page. I lost my card and need to order a new card. What is the URL? -Connie

    Connie, the Medicare beneficiary web page is www.MyMedicare.gov. Once logged in you can track your Medicare eligibility, enrollment, current plan status, and more. You will be able to update your personal information and have a new Medicare card sent to you.

    Medicare is Awesome!

    Ron

    Canceled Coverage

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    If my Medicare Advantage Plan (MA Plan) coverage was canceled by an insurer in 2021 due to no fault of my own and unknown to me until after the fact, can I enroll in another plan with the same insurer in 2022? This insurer only offers HMO MA Plans in my area. -Barbara

    Barbara,the only one who will know whether you can enroll in a plan with the carrier that canceled your coverage is the carrier. The first thing to do is call the customer service number on the back of your old Blue Cross card and ask why you were canceled and if you can get reinstated.

    If the company will not allow you to enroll in its plans (this seldom happens), you can enroll in one of several Preferred Provider Organization(PPO) plans offered by different carriers in your zip code. If you research the available PPOs in your area, you will find that there is similar coverage with little difference in copayments. If you treat a PPO like an HMO and stay in the network for all services, you will be fine.

    The easiest place to search and compare plans in your area is at www.medicare.gov; scroll down to the box Find Plans on the right side, then select Continue without logging in. Once there, enter the required information and you will be taken to the MA Plans available in your area.

    If you were canceled and returned to Original Medicare within the past two months, you will have a Special Enrollment Period (SEP) and be able to enroll in a new plan. If you have been on Original Medicare for a longer period, you may have to wait until October to enroll in a new plan with coverage beginning in January. Good luck; start with your old carrier.

    Regards, Ron

    Contacting an Insurance Agent

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    Is it a good idea to use an insurance agent when applying for Medigap and Plan D? -Elka

    Elka, because Medicare is such a confusing and convoluted program, it never hurts to hear from an expert when making decisions.

    When contacting an agent to help you regarding plans to enroll in be sure to ask the following questions: 

    First: Ask the prospective agent if they can represent multiple carriers in your area. If not, they may not be able to offer you the best rates on your policy. In the case of Medicare Supplement (Medigap) plans, the difference in plans offered by different carriers can vary for the same coverage.

    Second: Ask if they charge any fees for their services. Agents represent the carriers and do not work for or represent Medicare itself. Agents are compensated for their services by the carriers they represent. You should not have to pay your agent for their services.

    You can see the available plans in your area by visiting the Medicare Plan Finder. Select Medigap policy only and input the requested simple information.

    Association Member Benefits Advisors have agents throughout the country that can offer counsel and help you with enrollment. They can be contacted at (800) 258-7041.

    You may also contact your State Health Insurance Assistance Program (SHIP). The program offers free counseling on Medicare and health-related issues.

    Best regards, Ron

    Contacting Medicare

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    How do I call Medicare? -Sarah

    Hi Sarah, the type of questions you have will determine who you call. If you are not yet on Medicare or have questions about your enrollment, you will contact the Social Security Administration (SSA) at (800) 773-1213 as it handles Medicare Enrollment or online at https://www.ssa.gov/.

    If you have questions concerning your ongoing coverage and options, you can call the Centers for Medicare and Medicaid Services (CMS) at 1(800) 633-4227 or online at https://www.medicare.gov/.

    Regards, Ron

    Counseling

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    When do you/do you anticipate that Medicare will cover mental health counseling from Licensed Professional Counselors of Mental Health (LPCMHs)? Thank you. -Amy

    Amy, Medicare has covered psychiatrists, psychologists, and clinical social workers since 1989, but does not cover Licensed Professional Counselors (LPCs) or LPCMHs at this time. Their education, training, and practice rights are equivalent to or greater than existing covered providers. And even though they are covered by private sector health plans, they cannot bill Medicare.

    Sorry, but I have learned not to speculate on what the Medicare Program will do in the future, as it is a losing proposition.

    Medicare is Awesome! Ron

    Coverage Appeals

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    How can my patient’s family appeal a Medicare coverage decision? -Krissy

    Hello Krissy, Medicare beneficiaries have the right to appeal any payment decision made by Medicare. There are five levels of appeal available to the beneficiary. It is a simple matter to appeal and the first appeal is often successful. However, how you appeal will depend on whether the patient is enrolled in Original Medicare, with or without a Supplement, or a Medicare Advantage Plan (MA Plan). 

    In-depth information on the appeal process can be found on the Medicare website. However, I suggest you contact your local State Healthcare Insurance Assistance Program (SHIP) office for counsel and clarification. The office offers free counseling on Medicare and health-related issues.

    Don’t give up! A little tenacity when dealing with Medicare and insurance companies will often pay off.

    Dental Coverage

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    I am seeking info on dental coverage with AARP Medicare Advantage (MA)/UnitedHealthcare (UHC) Preferred Provider Organization (PPO). Is there any coverage at all? And if so, what is the coverage? -Janice

    Janice, there are several ways to obtain information on benefits from your current plan:

    First: you should receive a book each year from your carrier, in your case UHC. This book lists all the benefits, costs, and pertinent information concerning coverage, including dental coverage.

    Second: if you are working with an agent, ask them to email or mail you a copy of the Evidence of Coverage (EOC) for your current plan for a detailed look at everything you need to know about your plan, its benefits, how to access them, and much more. 

    Third: You can log on to the carrier (UHC) website and download a copy of the EOC for your plan. You can also call the customer service number on the back of the card and have them explain the benefits and send you a copy of your EOC.

    Fourth: Log ontowww.medicare.gov, scroll down to Find Plans, scroll to Continue without logging in, enter the information asked for, and you will be shown all plans in your area. Scroll to your plan and select Plan Details. Here you will find abbreviated information on your plan’s benefits and in the upper left under the Plan ID select Plan website. Here you can find the Schedule of Benefits (SOB) and the EOC for more information.

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    I need to find a plan that my dentist participates in. -Suzanne

    Hi Suzanne, Medicare Advantage Plans (MA Plans) are the only Medicare Plans with dental coverage currently. Each MA carrier contracts with its own networks of doctors and dentists. This makes it difficult to go to one place to get the information you are requesting. When shopping MA Plans for information on dental coverage, a good place to start is with the Plan Finder on the Medicare website.

    For a list of the in-network dentists in a specific plan, call the customer service number on the back of your insurance card. Many of them will have a listing for dental coverage. Ask for a provider directory or about specific dentists in your area who are contracted. Customer service will be happy to help you locate a dentist in your plan.

    Medicare is awesome, Ron

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    What will Medicare pay if you need dental implants? -Rebeca

    Rebeca, dental implants are not covered by Medicare Part A or Part B. However, some Part C Medicare Advantage Plans (MA Plans) cover routine dental and a portion of the cost for dental implants.

    Medicare is awesome! Ron

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    My wife is going to have Mandibulectomy and Fibula Free Flap Reconstruction for left side jaw cancer. We have Medicare and AARP Plan G supplemental insurance. Is there any coverage after this initial surgery to reconstruct the jaw with bone grafts that can support a denture (i.e. bridge or tooth implants) after the main surgery? -Joseph

    Joseph, the best way to be sure of your coverage for the necessary bone grafts is to have your surgeon file a treatment plan with Medicare and your Supplement Plan, which includes the bone grafts during reconstructive surgery, after which a determination of coverage is rendered. You may also call the AARP Medicare Supplement customer service at 1(800) 850-6807 for information on your coverage options. Also, you can call your local SHIP office that offers free counseling and information for Medicare beneficiaries. If the staff does not have the answer they will find it for you.

    Ron

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    Hi Ron, my wife, 68, has traditional Medicare with a supplemental insurance plan. She has a very limited income and is in need of serious dental work (crowns, etc.) Since there is no low-cost, comprehensive dental coverage that I am aware of, I am hoping that you might know of an affordable way for her to get her teeth repaired. Thanks for your assistance here. -Blessings, Tony

    Tony, neither Original (traditional) Medicare nor Supplement Plans offer dental coverage except in medically necessary circumstances. However, many have dental discount programs that offer considerable savings.

    Many of the Medicare Advantage (MA) Plans include dental coverage, offer extra plans for a fee, or both. But the only MA Plans that have significant coverage for dental are D-SNP Plans designed for low-income individuals. You state that your wife is on a very limited income. If that allows her to qualify for a D-SNP Plan she would have no premiums or copays for medical, dental, or vision coverage. You can check with your state Medicaid office for income limits.

    Some dental plans are offered individually, though they vary by state of residency and may not cover the type of issues your wife has.

    Please check with your State Health Insurance Program (SHIP) office that offers free counseling for your situation.

    Medicare is Awesome! Ron

    Dual Enrollment

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    Can you have both Medicare and Medicaid? -James

    Hi James, yes, you can have both Medicare and Medicaid. If you qualify for both programs those can work very well together. There are Medicare Advantage Plans (MA Plans) that are called Dual Special Needs Plan (D-SNP) which are specially formulated for those qualifying for both programs. If you’re on Medicare and full Medicaid, you may enroll at no cost, and your Part B monthly premium is paid by your state. In addition, most of your medical care, if not all, will be zero copays.

    Regards, Ron

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    I’m getting Medicare and Medicaid starting July 1 and need a Medicare Advantage Plan (MA Plan). -Timothy

    Timothy, thanks for writing. MA Plans can be researched and enrolled in through the Medicare Plan Finder. You will need to enroll in a MA D-SNP Plan, designed to coordinate the coverage of Medicare and Medicaid and offer services at the lowest possible cost to the member. Time is of the essence if you wish to have your D-SNP plan begin on July 1. If you would like help researching the plans in your area, feel free to call on me.

    Medicare is Awesome! Ron

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    I used to have UnitedHealthcare (UHC) when I lived in Chicago and when I moved to Lake Havasu City, Arizona. I loved it. Now that I’m in California, I’m wondering if I can still get over-the-counter benefits here if I sign up for UHC. Although I had Extra Help before I don’t know if I qualify now. Not sure, but I’ll find out soon. That’s my main question. Thanks. -Marti

    Hello, Marti. The UHC DualComplete plan is for dual-eligible individuals with both Medicare and Medicaid (Medi-Cal in California). However, the DualComplete plan is only available in Alameda County in California. One prominent dual-eligible plan in the state is offered by SCAN Health Plan and it has the over-the-counter benefit included. In many California counties, there are other carrier options available for coverage, and everyone should shop carefully before enrolling in a plan.

    Medicare is Awesome! Ron

    Fitness Club Memberships

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    Does my Aetna cover YMCA memberships? -Roger

    Hi Roger. Aetna has two types of Medicare plans available: Supplement and Advantage Plans (MA Plans). Aetna Supplement Plans do not offer gym memberships. However, Aetna MA Plans offer fitness club memberships through SilverSneakers, and many YMCA centers participate. Check out the locations accepting SilverSneakers in your area.

    How cool is Medicare? Ron

    Hearing Benefits

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    Does my plan cover hearing aids? -Robert

    Thanks for your question, Robert. Original Medicare and Medicare Supplement (Medigap) Plans do not cover hearing aids. Most Medicare Advantage Plans (MA Plans) have some degree of hearing aid coverage. However, it is impossible for me to tell you if your plan covers them without knowing which plan you have.

    Ron

    Living Outside of the U.S.

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    I have enrolled in Part A and Part B but have not made payment arrangements yet. My enrollment location is Massachusetts, but I currently split time between Europe and the U.S. I will likely purchase a home in New York in the coming months and live there more than 183 days per year. Since part of the year I live outside the U.S., can I deactivate and activate my plan as required? -Charles

    Hello Charles, the payment schedule for your Part B premium will depend on whether you are receiving Social Security Administration (SSA) retirement benefits. If you are, it will be taken out of your monthly check. If you are not receiving SSA benefits, the agency will bill you on a quarterly basis until such time as enrollment in benefits.

    Medicare A and B do not require residency in the U.S., only citizenship. However, to enroll in Medicare Supplement, Part D Drug, or Part C Medicare Advantage Plans (MA Plans), you must have a U.S. residence and in the case of Part D and Part C, you must maintain your address in the coverage area. Part D and most Part C plans require you to be in the coverage area six months per year.

    When you purchase in New York, your zip code will determine what types of Part C and D will be available to you. Because you will be resident for six months per year you will qualify for all available in your area.

    Good luck, Ron

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    What medical services are covered under Medicare Plan G and Transamerica Plan G outside of the U.S.? Also can you comment on coverage for dialysis outside the U.S.? -Athos

    Athos, because all Medicare Supplement Plans are standardized by letter, in this case, Plan G, the travel coverage will be the same for all Plan G policies no matter what company issues it. The worldwide travel coverage for Plan G covers overseas emergency and urgent care services with five conditions:

    • The insured pays a $250 deductible per year
    • The insured pays 20% of all services covered by Medicare
    • Coverage is limited to $50,000 per lifetime
    • Coverage is only for the first 60 days of each trip out of the U.S. or its territories.
    • All services must be paid for upfront by the insured and reimbursed upon submission of paid receipts.

    Dialysis is covered outside the U.S. only in urgent or emergency situations.

    Medicare is awesome!

    Ron

    Hospice and Palliative Care

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    Can a person get hospice without a firm diagnosis from a doctor? -Valori

    Hi Valori. No, you cannot receive hospice without a diagnosis from a doctor.

    Hospice is covered by Medicare under Part A and it is most often utilized in your home or a facility in which you live. You can also receive care in a hospital for hospice facility.

    There are three basic requirements to be eligible for hospice:

    1. Your regular doctor or a hospice doctor must certify that you’re terminally ill (with a life expectancy of six months or less).
    2. You accept comfort care (palliative care) instead of care to cure your illness.
    3. You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

    All hospice care must take place under the supervision of a Medicare-approved hospice care provider.

    Medicare is Awesome! Ron

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    My husband is in need of palliative care due to dementia and severe neuropathy. He is homebound and does not qualify for a Special Needs (SNP)-type Medicare Advantage (MA) Plan. His right leg to his foot is causing him to be unable to walk and be bedbound; he still needs ongoing therapy twice a week to help slow his dementia with a once a month advanced practice registered nurse (APRN) visit to check on his ongoing medication Rx-needs and catheter change. Do you have a plan that will cover palliative care under the MA program with $0 premium monthly payments? We understand that if you do, the plan will not go into effect until Jan. 1, 2023. Can you help us, please? -Florence

    Florence, palliative care is not covered by Medicare except when a doctor orders hospice care, which can be carried out in a hospital or in-home care. Hospice is covered under Part A of Medicare and coordinates with MA Plans.

    Home health care is offered by Medicare and MA Plans structure it differently. Here is the Medicare coverage allowed by home health services. Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance) cover eligible home health services like these: part-time or “intermittent” skilled nursing care, physical therapy, occupational therapy, speech-language pathology services, and medical social services. Part-time or intermittent home health aide care is only if you’re also getting other skilled services like nursing and/or therapy at the same time.

    These services are ordered by a doctor and normally coordinated by a home health service company.

    For information, call or visit a representative of your local State Health Insurance (SHIP) office, a free service offering Medicare counseling. Local SHIP offices can be found on the national web page.

    Medicare is Awesome! Ron

    Mandatory Medicare

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    Is it mandatory to go on Medicare when you turn 65? -Mary

    Mary, Medicare is not mandatory, but there are penalties for failure to enroll when you first become eligible. For every year you fail to enroll in Part B and are eligible for it, you will incur a 10% penalty. This penalty is recalculated each year by the Social Security Administration (SSA) and is based on the Part B premium at the time.

    Regards, Ron

    Medicare Advantage Plans

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    I am trying to get my mother out of Kaiser. She is currently on the Medicare Advantage Plan (MA Plan). My husband and I use Mercy Medical doctors for care and have been happy. It’s not part of Carefirst but Medicare Advantage Preferred Provider Option (PPO). How do I find out about this plan? How do I go about researching plans and doctors? I want to find a geriatric doctor, a nephrologist, and maybe a vascular doctor. -Judy

    Judy, the first thing to be aware of is the time of year. If your mother does not qualify for a Special Enrollment Period (SEP), she will have to wait until the Annual Enrollment Period (AEP), which runs from Oct. 15 through Dec. 7 of each year, with changes made on Jan. 1. Here’s a list of SEPS available for those on MA Plans.

    If your mother qualifies for a SEP, research the plans available in your area and compare them for the coverage you need. Select “Continue without logging in,” answer a few questions, and access the plans available. If you wish to search for doctors on a particular plan select “plan details,” “plan website,” “benefits and costs,” and “view provider network directory.” Here you can research doctors, clinics, hospitals, and more to see which are in the plan network. Search by the doctors’ names or search doctors by their specialty.

    Medicare is Awesome! Ron

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    What are the Medicare Advantage Plans (MA Plans) in my area with $0 premiums? -Dennis

    Dennis, MA Plans are specific to county and zip code location. Without knowing your county and zip I cannot help you directly with this information. However, you may go to the Medicare Plan Finder and research all plans available in your area. You may also contact me for help with this research.

    Ron

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    How much does my Medicare Advantage Plan (MA Plan) pay for Evenity? -Laurel

    Laurel, Medicare Advantage Plans (MA Plans) are specific to the zip code and county you are located in. Each plan establishes its own formulary which specifies the medications it covers and the cost. However, because Evenity is an injectable drug that is normally administered by your doctor in his office, it will be covered under your Part B benefits. Most MA Plans pay 80% of Part B injectables leaving you with 20%. A quick search online shows Evenity comes with a list price of $1,825 per dose, 20% of that would be $365 per dose. If you call the customer service phone number on the back of your Plan membership card they should be able to tell you the coinsurance amount you will be charged.

    I suggest you check with the manufacturer Amgen to see if you qualify for its Safety Net Program. This program will furnish Evenity at no cost. You can apply online at https://www.amgensafetynetfoundation.com/.

    Medicare is Awesome! Ron

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    I have questions regarding Medicare Advantage Plans (MA Plans) in North Carolina. Hopefully, you may offer help. Thank you. -Santina

    Santina, thank you for writing. MA Plans can only be changed or enrolled in from Oct. 15 through Dec. 7 with coverage beginning Jan. 1. Exceptions to this timeframe include your Initial Election Coverage Period (IECP), which runs from three months before you turn 65 through the third month after you turn 65. Or you have a Special Enrollment Period (SEP) due to special circumstances. Here is a list of SEPs for MA plans.

    MA Plans are subject to geographic areas for coverage and enrollment: usually zip code and county. To help you with any specifics, I would need these items. However, most areas of North Carolina have many carriers and plans available including HMO and Preferred Provider Organization (PPO) plans. Many of the available plans have $0 premium and low copays, low coinsurance, and low maximum out-of-pocket costs.

    Medicare is Awesome, Ron

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    Hello, I am trying to find a Medicare Advantage Plan (MA Plan) that will fit my needs. I am a New Hampshire resident, but my doctors are primarily in Massachusetts, and I would like to keep them. How do I find a provider that will cover my doctors since I live in New Hampshire? Thank you. -Cindy

    Hi Cindy. Because MA Plans have state- and county-specific networks, it is difficult to advise you on which plan would work for you without more information. However, there are a couple of possibilities that can make your situation workable. First, MA Preferred Provider Organization (PPO) plans allow you to go out of network and see a doctor in another state. The doctor must accept Medicare assignment and coverage will come at a substantially higher cost. Second, some PPO plans will allow use of their established network throughout the U.S. If the plans are in the network, you can live in one state and see a doctor in another state and pay in-network pricing. This takes a bit of research, but it can certainly be uncovered. Feel free to contact me with further questions.

    Medicare is Awesome, Ron

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    Does Medicare Advantage (MA Plans) cover nursing home service? Or is it 100 % out-of-pocket? -Chandra

    Chandra, most MA Plans do cover skilled nursing in a nursing home for the first 100 days. Most cover days one through 20 with a $0 copay, a $184 per day copay (2022) for days 21 through 100, and no coverage beginning day 101.

    However, seldom is a person qualified to receive Medicare assistance for the full 100 days. Your doctor, in conjunction with the Centers for Medicare and Medicaid Services (CMS), will determine when the patient has either plateaued or made enough progress to be discharged. In either case (plateau or progress) the patient can be disqualified from skilled nursing coverage. Once the plateau is reached, Medicare considers further confinement as long-term care (LTC), and LTC is not covered by any Medicare parts or plans.

    Download the pamphlet “Medicare Coverage of Skilled Nursing Facility Care.”

    Good luck, Ron

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    I have Medicare and Medicaid both part A and B. I have had Anthem insurance for three months but the customer service is not good so I want to switch to UnitedHealthcare (UHC). I applied but they wrote me that I don’t have Medicaid proof. I sent everything but it was not approved. Where do I request this? -Shaheen

    Shaheen, I assume you have applied for the UHC Dual Complete Plan. This Medicare Advantage Plan (MA Plan) is categorized as a Medicare Dual Special Needs Plan (D-SNP), combining both Medicare and Medicaid for one of the most comprehensive Medicare plans available. The plan has a premium and copays. But if you have the correct level of Medicaid, your state Medicaid steps in and pays the premium and all copays, coinsurance, and deductibles.

    For those over 65, Medicaid recipients fall into three basic categories.

    1. If you qualify as a Qualified Medicare Beneficiary (QMB), your state will pay your Part B premium plus all Medicare premiums, copays, deductibles, and coinsurance not paid by Original Medicare.
    2. If you qualify as a Specified Low-Income Medicare Beneficiary (SLMB), your state will pay only your monthly Medicare Part B premium. You will remain responsible for deductibles, coinsurance, and copayments.
    3. If you are eligible as a Qualifying Individual (QI or QI1), your state will pay all or a portion of your Part B premium but not copayments, coinsurance, or deductibles.

    Qualification is based on income, and all three levels qualify you for Low-Income Subsidy (LIS), which will help with your prescription drug premiums, copayments, and coinsurance.

    Most D-SNP plans, including the UHC Dual Complete Plan, require a person to have QMB status to be eligible for enrollment. In a few counties, the UHC Dual Complete Plan also requires enrollees to have Long-Term Care (LTC), Developmentally Disabled (DD), or DES listed on their card.

    For most Medicare recipients, MA plans can only be changed during the Annual Enrollment period (AEP), which runs from Oct. 15 through Dec. 7 with coverage beginning Jan. 1. Or you can change plans during the MA Open Enrollment Period (MA-OEP) from Jan. 1 through March 31 with coverage beginning July 1. If you are a Medicare and Medicaid recipient, you can change any MA Plan one time during each of the first three quarters of the year. For the last quarter of the year you must use the AEP.

    If you send me your county name and zip code, I will check on what UHC requires for enrollment in your area and your eligibility for the plan.

    Medicare is Awesome! Ron

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    Hello, my grandmother will need to sign up for a Medicare Advantage Plan (MA Plan) before the end of open enrollment on March 31. I am hoping to get some guidance as to which plan would best fit my grandmother’s needs based on her current age and health conditions. To provide some quick info, she is 84 years old, and had a head injury in a car accident about two years ago that was never officially diagnosed. She has also for a time been suffering from memory issues and general forgetfulness. She will need to go in for tests and an MRI soon, but first needs an insurance plan that covers 100% and will allow her to get any necessary tests. Our family would greatly appreciate any bit of feedback as to what plans may be a good fit for her. Thank you for your time. -Amyr

    Hello Amyr, you have a very short time, two days, left in the Medicare Advantage Open Enrollment Period (MA-OEP). If she does not sign before the end of day March 31 she will have to wait until January 2023 to change her coverage. However, the MA-OEP is the time of year when individuals who are enrolled in a MA Plan can make changes in their plan. It is not a time that someone on Original Medicare Parts A and B can elect to enroll in a MA Plan if there isn’t already one. There are exceptions called Special Enrollment Periods (SEPs), which would allow her to elect an MA Plan even if she does not have one now. Here is info on these SEPs. Among them is one for low income and another for moving.

    If she does have a MA Plan, she is covered for all the circumstances you have described but will have some small copayments for the services. It is very possible that by changing she can get better coverage for her needs. If you have more questions you can respond to this email.

    Medicare is Awesome! Ron

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    I will be turning 65 in July, but my wife is only 63. I am a retired federal employee and my current medical insurance is with the Government Employees Health Association, Standard Option. I understand that any Medicare insurance I select will only cover me, so I need to continue something for my wife for the next couple of years. Is there a Medicare Advantage Plan (MA Plan) that can cover both of us at this time? Or do I need to have to pay for two plans at the same time? I ask this because everything I see online does not talk about what to do for married couples where the spouse is not eligible. Thanks. -Kenneth

    Kenneth, I work with expats and frequent travelers regularly and this is often a problem.

    Medicare is strictly individual, and all Medicare plans are for the beneficiary only. In most areas of the U.S., MA Plans will have no premium above your Part B premium. The Part B premium is $170.10 per month in 2022 for those who earn less than $94,000 per year.

    The first thing you must do is make sure you are on track with the Social Security Administration (SSA) for your Medicare coverage to start on July 1. You can call SSA at 1(800) 772-1213 or open an account online. Choose SIGN IN/UP and then the box marked my Social Security. Often Medicare enrollment is automatic but more often it is not. Contact them in April and be sure they are planning to start both Part A and Part B on July 1. As soon as you have your Medicare number, you can get signed up for the correct MA Plan to begin at the same time..

    Medicare is Awesome, Ron

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    I have UnitedHealthcare (UHC) through AARP. I was sent a new card and informed that my PCP is no longer a part of AARP Medicare Advantage (HMO-POS). Does this qualify as an event that would allow me to change to another Medicare Advantage Plan? My wife is with Kaiser here in Northern Virginia. I would like to change to Kaiser. -Carey

    Carey, if the UHC plan has other primary care provider doctors available this would not constitute grounds for a Special Enrollment Period (SEP) allowing you to change your plan. The good news is every year there are two periods in which we can make changes to our existing plans, and you are still in one of them. The Annual Enrollment Period (AEP) runs from Oct. 7 through Dec. 7 with any changes becoming effective Jan. 1. During this time, you can change or enroll for the first time in a Medicare Advantage Plan (MA Plan). The Medicare Advantage Open Enrollment Period (MA-OEP) runs from Jan. 1 through March 31 each year. During this period, you cannot enroll in MA for the first time; however, you can make changes to the plan you are in.

    Until March 31 you can make your desired change from UHC to Kaiser with no questions asked. If you change before March 31 your Kaiser coverage will begin April 1.

    You can go to www.Medicare.gov, call your local Kaiser office directly, or explore Kaiser plans. In the lower right-hand corner is a box Chat with a Specialist. Click that and allow them to lead you through enrollment or hook you up with a local agent.

    You have 14 days left for the MA-OEP, but if you wait until after March 31 you will have to wait until the fall AEP.

    Medicare is Awesome! Ron

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    Hi, my mother is on Medicare Advantage (MA) in Oregon, and I am trying to find out to whom at Medicare I should address a concern about a provider and the negligent care my mother received. Thank you. -Jana

    Hi Jana, the place to file or speak with a representative who can help you with Medicare Complaints for quality of service is the Beneficiary and Family Centered Care (BFCC)-QIO (BFCC-QIO). It manages all complaints and quality of care reviews for people with Medicare and its representatives.

    The following interactive link will provide the phone numbers and websites for the BFCC-QIO offices in all states.

    The office for the state of Oregon is:

    • (888) 305−6759 (toll-free)
    • (813) 280−8256 (local)
    • (855) 843−4776 (TTY)
    • (833) 868−4064 (toll-free)

    The representatives will help you quickly resolve your concern regarding your doctor and the negligent care your mother received.

    Medicare is Awesome, Ron

    +

    I already have Medicare Parts A and B and have Medicaid that pays for my Medicare premium. I was trying to sign up for the flex card for $2,888. Can I still get it? -Linda

    Hello Linda, Medicare and Medicaid do not offer flex cards directly; they are offered by private insurance carriers authorized by Medicare to offer Medicare Advantage Plans (MA Plans).

    Much of the advertising concerning flex cards has been unclear at best and deceptive at worst. Some have intimated that you can get up to $2,880 in seemingly free money, but this is not the case.

    All Medicare-related flex cards are tied to specific MA Plans and are only offered to those who are members of their specific MA Plan. You can search plans online at www.medicare.gov and see if those offered in your area include a flex card.

    Please be aware that the advertising related to flex cards is trying to get you to enroll in their MA Plan and this will result in disenrollment from your current plan.

    Regards,Ron

    +

    Ron, I would like to know who you might recommend to me to assist me in reviewing the many Medicare Advantage (MA) Plans to determine which plan would best serve my needs. My head is swimming and the knowledge of someone familiar with this system would be of great help to me. Thank you so much for your time and advice. -Pam

    Hello Pam. Because MA Plans are specific to your region, county, and zip code, I must know where you are located. Send me your county and zip code and I may be able to help you directly or I can refer you.

    Regards, Ron

    +

    Which Medicare Advantage (MA) plans will cover an actual physical exam along with the Medicare Annual Wellness? I am not sure which plans will cover my physical and it is expensive. Thank you. -Carol

    Hi Carol. All MA Plans must cover all services offered under Original Medicare Parts A and B. Original Medicare does not cover annual physical exams. However, the “Advantage” of MA Plans is the optional services that go beyond the limits of Original Medicare, which vary widely based on the market in which they are written. They must be researched for the specific zip code and county in which you reside. Research can be done on the Medicare Plan Finder or the carrier websites. Specific information for coverage options and costs can be found in the Evidence of Coverage (EOC) for the plan you are interested in. Fortunately, most MA Plans cover the annual physical exam.

    Here is the terminology from one of the leading MA Plan carriers’ EOC:

    “Physical exam (Routine)

    In addition to the Annual Wellness Visit or the “Welcome to Medicare” physical exam, you are covered for the following exam once per year:

    Comprehensive preventive medicine evaluation and management, including an age and gender appropriate history, examination, and counseling/anticipatory guidance/risk factor reduction interventions. In-Network: $0 copayment (primary care provider (PCP)’s office– Note: Any lab or diagnostic procedures that are ordered are not covered under this benefit and you pay your plan cost-sharing amount for those services separately.”

    Most MA plans cover routine blood and urine tests at a $0 to $15 copay; check your EOC for your specific plan. I suggest you research the plans you are interested in and then download the EOC and review its coverage for the physical exam or call the customer service number.

    Medicare is Awesome!

    Ron

    +

    My name is Nancy. Judy is my sister, and she has suffered from untreated Lyme disease for many years and has always said she cannot afford treatment as she lives on only a few hundred dollars a month from a Social Security Administration (SSA) check. She has many health problems due to Lyme disease, including pretty significant memory loss and cognitive decline. She has double vision and has special glasses with prisms to see. Her eyesight has deteriorated so badly in the last couple of years I am concerned she is going to lose her vision completely. Is there any Medicare Advantage (MA) Plan that will cover treatment for Lyme disease available in Hernando County, Florida? Her zip code is 34601. -Nancy

    Nancy, there is not much good news to report on Medicare’s stand on testing, vaccine, or treatment for Lyme disease. As of this date, Medicare does not cover testing or vaccination for Lyme disease and will not cover treatment in most cases. The CDC in the U.S. does not consider chronic Lyme disease to be a legit disease. They say it does not exist. However, some MA Plans offer limited treatment for Lyme disease, and it is best to contact your provider directly for its coverage option.

    Your State Insurance Assistance Program (SHIP) will help with the research into the best MA Plans in your area, and at no cost to you.

    You may also get needed financial help from the following groups:

    Warm Regards,

    Ron

    +

    Is it true that diabetics can change their Medicare Advantage (MA) Plans any time? -Able

    Hi Able, yes and no. First, you must be eligible for MA by having both Parts A and B of Medicare active. Then it will depend on whether there are any Special Needs Plans, specifically Chronic Illness Special Needs Plans (C-SNPs) available in your coverage area. C-SNPs are for different types of chronic illnesses, such as heart-related or respiratory illnesses, and diabetics. If you live in an area that offers the diabetic C-SNP and you qualify, a Special Enrollment Period (SEP) allows you to join any time of the year. You can research C-SNP plans in your area on the Medicare website through the Medicare Plan Finder.

    Medicare is Awesome!

    Ron

    Medicare Denial

    +

    Can you be denied Medicare? -John

    John, if you meet the enrollment qualifications, you cannot be denied coverage under Original Medicare Parts A and B. The only impact on enrollment in Original Medicare caused by previous health concerns is the possibility that you may be able to enroll in Medicare before turning 65. There are no preexisting condition requirements for Original Medicare enrollment.

    Regards, Ron

    Medicare Enrollment

    +

    I have become unhappy with Kaiser, but given its rating, I wonder if all providers have experienced a degradation in services lately. -Ken

    Thanks for your question, Ken. I am sorry to hear you are unsatisfied with your Medicare carrier. Depending upon your circumstances you may not be able to change your plan until the Annual Election Period (AEP) from Oct. 12 through Dec. 7, with coverage beginning Jan. 1, 2023. Here is a link to the Special Enrollment Period (SEP). If you qualify under any of the exceptions, you can change your plan according to the rules.

    Email your zip code and your county and I will research plans available in your area to see if any of them are 5-star programs; if so, you can select one at any time of year.

    Medicare is Awesome! Ron

    +

    I am 77 years old and will be 78 in two weeks. I would like to enroll in the Medicare Advantage Plan (MA Plan). I have Parts A and B. Is there any Special Enrollment Period (SEP) prior to the open period of Oct. 15 to Dec. 7? -Susan

    Susan, thanks for asking. Under normal circumstances, the Annual Enrollment Period (AEP) from Oct. 15 through Dec. 7 (with coverage beginning Jan. 1) would be your only option to enroll in a MA Plan. However, there are SEPs for specific circumstances. The Centers for Medicare & Medicaid Services (CMS) publishes a list of SEPs available for enrollment in MA Plans.

    Medicare is Awesome! Ron

    +

    How do I know if I am choosing the right policy for me? -Steve

    Hi Steve, the first decision is whether you want to enroll in a Medicare Supplement or Medicare Advantage Plan (MA Plan), and there are several things to consider. Do you live in more than one place for long periods of time? Will you be traveling overseas for extended periods of time? Do you need access to Mayo Clinic or any Medicare hospital or doctor you wish? If the answer to these questions is yes, you may want to consider a Supplement Plan.

    If you have decided on a Supplement Plan, there are 10 plans available represented by letters. Plan G offers the highest level of coverage but has a bit higher premium. Once you have decided on the plan you would like, choose a company that has a strong track record and the lowest premium. The government mandates that all carriers offer the same coverage per plan, but the premium for the same plan can vary widely.

    If you want to enroll in a MA Plan, check if your doctors are in the plan and if your medications are in their formulary. Then compare the premiums, copayments, coinsurance, and deductibles for both medical and drugs. All plans must offer coverage for all Medicare-covered services with few exceptions. However, there are different add-ons, which should be compared. Add-ons include gym memberships, dental coverage, vision coverage, over-the-counter allowances, TeleMed, after-hospitalization meals, and more. MA Plans can be researched through the Medicare Plan Finder.

     Medicare is Awesome! Ron

    +

    My wife and I have our 65th birthdays in November and December so we need to enroll in August and September. I’m doing the research on plans but can’t find any information on how I begin the process of self-enrollment. I’ve opened an account on my Social Security Administration (SSA) account. What’s my next step? Thank you! -Mark

    Hi Mark, if you are currently receiving SSA or Railroad Retirement Benefits (RRB), you will automatically receive Part A and Part B beginning the first day of the month in which you turn 65. If your birthday is on the first day of the month, you will be enrolled in A and B on the first day of the month before turning 65. If you are auto-enrolled, you should receive communication from SSA three months before your eligibility date. If you are not receiving benefits before your 65th birthday, you will need to self-enroll in Parts A and B. SSA handles Medicare enrollment; you can enroll on the SSA website. Open an account or log on to the account you have already opened. There you will find Medicare enrollment for those who are on SSA or RRB benefits, or for those who wish to enroll without triggering their benefits. You may also enroll by calling SSA at (800) 772-1213.

    Once you have your Medicare number you can enroll in a Supplement and Part D or a Medicare Advantage Plan (MA Plan). I would be happy to help research the best plans for you. You can also go to the Medicare Plan Finder to research and self-enroll.

    Medicare is Awesome! Ron

    +

    I currently have traditional Medicare Part A, B, and C. When could I switch to a Medicare Advantage Plan (MA Plan)? -Patricia

    Patricia, if you have Medicare Parts A, B, and C, you already have a MA Plan, as Part C of Medicare is a MA Plan. You can only change Part C MA Plans during the Annual Enrollment Period (AEP), which runs from Oct. 15 through Dec. 7. Coverage begins Jan. 1. Also, during the MA Open Enrollment Period (MA-OEP) from Jan. 1 through March 31, coverage starts the month after the application is submitted. There are also Special Enrollment Periods (SEPs) available for life changes. A list of available SEPs can be found on the Medicare website. If you qualify for a SEP, you can change your MA Plan during the terms of the SEP.

    Medicare is Awesome, Ron

    +

    An insurance agent supposedly hooked me up with Medicare plan G and advised me I would get a call about getting Plan D coverage, but I have not received any paperwork or phone calls for either program. I have called several times but no one has called me back. -Jolene

    Jolene, you should have received plan information and a copy of the application or a confirmation statement at the time you enrolled. If you know what insurance company it is, call the company and ask them what the status of your application is. Numbers can be found by searching for the company online. If you find the company has no such application, abandon this gentleman and start the process over. Call Medicare at (800) 633-4227 and see if there are any applications in process; if not, file a complaint. Time may be ticking, depending on what enrollment period you are using for your eligibility. If I can be of any further assistance, please do not hesitate to contact me.

    Medicare is Awesome! Ron

    +

    I need a prescription plan. -April

    April, thank you for writing. A little more information would help me be more specific, but I will assume we are talking about a Medicare Part D prescription plan, a stand-alone Medicare Plan used to cover outpatient prescription medications. There are certain times of the year to enroll in these plans, and the person enrolling must be eligible for Medicare Part A and/or enrolled in Part B.

    We will assume you are eligible based on this criterion and you are living in the coverage area of the Prescription Drug Plan (PDP) plan you select. You may enroll during your Initial Enrollment Period (IEP), a seven-month period beginning one month before your 65th birthday, the month you turn 65, and three months after the month you turn 65. During this time, you may enroll in any Part D plan available in your area. After your IEP has expired you can enroll during the Annual Enrollment Period (AEP), which runs from Oct. 15 through Dec. 7 each year with coverage beginning Jan. 1. There are also certain Special Enrollment Periods (SEPs) that allow you to enroll for specific life events.

    You can research and enroll in Medicare Part D plans on the Medicare Plan Finder.

    Regards, Ron

    +

    My wife and I are 65 and enrolled in Part A and B. We both are currently covered by my insurance through my employer, and it is renewed every November for the following year. I am looking at switching to either a Medigap or Medicare Advantage Plan (MA Plan) along with part D coverage. My wife is undergoing chemotherapy with stage 4 breast cancer at Duke Oncology. Are there any pitfalls that you know of in trying to get a policy for both of us? Also, any advice on how to proceed would be appreciated. -Glen

    Glen, fortunately, you have been continuously covered by your employer coverage. Therefore a Special Enrollment Period (SEP) allows you to enroll in any Medicare Supplement, MA Plan, or Part D plan available in your area with no underwriting requirements. The SEP for a MA Plan or Part D plan will last for two months after your employer coverage ends.

    But the SEP for a Supplement Plan is a bit more involved and allows you to enroll no later than 63 calendar days after the latest of these three dates:

    • Date the coverage ends
    • Date on the notice you may get telling you that coverage is ending
    • Date on a claim denial, if this is the only way you know that your coverage ended

    If you tell me what state, county, and zip code you reside in, I will let you know what is available and be able to help you with the transition.

    Medicare is Awesome! Ron

    +

    Is there anywhere near me I can go in person and discuss what I need and should get for Medicare? I can sign up at the end of August and am lost. I don’t want to do it over the phone. -Terry

    Thank you for your question, Terry. There are advisors and agencies in almost every area of the country to help with Medicare enrollment. I suggest people contact Social Security Administration (SSA) three months before the month they turn 65. If you are turning 65 in August, contact SSA now (about Medicare enrollment), and be sure you are enrolled in both Parts A and B as of Aug. 1. You can apply online, by telephone at (800) 772-1213, or by visiting your local SSA office. Once you have enrolled in Parts A and B you will need help deciding whether to enroll in a Medicare Supplement and Prescription Drug Plan (PDP), or a Medicare Advantage Plan (MA Plan). This coverage should be set to begin at the same time as your Medicare A and B. If you let me know your city, state, zip code, and county, I will give you referrals to select from or help you by text, email, and phone conversations.

    Regards, Ron

    +

    I am new to Medicare. I am a single woman, I will be 65 in August and I am still employed part-time. I have no major health problems. Looking for suggestions on choosing the best health plan for myself. I currently have a health plan through the marketplace with Priority Health. Not sure I understand the difference between having Medicare with a Supplemental Plan vs. having a Medicare Advantage Plan (MA Plan). I have been inundated with calls and mailings and it’s become very confusing. Thank you for your assistance. -Mary Ellen

    Mary Ellen, your last statement is a common one with those approaching their 65th birthday. The amount of information pushed on us through calls, mail, and email is enough to make a grown woman cry.

    Medicare does not care if you are married or single; all Medicare beneficiaries are handled on an individual basis. The fact that you do not have group insurance through your employer makes it important that you begin your Medicare Part A and Part B during your seven-month Initial Enrollment Period (IEP). If not, you will begin to accrue penalties and will have delayed coverage when you choose to enroll later. IEP runs three months prior to turning 65, the month in which you turn 65, and ends three months after you turn 65. The perfect time to start coverage is the first day of the month in which you turn 65. Since you turn 65 in August you should begin your Medicare on Aug. 1, and now is the time to make sure things are in order. If you have not yet received communication from the Social Security Administration (SSA) informing you that your part A and B coverage will begin on Aug. 1, contact the agency immediately. SSA can be reached by phone at 1(800)772-1213, by visiting your local SSA office, or by creating an account at https://www.ssa.gov.

    Both MA and Supplement Plans are provided by private insurance carriers who contract with Medicare. It is important to enroll in one or the other because Original Medicare Parts A and B are an 80/20 plan. You pay 20% of all services and there is no limit to your liability for medical costs. MA and Supplement Plans mitigate this risk by limiting your liability. Supplement (Medigap) Plans pay claims secondary to Medicare while MA Plans become your primary insurance provider; both cover everything Original Medicare supplies and sometimes more.

    Supplement plans allow you to go to any doctor, hospital, clinic, or lab that accepts Medicare assignment. Advantage plans are Managed Care plans such as HMOs, Preferred Provider Organization (PPOs), and Private-Fee-For-Service (PFFS) plans. Many of them will have networks of doctors, hospitals, clinics, and labs. Supplement Plans have higher premiums and lower copays than MA Plans; however, many MA plans have low copays, $0 premiums, and benefits not offered by Original Medicare or Supplement Plans. Benefits include things such as vision, hearing, dental, gym memberships, over-the-counter stipends, and more.

    Both Medicare Supplement and MA Plan options and coverages can be researched on the Medicare Plan Locator. Whichever one you choose should be scheduled to begin concurrently with your Part B start date.

    I am available to readers of Medicareplans.com at no cost for consultations by phone, email, or text.

    Medicare Is Awesome! Ron

    +

    I am confused about what to sign up for. There are so many plans. -Vicky

    Vicky, you are correct, as there are many choices to be made for Medicare and it can be confusing and the timing of enrollments is of utmost importance. If you are new to Medicare, your choices will include whether to sign up for Parts A and B or Part A and delay Part B. You should only delay Part B if you are still working and have health care coverage through your employer based on current work. Once you have your Part A and B scheduled to start, you can decide whether to enroll in a Supplement (Medigap) Plan or Medicare Advantage Plan (MA Plan). Both types of plans can be researched on www.medicare.gov.

    I believe it is important that first-time Medicare recipients get help with the process. It is so involved and confusing that it can be overwhelming and mistakes can be costly. If you would like a referral to an agent in your area, I can help. You can contact me by email or phone; both are listed below.

    Medicare is Awesome! Ron

    +

    When I enroll in Medicare 90 days before my 65th birthday, do I have to choose a Supplement Plan at that time or may I wait until it is closer to my Medicare effective date? -Thomas

    Thomas, when you enroll in Original Medicare Parts A and B at 65, your start date will be the first day of your birth month. Once you have your Medicare number, it may take up to three weeks from the time you enroll; you will be able to enroll in any Supplement, Medicare Advantage (MA), and/or Prescription Drug Plan (PDP).

    I suggest that these applications be made by the first week of the month prior to your Medicare start date, you can apply as soon as you have your Medicare number. For example, if your birth month is April, you will enroll in Medicare in January for an April 1 start date. Your applications for your Supplement + PDP, or MA Plan, should be filed by March 10 with the start date of April 1. This will make sure all plans start concurrently on the first day of eligibility and you are fully covered.

    If you would like assistance, please let me know. Ron

    +

    I am 63 and currently unemployed. Can I qualify for Medicare? -Colleen

    Colleen, under normal circumstances, you are not eligible for Medicare until age 65 and unemployment does not qualify you early. However, if you are on Social Security Disability Insurance (SSDI), have end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS), you may enroll in Medicare before age 65.

    Ron

    +

    Hello Ron. I am a 66-year-old retiree enrolled in both Part A and Part B. I was also covered under my husband’s employee insurance plan through Aetna until he retired a month ago. He has decided to return to the workforce as he has a few years before he is Medicare-eligible. My concern now is how do I determine whether to have my husband include me under his new insurance? Or should I be looking into a Medicare Supplement Plan and prescription coverage, if that’s even possible at this point since my Initial Enrollment Period (IEP) is past? His previous plan through Aetna provided me with a letter stating that the plan was comparable to any Medicare plan, but it was quite the ordeal to obtain. Thanks for your time. -Connie

    Connie, great question. To determine whether to return to your husband’s plan or opt for Medicare, do a comparison between the coverage and cost to add you to his plan and the coverage and cost of a Medicare Supplement Plan plus a Prescription Drug Plan (PDP). You are eligible for a Medicare Special Enrollment Period (SEP) because you left your husband’s group coverage so you can enroll in any Medicare Plan. When making the decision there are several factors to investigate:

    • Does his plan require you to have Part A and Part B for the coverage offered? This can be found by calling the benefits department of his company.
    • If you are not required to have Part B you can put it on hold and not pay the monthly premium while you are covered under his insurance. The base premium is $170 for 2022 and increases if you and your husband’s income are over the threshold amount. That should be reflected in your premium at this time.
    • The cost of your husband’s plan will be the premium, deductibles, copayments, coinsurance, and possibly your Part B premium amount.
    • Your cost for Medicare will be the cost of your Part B, Supplement, and PDP premiums, plus the $233 Part B yearly deductible, copayments if you do not select Plan G, and any deductible and copays for drug coverage.
    • The amount of a Plan G (I recommend Plan G) depends on the area of the country you live in. In most cases for a 66-year-old female, it runs between $120 and $135 per month.
    • A drug plan will depend upon the type and number of medications you are on. Plans will average $20 per month.

    You may also want to consider a Medicare Advantage Plan (MA Plan). It is probably the kind of plan you have through your husband’s work, and an HMO or PPO. It varies with the area in which you live but most areas have $0 premium plans available, and include drug coverage, dental, hearing aids, vision, and more. You still must pay your Part B premiums. MA, Supplement, and Drug plans can be researched through the Medicare Plan Finder.

    If I can help, let me know. Ron

    +

    I will be turning 65 in September and will need to switch my plan. I now have a plan for those under 65 with disabilities and low income, Commonwealth Care Alliance. I need help finding the same type of plan that I don’t pay monthly fees or for doctor visits. I signed up for something different and was put on this plan. I don’t want the same mistake being made as this is the fourth plan I was wrongly put on. Thank you in advance for any help you can offer me. -Debra

    Debra, if you are on Social Security Disability Insurance (SSDI) and on Medicare you will continue with the same numbers. But you will have a new Initial Enrollment Period (IEP) when you turn 65. This will allow you to choose any Medicare plan available in your area. If you are on Medicare and Medicaid, there will be very good choices for your coverage; you will be eligible for a Dual Special Needs Plan (D-SNP) with no premium or copay for doctor visits. However, because Medicare Plans are specific to geographic locations, I cannot guide you in the correct direction without knowing your zip code and county.  You can research available plans and enroll at the Medicare Plan Finder.

    Medicare is Awesome! Ron

    +

    How can I enroll in Medicare Part B only, as part of my Initial Enrollment Period (IEP)? Details: My application for Medicare Part A is in process. At the time of that application (early July), I elected to wait on applying for Part B, because I wanted to talk to private insurers, first, about C and D. I thought, incorrectly, that if I got a Medicare Advantage (MA) Plan, I would discontinue paying Medicare and all costs would go through a private insurer. Now, I understand that the private insurers only administer A and B, but I must still pay for those through Medicare. So, I need to enroll in B only, as my Part A is in process. -Ingrid

    Ingrid, there are several ways to enroll in Part B. If you are still in your IEP, it is easy; if not, it simply takes a couple more steps in the process. Since your Part A is still processing, I believe the first option is to either call Social Security Administration (SSA) at 1(800) 722-1213 or log in or create an account online. It is good to have an online SSA account to keep track of your SSA status and Medicare enrollment. Once you have an account you will find it is easy to enroll in Part B. If you are beyond your IEP and have had coverage through an employer in the past 63 days you will need them to fill out and sign an Employment Information Request Form MS-L654_508. I have attached a copy.

    Once you know your Medicare number and both A and B start dates you can make an application for a MA Plan and schedule it to start concurrently. MA Plans, sold by private carriers who are authorized by Medicare, require active enrollment in both Parts A and B. MA Plans become your primary insurance and are required to cover everything covered under Original Medicare Parts A and B and much more. Because the plans have different cost structures, it is smart to compare the coverages before enrollment. Coverage comparison can be conducted through the Medicare Plan Finder.

    Medicare is Awesome! Ron

    +

    This has been my first year on Medicare. After months of researching and talking to people, I opted for traditional Medicare A and B with Supplement Plan N and a separate Prescription Drug Plan (PDP). Do you consider Medicare A and B and a Supplement and PDP better than a Medicare Advantage (MA) Plan? I am very frustrated that I am already about to enter the coverage gap phase of my PDP. This has been one of the most frustrating years of my life trying to figure out the Medicare world. I mainly just want to know if it is truly better to stay with Medicare A and B and a Supplement Plan and PDP or whether a MA Plan is really better. Thanks so much in advance. -Karen

    Karen, the answers to your questions can be frustrating and depend on your circumstances. One of the advantages of a Supplement Plan is the ability to go to any doctor, hospital, clinic, or labs that take Medicare assignment. There are no referrals necessary, but many specialists will require referrals so they can be sure to get your records. Many MA HMO-POS Plans do not require referrals nor do Preferred Provider Organization (PPO) plans. The networks for MA Plans are so large in most areas that once your doctors are in the network all referrals will also be in the network. Before choosing a MA Plan it is wise to check its network for your doctor’s inclusion.

    Plan N has a deductible of $233 in 2022 and some copays but its premiums are lower than Plan G. MA Plans normally have $0 or low premiums, no medical deductible, and drug coverage included, but have copays and coinsurance. But there is also a maximum out-of-pocket (MOOP) per year. Once you reach the MOOP with the copays of your A and B expenses you have no more costs for the year.

    As far as entering the coverage gap phase, it is the same for stand-alone PDPs and MA Plan drug coverage. There are ways to mitigate this problem. Attached is an unpublished article I wrote to help my clients with this. They all work for Medicare beneficiaries, though the last two are critical.

    Regards, Ron

    +

    Hi, thank you for your time. I am turning 65 until March but just trying to get a head start on understanding. I never smoked and am not overweight at 5 feet 11 inches tall and 175 pounds. I walk fast doing 3 miles a day, and am not on any medications. Both parents are still alive and very well. I have Blue Cross Blue Shield Preferred Provider Option (PPO) now and am happy with the coverage but unhappy with the price. Basically, I am living off Social Security Administration (SSA) and some rental income. My doctor said to check out BayCare Medicare Advantage (MA). I rarely ever go to a doctor, except for my yearly checkups and teeth cleaning. Are the MA Plans best for me? I plan to live to over 100 on a budget. Thanks for your advice -Alex

    Alex, congratulations on your health and healthy attitude. You are on a PPO now and once on Medicare a PPO is a form of MA Plan. Under Medicare, you will probably have a $0 premium, no medical deductible, and lower copays than now.

    When you turn 65 your choice will be between a Medicare Supplement (Medigap) Plan and a MA Plan. The Supplement Plan will have a monthly premium of over $100 per month, a yearly deductible of $233 for 2022, and no or low copays. You can go to any doctor, hospital, clinic, or lab if they accept Medicare. The Advantage Plans have low to no premium, no deductibles, and low copayments, but local networks of doctors, hospitals, clinics, and labs. The PPO will allow you to go out of network, though usually at a much higher price. With either plan, you must sign up for drug coverage even though you are not taking meds at this time. If you don’t sign up when you are first eligible you will begin accruing penalties of 1% of the average drug plan premium per month; one year equals a 12% penalty and it is in perpetuity. With the Supplement Plans, you must pay for a stand-alone Prescription Drug Plan (PDP), and there are copays for the drugs. Drug coverage is included in most MA Plans at no cost; however, you still have copays for drugs.

    Since you are already receiving SSA benefits, you should be signed up for Medicare A and B automatically. I believe in being proactive so call SSA at 1 (800) 722-1213, or visit a local SSA office. The preferred way is to sign up for an account online three months before you turn 65. Once you have your Medicare number you will be able to enroll in a Supplement or MA Plan, so it coordinates with your Part A and B start date. You can research Medicare plans available in your area on the Medicare Plan Finder and I can help if you like.

    Medicare is Awesome! Ron

    +

    Who can buy Medicare? Where do I apply for Medicare? -Eva

    Hello Eva. Eligibility for Medicare is as follows. In general, you are eligible for Medicare Part A at no cost if:

    1. You are age 65 or older and a U.S. citizen or permanent legal resident for at least five consecutive years immediately prior to applying for Medicare.
    2. You are disabled and receiving disability benefits. Medicare is automatic after you have been on Social Security Disability Insurance (SSDI) for 24 months.
    3. You are already receiving retirement benefits from Social Security Administration (SSA) or Railroad Retirement Benefits.
    4. You were a state or local government employee after March 31, 1986, or a federal employee any time after Dec. 31, 1982.
    5. You have end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS) at any age.
    6. You have been married to a qualified beneficiary for at least one year before applying.
    7. You are divorced from a qualified beneficiary whom you were married to for a minimum of 10 years, and you are single at the time of application. The marital status of the ex-spouse is of no consequence.
    8. You are widowed by a qualified beneficiary to whom you were married for at least nine months before their death, and you are single at the time of application.

    You can apply for Medicare by calling SSA at 1(800) 772-1213 (SSA handles Medicare enrollment), visiting your local SSA office, or by logging in or registering for an account at https://ssa.gov.

    Medicare is Awesome!  Ron

    +

    I am eligible for Medicare in October when I turn 65. I do not want to sign up for Part B at this time. I signed a paper back in July and sent it in declining Part B. Now I received a letter stating they will start taking out over $170 per month for Part B. I cannot afford this. What do I do just to sign up for Part A? I know this is just hospital coverage, which is all I want. I only see a doctor two times a year. -Allie

    Allie, Social Security Administration (SSA) handles Medicare enrollment. You can call 1(800) 772-1213, saying you have declined Part B coverage and the agency will get it straightened out. However, Part A covers hospitalization and Part B covers all medical issues, doctors, testing, lab work, x-rays, etc. If you do not enroll in Part B when you are first eligible and you are not covered by a group plan from your current employment, you will pay a Part B late enrollment penalty in the future. If you qualify for Medicaid, they will pay your Part B copayment of $170.10 per month in 2022. Once you have Part B you can enroll in a $0 premium Medicare Advantage (MA) plan that will give you full coverage with small copays for all Part A and B covered services. This will also give you dental, vision, hearing, and drug coverage, plus many more perks. If you would like to contact me at the email below, I would be glad to assist you in understanding the full ramifications of deferring Part B.

    Medicare is Awesome!

    Ron

    Medicare and VA Coverage

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    Ron, I am a 70% disabled Vietnam veteran. The only prescription I need help with is Trulicity(Tier 3). Thank you. -David 

    David, there are several ways you can lower your costs for Trulicity. I will discuss five of them here, in no special order.

    First: Because you are a disabled veteran, you have privileges through the U.S. Department of Veterans Affairs. Medicare Advantage Plans (MA Plans) and the VA are not mutually exclusive, so you can use both of them. Under VA guidelines, the copays for prescription drugs are straightforward. The medication tier copay amounts for a one to 30-day supply are Tier 1 (preferred generic) $5, Tier 2 (non-preferred generic and some over-the-counter drugs) $8, and Tier 3 (brand name) $11. You will need to see a VA doctor once every six months to qualify.

    Second: You can log on to the Medicare.gov plan finder. Search and compare the available MA Plans in your area. This will allow you to input your medications and compare costs among the plans available.

    Third: Contact the manufacturer of the drug in question and see if the company has a plan in place to help those who need it. You can start at the Savings and Resources page on the Trulicity website.

    Fourth: Extra Help through Social Security Administration (SSA) is available for those with an annual income of less than $20,385 for an individual ($27,465 for a married couple living together). For those who qualify, it is a monumental saving on all prescriptions, especially those in Tier 3 and above.

    Fifth: Contact your local State Health Insurance Assistance Program (SHIP) office and ask for the local options for help with prescriptions. This is a government-funded organization and there is no charge for those who use its help.

    Hope this helps! -Ron

    +

    I have Medicare Part A. My medical is VA full coverage. Can I still get covered for dental through Medicare Advantage (MA)? I do not have Medicare Part B. -Robert

    Hello Robert, unfortunately, you are required to have Medicare Part A and Part B active to enroll in any MA Plan. MA and VA health benefits work very well together, but you would first have to enroll in Part B.

    Regards, Ron

    +

    Is there more than one wraparound Medicare Plan for military retirees residing in Tennessee who have TRICARE For Life? -Sandra

    Hi Sandra, when military retirees turn 65, they automatically transition from TRICARE to TRICARE For Life (TFL). For TFL, they are required to enroll in and maintain both Part A and Part B of Medicare. Medicare becomes your primary and TFL is your secondary coverage, with automatic coordination between the two.

    Medicare Parts A and B are also a requirement for enrollment in Medicare Advantage Plans (MA Plans), considered wraparound plans. However, the plans replace Original Medicare and become your primary coverage with TFL paying secondary. Not all MA Plans will automatically coordinate with TFL. Once the plans have paid your claim you may have to submit the leftover charges to TFL for payment. You can call TFL at (866) 773-0404 to determine the level of coordination between TFL and specific MA Plans.

    Depending upon where you are in Tennessee, there are several viable MA options available. Many have a $0 premium, low copayments, and benefits not covered by TFL. To research available plans, log on to the Medicare Plan Finder or contact me for assistance.

    Medicare is Awesome! Ron

    +

    Does a military retiree receive a reimbursement of his Medicare Part B premium? If yes, how does he apply for this reimbursement? If he is entitled to reimbursement, why is he not receiving it automatically on his monthly retirement check? -Roy

    Hello Roy. There is no reimbursement for any military retirees. However, there are two ways to get a portion of your Part B premium back. The first is by qualifying for your state Medicaid program. If you are low-income and qualify for your state Medicaid program it will reimburse you in full for the Part B premium. The second way is to join a Medicare Advantage Plan (MA Plan), which has a Part B giveback. These plans will reimburse you for a set amount of the Part B premium and often cost you nothing unless you use the services. The plans can be added to your Medicare and will not conflict with Tricare for Life or VA coverage.

    Medicare is Awesome! Ron

    +

    I am 70 years old and I pay for Medicare. I am retired from the Air Force. I am going to the Veterans Affairs (VA) and questioning the statement occurring on two of my bills that were sent from OPTUM VA CCN to me as a receipt I guess. One is a bill from my allergist, saying “Veteran Responsibility: 0 1 – MEDICARE ALLOWABLE FOR VA CCN.” I also pay a copay of $50 to VA per visit. Is Medicare paying anything? VA said it is not, so then why put this statement on the bill? Could you clarify this for me? VA doesn’t answer the phone lately for billing questions. I have asked several veterans about this but they don’t have insurance so they don’t know. If Medicare is paying then why do I have a copay? Can you please ensure me Medicare is not involved with the military VA billing program? -Darlene

    Darlene, thanks for your question. Medicare and VA coverage are not mutually exclusive. However, the companies seldom work together on claims. Most of the time you are either seeing a VA doctor and your coverage is through the VA or you are seeing a doctor outside of the VA system and Medicare is your coverage. The document is probably your explanation of benefits (EOB). This is not a bill and simply reflects what has been paid up to the date of the EOB by the different coverages you may have involved. Without seeing exactly what you are looking at, I cannot help you with why things are covered by which insurance. It may be because of the type or place of treatment. Or it may be influenced by who referred you for the services and how the referral was made.

    One thing I would check out if you are not using it is TRICARE For Life (TFL). While you were under 65 you were covered by the federal TRICARE system, and once you turned 65 and joined Medicare that automatically became TFL. This is very good coverage and many retired service members rely on it for lifetime coverage. You can add a $0 premium Medicare Advantage Plan (MA Plan) to it for even broader coverage.

    Medicare is Awesome! Ron

    +

    Hello, I am in desperate need of guidance in helping my beloved grandpa get Medicare health insurance. He is a Vietnam veteran who has prostate cancer, high blood pressure, and other health issues but he does not have access to a doctor or his medications. We have gone in circles with the Social Security Administration (SSA) office in an attempt to sign up for coverage. We’ve gotten very few answers and don’t know where to turn to next. I found your website and am hoping you can help with this process. Thank you for your help! With gratitude, Clarissa 

    Hi Clarissa, several observations can be made before we get specific with your grandpa.

    1. Your grandpa may be eligible for Veterans Affairs (VA) benefits and if he is not signed up it would be advisable. VA coverage does not compete with Medicare; the two are able to work together. However, VA coverage has some different coverages. For VA information and to apply for coverage visit here.
    2. Much of what is available for your grandpa is determined by whether he is already signed up for Medicare Parts A and B. If not, he will probably be dealing with some late enrollment penalties; they are not prohibitive but must be understood. If he is not just coming off work-related medical coverage, he will have to sign up for Part B during the General Enrollment Period (GEP) which runs from Jan. 1 through March 31 with coverage beginning July 1. If this is the case, he will not be eligible for Part B until July 2023, and Medicare Supplement and Advantage Plans (MA Plans) are dependent on being enrolled in Parts A and B. If he already has Parts A and B he is eligible for a MA Plan and it will cover his medical problems and have no medical underwriting or preexistent penalties.

    I believe it would be good for us to have a telephone or Zoom conversation at your earliest convenience. Please email with a time and number where I can call. I am sure I can give you clear answers to your questions and plan a strategy.

    Medicare is Awesome! Ron

    +

    Is there a Medicare carrier that has a plan in conjunction with Veterans Affairs (VA)? I have hearing, eyes, prescription, and doctor visits covered and I did use Medicare Plan D for dental. -Craig

    Craig, all Medicare Advantage Prescription Drug Plans (MA-PDP) include prescription coverage and work well with the VA. Many carriers market Medicare Advantage (MA) plans that do not include prescription coverage to VA-covered individuals because VA coverage includes prescription drugs. However, MA-PDP plans work well because most have no copayments on tiers 1 and 2. That way the beneficiary can get their Tier 1 and 2 drugs filled by their MA-PDP and higher tier drugs by the VA. Remember that prescriptions must be written by the appropriate doctor who is contracted with the plan which is paying the prescription cost. In most areas of the U.S. Medicare Advantage plans have a $0 premium and $0 copayment to see a primary care doctor. They include dental, vision, hearing aids, gym memberships, over-the-counter benefits, and many other perks not covered by the VA. You can research the plans available in your area on the Medicare Plan Finder.

    Medicare is Awesome!

    Ron

    Medicare MSA Plans

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    I am interested in Medicare MSA Plans for my Part C and the plans seem difficult to find. Why is that? -Charles

    You are correct. MSA plans are not available in many areas of the U.S., and the plans are a bit of an anomaly. Because this is a form of Medicare Advantage ( MA Part C), you are only eligible to enroll in the plans offered in your current area of residence. You can research plans available to you through the Medicare Plan Finder. For MSA plan research, select Medicare Advantage Plans, enter your zip code, scroll down and select I do not get help from any of these, and Continue. On the next screen select No to the question concerning drug costs, as drug coverage is not included with MSA plans, select Next and you will see all plans available in your area. Here you can select filter MSA plans in the drop-down menu under Select a Plan Type.

    Good luck, Ron

    Medicare Part B

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    Is it mandatory to have Medicare Part B? -Michael

    Hi Michael, no, Medicare Part B is not mandatory. However, if you do not sign up for Part B when you are first eligible you may incur penalties when you sign up later. If you qualify for one of the two Part B Special Enrollment Periods (SEP), you may defer Part B and avoid penalties or delayed coverage.

    The first Part B SEP is for the working-aged. To be eligible for this SEP, you must be 65 or older and either you or a spouse must be working and covered by a group health plan that is based on current employment.

    The second Part B SEP is for international volunteers. If you volunteer internationally for at least 12 months for a tax-exempt nonprofit organization and have health insurance during that time, you will have a six-month SEP to enroll in Medicare without gaps or penalties. This SEP begins once your volunteer work stops or your health insurance outside of the U.S. ends, whichever is earlier. Coverage must be through the organization you are volunteering for or the national health care of the county in which you are volunteering.

    Regards, Ron

    Medigap

    +

    Can a patient with Medicare part A and B get a Medigap plan that will cover coinsurance and deductible while they are currently admitted in a short-term acute care hospital? -Samantha

    Thanks for your question, Samantha. Unfortunately, you can’t get a Medigap plan while admitted to a hospital, unless you are in your Initial Enrollment Period (IEP). The IEP runs three months before turning 65, the month of your 65th birthday, and three months after you turn 65.

    All Medigap plans want you to be clear of hospital admissions for the previous year when making an application. However, if you are in your IEP because of turning 65, or in some cases, if you have a guaranteed issue Special Enrollment Period (SEP) you can enroll without underwriting. Still, even with one of these exceptions, your enrollment will not take effect until the first of the month after application.

    Regards, Ron

    +

    My husband and I are U.S. citizens living in Washington state. When we retire in a year we would like to move just across the border on the Canadian side 60 minutes from here. Our children live there and we would like to be closer to them. We know we can keep our Social Security Administration (SSA) and Medicare when we move as long as we use Medicare in the U.S. Our question is regarding Medigap. Enrollment is contingent on residence at the time of enrollment; after that it is portable. Can we be disenrolled upon moving and changing our address? When we call the insurers their knowledge of this kind of situation is very limited. Nobody has been able to give us the answer so they just say no. Also, as I am a dual citizen due to tax complications, I am contemplating renouncing my U.S. citizenship. How will that affect Medicare and Medigap considering a wife of an American citizen gets Medicare? Thank you. -Karin

    Karin, thank you for your questions. First, supplement coverage will not be canceled because you move. If you purchase the insurance while you are a resident of the state it is issued in, and you continue to pay your premiums for Part B and the Supplement, you may keep it. You will have emergency and urgent care coverage in Canada for the first 60 days of each trip out of the country. When you return to the U.S. be sure to have your passport stamped. Other than the emergency coverage, your Medicare and Supplement will not be of use while living in Canada.

    The answer to your second question is a huge BE CAREFUL. Once you renounce citizenship you will lose your SSA and Medicare benefits, and this can be the least of your worries. If you have received SSA or any Medicare benefits before you renounce your citizenship, you will have to reimburse the government for all SSA benefits received and the cost of all benefits you received through Medicare at any time.

    Medicare is Awesome! Ron

    Moving From a Work Plan

    +

    My husband and I are on his work plan. He will turn 65 in two years and plans on working for many years. I am only 59 (funny how 20 years ago I thought that was so old but now, not so much) and I am on his plan. 

    Does it make sense for us both to stay on his plan until I become eligible for Medicare? We pay a fortune for his plan for us both, but it is a premium plan. I think it’s about $1,400 a month: 900 for me and 500 for him. The employer pays a large majority of his and a small amount of mine. 

    Should he sign up for Part A and keep his plan as well? If he signs up for Part A Medicare, could we potentially get a reduction from the private plan? It’s Blue Cross Blue Shield. Thank you in advance for your assistance. -Denise

    Hello Denise, there are several factors that may make a difference in how you handle your health insurance going forward.

    First: Many employer plans will not allow the employee to drop their company insurance and allow the spouse or family to maintain coverage. If he can drop and keep you insured, we must look at the cost differences if he moves to Medicare. This will depend on the type of plan he chooses and the amount of your combined yearly income while he is working.

    Second: you have a ways to go before you reach Medicare age and if your husband’s plan is as good as you say, it will be difficult to replace at the current rate.

    Third: As long as your plan is not a health savings account (HSA) plan to which you are contributing, he should take out Part A when he turns 65. Many employers require Part A when the employee turns 65. You will not get any kind of notification from BCBS, however, your employer may and they may pass it to you.

    Fourth: As long as the employer coverage is considered creditable by Medicare, (good plans most often are) your husband will have a penalty-free Special Enrollment Period (SEP) to enroll in Part B any time while working and for eight months after his coverage ends, whether by his choice or the company’s. He will also be able to choose a Supplement or Medicare Advantage (MA) Plan, and Drug Plan during this time.

    One last caution: If he retires and is allowed to keep the insurance, he must enroll in Part B at that time or risk incurring penalties. Retirement and COBRA coverage are not considered creditable for the Part B SEP.

    Regards, Ron

    +

    I have been on my husband’s insurance, but he is retiring in three months. I already have Medicare A but that is all, so what do I need to do to get my insurance brought up to date and be covered? I am 73 and diabetic but I do take medicine to control it. I will wait for your phone call or email. -Bobbie

    Bobbie, thanks for your question. Now is the time to put things in place for your change to Medicare. The first thing you must do is contact the Social Security Administration (SSA), as it is  the agency that handles enrollment to start Medicare Part B. You should have it set to start the first day of the month after your husband’s coverage ends. This can be done by creating an online account or logging onto a previously-created account. Online is the easiest way because there you can fill out the application and upload the form MS-L564_508. This form is simple but must be signed by your husband’s human resources department. Be sure to write on the form the date you would like your Medicare to begin; it must always be the first day of the month. You may also contact them at (800) 772-1213.

    Once you have the application for enrollment and form MS-L546-508 submitted, we can enroll you in either a Medicare Supplement or Medicare Advantage Plan (MA Plan) to begin concurrently with your Part B. I am willing to research the plans available in your area and make sure you get in the best plan for your circumstances.

    Medicare is Awesome! Ron

    +

    My husband is 69 and he was covered under my insurance for many years, but as of October 2020 is on Medicare. I changed employment and so my insurance changed as well. I need to gain a better understanding of options and costs related to Medicare and supplements. I decided to reach out to you because the bios on your team are quite impressive. I look forward to learning from your expertise and guidance. Thank you. -Susie

    Thank you, Susie. My answers assume that when your husband turned 65, he enrolled in Part A of Medicare and deferred Part B. It only makes a difference if he deferred Part B. If so, when did you change employment and insurance, and did your husband lose coverage under your employer group coverage? The time from the loss of group coverage until now will determine what time of year he may enroll in Part B and the cost of any penalties he may have accumulated for Parts B and D late enrollment.

    From the time his group coverage ends, he has eight months to enroll in Part B without delays or penalties. If it has been longer, he will have to sign up during the General Enrollment Period (GEP) which runs from Jan. 1 through March 31, with coverage beginning July 1. Late enrollment penalties will also be calculated. He has a Part B Special Enrollment Period (SEP) for eight months after the loss of group coverage. It does not matter if he had COBRA or retirement coverage after the end of his group coverage, as those are not considered creditable coverage for Part B. After eight months he has no special privileges.

    If you are still within the eight-month SEP, he can enroll in Medicare Part B at any time without delay in coverage or penalties. You will need to get Form MS-L564_508 REQUEST FOR EMPLOYMENT INFORMATION filled out by your employer. If your income is below $182,000 for joint filers or $91,000 for single filers, your cost of the Part B monthly premium will be $170.10 for 2022. If he is receiving Social Security Administration (SSA) benefits the cost will be taken out of his benefit check, but if not, it will be billed on a quarterly basis.

    Once you know the Part B start date, immediately enroll in either a Medicare Supplement (MEDIGAP) plan plus a Part D drug plan or a Medicare Advantage Plan (MA Plan). Because he has delayed his Part B coverage, the SEP for a Supplement Plan is six months after his Part B starts. If he misses this SEP, he will no longer have guaranteed coverage and will have to go through underwriting. His Part D SEP has been shortened to three months before his Part B begins, with the Part D start date coinciding with his Part B start. If he does not enroll with those coinciding, he will have to wait until the Annual Enrollment Period (AEP), which runs from Oct. 15 through Dec. 7 with coverage beginning Jan. 1. Late enrollment penalties will be added. Only the government could be this confusing.

    The go-to Medicare Supplement Plan is Plan G as it has the highest level of coverage. There are 10 lettered Supplement Plans, and all have the same mandated coverage no matter what carrier you purchase it from. However, the cost varies widely based on the carrier and your geographical location. For a 69-year-old male, the lowest cost of Plan G will run between $150 and $230 depending on where in the U.S. you are located, in addition to the Part B premium. If he is not in his Supplement SEP, he will go through underwriting and may be denied coverage or offered it at a much higher cost. Part D will cost between $7.50 and over $100 per month, depending on the coverage.

    Despite all the confusion, Medicare is awesome!

    Hope this helps, Ron

    +

    I just retired on June 1 at age 67. I am looking for a Medigap Plan that will cover what Parts A and B will not cover and also for dental and vision. Basically, I do not want to have surprise out-of-pocket expenses. Ideas? Thanks. -John

    Thanks for asking, John. I assume when you retired you left an employer plan and are already enrolled in Original Medicare Parts A and B. If either of these assumptions is incorrect it may change the timing of your enrollments. If you are not enrolled in A and B, that is where you start.

    Original Medicare Parts A and B cover basically 80% of your medical and hospital expenses. The extra 20% can be significant and has no limit on your exposure. There are two choices for covering the 20%: Medicare Supplement (Medigap) or Medicare Advantage Plans (MA Plans). Supplement plans give more flexibility for doctors, hospitals, clinics, and such. However, there are much higher premiums and no coverage for dental, vision, or prescription medications. MA Plans cover everything Original Medicare covers, plus dental, vision, prescription meds, and more. The plans have low or $0 premiums, copayments, and a yearly maximum out-of-pocket limitation.

    Supplement Plans depend on the state you reside in at the time of application for availability and pricing. MA Plans are relegated to your county and zip code for availability and pricing. You can research either of these through the Medicare Plan Finder.

    Feel free to contact me for more information and help in obtaining a good plan for your circumstances.

    Medicare is Awesome! Ron

    +

    I retired from the California state public school system [teacher] in 2018 at age 60. I have district-provided medical coverage until 2023. Do I still enroll in Medicare when eligible or do I wait for my coverage to expire? Will I be given notice as to when I should begin enrollment or do I find those things out on my own? All the information that I have is from word of mouth from other retirees, which is confusing, to say the least. I have been told that you can enroll after your 63rd birthday at 63.5 years. I’ve heard that you should wait until 64.5. That’s a discrepancy of a year. When exactly should one enroll in Medicare so as to not have a lapse in coverage? -Kenneth

    Kenneth, let’s take this from the beginning. Whether you stay with California state or not when you turn 65, be sure you enroll in Parts A and B of Medicare during your seven-month Initial Enrollment Period (IEP). IEP begins three months before you turn 65, the month you turn 65, and ends three months after the month in which you turn 65. Retirement coverage is not considered creditable coverage to defer Part B so you will begin accruing late enrollment penalties after your IEP.

    The ideal strategy is to contact the Social Security Administration (SSA). It handles Medicare enrollment three months before your 65th birthday. You can call SSA at 1(800) 772-1213, visit your local SSA office, or open an account on the SSA website.

    You will only be given notice of Medicare enrollment if you are receiving SSA or Railroad Retirement Benefits for four months before your 65th birthday. If you are receiving benefits, you will be automatically enrolled in both Parts A and B.

    You only become eligible for Medicare Enrollment when you turn 65 years old, or you receive Social Security Disability benefits for 24 months. Your colleagues are confusing Medicare with SSA timing. You can start receiving SSA benefits as early as 62, but Medicare begins at 65.

    I suggest that when you are about 64.5 you begin researching what retirement Medicare benefits will be available from the California state public school system, which will offer several Medicare options for you. However, state plans are often more expensive for less coverage than you can get directly from Medicare. When that time comes, I will be happy to help you decipher the benefits.

    Regards, Ron

    Moving With Medicare

    +

    I am presently with UnitedHealthcare (UHC) as my Medicare Advantage Plan. My agent here has advised me to find an agent in Maine to advise me about changes. Thanks so much. -Debbie 

    Hello Debbie, Medicare Advantage Plans (MA Plans) are area-specific, and the agent who helps you must be licensed in the state and authorized to offer the plans available. Your agent is correct in sending you to someone else that covers your new area.

    If you have relocated to Maine within the last two months, you are in your Special Enrollment Period (SEP) for a new move. If you have been in Maine longer than two months, because you have a current MA Plan, you have until March 31 to select a new plan under the yearly MA Open Enrollment Period (MA-OEP).

    Medicare is Amazing! Ron

    +

    We are moving my brother-in-law to Pennsylvania from Tennessee. He currently has UnitedHealthcare (UHC) in Tennessee. What steps does he need to do to have this plan automatically transferred to Pennsylvania? Will he lose any coverage? Please advise. -Teresa

    Hello Teresa, several steps need to be taken to be covered in Pennsylvania. I checked and most areas in the state have his plan available. There are two places I would suggest you call for information on the process. You will need to qualify for Medicaid in Pennsylvania, so you will need to check with the Medicaid office in the area he’s moving to. However, the first call I would make is to the 800 customer service number on the back of his UHC card. Tell them where and when he is moving and ask them how he should go about moving his plan from Tennessee to Pennsylvania.

    If your brother qualified for Medicaid in Tennessee and his income will remain basically unchanged when he moves to Pennsylvania, he should qualify for Medicaid in Pennsylvania. If this is the case, he will be able to enroll in the same in Pennsylvania and not lose any services.

    Medicare is awesome, Ron

    +

    I am starting our move from Nashville, Tennessee area next week. We hope to move into our new home in late July. What is the process of changing Medicare plans from one state to another? -Gilbert

    Gilbert, thanks for writing. The process will depend upon what kind of Medicare coverage you have. If you have a Medicare Supplement Plan and a Prescription Drug Plan (PDP), you must notify the company your Supplement Plan is carried by once you move. You will be able to maintain the Supplement Plan with the possibility of a change in the premium amount. However, you will need to select a new PDP as this is state-specific. If you are covered by a Medicare Advantage Plan (MA Plan), you will need to change your plan as their coverage area is usually county-specific. You have two months from the time you move to make a change in your MA Plan or PDP but do it as soon as possible. I will be happy to help you with this process.

    Medicare is Awesome! Ron

    +

    I am thinking about moving back to Colorado and right now I’m assessing all anticipated expenses and comparing them to my current ones in Wyoming. I need a phone number for someone that can talk with me about possibly reinstating my previous Medicare Advantage Plan (MA Plan) I had in Denver in 2019. I’m pretty sure it was with UnitedHealthcare (UHC) but I’m not positive. -Karen

    Karen, thanks for writing. If you are looking at MA coverage, it is much stronger and less expensive in Colorado than in Wyoming. However, it is not a process of reinstatement but a simple reapplication process that can be completed online. It would be best to compare the plans available in the area you are moving to and make sure any doctors you may desire are part of the plan’s network. Also, make sure the medications you take are covered by the formulary of the plan. If you have a Supplement Plan, you may keep it when moving and the company will simply adjust your premium if necessary.

    You are welcome to call me at the phone number below and I will help you with the information you are looking for and put you in touch with the correct person.

    Medicare is Awesome! Ron

    +

    Hello, I am in Seattle, Washington, and possibly moving to Casper, Wyoming, in the next couple of months. I am a low-income senior and currently have Medicare and UnitedHealthcare (UHC) Dual Complete. Am I right in assuming I can maintain this coverage in Casper? I’m also assuming when I get there I have to apply for Medicaid then UHC would kick in? Thanks for any and all information. -Stephanie

    Stephanie, I assume you are talking about Casper, Wyoming (I grew up there). It is important to note that Wyoming has one of the lowest Medicaid budgets per capita in the nation. The income limit for Medicaid in Wyoming is $783 single and $1,175 for a married couple. You can check to see if you qualify for Wyoming Medicaid. However, UHC Dual Complete does not service Natrona County where Casper is located. There are only two Medicare Advantage Plans (MA Plans) available in Casper; both are Private-Fee-For-Service (PFFS) plans underwritten by UHC. Until a couple of years ago, Medicare Supplement plans were the only ones available in Natrona County.

    Once you move, you will have two months to choose a Medicare plan in your new location. It is best to have that in place before you move so it will start when you arrive. Once there you can apply for Medicaid and then switch to a plan that coordinates with Medicaid.

    Regards, Ron

    +

    I’m moving from Colorado Springs, Colorado, to Boise, Idaho, later this year. I’m starting Medicare on July 1. My current plan is with Kaiser Permanente. Could you briefly explain how I transfer my Colorado plan to the Idaho plan? Thanks!! – Eric

    Eric, a Special Enrollment Period (SEP) will allow you to change plans up to two months after you move. It is best to get signed up before you move so that it is in place and you can settle in quickly after your move. You will be able to choose from any Medicare Advantage Plan (MA Plan) available in your new locale. However, because Kaiser Permanente does not service Boise you will need to pick from the available plans; there are 44 plans available in the Boise area. If you would like help researching plans, making a decision, and enrolling in your new area, please feel free to contact me.

    Ron

    +

    I need to know how to sign up in Georgia. We already have started the process in California, but we are moving. – Laura

    Laura, your question will be different based on what parts of Medicare you are signing up for. If you are in process in California for enrollment in Medicare Parts A and B you can continue the process there and once complete it will be good in any state. If you are signing up for a Medicare Supplement, Medicare Advantage (MA), or Prescription Drug Plan (PDP) you have a Special Enrollment Period (SEP) which lasts for up to two months after you move to Georgia.

    If you get signed up for a Supplement Plan while in California, you can use that plan in Georgia also. Once you get to Georgia, call your plans customer service number on the card within 63 days of your move. Inform the company that you have moved, and in most cases, you will remain with the plan; however, you may just have an adjustment to the amount of the monthly premium payments.

    For MA and PDP Plans, you have two months after your move to sign up for a plan in your new coverage area. You can log on to the Medicare Plan Finder and enter the information called for. There you can research plans and sign up directly from the plan finder if you feel confident in your decision.

    For help with the research and signing up, contact me and I will assist you.

    Medicare is Awesome! Ron

    +

    My father is 87 and moved 8 miles east of Mesquite, Nevada, to Littlefield, Arizona. I was updating his address with Humana and was informed he would need to change his plan to one in Arizona. This little strip of land doesn’t have any medical care providers. He has a primary care doctor in St. George and does all his medical in Utah. I am confused if he must choose another Humana plan or if that even matters. I also do not understand the Medicare Advantage Plans (MA Plans) when it comes to the drugs. It often says N/A under the drug section while at the same time it says drugs are included in the said plan. I was also given until the end of the month to make the change or he would lose coverage. He is in the middle of a health crisis and having spinal surgery next week. If I do change his plan, does that go into effect now? -Cindy

    Cindy, because MA Plans have coverage based on your state and county, when you move out of state (even 8 miles), you must change your MA Plan. There are a couple of plans in Mohave County, Arizona, that will cross the state line and host in-network providers in Mesquite, Nevada. I can help you with this change in a timely manner if you contact me by email or phone.

    When a plan has given you a disenrollment date, enroll in a new plan with a start date concurrent with the end date of the previous plan. It certainly matters, as if your father has a lapse in coverage he will not be covered for his upcoming surgery. There is a Special Enrollment Period (SEP) for moving, which allows you to change plans anytime during the two months following your move.

    I am uncertain where you are getting a N/A when inputting your drugs for inclusion in your plan. All MA Plans with drug coverage must have drugs available for every category manufactured, but not all drugs are included in a plan’s formulary. It is important that you check medications before choosing a plan. Some plans’ online formularies may return a N/A when you search for a drug that is not in the plans’ formulary.

    Regards, Ron

    +

    I have Plan G through Premera in Washington. How do I choose a company in Colorado best for my needs? -Debra

    Debra, with a Medicare Supplement Plan G you normally do not have to change plans when you move. However, if your plan will not cover you in Colorado then you will have a Guaranteed Issue Enrollment Period. You can research Supplement Plans available in Colorado. Enter your information to see which are available and the approximate cost. If you would like assistance, please feel free to call on me.

    Regards, Ron

    +

    My father recently passed and my mother is 81 years old with dementia. She is living in California and has a full-time caretaker. Her health plan is with Kaiser Permanente. I need to move her to Illinois to a facility near my home. What is the procedure for switching health insurance this late in the year? -Pam

    Pam, I am sorry to hear about the loss of your father and the struggle you face with your mom. The time of year makes no difference when a move is involved. Medicare Advantage Plans (MA Plans) have a Special Enrollment Period (SEP) for moving from one coverage area to another. This SEP runs for two months before your move, with service beginning the month in which you move, or for up to two months after the move has been completed. The main thing is to research plans in your local area and be sure your mother’s doctors and medications are covered.

    Regards, Ron

    +

    I am moving from Michigan to Wisconsin in September. When do I need to sign up for a Medicare Advantage (MA) Plan? Are all available in Dane County? One site I looked at only gave me three choices. -Deborah

    Deborah, you have two months from the date you move to switch your MA Plan. You can apply before you move so it is ready when you move or wait until you move; just be sure to enroll within the first two months.

    There are three zip codes for Dane County, Wisconsin: 53529, 53527, and 53528. Each one has 34 Medicare Advantage Plans available. The Medicare Plan Finder shows all plans available in any zip code. It allows you to compare plan coverages and enroll when you are ready. Here are the results in Dane County. If you need assistance, let me know.

    Medicare is Awesome! Ron

    +

    Hi Ron. My mother and I live in Tennessee but will be moving to the Buffalo, New York, area soon. My mother has yet to apply for health insurance until we settle in. She is 55 years old and is disabled with a bad knee from an injury she suffered six years ago. She also has a dislocated shoulder from a car accident that she suffered years prior. I read that even if she’s not 65, she can still qualify for Medicare due to disability. If so, would you recommend it for her now? She’s looking to enroll in UnitedHealthcare (UHC) D-SNP for $0 copays on medications and $0 premiums so it can give her the complete coverage she’s looking for. Can Medicare help her even more so at this point? If so, what can it do? What Medicare plan would best help with the insurance plan she plans to have? Thanks. -Ana

    Ana, several questions must be answered to be able to apply for the UHC Dual Special Needs Plan (D-SNP) when relocating to Buffalo.

    1. All D-SNP Plans are Medicare Advantage Plans (MA Plans) so she must be on both Medicare A and B to qualify.
    2. Because your mother is only 55 years old, to qualify for Medicare she must be on Social Security Disability Insurance (SSDI) for 24 months. Original Medicare Parts A and B automatically begin the first day of the 25th month of SSDI benefits.
    3. D-SNP MA Plans require the member to be on Medicare and Medicaid to avoid premiums and copayments. If she is on Medicare A and B, she must be enrolled in Medicaid in Erie County, New York; here is the website.
    4. If your mother is on Medicare and qualifies for Medicaid, the UHC Dual Complete D-SNP will offer her very good medical coverage with $0 premium and $0 copayments. Some prescriptions will cost between $3 and $9, and will include dental, vision, hearing, over-the-counter, transportation, and many more benefits with $0 copayments.

    Medicare is Awesome, Ron

    +

    I am on SSDI and have Medicare. I moved to Alabama from Arizona, I am looking for a Medicare Advantage Plan (MA Plan). I get confused very easily and don’t understand the plans and process for applying. -William

    William, any time you are on Medicare it is important that you change your MA Plan within two months of moving to a new area. You have a Special Enrollment Period (SEP) in which you can make changes to your plan, and it only lasts for two months after your move. Unless you qualify for low-income assistance or other SEP, if you miss your two-month moving SEP you will have to wait until January for new coverage.

    Because of your SEP, you are eligible for all MA Plans available in your new zip code and county, regardless of the fact you qualified through SSDI. If you email your zip code and name of the county you live in, I will be happy to do some research for you and we can connect by email, phone, or Zoom.

    Medicare is Awesome! Ron

    +

    Dear Ron: My wife turns 65 on June 26 and I turn 65 on Aug. 29. We have both enrolled in Medicare Parts A and B. Here in Washington we have been on Medicaid for a number of years and have had all our medical concerns covered. If we were to stay in Washington, I understand that Medicaid will cover everything that Medicare will not. We plan to move to Boise, Idaho, this summer. What sort of plan should we seek to cover all our prescription drugs, eye, ear, and dental? Is there a way to transfer Medicaid Washington to Medicaid Idaho, or what Medicare Advantage (MA) Plan should we seek? Thank you. -Joseph 

    Hello Joseph, I believe it would be best if you enroll in a Dual Special Needs Plan (MA D-SNP) in Washington to begin concurrently with your Part A and B. This will not only give you full coverage while there (whether you stay for a few days or permanently), but it will also work as a transition plan if you move to Boise. You will need to apply for Medicaid in Boise as Medicaid does not have reciprocity from state to state. You apply through the Idaho Department of Health and Welfare/Medicare for Elderly or Adults with Disabilities. Once you are enrolled you can switch your Medicare D-SNP plan to Boise.

    Since you are already enrolled in Medicaid in Washington it is an easy application for D-SNP coverage, which will give you dental, vision, hearing aid, an over-the-counter allowance, and much more. Please let me know your zip code and I will help with the research and enrollment.

    Medicare is Awesome, Ron

    +

    My husband is retiring at the end of May, so we will no longer have medical benefits. We will be moving to Colorado in June. We both have Medicare Part A. Should we wait till we are in Colorado to find a Medicare Advantage Plan (MA Plan)? Thank you, Betsy 

    Betsy, first let me address your Part B enrollment. Now is the time to begin the process of enrolling in Part B, which must be in place before you can enroll in any MA Plan. I assume you have been continuously covered by your husband’s employer group health plan. If this is the case you will need to have a Form MS-L564-508 filled out by his employer. Be sure to have one filled out for each of you, as the Medicare enrollment process is per individual. Once this is in hand, the easiest and best way to enroll is here. There is an option for those who will be opting for Social Security Administration (SSA) benefits to start and those who wish only to enroll in Part B. You may also call SSA at 1(800) 772-1213. This process should begin now! You can request your Part B start on June 1, assuming your employer coverage ends May 31.

    If you are moving to Colorado in June, you can make an application for a Colorado MA Plan to begin June 1 with your Part B. Enrollment can be done as soon as Medicare has accepted your June 1 Part B start date. Research MA plans here, select Continue without logging in, and follow the prompts. If you would like assistance, feel free to contact me.

    Medicare is Awesome, Ron

    +

    Following my dad’s recent death, we needed to relocate my mom from Florida to Maryland to be closer to family members. We’ve just learned that her Medicare insurance provider in Florida (Humana) does not offer coverage in Maryland. How do we go about finding similar coverage for her in Maryland? The plan she had in Florida seemed to work fine for her needs. Thank you. -Chuck

    Chuck, my condolences for your father’s passing. Medicare Advantage Plans (MA Plans) are all subject to state and county coverage areas, and you are correct Humana does not cover Maryland. However, Maryland has many MA plans that will fit your mother’s needs. The plans will have equal coverage as her plan in Florida; however, the copays may be a bit different. Only research will determine which is best for her.  Research plans, scroll down to Find health & drug plans. Then choose Continue without logging in (right above zip code and plan type). Answer a few questions and you will see plans from several carriers, and you may enroll right there online.

    If you like, I can help you research the plans or refer you to a local agent for help.

    Medicare is Awesome, Ron

    +

    My wife and I are both on Medicare with Kaiser Permanente of Oregon. This summer we are going to be full-timers with our RV using South Dakota as our domicile. Which Medicare plans in South Dakota work in all states? Thanks for your time and your opinion. -Joe

    Hello Joe. Because Kaiser Permanente is a Medicare Advantage Plan (MA Plan), and those are relegated to service areas (most within the county of residence), you will have to enroll in a new plan when you move. All MA Plans work well when traveling anywhere in the U.S. The plans provide emergency and urgent care coverage while in the U.S., and most will allow the same worldwide. When you move, you will have a Special Enrollment Period (SEP), which begins one month before you move and extends two months after your move to make the change.

    The other option you may want to consider is changing from a MA Plan to a Supplement (Medigap) Plan before you begin traveling. The Medigap plan will allow you to make an appointment with any doctor in the U.S. or its territories if they accept Medicare assignment. However, you must undergo medical underwriting to qualify for Medigap plans and there is a monthly premium and annual deductible to consider.

    Medicare is Awesome! Ron

    +

    Hi, I am looking to move my mother from Florida to an assisted living facility here in Maryland. As I understand, I will need to switch her Medicare to Maryland? Can you give me any information on that process, please? How long does it take, and is there overlap coverage for both states while the transition takes place? She is in a rehab facility in Florida now. I appreciate any information/links you could send me. -Linda

    Hello Linda, the coverage your mother has in Florida will determine how to proceed when moving to Maryland. If she has a Medicare Supplement (Medigap) plan she can simply inform the carrier that she has moved and the coverage will remain intact. However, if she is on a Medicare Advantage Plan (MA Plan), she will need to select a plan in Maryland before the move so it can be in place when she arrives.

    All MA plans begin on the first of the month. If you move her in the middle of the month, the coverage she has in Florida will cover her for both emergency and urgent care in Maryland until the new plan begins. It is difficult to send you information on the available plans in your area without knowing what your zip code and county are, as MA Plan availability is tied to coverage area.  All areas can be researched at https://www.medicare.gov. On the lower right side of the screen choose “Find Plans” and then “Continue without logging in.” Enter the information required (nothing personal) and you will be able to see the plans available in your area. You can also speak to a trained counselor through your State Health Insurance Assistance Program (SHIP), where counselors are ready to help with your Medicare questions. Find your local SHIP office.

    Medicare is Awesome, Ron

    +

    I have Kaiser coverage in California but we have a new home that is being built, so we will be moving in late April. Since Kaiser is not available in Arizona I will need a new carrier. I have recently undergone bladder cancer surgery on Jan. 28, 2022, and am still undergoing treatments and procedures as part of my recovery. I will need to continue all scheduled CAT scans, etc. when I move. How do I go about signing up with your company? Thank you for a prompt reply! -Stephen

    Hello Stephen,

    Kaiser in California offers Medicare Advantage Plan (MA Plan) coverage. When you get ready to move you will have a Special Enrollment Period (SEP) to enroll in another MA Plan in your new area. Your SEP begins one month before your move and continues two full months after you move. If you miss your SEP, you will have to wait until the Annual Enrollment Period (AEP), which begins Oct. 15 and goes through Dec. 7 with coverage beginning Jan. 1.

    MA Plan availability in Arizona is very strong; however, it depends upon what area of the state you will be moving to. Whenever a domestic move within the U.S. is anticipated, MA Plans will need to be researched based on the zip code and county you are relocating to.

    The follow-up care for your cancer surgery will not be an issue for qualification for MA coverage. The local plans should be analyzed for coverage, copay, and coinsurance costs, though. With MA coverage there are no medical conditions that are considered preexisting for coverage qualification, and there is no medical underwriting for them.

    Because I am licensed in Arizona, I will be happy to help you with the relocation process. You can email me directly at [email protected]

    Medicare Is Awesome! Ron

    +

    My wife and I are on Medicare and have Kaiser Permanente as a Medicare Advantage Plan (MA Plan). We sold our home on May 31, 2022, and now are full time in an RV with Sioux Falls, South Dakota as our domicile. Because we no longer live in Oregon we need to find a plan that will cover us no matter where we are in the U.S. Any info would be greatly appreciated. -Joe

    Joe, the type of plan you are looking for depends on your health and usage. The time of year you switch depends on when you changed your domicile from Oregon to South Dakota. Let’s begin with your eligibility to change plans. If you have changed your domicile within the last two months, you can immediately switch to a new plan. You have a Special Enrollment Period (SEP) which runs from one month before your move through two months after. If you are in that window, you can make the change immediately. If your SEP passed, you will have to wait until the Annual Enrollment Period (AEP) which runs from Oct. 15 through Dec. 7 with coverage beginning Jan. 1.

    Now let’s talk about the kind of plan you are looking for. Whether you get another MA Plan or try to qualify for a Supplement Plan you will be able to receive care anywhere in the U.S. The difference is in the fact that with an MA Plan you may need to access care through urgent care or emergency centers. With a Supplement, you can make an appointment with any doctor in the U.S. if they accept Medicare Assignment.

    MA Plans are normally an HMO or Preferred Provider Organization (PPO). HMOs have local networks usually bounded by county or state lines; however, some have travel options allowing you to see in-network doctors anywhere they have service. PPO plans allow you to see doctors outside of your local network, but you may have to pay more for the services, with some plans much more. In Sioux Falls there are some very good HMO and PPO Plans by carriers like AARP/UnitedHealthcare, Aetna, Humana, and more. Several of the PPOs have fixed copays for both in- and out-of-network care. This is important because if you have a 40% or 50% copay the service can become expensive. You can search for available plans on the Medicare Plan Finder. Simply log on, scroll down and select the box, Find Health and Drug Plans, add your zip code and county, and proceed. Or let me know and I will be happy to help you, at no cost.

    The other option is to see if you qualify for a Supplement Plan. The plan premium will depend upon your age, and whether you qualify or not will depend on your health. You will also need to add a Prescription Drug Plan (PDP) which will have an additional premium depending on your medications. Most MA Plans include drug coverage. Supplement and PDP Plans can also be researched on the Medicare Plan Finder, or I can help out.

    Medicare is Awesome, Ron

    +

    Hello, how can I find a local agent to help me with my mom’s and dad’s Medicare in Utah? They have already had Medicare and Medicaid but I need to get them switched over to Utah. -Ave

    Ave, you can do it all by yourself on the Medicare Plan Finder if you are both Medicare and tech savvy. But I would suggest you speak to someone who can help you understand the plans in your area. Tim Gustafson is a trusted Medicare professional who is licensed in all 50 states and would be happy to speak with you and help you through the process. You can access Tim’s calendar and set an appointment that is convenient for you; there is never a charge for his Medicare services.

    Medicare is Awesome!

    Ron

    +

    If I have a Massachusetts Supplement Plan and move to another state (Georgia) I would not be able to take that plan with me as MA has state-specific plans. Will I be able to choose another Supplement Plan in that state without medical underwriting? -Ken

    Hello, Ken. You are correct in assuming that when you move from Massachusetts you probably will not be able to continue in your Supplement Plan within that state. In most cases, you will have a guaranteed issue right when you arrive in Georgia.

    Guaranteed issue rights (also called “Medigap protections”) are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company:

    • Must sell you a Medigap policy
    • Must cover all your pre-existing health conditions
    • Can’t charge you more for a Medigap policy because of past or present health problems

    In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health coverage.

    However, it is always best to call the State Health Insurance Assistance Program (SHIP) office in the state you are moving to for a definitive answer to this question. The Georgia SHIP office can be contacted by phone at 1 (866) 552-4464, and the website is https://aging.georgia.gov/georgia-ship.

    You have 63 days from the time you move to sign up for either another Medigap Plan or a Medicare Advantage (MA) Plan.

    Medicare is Awesome!

    Ron

    +

    We have just moved from Illinois to Wisconsin and need to change the Part D plan. How do I cancel the Illinois plan and start a Wisconsin plan? -Gail

    Hello Gail, once you move you have two months to change your Part D Plan. To research and enroll in a new plan where your new domicile is located, simply go to the Medicare Plan Finder. Here you can research and compare plans offered in your new locale and enroll from the same platform. Once you have enrolled in a new Part D Plan, Medicare will automatically disenroll you in your current plan; you do not have to do anything with the old plan.

    Medicare is Awesome,

    Ron

    Name Changes

    +

    How do I correct my name now that I’m married? -Kerry

    Kerry, whether you are trying to change your name with Medicare or Social Security (SSA), the latter handles the change. Creating an SSA account is a good idea as it allows you to track your SSA and Medicare business. You may also call them at 1(800) 772-1213.

    To make a name change you will have to supply documents proving your legal name change and identity. These must be original documents or copies certified by the issuing agency. You will also need to fill out a Form SS-5 Application for a Social Security Card.

    Once you have made the change, the information will be shared with Medicare. However, once the process with SSA is complete, check with Medicare in a couple of weeks to be sure the changes have reached them and to order a new card. Medicare can be reached at 1(800) 664-4227 or online.

    Medicare is Awesome! Ron

    Plan N Guaranteed Issue Rights

    +

    Can you tell me if Medicare Supplement Plan N is a guaranteed enrollment plan? -Jim

    Jim, you just asked the $64,000 question. This is a disputed area by many; however, I can tell you that while The Centers for Medicare & Medicaid Services (CMS) does not say Plan N does not have Guaranteed Issue Rights, it does not include it in its list of plans that do.

    CMS tells you to call your SHIP office to see if it qualifies. I believe your local SHIP office is the next call you should make. SHIP offices are government-sponsored and free to the customer. Call (800) 252-8966.

    Good luck, Ron

    Preventive Surgery

    +

    I am 81 years old and was recently diagnosed with breast cancer. Because I was being treated for arthritis, I may have had this disease process for over 18 to 24 months. My left breast is involved and soon I will get a bone scan to see how far the cancer has spread. 

    My question to you is, if the surgeon removes my afflicted left breast, will Medicare help pay for the right one to be removed at the same time? Since my three sisters and myself all have cancer, it is almost certain cancer will show up in the right breast. Is preventive surgery accepted under Medicare? -Nora

    Hi Nora, Medicare provides coverage for most cancer treatments and testing with various cost-sharing options, depending on the treatment and Medicare plan you have in place. It will cover breast exams, mastectomies, and reconstruction, with different parts of Medicare covering different areas of the treatment.

    The doctors’ visits, consultations, and outpatient services or surgeries are covered by Medicare Part B. Part B also covers some oral chemotherapy and other medications administered by a doctor.  The hospitalization and inpatient surgery are covered by Part A, as well as most medications administered while an inpatient. If the decision for reconstruction is made, Part A will cover surgically implanted prosthetics and Part B will cover external prostheses and related bras. If you need other medications, you will need to have Part D prescription drug coverage.

    Preventive mastectomies are not guaranteed by Medicare. However, if you have a cancer diagnosis that requires a mastectomy, and you have a family history of breast cancer, ask your doctor to provide the needed information and documentation and to support your claim for the preventive surgery.

    If you are denied, the process is in place to appeal any decision made by Medicare. Be sure to enlist the aid of your doctor.

    Regards, Ron

    Qualify for Medicare

    +

    Who qualifies for Medicare? -Rebecca

    Hi Rebecca, in general, you are eligible for Medicare Part A if you are age 65 or older and a U.S. citizen or permanent legal resident for at least five consecutive years. You are eligible if you are already receiving retirement benefits from Social Security Administration (SSA) or Railroad Retirement Benefits (RRB), if you were a state or local government employee after March 31, 1986, or a federal employee any time after Dec. 31, 1982.

    You are eligible if you are disabled and receiving disability benefits. Medicare is automatic after you have been on Social Security Disability Insurance (SSDI) for 24 months. Everyone eligible for SSDI benefits is also eligible for Medicare after a 24-month qualifying period. The first 24 months of disability benefit entitlement is the waiting period for Medicare coverage. You are eligible for Part A and B if you have end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS). Contact the SSA at (800) 772-1213 to learn if you have enough work history to qualify for ESRD Medicare.

    You are eligible if you have been married to a qualified beneficiary for at least one year before applying. If you are divorced from a qualified beneficiary to whom you were married for a minimum of 10 years and you are single at the time of application. Or you are widowed by a qualified beneficiary to whom you were married for at least nine months before their death, and you are single at the time of application.

    Regards, Ron

    +

    My friend is on Social Security Disability (SSDI) and is becoming eligible for Medicare in August. She lives in Arizona and is 56 years old. We have been told she cannot purchase a Medigap Plan in Arizona due to state laws. Do you know more about this and is there any way around this problem? She is not eligible for financial assistance plans as her retirement and disability plans bring in too much. We are not as interested in Medicare Advantage Plans (MA Plans) for a number of reasons, but most importantly, she is a Mayo Clinic patient and would have to do the Preferred Provider Organization (PPO) and would only be covered out-of-network. -Sara

    Thanks for writing, Sara. In 2022 there are six companies offering Supplement Plans in Arizona to people on SSDI who are under 65. However, the cost is quite high. For the most popular Plan G, it would cost a 65-year-old female around $100 per month. For a 56-year-old female, it would cost about $435 per month. This is on top of the $170.10 Part B monthly premium and a Part D drug plan costing an average of $25.

    However, a Supplement is the only option for Mayo, which does not take any Medicare Advantage Plans (MA Plans), including PPO. Because a Medicare PPO plan is a type of MA Plan it is not accepted by Mayo. Unless your friend has very deep pockets I would advise against staying with Original Medicare A and B only. She would pay 20% of all services and there is no limit on the exposure.

    Once she turns 65 she will have an opportunity to enroll in any Supplement offered with no underwriting required. I can help with research and enrollment in all plans available.

    Medicare is Awesome! Ron

    +

    I am 32 years old and recently was approved for Social Security Administration (SSA) disability and was told I qualify for Medicare. My total income will be $830 per month, and if I sign up for Part A and B my cost would be $170 per month. Do you recommend I do Part B or what would you suggest? Thank you. -Deanna

    Hi Deanna. Your meaning behind “recently approved” will make a big difference in your Medicare eligibility. If you have recently been approved and are just beginning to receive Social Security Disability Insurance (SSDI) benefits you are eligible for Medicare; however, you are in the 24-month waiting period. Once you begin receiving SSDI benefits, Medicare automatically starts on the first day of the 25th month. When your Medicare starts you will have $170.10 per month (2022) taken out of your SSDI check for the Part B premium. But with an income of $830 per month, you should qualify for Medicaid. Each state has its own income limits, but I believe all states are higher than $830 per month. If you are enrolled in Medicaid the state will pay your $170.10 premiums. It is important that you have both Part A and Part B so you can enroll in a Medicare Advantage Plan (MA Plan). Once you are on Medicaid you will qualify for a Dual Eligible Special Needs Plan (D-SNP). On this plan, you will have no premiums, deductibles, copayments, or coinsurance for any medical services covered by Medicare. In addition, you will have dental, vision, food, fitness, and more.

    Medicare is Awesome! Ron

    Replacement Cards

    +

    I lost my card and need a replacement. I need my number for a recent doctor’s appointment. -Robert

    Hi Robert. It depends on what card you have lost. If it is your Medicare Card, you can log on or open an account directly. Once you have logged in, print or have a new card sent to your address of record.

    If you have lost the card for a Medicare Advantage Plan (MA Plan) or Medicare Supplement Plan, you will need to call the customer service department of the company that underwrites your policy. You can find their numbers by doing an internet search for the insurance company by name. Or you can go to the Medicare Plan Finder and look it up there.

    Regards, Ron

    Respite Care

    +

    Are there any Medicare Advantage programs (MA Plans, Part C) in Alabama that will pay for seniors to have home care services, such as personal care, homemaker services, or unskilled respite? -Tiffanie

    Tiffanie, unfortunately, the type of home services you are inquiring about is not covered by either Original Medicare or MA Plans. The only home care Medicare covers is for a short period of time after release from the hospital and that is for skilled nursing ordered by a doctor. Home care can be covered by Medicaid if the person is on low income and some areas of the country have senior services that help with it.

    Check with the Alabama Personal Choice Program, which works with Medicaid to help seniors in need of long-term care and home health care. The program can be contacted through the website or by telephone at (855) 481-6777.

    Good luck, Ron

    +

    Are there any Medicare Advantage programs (MA Plans) in Connecticut that will pay for seniors to have home care services, such as personal care, homemaker services or unskilled respite? -James 

    James, home care services are a tricky issue with both Original Medicare and MA Plans. Personal care by unskilled persons not associated with skilled services also is considered maintenance and is not covered by Medicare. However, most MA Plans include home care based on a doctor’s orders and skilled care is required along with non-skilled care. Home care requires that it be recommended by a health care provider and deemed medically appropriate for the covered individual.

    Ongoing personal, respite, and homemaker services are covered under long-term care insurance policies.

    Your local State Health Insurance Assistance Program (SHIP) office can give you counsel and answers specifically detailed to your area of the country. The services are knowledgeable and at no cost to you.  Locate the number for your local SHIP office here or by calling the national number at (877) 839-2675.

    Ron

    +

    Hi Ron, my sister is the full-time caregiver for my parents who both have dementia. On top of that, she is working full time and has a son in kindergarten. She needs help with services such as adult care and in-home caregivers. We are in desperate need of a reliable and dependable agency or trained individual who can provide respite. Both of them are on Medicare. My dad needs the most help with Medicare A and B I believe. My mom has Social Security Disability Insurance (SSDI) Medicare. They live in Waimea and Kekaha, Kauai. I would love to talk to a Medicare counseling specialist. Thanks in advance. -Amanda 

    Hi Amanda, I would suggest you start with your local State Health Insurance Assistance Program (SHIP) office. The organizational mission as stated on the website is:

    “The SHIP Mission is to empower, educate, and assist Medicare-eligible individuals, their families, and caregivers through objective outreach, counseling, and training to make informed health insurance decisions that optimize access to care and benefits.”

    SHIP offers free advice and counseling for the situation you are in. You can contact your local office at 1 (888)875-9229, the website is http://www.hawaiiship.org/.

    Good luck! Ron

    +

    My mother is 91, a wheelchair user, has limited vision in one eye, and lives in an assisted living facility. She has fallen many times, with a broken pelvis, broken ankle and some other falls. She fell last week which caused some dementia. The facility is requiring a 24-hour sitter to aid her and ensure she does not fall again. This is in addition to the facility care. If I get a doctor’s order will Medicare cover this service as a personal care service? Thanks. -Pat

    Pat, sorry to hear that your mother is having so many issues even at 91. My answer is not good; the answer is no. Medicare will not cover a 24-hour sitter as that comes under the heading of long-term care, which Medicare does not cover. Contact your local State Health Insurance Assistance Program (SHIP). The number can be found by clicking Find Local Medicare Help on the SHIP Homepage, or by calling (877) 839-2675.

    Good Luck,
    Ron

    Retirement

    +

    Hello, I am 65 and plan to retire in May. I am enrolled in an employer health plan and I also have Medicare Part A. My health coverage runs out in August and my wife does not work. She has not been able to work for nine years due to a medical condition, but she does not have disability status. She is 57 years old. Since I will only have Social Security Administration (SSA) income for both of us (and my wife nothing for five years), as well as some savings, what Medicare Advantage Plan (MA Plan) is best and most affordable for me? I would like to avoid any premiums if possible. I have no major health problems. What plan is best for my wife? I am assuming it will have to be a federally-subsidized health plan. -John

    Hello John,

    Since you are going to retire in May, now is the time to notify SSA that you wish to enroll in Medicare Part B. You must have both Part A and Part B active before you can enroll in a MA Plan.

    You can call Social Security at (800) 772-1213, or enroll online. Be sure to begin your Part B to coincide with your end of employer coverage. Once you have a start date for your Part B, you can apply for a MA Plan.

    Your Part B premium will be $170.10 per month as of 2022. However, if you qualify for financial help this amount will be covered by your state Medicaid. Medicaid may be able to help both you and your wife, you with your Part B premium and your wife with health insurance.

    There are several good MA Plans with $0 premiums. You can research them on Medicare’s website. Answer a few questions, enter your zip code, and you can research plans. It is important that you check which plans include your doctors and medications in their coverage. Both can be accomplished on this website.

    Medicare is awesome, Ron

    +

    First: My husband and I are now 69. At 65 we enrolled in Medicare Part A. We both are now 69 and are continuing to work. I provide health insurance through my employer for both of us. But, this year I am retiring and want to enroll us both in a Preferred Provider Organization (PPO) plan for Medicare B/C/D. Can you help me with this? I want a company that is at least 4 stars.  I’m an RN and work in the health care industry. Thanks so much. -Cathy

    Cathy, When you know the date you are planning on retiring from work and the end of your employer’s medical coverage, there are a couple of steps that should be made in a timely manner.

    You must either go online and log in to your account or set up a new one. There you can apply for your Part B coverage. You will need an account for each of you. Or you may call the Social Security Administration (SSA) at 1(800)772-1213.  Be sure to start this process two to three months before your retirement date. You will have the choice of beginning SSA retirement payments and Part B or signing up for Medicare Part B only. You will need to fill out a Part B Enrollment Application and have your employer fill out a Form-MS-L564_508 Request for Employment Information. Both can be downloaded from your SS accounts or here.

    Once you have your Part B start date you can apply for a Medicare Advantage (MA) or Supplement plan to begin concurrently with your Part B. In the case of the PPO you are looking for, I can certainly help you research and decide on the best fit for you. Please feel free to contact me directly at [email protected] for help with the MA Plan and any other questions you may have.

    Medicare is Awesome, Ron

    +

    My wife is retired and drawing Social Security Administration (SSA). I am still working but plan to exit my job and draw my SSA in January 2023. I have a 15 year old dependent. How can we cover her medical needs (she is not disabled)? -Kenneth

    Kenneth, if you are over 65 and retiring in January 2023, start the Medicare enrollment process in October 2022. You can enroll in Medicare A and B by calling SSA at 1 (800) 772-1213, by visiting your local SSA office, or the preferred way of logging in or registering for an SSA account at https://ssa.gov. You will need to have the attached form MS-L564_508 signed by your employer. I also attached a copy of the enrollment application for you to look over; it is a bit different online, but asks the same questions. You can start your SSA benefits at the same time if you like. Once you have a Medicare number and start date for Original Medicare Parts A and B it is good to enroll in either a Medicare Supplement (Medigap) Plan and Prescription Drug Plan (PDP) or a Medicare Advantage (MA) Plan with prescription drug coverage (MA-PD) to begin concurrently with your A and B. You can research and enroll in plans through the Medicare Plan Finder.

    I assume that your daughter is on your current plan and will lose her coverage. If so, you can enroll her through Healthcare.gov.

    Medicare is Amazing! Ron

    Special Needs Plans

    +

    How do I change my plan? I want a food card. -Leanna

    Leanna, food cards are only available on certain Medicare Advantage Plans (MA Plans) for those who qualify. In 2022 the food cards are available on Special Needs Plans (SNPs), either Dual-SNP (D-SNP) or Chronic Illness-SNPs (C-SNPs). D-SNPs are for those who qualify for both Medicare and Medicaid, and most plans offer food cards. C-SNPs are for those who qualify for having certain chronic health conditions, but not all have the food cards. All MA Plans are specific to the county and or zip code you are located in. The best place to research plans is on the Medicare Plan Finder. Most MA Plans can only be changed during the Annual Enrollment Period (AEP) from Oct. 15 through Dec. 7, or the MA Open Enrollment Period (MA-OEP) from Jan. 1 through March 31. However, all SNPs have special enrollment periods allowing qualified beneficiaries to enroll in or change plans once per quarter for the first nine months of the year.

    Medicare is Awesome! Ron

    +

    What form needs to be filled out by the primary care provider (PCP) to verify eligibility for a chronic special needs plan (C-SNP)? And who sends this form to the PCP, the sales agent, or the health plan? -Maureen

    Hello Maureen, the form will differ in its specific name but will be something along the lines of “Verification Form for Chronic Special Needs Plan,” which may or may not be proceeded by the specific scope of illness covered by the C-SNP. This form will come with the application, whether it is a written one or online. You fill out the form and return it to the carrier, preferably with the initial application. Filing information will be on the form so it can be mailed or faxed to the address or number on the form later.

    It is normally the insurance carrier’s responsibility to contact the doctor whose information is on the form. If the carrier does not receive verification in a timely manner, the application will be pending. The carrier may enlist your help to get verification from your health care provider.

    Medicare is Awesome! Ron

    +

    In Florida moving to North Dakota. Have Special Needs (D-SNP)Plan Medicare and Medicaid. Need to transfer. – Diana

    Diana, to qualify for a D-SNP you will have to enroll in the North Dakota Medicaid plan before enrolling in a D-SNP plan. You can apply for the North Dakota Medicaid online. Once you have Medicaid in place you will be able to research and apply for the D-SNP Medicare plan. However, watch out for the Special Enrollment Period (SEP) trap as you have just two months from the time of the move. If you do not sign up within this period you will have to wait until the next Annual Enrollment Period (AEP), which runs from Oct. 15 through Dec. 7, with coverage beginning Jan. 1. Those on Medicaid have a SEP that allows them to change their Medicare plan one time during each of the first three quarters of the year. If you need help researching the D-SNP plans available in North Dakota, feel free to contact me.

    Ron

    Supplement Plan Acceptance

    +

    Does the Cleveland Clinic (facilities and doctors) accept Mutual of Omaha (MOO) Medicare Plan G? MOO does not show on its online list of insurances accepted. -Tom

    Tom, the upside of any Plan G is the fact that it is a Supplement Plan, which pays secondary to Medicare. This means that the provider, whether doctor, clinic, hospital, or lab, has a contract with Medicare, not the Supplement carrier. They bill Medicare and simply attach the Supplement information with it, Medicare pays their part and passes the remainder to the Supplement carrier. If Cleveland Clinic accepts Medicare, it should accept any Supplement Plan.

    Regards, Ron

    +

    My wife and I have had Plan F (with Gerber) since 2012. I did a cost-benefit analysis for inception to date and we paid $55,000 and Gerber paid $7,300. My wife will turn 75 this month and I will be 80 in July. She identified as a smoker but since 2022 she is smoke-free. My question is how much premium can I save by going to plan G? -Steve

    Hi Steve. There are several things to consider in answering this question.

    1. Changing a Supplement Plan will require underwriting unless you have a Special Enrollment Period (SEP). The exception: if you are downgrading your plan, moving from F to G is considered a downgrade, which must be with the same company. However, not all companies will allow even this change without underwriting approval.
    2. The premiums on supplement plans vary considerably from state to state so I would need to know which state you live in to research the difference in the premium amount between F and G.
    3. Smoke-free makes a difference in the amount of the premium you pay for any supplement policy. However, your wife has been smoke-free for less than one year and most companies require at least one year before issuing a policy with a premium based on nontobacco use.
    4. There is only one difference in coverage between Plan F and Plan G; under Plan G you are responsible to pay the Part B yearly deductible, which is $233 in 2022. The difference in premium between F and G is usually over $300 per year and often much more. This makes Plan G a less expensive plan, but you must be willing to pay the deductible with your first use of Part B services each year.

    Medicare is Awesome! Ron

    Supplement Plan Denial

    +

    I tried to sign up with a major insurance company for the supplemental Medicare Plan N. It refused coverage in Plan N and said I could only get Plan F. The reason is that I use a prescription that disqualifies me for Plan N.

    Is taking this one drug reason enough for the company to say I can’t get Plan N?

    Any help you could provide would be greatly appreciated. -Jim

    Jim, if you buy a Medicare Supplement policy when you have a guaranteed issue right (also called Medigap protection), the insurance company cannot refuse to sell you any supplement policy offered, charge you more for a Medigap policy than those with no health problems, or make you wait for coverage to start (except in certain circumstances).

    Under certain circumstances, an individual can be denied a Supplement Plan. You may be denied coverage if you are not enrolled in both Part A and Part B of Medicare at the time of application. In most states, if you are under 65, you are not eligible for Medigap policies even if you are on Medicare because of disability or other health reasons. You may be denied coverage if you are on a Medicare Advantage Plan (MA Plan) or a Medicare Medical Savings Account (MSA) Plan unless you schedule disenrollment from these plans. You may be denied coverage if you are not within your Supplement Open Enrollment, or other Special Enrollment Period granting guaranteed rights, and have pre-existing health conditions.

    If you qualify for guaranteed issue rights, insurance companies cannot turn you down or charge you more for a Medicare Supplement policy despite past or current health problems.

    Please let me know how this turns out.

    Regards, Ron

    Transportation

    +

    Does Medicare pay for transportation to your doctor’s appointment in St. Petersburg, Florida? -Brenda

    Hi Brenda. Original Medicare consisting of Part A and Part B does not offer any form of transportation to and from medical appointments. Emergency ambulance transport is covered; in most cases, you pay a 20% coinsurance after you meet your Part B deductible ($233 in 2022).

    Many of the Medicare Advantage Plans (MA Plans) in the St. Petersburg area offer routine transportation to and from plan-approved health-related locations. Each plan will vary in the number of one-way trips and mileage allowed per calendar year. With most, the member will have a $0 copay for each plan-approved trip.

    Medicare is Awesome, Ron

    +

    I have South Carolina BlueCross Total. My question is: I have an upcoming day surgery for a toe correction on March 8. Can I get transportation to and from the hospital that’s less than 10 miles from my home? -Felix

    Hello Felix, if South Carolina BlueCross Total is a Medicare Advantage plan (MA Plan), there may be transportation coverage. However, since every plan has different coverage options, the best option is to call the customer service number on the back of your card.

    Regards, Ron

    Vision Benefits

    +

    My mother-in-law had cataract surgery on both eyes. She just got a new pair of prescription eyeglasses. I thought there was a program for her to get partial payment on her new prescription glasses. Does she need to fill out a form to do that? Where can I get a form for her? Thank you! -Charlene 

    Charlene, you have asked one of the more confusing and possibly misleading questions concerning Medicare coverage. Let me try to put it in perspective as succinctly as possible.

    Medicare will cover cataract surgery and one pair of glasses after cataract surgery. However, there are some unexpected quirks to this coverage.

    Under Original Medicare, the surgery is covered under Part A if it is inpatient and Part B if it is an outpatient service. The coverage for the pair of glasses is the same for either type of surgery, as they are covered under Part B of Medicare. There are several stipulations made by Medicare as to when and how this glasses coverage is to be offered. One pair of conventional glasses or contact lenses is covered after each cataract surgery with the insertion of an intraocular lens.

    These post-cataract eyeglasses benefits cover standard frames, prescription lenses, balance lenses, wide segment, and UV filtration. It will not cover scratch coating or edge treatments, tint, oversize lenses, anti-glare coating, or polycarbonate lenses.

    This pair of glasses is covered under Part B of Medicare and the glasses are not free as some suppose. They come with the Part B 20% coinsurance and the Part B yearly deductible ($233 in 2022). This means that a $400 pair of glasses could cost $233 for the copayment if it has not been met, plus 20% of the remaining $167.00 or $33.40 for a total cost to the patient of $266.40. If the yearly deductible has already been met, the cost should be 20%, which is $80.00.

    Most Medicare Supplement (Medigap) Plans will cover the 20% coinsurance cost but unless you have an F supplement policy, you are subject to the $233 deductible.

    Many Medicare Advantage Plans (MA plans) cover post-cataract eyeglasses with a $0 copayment.

    Depending upon which coverage you have, you can contact Medicare or the customer service department of your carrier and find your payment obligation.

    Best regards, Ron

    +

    My aunt is nearly blind with macular degeneration and we are wondering if Iris Vision glasses for the visually impaired would be covered by Medicare? My aunt lives alone at home, and is pretty self-sufficient, except for her eyesight. -Sandy

    Hi Sandy. While treatments and most medications for macular degeneration are covered by Original Medicare and Medicare Advantage Plans (MA Plans), at this time Medicare plans have no coverage for low vision aids like Iris Vision.

    Regards, Ron

    +

    Does Medicare cover cataract surgery? -Dale

    Yes, Medicare does cover cataract surgery. For details on how and what is covered please read this article.

    Medicare is Awesome! Ron

    +

    I am in Fort Worth, Texas, and am about to schedule cataract surgery. The doctor’s office is telling me that Medicare and my supplemental insurance will only pay for the surgery if no laser is used. Is this correct? -Cynthia

    Cynthia, this is incorrect. Speak with the doctor’s office and make sure you have someone who understands Medicare coverage. Original Medicare covers cataract surgery under Part B if it’s done using traditional surgical techniques or lasers. If you have Medicare plus a Supplement Plan, you should have a $0 out-of-pocket expense for the surgery. This page on the Medicare.gov site covers eyeglasses and contacts; scroll to the bottom under “Things to Know.”

    Ron

    +

    I collect $1,184 monthly in Social Security Disability Insurance (SSDI). I have Specified Low Income Medicare Beneficiary (SLMB) benefits through the Department of Health and Human Services (DHHS) in the state of New Hampshire, which I am told is them paying my premium for Medicare Part A and Part B. When I call Medicare, the staff tells me I have Medicaid benefits as well. DHHS says I don’t. I can’t find a number for Medicaid except for DHHS. I need to see an eye doctor for glasses and an exam. They told me to get gap insurance but it looks like it will cost me $200 monthly. I can’t afford that. Is there any way you can advise me on what to do? Thanks. -Michael

    Michael, you are at the correct level of New Hampshire Medicaid based on your $1,184 income per month. Help with Medicare and medical costs are limited for those who qualify as SLMB. Those on the SLMB level of Medicaid are limited to the reimbursement of their Part A and B premiums and any late enrollment penalties they may have accrued. They will also qualify for help with their prescription medication costs through the federal Low-Income Subsidy (LIS) or Extra Help program. I am not sure of the number you are calling for SSDI, but the Beneficiaries Savings Program in New Hampshire is (603) 271-9700. If you cannot get the help you need there, contact your State Health Insurance Assistance Program (SHIP); your local SHIP office can be located here. SHIP provides in-depth and objective insurance counseling and assistance to Medicare-eligible individuals, their families, and caregivers.

    Because you are on Medicare A and B you are eligible for a Medicare Advantage Plan (MA Plan) in your area. MA Plans are the suggested Medicare coverage for those on both Medicaid and Medicare. The premiums are low, and the coverage is wide-ranging. There are many MA Plans to choose from in your state; availability will depend on the zip code and county you reside in. New Hampshire has a variety of plans with $0 premiums and strong coverage for glasses. If I can be of help, please feel free to email me directly.

    Medicare Is Awesome! Ron

    +

    Getting ready for cataract surgery and eyeglasses after surgery. I want to know if I get glasses at Thomas Eye Center in Roswell, Georgia, who will be doing cataract surgery? Are they a supplier enrolled in Medicare so my one pair of glasses is covered, or do I need to get a glasses prescription somewhere else? -Joanne

    Joanne, the Thomas Eye Center in Roswell, Georgia, does accept Medicare assignments. If you are on Original Medicare with or without a Supplement you are covered for a pair of glasses within one year of the surgery. However, only one pair of glasses per beneficiary is given, whether you have one or two surgeries. It is best to wait until both are done to select your glasses. If you are covered by a Medicare Advantage Plan (MA Plan), be sure to call the customer service number on your membership card to verify that the Thomas Eye Center is in your network.

    Medicare is Awesome, Ron

    +

    I just had surgery to repair a detached retina which was covered by Medicare and my Supplement Plan. Will Medicare help pay for the new lens that I will need for my eyeglasses when my eye heals? I already had cataract surgery in both eyes. -Fred

    Hello, Fred. Yes, Medicare will cover 80% of one pair of glasses after cataract surgery and your Supplement Plan should cover the 20%. If you had your cataract surgery done in both eyes and the retina surgery was a new surgery, it will depend upon the circumstances. If Medicare covered a new pair of glasses after the last cataract surgery, it will not cover another pair for the retina surgery. However, if you did not get glasses through Medicare after the last cataract surgery and it was completed within the past year Medicare should cover new glasses.

    Good Luck, Ron

    +

    If I have Medicare in California, can I get cataract surgery covered in Colorado? I have two sons that live out of state and work full time. I have no one to help take care of me here in California after the surgery. Could I have it out of state so I can have my sons take care of me in their hometown? -Alyssa

    Alyssa, Original Medicare covers cataract surgery anywhere in the U.S. or its territories. If you have Original Medicare only or have a Medicare Supplement (Medigap) Plan you can have the surgery in Colorado even though you are living in California.

    However, if you have a Medicare Advantage Plan (MA Plan) it will depend on the Plan. If you have an HMO, you probably will not be able to go to Colorado for the surgery. Most MA HMO programs require you to use in-network doctors and the networks are typically county or statewide. But some HMO plans do allow you to use the network anywhere serviced by the plan, and information can be found in the Evidence of Coverage (EOC) pertaining to your specific plan. If you have a Preferred Provider Option (PPO) Plan, you can go out of network and have the surgery in Colorado. Out-of-network services will cost more; refer to the EOC for the cost structure.

    Medicare is Awesome! Ron

    What Medicare Covers

    +

    If Medicare pays for ostomy supplies, should I pay a copay if I have Part B and Supplemental Aetna Plan G? -Tamara

    Hello Tamara, Medicare Part B will cover your ostomy supplies. It pays 80% of the cost for you. Your Supplement Plan G pays the remainder of the cost of the ostomy supplies so you should have no copayment if two items are in order. First: the supplier must take Medicare assignment. Second: because ostomy supplies are covered under Part B of Medicare, you are responsible for a yearly Part B deductible. The deductible for 2022 is $233. Once you have paid that amount, there should be no further cost for any Part B-covered supplies or events.

    Medicare is awesome, Ron

    +

    Will Medicare cover my diabetic supplies such as strips and a monitor? -Helen

    Hello Helen, the answer to your question about Medicare coverage and diabetic supplies such as glucose monitors, strips, and lancets is yes, Medicare will cover them. However, it will depend on how you have your Medicare set up as to how much it will pay and what you must do to qualify.

    If you have Medicare A and B alone, Part B will cover 80% of these items after you have met your yearly Part B deductible, which is $233 in 2022. If you have a Supplement (Medigap) Plan in place, it will pick up the remaining 20% of the cost once the deductible has been met. If you have a Medicare Advantage Plan (MA Plan), check with your plan carrier for the coverage options. Most MA Plans will cover these items 100%. However, you must get them from suppliers in the network, and in the case of the glucose meter, your carrier will specify which brand of device is covered.

    Medicare is awesome, Ron

    +

    I currently have a UnitedHealthcare (UHC) HMO plan. I am a state retiree and will be 65 in August. I am on a specialty medicine. Will my specialty medicine be covered if I choose the UHC Medicare Advantage Standard Plan (MA Plan) instead of the UHC Medicare Advantage Premium Plan? -Janet

    Thanks for asking, Janet. Even though the plans are both offered by UHC, MA Plans vary by geographical area as well as if the plans are purchased in a retirement package or individually. MA Plan formularies have tier levels that determine the cost of each medication included, which can vary from one plan to another. Therefore, it is necessary to know your state, zip code, county, and how it will be purchased to research any medication availability and cost.

    Feel free to contact me for a follow-up.

    Regards, Ron

    +

    I had a total right knee replacement. My surgeon has given me a prescription for rehabilitation sessions (outpatient). The rehabilitation facility is charging me a $20 copay for each session. I had rehabilitation five years ago for the left knee replacement and there was no copay. Has this changed and I am now required to pay $20 for each session? -Kenneth

    Thanks for writing, Kenneth. The answer will depend on the type of Medicare plan you have. If you are on Original Medicare (Parts A and B only), you will be charged 20% of the session, or less if the therapy facility wishes. If you have a Supplement Plan, it will depend on the level of plan you have; most Supplement Plans do not charge a copay for rehab therapy. If you have a  Medicare Advantage Plan (MA Plan), you will have a copay in most cases. For MA Plans the therapy copay is normally between $20 and $40 per session. The change from years ago may be caused by the fact that you were under 65 and on a plan other than Medicare at the time. You may have changed your Medicare plan over the years, or if you are on the same plan, the payment schedule may have increased for rehab therapy.

    The rehab therapy copay will be listed in the Schedule of Benefits, which you were supplied when you enrolled in your current plan. Download it from the carrier website, or call the customer service number on the back of your member card.

    Hope this helps, Ron

    +

    Is a cystoscopy covered by Medicare in South Carolina? -CA Kaplan

    Hello CA, and thanks for writing. Since January 1988, the use of the cystoscope has been covered by Medicare for the treatment of ureteral and renal stones. It is covered under Part B, so Medicare covers 80% of the approved amount. If you have a Medicare Supplement Policy, your procedure would be covered by Medicare and then transmitted to your supplement carrier for its part. If you have a Medicare Advantage Plan (MA Plan), call your carrier to get their specific coverage options; you will most likely need a pre-authorization and referral for the procedure.

    Medicare is Awesome! Ron

    +

    I take Ozempic and Jardiance and they are wiping out my finances. Is there any plan or coverage where I could get a discounted price on these prescriptions? Because the prescription for Ozempic costs about $2,000, I move right into gap coverage after the first round. -William

    William, I am sorry to hear about your predicament. If there is no drug that can be substituted by your doctor, Medicare plans will put you in the coverage gap. However, I have had several clients who have received relief by going outside of Medicare for help. Try the manufacturer’s Patient Assistance Program for Ozempic. Also, check the nonprofit site NeedyMeds.org, or reach the organization by telephone at (800) 503-6897. You may get more assistance through your local State Health Insurance Assistance Program (SHIP) office, which offers free counseling for Medicare beneficiaries and has a host of resources available.

    Medicare is Awesome! Ron

    +

    I am 80 and have several health challenges including arthritis and a bad knee. I’ve read that Medicare B will help pay for a recliner chair. I do have part B and would like some info about that. Thank you. -Philip

    Hello Philip. In some cases, Medicare Part B will help with the purchase of a medically-necessary lift chair. If you have Part B and do not have a Medicare Advantage Plan (MA plan), then the Part B Durable Medical Equipment benefit may work for you. The chair must be deemed medically necessary, prescribed by a doctor, and purchased from a Medicare-authorized medical equipment company. Start with your doctor, and have him/her write a prescription for the needed chair. Then take the prescription to an authorized equipment company that can work things out with Medicare. The durable medical equipment benefit of Part B of Medicare is 80%, Medicare 20% coinsurance. Sometimes the equipment company will work with you on the cost of your portion (coinsurance) of the chair; it’s worth asking.

    If you are on a MA Plan, you will need to speak with customer service and get the proper procedure for obtaining your chair. The agent will tell you which durable medical equipment company it works with and the process for obtaining the chair. In either case, you will need a prescription from your doctor.

    Regards, Ron

    +

    My husband has Medicare Part A insurance. He did not sign up for Part B because he liked his insurance. He had Blue Cross Blue Shield but when the company found out he was eligible for Medicare it terminated his coverage. Unfortunately on May 29, 2022, he suffered a stroke in Portland, Maine, and is currently in the hospital. He needs to go to rehab after he is discharged and I do not know what to do. We live in New Hampshire and I am trying to get him into a facility in southern New Hampshire. Is he covered for anything under Medicare Part A for the rehab? Would he be covered for home health visiting nurses? Can I sign up for any other plans and pay a premium to help with the rehab costs? Any help you can provide is greatly appreciated. -Laura

    Laura, several missing factors in this question may determine the options you have but I will try to give a general answer.

    The rehab options: Medicare states that “Medicare Part A covers medically necessary inpatient rehab (rehabilitation) care, which can help when you’re recovering from serious injuries, surgery, or an illness.”

    His doctor must state that he requires intensive rehab, coordinated care from doctors and therapists, and continued medical supervision. Then Part A will pay for rehab while in a skilled nursing facility, inpatient rehabilitation facility, acute care rehabilitation center, or rehabilitation hospital. Once he is discharged from the hospital, rehab becomes a Part B-covered event. Under certain circumstances, Part A will pay for home health care. Medicare’s information pamphlet can be downloaded.

    All Medicare Supplement and Medicare Advantage Plans (MA Plans) require you to have both Part A and Part B to be eligible. Your husband can sign up for part B during the General Enrollment Period from Jan. 1 through March 31, with coverage beginning July 1. Once he is on A and B, he can add Supplement or MA Plan coverage. Depending on how long he has been without insurance will determine if he must pay Part B late enrollment penalties. If he left his employer coverage less than eight months ago, he could sign up for Part B immediately with no delays or penalties and a Supplement or MA Plan to begin concurrently with his Part B start date.

    Feel free to contact me for further information or assistance.

    Medicare is Awesome! Ron

    +

    Hi there. I’m trying to be proactive about finding a Part D plan that will give me an affordable copayment for Shingrix vaccinations. With my current plan, the shots are going to cost me over $200 each. I have a $480 deductible and am lucky enough not to have expensive prescriptions at this point in time. But I just can’t afford to pay nearly $500 total. My pharmacist suggested I search for a plan that will give me a better price. I’m not getting anywhere so I am hoping you’ll be able to provide some suggestions. Thank you. -Cheryl

    Cheryl, if you do not have a Special Enrollment Period (SEP) available because of special circumstances you will not be able to change plans until the Annual Enrollment Period (AEP) from Oct. 15 through Dec. 7, with coverage beginning Jan. 1.

    If you go to the Shingrix (Zoster Vaccine) website, it shows most Medicare Part D plans cover the shingles vaccine for $50 or less. However, I have not found that to be accurate. Part D plans vary by the geographic area of the U.S. you live in. I cannot speak directly about the plans available in your area without knowing your zip code. But Part D coverage of the Shingrix vaccine runs between $160 and $220 per shot. In most cases, the lower the vaccine cost per dose, the higher the Part D premium is. When looking for a new Part D plan, always look at the total yearly cost of the plan with premiums and all prescriptions you take included. Plans can be researched on Medicare.com, or I would be happy to assist you.

    Medicare is Awesome! Ron

    +

    Looking for one down the road with low out-of-pocket costs for possible knee or hip surgery. I would need not too much more of a premium. I currently have A and B and turn 68 next month. Please text as I can’t hear the phone. -Robert

    Hi Robert, there are probably several great options for the coverage you are looking for. If you are on a Medicare Supplement Plan, you could change companies and save money, or go to a different plan. However, there are probably several good options in the Medicare Advantage (MA) market; this will depend upon the area of the country you live in. If you send me your city, state, zip code, and county I can let you know what is available and give you a local referral if necessary. Sorry I couldn’t text as your phone number did not come through.

    Regards, Ron

    +

    My mother-in-law recently moved into assisted living from independent living. She used to give herself a daily insulin shot but now has dementia. She has Medicare Part C. We are currently paying $95 for a daily service of insulin injection. The assisted living facility receives her insulin but won’t inject it. Is there a better plan we should have that will help offset the costs? Thanks. -Patricia

    Patricia, sorry to hear of your mother-in-law’s deteriorating circumstances. The answer could depend upon whether she is on a Medicare Supplement Plan and a Prescription Drug Plan (PDP) or a Medicare Advantage Plan (MA Plan). However, in most cases, the service you are requesting will not be covered by Medicare. Assisted living is considered custodial care, which is not covered by Medicare. Many people in this situation have a friend or relative trained to give this injection. Be sure to check the rules and restrictions that may be in place based on the care center’s policies.

    Ron

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    I have Aetna Medicare Preferred Provider Option (PPO). The orthopedic group I would like to make an appointment with stated they accept traditional Medicare. I would like to make an appointment online, but I don’t know if my Aetna Medicare PPO plan will be accepted. Is there a difference? The name of the group is Princeton Orthopaedic. -Carol

    Hi Carol. Medicare Advantage Plan (MA Plan) doctors’ networks are dependent upon your geographical location. If you are in the Princeton, New Jersey, area, the doctors affiliated with Princeton Orthopaedic Associates on Princeton Avenue are in the network for most of the Aetna Plans. However, to be sure, search your specific plan for the orthopedist you are wishing to make the appointment with.

    Ron

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    I just received a Medicare Summary Notice (MSN) for my husband’s Part B (Medical Insurance). He has several charges on it that say the procedures were approved and that the amount the hospital charged was approved but that the payment is included in another service received on the same day. There are also a couple of procedures that were for a few thousand dollars that have been approved and the amount was approved but less than $50 was paid on them. Who is responsible for paying for these procedures? -Patricia

    Patricia, the MSN is not a bill but a summary of health care services and items you have received during the previous three months. Often the MSN is sent from a Medicare contractor and will have the contractor’s name and address on the document. In the “You may be billed” column are the charges you may be responsible for. However, often the insurance carrier will settle them before you receive a bill. If you do receive a bill from a provider, you may dispute it at that time.

    Regards, Ron

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    Hi, my psychiatrist/therapist is out-of-network, and we just moved to San Francisco. Can I submit an out-of-network claim and pay 80%? Will Medigap Plan G Blue Shield of California cover the 20%? So far my one claim for COVID-19 tests has taken four months and is still not processed. -PK Jain

    Thanks for your question, PK. It will depend on your specific plan. If you are worried about out-of-network, you must be referring to a Medicare Advantage Plan (MA Plan). If your plan is a Preferred Provider Organization (PPO) or an HMO-Point-of-Service Plan (HMO-POS), you may see doctors out-of-network if they accept Medicare. If you have an HMO you cannot go out-of-network and be reimbursed. PPO and HMO-POS plans have different copayment and coinsurance structures for in-network and out-of-network costs. Some will have a set copayment dollar amount for out-of-network and others will have a coinsurance percentage of the cost of the visit; refer to your schedule of benefits for the specific charges. Either plan should charge you the copay or a set amount during the visit. When you submit the bill to Medicare for determination you will be billed for the remaining cost. However, if you have paid the bill for services upfront, you can submit the paid bills to Medicare and the agency will instruct the provider to reimburse you the excess amount paid.

    Medicare is Awesome! Ron

    +

    I am trying to learn more about Medicare Part D coverage. Is there a plan that is just for catastrophic coverage, or are all the deductibles the same, such as $480 and $4,430? I can find the drugs I am taking much cheaper than using the local pharmacy and the plan I am currently on. Also, it seems they can change tiers on you from year to year. They moved one of my tier 1 drugs to tier 3 and I had to consult my physician to change. – Robert

    Hi Robert. Medicare Prescription Drug Plans (PDPs), whether purchased through a Medicare Advantage Plan (MA Plan) or a stand-alone plan, all offer four standard stages of drug plan coverage:

    • Stage 1- Annual Deductible. Deductibles can range from $0 to $480 for 2022. Carriers may offer Enhanced Plans, which charge higher monthly premiums than basic plans but typically offer a wider range of benefits and may not have a deductible.
    • Stage 2- Initial Coverage. This begins when your annual deductible has been met. It ends when the amount spent by you and your plan on your covered drugs equals the initial coverage limit set by Medicare for that year. In 2022, that limit is $4,430. Your monthly premium payments do not count toward reaching that limit.
    • Stage 3- Coverage Gap. Also known as the “donut hole,” this begins once your initial coverage of $4,430 is achieved. It continues with you paying 25% of the cost of drugs until you and the manufacturer have paid $7,050 in 2022. Read in-depth information on the coverage gap. PDP Plans may choose to provide coverage during the donut hole.
    • Stage 4- Catastrophic Coverage. Once you have escaped from the donut hole you will pay 5% of drug costs until the end of the year.

    I suggest you use the Medicare Plan Finder to research available plans in your area annually. Here you can input your drugs and choose up to five pharmacies at one time. Once your drugs are entered and pharmacies selected it will show all available plans in your area with cost information. You can sort according to plan type, carrier, yearly cost, and more. By choosing a specific plan you can compare pharmacy costs; often there is a difference between premier, standard, and mail-order pharmacies. You can find which tier your drugs are assigned to by the various carriers and plans.

    I often encourage my clients to use discount sites like SingleCare.com and GoodRX.com even when they are enrolled in a PDP plan. The combination may enable you to enroll in a less expensive PDP plan.

    Medicare is Awesome! Ron

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    Does Medicare approve dermatology cancer screening services e.g., a full body exam? If so, how many per year? Melanoma runs in my family and my dermatologist has suggested that I come in for a screen every four months. Will that be approved? -Katherine

    Katherine, Medicare does not cover screening for skin cancer in asymptomatic people. It does, however, cover a physician visit initiated by a concerned patient who has noticed, for example, a change in the color of a mole. If the doctor refers you to a dermatologist for further testing, including a full body scan, that is also covered. Yearly referrals are covered by Medicare and for those who are considered at risk, Medicare will cover your four visits if your primary care provider (PCP) will deem it medically necessary. To be on the safe side you can request your dermatologist to get a pre-authorization before each visit.

    Medicare is Awesome! Ron

    +

    My wife has Parkinson’s disease and diagnosed major cognitive issues. She has been having physical therapy (PT) at home and the provider wants to end treatment because “PT is not forever.” The provider does not seem to understand the changes that have taken place in Medicare coverage of PT for Parkinson’s since 2013. If my wife’s doctor deems it “medically necessary” to help maintain her mobility and general health, and should be administered by a physical therapist because my wife’s condition requires oversight by a skilled and knowledgeable professional, shouldn’t my wife’s treatment be continued? -Glen

    Thank you for your question, Glen. This is a wide-ranging question with a multilayered answer.

    You are correct that Original Medicare covers 80% of Medicare-approved PT under Part B, and a 20% coinsurance is paid by the client. Medicare states “There’s no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year.”

    • If you have Part B and a Medicare Supplement plan, the Supplement will cover the 20% Part B does not.
    • If you have Part C of Medicare, a Medicare Advantage Plan (MA Plan), your coverage differs in the copayment you are required to make but most MA plans now cover PT with no limits per year.
    • If the PT services are outpatient, you will pay the plan’s specified specialist copay amount.
    • If you are an inpatient at a hospital, rehab center, or nursing home the PT will be included in the daily cost per stay.

    If your doctor certifies that you need home health services, he may order that to be provided by a home health agency. You must be homebound, which means leaving home is a major effort. Covered home health services include but are not limited to part-time or intermittent skilled nursing and home health aide services.

    Services performed will include but are not limited to physical therapy, occupational therapy, speech therapy, medical and social services, and medical equipment and supplies. All services received from skilled nursing and home health aides must total fewer than eight hours per day and 35 hours per week.

    Your doctor will make the initial determination for PT. However, re-evaluations are conducted periodically with the following criteria:

    1. Is the patient no longer significantly benefiting from ongoing therapy services?
    2. Does the patient no longer require therapy services for an extended period of time?
    3. Has the patient experienced a significant change in medical status that necessitated discharge?

    These evaluations are most often made by a qualified clinician from each appropriate discipline; in the case of PT, it is made by the qualified physical therapist.

    If you disagree with the decision that is made, you have the right to an appeal.

    Medicare is Awesome, Ron

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    Does Medicare cover medical alert devices for seniors? -Julie

    Thanks for writing, Julie. Neither Original Medicare Parts A and B nor Medicare Supplement (Medigap) Plans cover medical alert devices. However, many of the current Medicare Advantage Plans (MA Plans) will cover the devices. You can research MA Plans in your area at www.Medicare.gov.

    Medicare is Awesome, Ron

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    Is there a Medicare plan that covers two of my glaucoma meds: Alphagan and Azopt? Thank you. -Patty

    Hello Patty. This is a very good Medicare question. Prescription drugs are covered under Medicare by either a stand-alone Prescription Drug Plan (PDP) or a Medicare Advantage Plan (MA Plan) with drug coverage (MA-PD). Every PDP and MA-PD will have different formularies which list the drugs the plan has selected for coverage. However, all plans must cover drugs in every medication category.

    The answer to your question is yes. Many PDP and MA-PD plans will cover both Alphagan and Azopt. However, some will only cover the generics for these drugs; the generic for Alphagan is brimonidine tartrate and the generic for Azopt is brinzolamide. The plans may be restricted by Step Therapy (ST), which requires you try certain less-expensive drugs to treat your medical condition before covering another more expensive drug for that condition. If your doctor feels the prescribed medication is the only one that will work properly, they can file a request for an exception on your behalf. If the exception is granted, you will be able to continue taking the drug the doctor prescribed. If the request is turned down, you may appeal the decision.

    You can research which drugs are covered by which PDP and MA-PD plans at https://www.medicare.gov. If you are enrolled in either type of plan, you can log on to the website or call the customer service number for answers. Both the website and phone number should be on your membership card.

    Medicare is Awesome, Ron

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    I currently have prescription medicine that I take. I will also need coverage for hearing, dental, and vision. These items are covered on my insurance I presently have from my employer. I don’t want to give up anything. I need to know which plan to select to maintain my coverage. -Frank

    Frank, Medicare Advantage Plans (MA Plans) cover Part A hospital and Part B medical; most cover Part D outpatient prescription drugs, and have coverage for hearing, dental, and vision. You must be enrolled in Medicare Parts A and B to be eligible for any MA or Supplement Plan. These Plans vary in costs and type such as HMO, Preferred Provider Organization (PPO), and Private-Fee-For-Service (PFFS), but all have excellent coverage. The plans available for you will depend on the zip code and county you reside in, and can be researched on the Medicare Plan Finder where you can also check the availability and cost for any medication you are currently on. I will be happy to assist if you email or text.

    If you are just turning 65 you have a seven-month Initial Enrollment Period (IEP) which begins three months before you turn 65, the month of your 65th birthday, and three months after the month you turn 65. During IEP you must make sure you are enrolled in Medicare A and B through Social Security Administration (SSA). Once you have your Medicare number you can enroll in a MA Plan to start concurrently with your Parts A and B.

    If you are over 65 and leaving your current plan or have recently done so, be sure to get your Medicare in order ASAP. You have an eight-month Special Enrollment Period (SEP) from the time your active employment coverage stops or you leave the company, whichever is first. You will need to have both A and B of Medicare active at the time of application for an MA Plan.

    Medicare is Awesome! Ron

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    Do you have a plan that covers hearing aids, dental, and drug coverage? -Karin

    Karin, Original Medicare does not cover hearing aids, dental, or drug coverage. However, you can get drug coverage in a stand-alone Prescription Drug Plan (PDP) and add it to Original Medicare and a Medicare Supplement Plan. Medicare Advantage (MA) Plans cover all three items in question and more. Because MAs vary in their coverage for these items, and because MA plans are regional and often tied to your zip code and county, research is required. You can research and compare MA plans on the Medicare Plan Finder located on the Medicare website. If you need some assistance, please let me know.

    Medicare is Awesome! Ron

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    Need advice regarding the best Part D Prescription coverage for me. -Daniel

    Daniel, because Part D Plans are specific to the state and can be researched by zip code, I can not be specific to your situation. However, Part D Plans can be researched through the Medicare Plan Finder. It is an easy system to use.

    • Once on the site, enter your zip code and the type of plan you are looking for (Drug Plan Part D), click Apply, then click Start.
    • Answer the question about the type of financial assistance you receive and click Next.
    • You can then enter the medications you are taking, pick from a list of local pharmacies, and click Find plans.
    • This will show you a list of all the plans in your area, beginning with the lowest overall cost per year.
    • You can compare and look at the details of each plan, as well as enroll in the plan you choose on this website.

    Medicare is Amazing! Ron

    +

    My dad and I are both on Medicare through Social Security Disability Insurance (SSDI). My dad will be turning 65 next March and we are getting bombarded with unrequested calls telling us that Medicare for disabled is different from Medicare for those 65 or older. Is this true? If so, what is the difference? -Ms. Eckstein

    Hello Ms. Eckstein, Original Medicare Parts A and B have no difference in coverage whether you qualify through disability or age. You also have access to the same Medicare Advantage (MA) Plans and coverages, but most Medicare Supplement Plans are either limited or unavailable to those under 65. When your father turns 65, he will have a seven-month Initial Enrollment Period (IEP) even though he is already on Medicare. His IEP runs for three months before he turns 65, includes the month in which he turns 65, and lasts for three months after the month in which he turns 65. During this period, he can enroll in any Supplement or MA Plan available in his area. You can research the available plans in your area through the Medicare Plan Finder. If I can help, let me know.

    Medicare is Awesome! Ron

    +

    I recently had eyelid surgery in which they removed tissue from the roof of my mouth to implant in my eyelids. This left two large and deep wounds in the roof of my mouth that were exposed without sutures. My surgeon had me order a stint plate for the roof of my mouth to protect the unsutured wounds while they healed. UnitedHealthcare Medical Advantage (MA) Plan denied my claim for the plate. They are calling this an oral procedure and not classifying it as part of my eyelid surgery. I’m not sure how to prepare an appeal. Any help would be appreciated. -Tom

    Hello, Tom. The first thing I would do is get a letter from the surgeon who performed the operation stating that the plate is medically necessary and part of the surgical procedure. Medicare will only pay for medically necessary procedures so the key phrase here is medically necessary. Then file this letter with your appeal to UnitedHealthcare and Medicare if necessary.

    Ron

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    If I have a private medical insurance policy and Medicare Parts A/B, can I get free COVID-19 home testing kits through Medicare? -Randy

    Hello, Randy. COVID testing is available through Medicare for those who are enrolled in Part B. For detailed information, read the CMS paper Medicare Covers Over-the-Counter COVID-19 Tests.

    Free COVID-19 testing kits are also available through the U.S. Postal Service’s Free Test Kits.

    Medicare is Awesome!

    Ron

    Working With Medicare

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    Can I work full-time while on Medicare? -Robert

    Hi Robert, yes, you may work and receive Medicare at the same time. Work has no bearing on your ability to enroll in Medicare when you are eligible.

    Regards, Ron

    ron square headshot
    Medicare consultant and expert, seniors advocate, and author

    Ron Elledge is an accomplished Medicare agent, planner, and author. Elledge earned a bachelor’s degree in Bible theology from International Seminary and spent 30 years in pastoral ministry. He began his current career in insurance with a specialty in Medicare in 2008 and has since authored “Medicare Made Easy: What Expats, Frequent Travelers and You Need to Know” and is often a featured speaker at the International Living conferences. Elledge is a contributor to International Living, supporting Medicare beneficiaries with articles, podcasts, and Q&As.

    “A licensed seniors market insurance agent in Arizona and New Mexico, Elledge has helped thousands decipher the intricacies of Medicare rules and regulations, enabling them to make educated selections for their health care needs. As a world traveler with his wife, Shelli, Elledge specializes in Medicare for expats and frequent travelers. He’s up to date with Medicare regulations, coverage options, and enrollment protocols and is fervent in his resolve to present trustworthy data on this confusing and often maligned program.

    “By obtaining dependable details on how to read their Medicare options, recipients can plan for it correctly and make the best choices,” says Elledge. “These choices often make a huge financial and emotional difference in their futures. When Medicare is correctly utilized, it becomes a powerful financial and medical tool for all who qualify.”