Ask the Medicare Expert

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

If they will not allow you to enroll in their plans (this seldom happens) you can enroll in one of several PPO plans that are offered by different carriers in your zip code. If you research the available PPOs in your area, you will find that they have 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 the Find Plans on the Medicare.gov web site. Go to 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 Advantage 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

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). They offer free counseling on Medicare and health related issues.

Best regards, Ron

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 at 800-773-1213 as they handle 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 at 1-800-633-4227 or online at https://www.medicare.gov/.

Regards, Ron

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. 

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 council and clarification. They offer 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.

Ron

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 United HealthCare. This book lists all the benefits, costs, and pertinent information concerning coverage, including dental coverage. 

Second: if you are working with an agent, contact your agent and ask them to email or mail you a copy of the Evidence of Coverage (EOC) for your current plan. The evidence of coverage is 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 (United HealthCare) 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 onto www.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 plans 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.

Good luck, Ron

Hi James, Yes, you can have both Medicare and Medicaid. If you qualify for both programs they can work very well together. There are Medicare Advantage Plans that are called D-SNP (Dual Special Needs Plan) 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 paid by your state. In addition, most of your medical care, if not all, will be zero copay.

Regards, Ron

Hello Charles, The payment schedule for your Part B premium will depend on whether you are receiving Social Security retirement benefits. If you are, it will be taken out of your monthly check. If you are not receiving SS benefits Social Security 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 Advantage Plans, you must have a U.S. residence and in the case of Part D and Part C you must maintain your address in their 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

Mary, Medicare is not mandatory; however, 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 Social Security and is based on the Part B premium at the time.

Regards, Ron

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 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, 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. You can then search and compare the available Medicare Advantage Plans in your area. This will allow you to input your medications and compare their costs among the plans available. 

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

Fourth: Extra Help through Social Security 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 savings 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 their help.

Hope this helps! -Ron

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

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. If you qualify for a Special Enrollment Period (SEP) under any of the exceptions, you can change your plan according to their rules.

Alternatively, if any plans in your area are five-star programs, you can select one at any time of year.

Medicare is Awesome! Ron

You are correct, MSA plans are not available in many areas of the US, they are a bit of an anomaly. Because they are a form of Medicare Advantage ( 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

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 Election 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 non-profit 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 healthcare of the county in which you are volunteering.

Regards, Ron

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

Hello Denise, There are several factors which 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 an 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 he 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 8 months after his coverage ends, whether by his choice or the company’s. He will also be able to choose a Supplement or Advantage 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

Hello Debbie, Medicare Advantage 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 Advantage Plan, you have until March 31 to select a new plan under the yearly Medicare Advantage Open Enrollment Period (MA-OEP).

Medicare is Amazing! Ron

Jim, You just asked the $64,000 question. This is a disputed area by many, however I can tell you that while 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 of no charge to the customer. Call 1-800-252-8966.

Good luck, Ron

Hi Nora, Medicare provides coverage for most cancer treatments and testing with various cost sharing. Cost sharing depends 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 prosthesis 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 you should 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

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 or Railroad Retirement benefits, if you were a state or local government employee after March 31, 1986, or a federal employee any time after December 31, 1982.

You are eligible if you are disabled and receiving disability benefits. Medicare is automatic after you have been on Social Security disability for 24 months. Everyone eligible for Social Security Disability Insurance (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 Social Security Administration 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 whom you were married to 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

Unfortunately, the type of home services you are inquiring about are not covered by either Original Medicare or Medicare Advantage. 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. They can be contacted through their website or by telephone at (855) 481-6777.

Good luck, Ron

Hello John,

Since you are going to retire in May, now is the time to notify Social Security that you wish to enroll in Medicare Part B. You must have both Part A and Part B active before you can enroll in an Advantage 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 Medicare Advantage 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 Advantage 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

Tom, The upside of any Plan G is the fact that it is a Supplement Plan. Supplement Plans pay 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, they should accept any Supplement Plan.

Regards, Ron

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 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

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.

This post-cataract eyeglasses benefit covers 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 cover the 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

Hello Tamara, Medicare Part B will cover your ostomy supplies. It pays 80% of their 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

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