Did you choose the wrong plan last fall?

Did you choose the wrong plan last fall? 

You may qualify for a second chance to correct the mistake!

How can you Change your Medicare Advantage Plan?

There are a lot of rules around when you can change your Medicare Part C or Medicare Advantage Plan.

Most people know that you can enroll in or leave a Medicare Advantage Plan during the Annual Open Enrollment Period in the Fall which starts October 15 and ends December 7 each year. 

What most people don’t know is …

You can also leave your Medicare Advantage Plan (Part C) and go back to Original Medicare (Parts A & B) during the first 6 weeks of the new year.  This is called the Medicare Advantage Dis-enrollment Period.

You can only make this coverage change if you have a Medicare Advantage Plan. 

This Disenrollment Period occurs every year from January 1 to February 14.

And changes made during this period will become effective the first of the following month. For example, if you switch from a Medicare Advantage Plan to Original Medicare in February, your new coverage will begin March 1.

Why would you want to go back to Original Medicare?

Medicare Supplement plan benefits are standardized, which means Plan F is Plan F and Plan G is Plan G.  No matter which insurance company you choose to provide this plan the coverage is the same. But they all charge a different price.  [READ MORE…]

Perhaps your Medicare Advantage plan has some costs you were not aware of when you signed up or your plan changed this year.  Some of these changes may include; higher deductibles, higher monthly premiums, new restrictions on doctors, hospitals, and pharmacies that are different from last year.

Sometimes the cost of your prescription drugs may have increased or your anticipated costs of health care and hospital services has gone up. If you find you’re going to physical therapy or seeing a doctor more often then you may be paying a lot more out of pocket and this might increase as you get older.

Since Medicare Advantage plans are completely administered through a private insurance company, the rules and guidelines can vary between plans and from year to year, which can lead to restrictions like these:

Your Medicare Advantage plan may require higher out-of-pocket costs than with Original Medicare and these may increase each year as your health needs change.

The insurance company may require you to follow stricter rules to get coverage for certain services or health products, like getting referrals to see specialists or getting prior authorizations that delay necessary tests. You may also have to change your doctor or hospital to one within the new plan’s network, or you may have to pay a higher cost.

If you want to change, you can.  You just have to know when.

If you missed the February 14th deadline for the Dis-enrollment period, there are also certain circumstances that would make you eligible for a Special Enrollment Period (SEP) to change your health and or drug plan outside of the usual enrollment or dis-enrollment periods. 

If you qualify for a Special Enrollment Period, you may leave your Medicare Advantage Plan and your new Medigap or Supplement plan will start the first of the month after you sign up for or dis-enroll from the Medicare Advantage Plan. 

One example of when you qualify for an SEP: when your Medicare Advantage Plan leaves your area or you move out of your plan’s service area, you can switch to another Advantage plan or go back to Original Medicare and get a Medicare Supplement. Remember to enroll early during any enrollment period to make sure that your new coverage starts when it should.

If you have any questions about this or need help making a change, I will be happy to help you.  

And it won’t cost you anything!

I do not charge anyone for my help, whether you enroll with me or not.  I get paid by the insurance company when I deliver your application so once we pick the right plan I will help you fill out the application and I will turn it into the insurance company for you. It doesn’t get any easier than that!

You can use the BOOK APPOINTMENT(link is external) button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started. 
 
Book an appointment with Maine Medicare Options using SetMore
 
 
 
Have a question that needs to be answered right away?
 
Just give me a call at your convenience.  
 
You can talk to me at (207) 370-0143
or call toll free 866-976-9038. 
Or send me an email using this form –> https://www.mainemedicareoptions.com/contact
 
 
 

Are you turning 65 and still working?  Read this.

SSA not Deducting Premiums?

If you changed Medicare plans this year and received a letter from Social Security saying they will no longer deduct your Medicare prescription drug plan premiums from your monthly benefit, then this blog is for you.

So, What’s going on?

It’s January and if you changed your Medicare Part D prescription drug plan or your Medicare Advantage plan during open enrollment then you may have received a bill from the insurance company instead of having the monthly premium deducted automatically from your monthly Social Security check as it had been in the past.

What do you have to do?

When you changed your Medicare Part D prescription drug plan or changed your Medicare Advantage (Part C) plan you may have chosen to have the monthly premiums automatically deducted from your Social Security check.

But now you have received a letter from Social Security saying: “We will no longer deduct money for your Medicare prescription drug plan costs from your monthly benefits.”

This letter also says, “If you have any questions about your Medicare prescription drug plan costs, please contact your Medicare prescription drug plan.”

You should do just that!

Call the insurance company’s Member Services phone number (usually found on the back of your new insurance card) and they will instruct you to either pay your monthly premium by sending in a check (possibly with a coupon book) or set up automatic electronic funds transfer from your bank account (or a debit card).

This is because your new Medicare plan may not have had time to organize the automatic Social Security deductions and so you will be asked to use another form of premium payment.

But don’t worry. You can have it deducted from your Social Security payment. All you have to do is ask them to start having your monthly premiums deducted automatically from your Social Security check.

Please note: It can take up to three months to coordinate these automatic deductions with Social Security so you will need to continue paying your monthly premiums until then to avoid any lapses in coverage.

Want to know more?

The Centers for Medicare and Medicaid Services (CMS) has published a guide entitled, “Withholding Medicare Prescription Drug Premium from Your 2018 Social Security Payment” that outlines why some people are being denied automatic Social Security check deductions as their chosen form of premium payment.

You can download a copy of the document here: https://www.medicare.gov/Pubs/pdf/11400-Withholding-Medicare-Drug-Premium.pdf

This Medicare guide says that if you changed your Medicare Advantage (Part C) or Medicare Prescription Drug (Part D) plans, “depending on when you made your enrollment decision, you may be asked to pay your new plan directly for a while. If that happens, you’ll get a bill or payment book from your new drug plan telling you the amount you owe. Your new plan will expect you to pay premiums directly until premium withhold is started with your new plan. You may need to contact the plan to let them know you still want to have premium withholding.”

They continues with the example: “You enrolled at the end of Open Enrollment and chose to have your premiums withheld from your Social Security payment. However, you just got a payment book from your drug plan saying you owe $36.50 each month, starting in January 2018.

You call the plan, and the plan says that it didn’t get your request for enrollment in time to arrange for your January premium to be withheld. The plan says it will request to have the premiums withheld from your Social Security payment starting in February. You’ll need to send your premium payment for January directly to your plan.”

So some Medicare plans may not allow Social Security check premium deduction at the start of this year, even though this was chosen by you as the payment method on your application.

Instead, you will be told to either send the first premium payment by check or submit the Electronic Funds Transfer request. When you call the Medicare plan Member Services representatives they will send you the forms necessary to request the Social Security payment option – as per the new rule.

If you live in Maine or New Hampshire and would like more answers or if you’re looking for help choosing a Medicare plan or just have some questions, I would be more than happy to help you.

You can fill out this form to send me an email message or call me.

Please note: We are only able to give general information about Medicare related issues. If you have questions about your Social Security Benefit, please contact your the Social Security Administration directly.

Still have questions or want help comparing Medicare Supplement plans?  I can help you!

Just give me a call at your convenience. My cell number is (207) 370-0143
or call toll free 866-976-9038.  Or send me an email using this online form;

The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you talk with me.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

Medicare & Dental

Medicare’s coverage of dental care is very limited. Generally, Medicare will not cover preventative dental care, that is care you need primarily for the health of your teeth or your gums and jaw. For example, Medicare will not cover routine checkups, cleanings, or fillings, and will not pay for dentures.

Medicare will cover some dental services if they are required to protect your general health, or if you need dental care in order for another health service that Medicare covers to be successful. Such as dental services that are necessary for radiation treatment, or if you need surgery to treat fractures of the jaw or face, Medicare will pay for these types of “medically necessary” dental services. 

It will not, however, pay for any follow-up dental care after the underlying health condition has been treated. So, if Medicare paid for a tooth to be removed as part of surgery to repair a facial injury, do not expect Medicare to pay for any other dental care you may need later because you had the tooth removed, and Medicare will not pay for dental implants or dentures to replace the extracted tooth.

This is an unexpected reality for most people that I meet with who are leaving an employer insurance plan and have had dental insurance. When you’re used to your insurance covering these types of things it can be frustrating to find out that you will no longer have this coverage. But…

Some Medicare Advantage Plans Include Dental Coverage

There are a few Medicare Advantage plans available in Maine and New Hampshire that cover routine cleanings and other work at the dentist.  When it comes time for you to enroll in Medicare or during the Annual Open Enrollment Period (October 15th – December 7th in 2016) it is a good idea to review these plans if dental care is important to you.  Plans change every year and your plan may have added dental coverage and you may not know it.

Dental insurance is also an alternative.

You can get a free quote from Delta Dental by clicking here.(link is external)  The monthly premiums equal what most people pay out of pocket for their 2 cleanings each year so why not spend that money on the insurance now so when you need a filling you will have the coverage.   [Click here to see plans](link is external)

Dental Discount Plans are another popular option.

Discount plans are gaining in popularity.  For a yearly membership fee (roughly $10/month,) you can buy into a discount dental plan, which allows you to get some pretty significant discounts (up to 60% and 70%) and the only catch is that you use dentists that are in your plan’s network.  [Click here to see plans](link is external)

“Discount dental plans work like a BJ’s or a SAM’S Club membership,” says Edan Barshan, president of Universal Dental Plan.  In return for the membership fee, you can choose among a network of dentists who will give 15 to 60 percent rate reductions for certain services.  A $1,000 crown might only cost $600 for a member of a plan.”

“And unlike dental insurance, which may not cover preexisting conditions or have waiting periods, you can shop for a discount dental plan knowing you need a root canal and select the plan that offers the cheapest price,” says Buddy Johnson, chief executive officer of national discount dental provider DentalPlans.com(link is external).  “You could sign up today and go to the dentist tomorrow,” he says.

Dental discount plans differ in several ways from dental insurance plans:

  • Discount plans generally cost less than traditional dental insurance.
  • You have to pay for the service in full, or negotiate a payment plan with the provider.

There are generally no restrictions on how many procedures you can get at a discounted price in a given year. Discount plans generally run for one year, so you can switch plans as your needs change. If you have a dentist already, you should ask whether he or she will accept the plan. Otherwise, you’ll need to find a provider who will. A number of discount dental plans include elective services, which are often not covered by insurance plans. Cosmetic dentistry, for example, is almost always excluded by insurance, but cosmetic procedures like tooth whitening are included in many discount plans’ list of services. 

To search for discount plans in your area CLICK HERE(link is external) and put in your zip code.

As with any important financial decision, do your homework first.  Find out what providers in your area are on the plan and what procedures are covered.  Make sure that costs and benefits add up to a net plus for your particular situation.  And if you need help or have any questions just give me a call or send me an email.  I am happy to help you!

Would you like my help?

If you would like help finding the right dental plan or ask a few questions, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.  The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay anything to meet with me and you will pay the same price for your insurance that everyone pays whether they had my help or not.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

Goodbye Obamcare!

Here is what you need to know if you are turning 65 soon and making the move from Obamacare to Medicare…

Your transition from your health insurance plan on the healthcare.gov marketplace won’t be automatic, but moving to Medicare doesn’t have to be difficult.

For decades people have been transitioning from individual coverage or group plans offered by employers onto Medicare but if you enrolled through the healthcare marketplace exchange or “Obamacare” as it is most often called, the process is a little different – especially if you are receiving the monthly tax credits that lower your monthly premiums.

If you are collecting your Social Security or Railroad Retirement benefits prior to age 65, the government will automatically enroll you in Medicare the month you turn 65.

If not, you will have seven months to contact your nearest Social Security office and enroll in Medicare.  Your initial enrollment period starts three months before the month you turn 65, the month you turn 65, and three months after, totaling seven months.

Most people pay no premiums for Medicare Part A, based on your work history. Medicare Part B has a monthly premium, which is $134 per month in 2017.

Beware: No automatic plan termination!

Prior to 2014, coverage in the individual market generally terminated automatically when you reached age 65. This changed under the Affordable Care Act. Now you need to contact the marketplace to cancel your coverage in order to make the move to Medicare.

Subsidies also end with Medicare eligibility.

You are not required to cancel your healthcare exchange insurance plan when you enroll in Medicare, but if you’re getting premium subsidies, they’ll end when you become eligible for Medicare.

Keeping an exchange plan might not be smart.

In almost every scenario, keeping your individual exchange plan along with Medicare would be a waste of money. The plans would provide duplicate coverage, and exchange plans are not set up to coordinate with Medicare.

Plus the most expensive Medicare plans are around $200 per month and have no deductible or out of pocket costs. So if you’re thinking of keeping it because you’re very unhealthy it just doesn’t make sense.

It makes even less sense if you are healthy! There are some plans that are actually $0 per month and have no deductible and the copays for doctors and specialists visits are very low. Ranging from $0 to $50.

When you’re ready to cancel your Obamacare health plan.

If you’re enrolled in a plan through HealthCare.gov, you can follow these directions for cancelling your plan so you can smoothly transition to Medicare. Or you can remove only yourself from the policy if you have other family members who need to stay on the exchange plan.

In Maine or New Hampshire, you’ll need to contact the Marketplace call center at 1-800-318-2596 or call your insurance agent or broker if you are working with one. If not, I can certainly help you. My number is 207-370-0143.

Helpful Tip: Cancelling your exchange coverage to switch to Medicare should be relatively simple, but I have seen cases where cancellation requests weren’t transmitted to the carrier in a timely manner. For that reason, I advise my clients to switch from bank draft to paper billing prior to submitting their cancellation request.

That way, if something goes wrong when the cancellation request is being processed, you won’t end up with premiums being automatically withdrawn from your bank account after your coverage was supposed to be terminated.

When should you cancel your plan?

My advice – to avoid any gaps in coverage – is to cancel call the Marketplace to cancel your plan 1 month before your Medicare begins. So if your Medicare starts January 1, you should schedule your exchange plan to terminate December 31st. It is best to call before the 15th of the month before you want your coverage to end.

Would you like my help?

If you would like to talk ask a question or schedule a meeting at your home or a nearby meeting place, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.

The best part about working with me is that it does not cost you anything to talk with me to discuss your options and review the plans that are available. I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You pay nothing.

And you will not pay any more than anyone else and you are under no obligation whatsoever to change your plan if you talk with me.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

 

2018 Social Security COLA

Don’t wait for Social Security to give you a raise.

Give one to yourself!

How?  It’s Simple.

As the Medicare Part B premium increases each year and your cost of living increase from Social Security is $0 – this tactic might be one way to give yourself a raise! 

Ask yourself: Are you paying more than you have to for insurance?
Do you know what other people pay?

Most people who choose the Medigap type of Medicare supplement plan choose Plan F because it covers 100% of the costs left over after Medicare pays part of your doctor and hospital bill.  It’s easy to understand and easy for agents to sell. But it’s the most expensive of all Medicare supplemental plans!

The answer is to SHOP AROUND!

There is another plan (Plan G) that works the same way with one small exception. It pays 100% of the costs AFTER you pay the Medicare Part B deductible, which for 2017 is only $183.00.

That’s right, $183 is the entire deductible for Medicare Part B.

One of the big benefits to Plan G is lower monthly costs.

For example, several insurance companies are offering Plan G in Maine and starting in January of 2018 there will be more.

The lowest cost for Plan G is $165 and the lowest cost for Plan F is $206. This is a difference of $41 per month or $492 for the year!

That means after you pay the $183 Part B deductible you will save, $309 per year on Plan G!

Want to know more?

If you would like help reviewing these costs and comparing the different plans you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message or you can book a meeting online by clicking here. Book an appointment with Maine Medicare Options using SetMore

The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available. I am paid by the insurance companies in the form of a commission when you enroll in a plan.

You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you talk with me.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

2018 Part D Changes

These are some of the changes that you will see for Medicare Part D in 2018.

The standard Deductible will increase by $5.00. The standard Part D Deductible will be $405 for 2018.

What does this mean to you?

If your Medicare Part D Rx drug plan has a deductible, you may pay $5 more out-of-pocket in 2018 before you did in 2017. Most Part D plans exclude lower-cost Tier 1 and Tier 2 prescriptions from the deductible, giving you coverage for lower cost generic medications before you need to meet your deductible.

Beginning January 1, 2018 your Initial Coverage Limit (ICL) will increase $50 to $3,750.

This means that you will be able to buy slightly more medications before reaching the 2018 Donut Hole or Coverage Gap.  A good rule of thumb is that if the full retail cost of your medications is less than $312 per month, you will not enter the Donut Hole.

The Donut Hole discount will increase for both brand-name and generic drugs.

The generic drug discount you get while in the Donut Hole will increase from 49% to 56% and the discount for brand-name drugs will increase from 60% to 65%. So, if your brand-name medication has a retail cost of $400, you will pay $140 for your medication while in the Donut Hole.

Total Out-of-Pocket Costs will increase by $50.

The TrOOP or your total out-of-pocket cost is the dollar figure you must spend to get out of the Donut Hole or Coverage Gap, not including your monthly premium. The 2018 TrOOP will now be $5,000 in 2018.

What is the end result?

In 2018, you will have to spend only a little bit more to get out of the Donut Hole than you did in 2017.  So, to get out of the Donut Hole your total retail medication need to be over $702 per month. In which case you will enter the Catastrophic Coverage phase where you will remain for the rest of the year.

Once you enter the Catastrophic Coverage phase you will pay either 5% of the total retail cost of the drug OR $8.35 for brand-names and $3.35 for generics, whichever is higher.

If you need a more in-depth explanation of how Part D works or want to review what plans will help you avoid the Donut Hole, give me a call. My number is 207-370-0143. I will be happy to help you.

Be sure to read your Annual Notice of Change Letter (ANOC) that should arrive in the mail each year at the beginning of October to see how your plan is increasing – this may help you determine how much you need to budget in 2018 to cover the costs of coverage. [READ MORE …]

If you would like to talk to me, ask a question or schedule a meeting at your home or a nearby meeting place, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.

The best part about working with me is that it does not cost you anything to talk with me to discuss your options and review the plans that are available. I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You pay nothing.

And you will not pay any more than anyone else and you are under no obligation whatsoever to change your plan if you talk with me.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

Does the early bird get the worm?

You’ve probably heard the old saying “The Early Bird Gets the Worm.”

Well, as it turns out that expression is completely wrong, both literally and figuratively.

Last week, I was parked in a parking lot, returning phone calls in between appointments and saw these seagulls flying around foraging for food.

If you live in Maine or New Hampshire then you’ve seen seagulls up close and personal, their lives are pretty simple; they basically just wander around all day scouting for some food to eat. (left over lobster roll bun, french fries, etc…)

Every time one of them would find something that may or may not have been edible on the ground, the nearby gulls would immediately dash over and start tugging at the food.

One would steal the scrap from the other and run off with it in its beak, upon which the other gulls would pounce and steal the food again.

It was hilarious to watch, all that was missing was the theme song from The Benny Hill Show!

But there was one seagull who had it in her instinct to separate from the group.

She didn’t have to go far – just far enough to be uninteresting to the rest of the gulls who couldn’t see past their own beaks.

Sure enough, after a while the solo gull discovered a treasure trove of something tasty nearby a dumpster.

While the other gulls were fighting over scraps, this one had a whole half-eaten hamburger or something to herself.

That’s why the saying isn’t true. It’s not the early bird who gets the worm.

It’s the one who has the courage and independence of mind to avoid the crowd and go where everyone else isn’t.

Life, business, and retirement planning aren’t so different than nature: we humans seldom succeed and prosper by following the crowd and doing what’s popular.

so… how does this relate to health insurance??

Keep an open mind!

Don’t pick your insurance plan because “everyone says it’s the best.” Do your own research or enlist the help from a professional like myself and compare rates and costs.

Just because your friend or neighbor said the plan they have is the best, does not mean it’s the best for you.

Likewise, just because Medicare rates one plan higher than another, that ALSO does not mean it’s the best one for you.

You are unique.

Your needs are unique. The only way to be sure you have the best health insurance plan is to shop around.

Plans have different costs and different rates and they each work with different doctors and hospitals.

So it makes more sense to find a plan that will let you go to the doctors and hospitals you choose, rather than the one your friends or relatives choose.

Feeling overwhelmed with all your choices?

I will help you compare Medicare supplement rates and costs so you can choose the best plan!

And it won’t cost you anything!

I do not charge anyone for my help, whether you enroll with me or not.  I get paid by the insurance company when I deliver your application so once we pick the right plan I will help you fill out the application and I will turn it into the insurance company for you. It doesn’t get any easier than that!

You can use the BOOK APPOINTMENT(link is external) button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started. 
Book an appointment with Maine Medicare Options using SetMore
Have a question that needs to be answered right away?
Just give me a call at your convenience.  
You can talk to me at (207) 370-0143
or call toll free 866-976-9038. 
Or send me an email using this form –> https://www.mainemedicareoptions.com/contact

Are you turning 65 and still working?  Read this.

Annual Notice of Changes (2018)

3 things to know about the Annual Notice of Change (ANOC)

 

Avoid surprises – Review your Annual Notice of Change each fall!

If you have a Medicare Advantage plan (Part C) you will receive an Annual Notice of Change (ANOC) from your health insurance company at the end of September. If you are new to Medicare, then you may not know what this is.

Who gets one and what should you do with it?

The ANOC is an important notice sent each year to people who have a Medicare Advantage (MA) Plan or a Medicare Part D Prescription Drug Plan.

The health insurance companies that administer these plans are required to send notices to you each year to notify you of cost and/or benefit changes that will take effect starting January 1, 2018.

When should you expect it?

You should receive this notice by September 30th of this year. If you haven’t received it by then, you should contact your plan to ask for it or call your agent to learn about what is changing. Your agent will know everything that is changing and can explain how it will effect you.

If there are changes to your costs and benefits that could raise your costs or get in the way of getting the health care you need, you may want to think about making changes to your Medicare coverage during Medicare’s Fall Open Enrollment Period.

When can you make changes?

Fall Open Enrollment runs from October 15 to December 7 every year. If you make changes to your Medicare coverage during Fall Open Enrollment this year, they will go into effect on January 1, 2018.

Even if you review these notices and decide that there won’t be any major changes to your Medicare coverage in 2018, it still might be helpful to look at other Medicare options and compare them to your current plan.

Another plan in your area might offer health and/or drug coverage at a better price than what you currently pay. To learn more about different Medicare coverage options, call 1-800-MEDICARE or use the Plan Finder tool at medicare.gov or click this link.

Still have questions?

If you would like help comparing your needs against the many Medicare plans out there or if you just want to ask a few questions, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.  

The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay anything to meet with me and you will pay the same price for your insurance that everyone pays whether they had my help or not.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

 

Top 5 Medicare Myths

Educate yourself on these common Medicare myths — both your health and your wallet will thank you.

Medicare is a great program. I know because I meet with people every day who are turning 65 and entering the Medicare system and looking for help and advice on where to start and what to look for.  Medicare saves you from having to pay enormously high private health-insurance premiums, and it protects you from catastrophic medical expenses. But if you’ve heard one of these common misunderstandings about Medicare, you will be glad you found this website.

1. Medicare enrollment happens automatically at 65

Everyone becomes eligible for Medicare at age 65, but actually enrolling in the program is up to you. The only way you’ll be automatically enrolled in Medicare is if you’re already receiving Social Security benefits when you hit your 65th birthday or if you are collecting Social Security Disability payments. In either of these cases, you’ll be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance) as soon as you become eligible, although it’s still up to you to sign up for any prescription drug coverage, Medigap, or a Medicare Advantage plan. — That’s where I come in! smiley

Read more about How and When to Enroll.

2. You can enroll any time after age 65

This is not quite accurate. Your initial enrollment period for Medicare begins three months prior to your 65th birthday and ends three months after the month which you turned 65. If you don’t enroll during this seven-month period, you’ll have to wait for the next Medicare open enrollment period which happens between January 1 and March 31 and your Medicare benefit will begin on July 1st. And if you are enrolling in a Medicare plan it must be done prior to July 1st!

There are also penalties for late enrollment. If you don’t sign up for Part A during your initial enrollment window, then your monthly premium will go up by 10% for twice the number of years you could have been enrolled but were not. For example, if you file for Medicare Part A three years after you become eligible, then you’ll have to pay a higher premium for six years.

You should also sign up for Part B as soon as you’re eligible. If you don’t, your premium will go up 10% for every year you delayed — permanently.

Read more about How to Correctly Plan Your Enrollment.

3. Medicare is free

This is a big one! Especially with all the advertisements out there saying that plans have no cost or $0 monthly premiums.

Some parts of Medicare and some covered services are indeed free, but there are certainly some costs involved. Medicare Part A, which covers in-patient hospital stays, has no monthly premium if you worked (and paid Medicare taxes) for at least 40 calendar quarters (or 10 years) by the time you enroll. Medicare Part B, which covers outpatient doctor visits, routine bloodwork and similar expenses, has a premium of $134 per month in 2017, although high-income enrollees may pay higher premiums.

Other Medicare parts and plans have a wider range of premiums, often based on the type of plan and where you go for care. As for services, different Medicare parts and plans offer different levels of coverage for various medical expenses. Some expenses may be completely covered by Medicare, such as an annual wellness exam, while others require you to pay a co-pay or meet an annual deductible.

Read more about How can insurance can have a $0 premium?

4. Medicare covers all types of healthcare expenses

The different parts of Medicare cover different types of healthcare. Medicare Part A covers only hospital-related services, while Part B covers other types of medical expenses such as doctors’ visits and lab tests. Part D covers prescription expenses.

Part C, also known as Medicare Advantage, can cover additional services such as vision and dental care. Medigap plans help cover some of the costs that Medicare Part A and Part B don’t cover, but it doesn’t include prescription coverage, dental, vision, and so on. So the exact coverage you have will depend on which parts of Medicare and which specific plans you sign up for.

5. You may not qualify for Medicare

Happily, you cannot be rejected from Medicare coverage just for being sick or having a pre-existing condition. For that matter, pre-existing conditions won’t raise your premiums, either. This should continue to be the case for Medicare even if Congress repeals the Affordable Care Act’s pre-existing condition clause.

Still have questions or want help comparing the different health insurance plans?  I can help you!

You can use the BOOK APPOINTMENT(link is external) button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started. 
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Have a question that needs to be answered right away?
Just give me a call at your convenience.  
You can talk to a licensed insurance agent at (207) 370-0143
or call toll free 866-976-9038. Or send me an email using this form –> https://www.mainemedicareoptions.com/contact

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There is no obligation to you and no cost to meet with someone.

$0 Premium Plans

How can insurance have a $0 premium?

If you’re ready to see some plans right now, use the Compare Plans tool here.

We have all seen the ads on TV or gotten something in the mail advertising Medicare plans with $0 monthly premium or $0 co-pay for prescriptions or for a doctors visit or a routine eye exam.  And I am often asked how these Medicare Advantage plans can be “free”.

$0 Premium Medicare Advantage Plans do actually cost you nothing per month for the insurance plan and they also often times offer other services or generic prescriptions for $0 but these plans are not actually free.

This is because you have to pay for Medicare to be eligible to enroll in these plans and Medicare has a monthly premium.

Some parts of Medicare and some covered services are indeed free, but there are definitely some costs involved. Medicare Part A, which covers hospital services, has no premium if you worked (and paid Medicare taxes) for at least 40 calendar quarters by the time you enroll. Medicare Part B, which covers doctor visits and similar expenses, has a premium of $134 per month in 2017, although high-income enrollees may pay higher premiums.

Other Medicare parts and plans have a wider range of premiums, often based on the type of plan and the provider or service you use. Medicare parts and plans offer different levels of coverage for various medical expenses. Some expenses with these plans may indeed have a $0 co-pay, while others require you to pay a higher co-pay or meet an annual deductible.

Under Medicare law, these private insurance companies that offer these plan are contracted with Medicare to provide Medicare Advantage (also called Medicare Part C) plans must offer the same benefits as Original Medicare (Parts A and B.)

All beneficiaries with Medicare Part B need to pay the Part B premium, even if they obtain their benefits through a Medicare Advantage plan, regardless of the plan premium. Because the federal government pays insurance companies a certain amount for each beneficiary that the plans cover, this is how the insurance company can offer plans with $0 premiums. Because they are getting money from Medicare to offset the costs.

However, $0-premium Medicare Advantage plans might not always be the most affordable option.

Even if you enroll in a plan with a $0 premium, you could have other out-of-pocket expenses that might add up over the year. So, it’s a good idea to compare a the Medicare plan’s deductible, out-of-pocket maximum and co-payments, as well as the monthly plan premium.

As you can see, the cost of a plan’s monthly premium isn’t all there is to choosing which plan is right for you.

If you would like help comparing Medicare plan options that fit your budget and health needs, you can contact me using the CONTACT page on this site or by calling me directly at 207-370-0143.

Get to know me by clicking the “About” link on the menu above. There are also links below so you can schedule a phone appointment or have me email you details on Medicare Advantage plans that could be right for you.

Would like my help?

If you would like to talk to me, ask a question or schedule a meeting at your home or a nearby meeting place, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.

The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available. I am paid by the insurance companies in the form of a commission when you enroll in a plan.  

You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you talk with me.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

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