Medicare: Choosing The Right Plan

Medicare: Choosing The Right Plan

by D. S. Mitchell

AARP Contribution

I am convinced one of the best publications for a senior citizen is AARP magazine. This little newspaper is a gem. A year ago Dena Burns wrote an article on how to be a smart consumer when it comes to Medicare benefits. I thought her observations were worth passing on.

Important Calendar Events

I can’ t stress this enough. When it comes to signing up for Medicare, time matters. So, sign up on time to avoid hassles and higher monthly premiums. The initial enrollment time is called the IEP, unless you have health insurance through your job or your spouse’s. The IEP spans 7 months; the month a beneficiary turns 65 and the 3 months before and after that birthday.  Missing the IEP can cost you, for the rest of your life. Here’s how it works for parts A, B, and D.

• Part A: This is the hospitalization portion of the program and covers hospital stays and short term nursing facilities. If you miss your deadline you will have no coverage until you enroll.
• Part B: This portion of the program covers doctor services, outpatient and preventive care along with some covered medical supplies. If you miss your enrollment deadline your premium will increase by 10 percent for every 12 months you are overdue in signing up. As an example, if you sign up 2 years late you will pay an estimated $6,500 more in monthly premiums over the next 20 years. 
• Part D: Part D helps pay for prescription medications. In this case, if you miss your IEP your monthly premium will increase by 1% each month you remain unenrolled. In 2019 the average monthly premium was $31.83.  As an example, if you delay for 24 months to enroll, you will pay an additional $8.00 per month for your coverage for life. (* I personally have a  story regarding Part D.  I was hit with the additional 1% when I filed nearly 2 years late for Part D. In my case it was my employers fault and when I appealed the decision and it’s penalty I won the appeal because my employer had failed to provide the information to me, although they had provided all the enrollment information on Parts A and B.*)  So, remember, in some cases you can appeal the ruling and win, but it is easier to do it right to start with.
• Once you are enrolled it is important to make a note each year that between October 15 and December 7 you can legally switch coverage for the upcoming year.

Choose Your Doctor Carefully

One of the first things to understand is that Medicare does not provide health care. We do not have a national health care system in the United States, even for the elderly. In the United States individual doctors and other care givers (Physical Therapists, Nutritionists, etc.) provide care.

Two Factors To Consider

At this point at least two factors must be considered, and a couple of clarifications are in order.  First, does the provider accept Medicare? 

Three categories of doctors:

1.) Participating: These providers accept what’s on original Medicare’s fee schedule as full payment. (You or your gap provider will still be responsible for the deductible and co-insurance amount.)

2.) Nonparticipating: Doctors in this category take Medicare’s approved payment, but are allowed to charge you up to 15% more than the scheduled fees.

3.) Opting Out: These providers can charge patients whatever they want.

Second, does the provider have the skills you need?

As a senior you are part of a particular health group with special needs. It is important that you consider finding doctors who specialize in caring for geriatric patients. Such things as diabetes, heart disease, dementia and arthritis are chronic conditions that afflict the older population. It is important that your practitioner be up to date on nutrition, fitness, vitamins, changes in geriatric treatments, and sleep science.

STOP Surprise Charges

No one wants to get a surprise medical bill. Always check in advance if your doctor’s accept Medicare and if Medicare covers the treatment or procedure that you are planning on having done. This is particularly important if it is an elective or optional surgery. There is a list of covered services at the medicare.gov website.

How To Deal With The Unexpected 

• Delay payment. Check with your doctor to make sure the bill was sent to the insurance company using the correct billing code.
• Connect with your Medicap (supplemental) insurer and ask why the bill has not been paid.
• If Medicare or your supplemental insurer has rejected the claim, file an appeal.
• If all else fails, negotiate for a lower billing amount.

Don’t Leave Freebies On The Table

• Wellness visits. Each year you can see a doctor for free to review your medical history and status and receive several basic screenings, like weight, blood pressure and cognitive health. It is not a full blown physical but it does give important diagnostic information.
• Eyeglasses. Original Medicare does not cover routine eye exams or glasses. It will pay for eyeglasses one time after cataract surgery to implant intraocular lens. Some Medicare Advantage plans include vision coverage.
• Nutrition assessment and counseling. Medicare will cover nutrition assessment and counseling if a patient has diabetes, kidney disease, or have had a kidney transplant in the last 36 months.
• Smoking Cessation. Medicare will fund 8 quit smoking counseling sessions to help kick nicotine.
• Go to medicare.gov to see a full list of covered services.

Keep Good Records

Some health care experts suggest each of us keep an up-to-date diary of our medical information and history. If you have a Health Care Directive, keep it in a visible place. Mine is taped to the refrigerator. Information to include in your personal medical diary:

1.) Health condition and when diagnosed. 2.) Hospital stays, include dates and procedures. 3.) Your prescription drug list, including dosages. 4.) Any medical equipment you use. 5.) Contact information for your preferred pharmacy 6.) Insurance for all policies, including supplemental 7.) Emergency contact list, durable power of attorney, and a health care directive.

Be Adaptable, Be Open For Change

Sometimes we don’t know there is a better deal out there because we don’t pay attention to changes. Regarding Medicare that can be a big mistake. Be open to change. Be adaptive. You may be able to improve your current plan during the open enrollment period, and maybe even save some money. Here are a few things to focus on:

• If you have a Medicare Advantage plan review the annual list of member doctors, facilities and medication coverage. Have there been changes that will effect your health and your wallet? If so you need to know about it, ahead of time.
• During open enrollment participants are allowed to switch from Medicare to Medicare Advantage and vice versa. This can be a big decision in future care. Each of the Medicare Advantage programs are different depending of state and regional ‘zone’. Medicare and Medicare Advantage each have benefits and drawbacks. Be sure you understand the differences before you switch. If you have questions go to shiptacenter.org and click on SHIP Locator to find neutral advice. 
• Shop around for a Part D prescription drug plan, it is common for each plan’s drug list, prices and preferred pharmacies to change annually.
• If you are a retiree that has a health plan from your former employer that complements your Medicare be sure to check with the plan provider to learn about any plan changes.

This last one is a biggie,

Know Your Rights 

If a Medicare claim is denied, whether you have original Medicare or have a Medicare Advantage plan, you are entitled to an appeal. There are people who can help you. Call the Medicare Rights Center hotline at 800-333-4114. A few hints about the appeal process.

• You can designate someone to represent you. The person you chose does not have to be an attorney.
• Ask your doctor to put in writing why you need or have needed the service, medication, treatment or equipment.
• You can appeal a discharge from a hospital or a skilled nursing facility; in many cases you may be able to stay in the hospital at no additional charge.
• If you or your doctor are concerned that your health may be seriously damaged by delay you can ask for a quick answer and they will give an answer to the appeal within 72 hours.

https://www.calamitypolitics.com/2017/03/21/know-medicare-terms-and-players/