What to know about Medicare to avoid costly Medicare mistakes

Medicare is not a complex subject as long as you are familiar with Medicare checkpoints.  These are not strict rules like ‘Who is eligible for Medicare?’ or ‘How do I apply for Medicare?’ but rather practical, common sense tips that can help you to avoid errors and save a substantial amount of money.  Therefore, getting as much knowledge as possible about these Medicare checkpoints  is quite important. Some of them are applicable only when you are turning 65 (or get Medicare because of a disability). Others are available, once you are on Medicare. In any case, here are our guidelines for the question “What to know about Medicare to avoid costly Medicare mistakes”.

What to know about Medicare to avoid costly Medicare mistakes– Turning 65

1. Do I need Medicare Part B?

It depends on whether

  • you can afford it
  • you or your spouse are currently working and covered by an employer group plan
  • you will be ready to enroll in Medigap within 6 months after getting Part B

For more information refer to Decide if you need Medicare Part B.

There is also an important concern of what will happen with dependents of people moving to Medicare.  Dependents can continue their coverage for 3 years under COBRA, shop for an individual health plan, or, if they have been uninsured for six months, apply for the state’s high-risk pool.

2. Do I need Medicare prescription drug coverage?

Definitely, unless you have Creditable Prescription Drug Coverage. You may find more information in Do you need to enroll in Medicare Part D?

3. Do I need to enroll in Medigap plan?

You should seriously consider enrolling in a Medigap plan as soon as possible after getting Medicare Part B, particularly if you have serious health problems.  The first 6 months after you receive Part B is a timeframe known as the Open Enrollment Period (OEP).  During this period the insurance company cannot deny you any insurance policy they sell because there is no medical underwriting allowed during the OEP.  Outside of this period, medical underwriting is allowed. Therefore, the insurance company may reject anyone with a questionable health record.  Read more in Should you enroll in Medigap policy?

What I should know about Medicare to avoid costly Medicare mistakes – Anytime after enrollment

1. Original Medicare or Medicare Advantage

This is an important choice you need to make when first enroll in Medicare; as well as every year during the Annual Enrollment Period (AEP).  Each choice has its pros and cons.  (See Comparing Original Medicare vs. Medicare Advantage).  The overall conclusion is that you should enroll in a Medicare Advantage plan as long as you are healthy and willing to stay within the plan’s network.

Otherwise, select the Original Medicare, buy the stand-alone Part D and complement it with the Medigap plan.  The Medigap plan will protect you against high medical expenses in the event of serious illness. Just remember, never drop  the existing plan (Medicare Advantage or Medigap plan) before being accepted into the new Medigap plan.  Because of medical underwriting (unless you just turned 65), there is no guarantee that you will be accepted.

2. How important is the insurance company rating?

It depends.  Medicare Advantage  Plans (MA), Medicare Advantage with Prescription Drug Plans (MAPD), as well as stand-alone Prescription Drug Plans (PDPs) don’t have any standardized  plans. For these plans insurance company ratings are very important.  The major factors in the MA/MAPD selection are insurance company network, company plan rating, and premium price.  For PDPs the major factors are annual drug costs, formulary, and company plan rating.

This, however, is not a case for Medigap (Medicare Supplement) plans.  All Medicare Supplement plans are standardized.  This means that:

  •  Benefits for any particular plan are the same for all insurance companies
  • Claims processing is identical for all companies
  • All claims decisions are made by Medicare, not by insurance companies
  • There is no network; any doctor that accepts Medicare will accept you in a Medigap plan

The ONLY difference is insurance premium – it may be significantly different from one company to another.  A.M. Best Company actually publishes the financial strength ratings on Medicare Supplement insurance companies, but it is NOT much of a factor in company selection.

3. How to select Prescription Drug Plan (PDP) insurance company?

The selection of the insurance company covering your prescription drugs (Part D) is too important to be ignored.  Saving money by making the right PDP choice is very essential part of your Medicare savings. There are four guidelines for the Part D selection process described in How to save money on Medicare Prescription Drug Plans (PDPs). They are:

  • Select a plan based on YOUR list of prescription drugs rather than on recommendations from your friends or family members.
  • Always make your selection based on  lowest Estimated Annual Drug Costs rather than on lowest “Monthly Premium”
  • If possible, try to use generic rather than brand name medications.
  • Always check whether you are eligible for prescription drugs Assistance Programs

4. What about extra coverage?

Extra Coverage includes benefits  such as vision, hearing, dental, and health/wellness programs.  They are normally not covered by Medicare.  Medicare Advantage plans very often include them as a part of their plan, or offer them at additional cost.  Recently, some Medicare Supplement insurance vendors also started to add limited extra coverage (such as vision) to their offerings.

Obviously, an addition of extra coverage makes the plan more appealing.  But don’t let it sway you from the proper selection of Medicare plan based on the above guidance.

5. Are you entitled to Medicare Assistance programs?

There are several Medicare Assistance programs that provide Help with Medical and Drag Costs.  They include both Federal and State programs:

Medicare Savings Programs – State programs that help to pay for Medicare premiums and, in some cases, for Parts A and B deductibles, coinsurance and copayments.

Extra Help / Low-Income Subsidy (LIS) – Federal programs that pay for the cost of Medicare Prescription Drug Coverage.

State Pharmaceutical Assistance Programs (SPAPs) – State programs that help to pay for prescription drugs based on financial need, age, or medical condition. See Plans by State.

Surprisingly, many seniors are either not aware about the existence of those programs, or wrongly assume that they are ineligible.  Actually, there are a variety of plans that offer benefits based upon your income and resources. Therefore, always apply to help programs – you’ll be surprised how often you’ll find you are eligible. Enrolling in one of these programs gives you an additional advantage: you will be allowed to change MAPD/ PDP plans multiple times during the year.

6. What about long-term care?

Medicare does not pay for long-term nursing home care or other long-term care services.  However, because of the recent changes in Medicare coverage for at-home skilled nursing care and rehabilitation therapy, Medicare will pay for services to maintain the patient’s current condition in order to prevent or slow down further health deterioration.  Previously, Medicare did not pay for skilled nursing care and rehabilitation unless the patient’s improvement was proven.

7. Agent Role

Always work with a full service, licensed independent insurance agency specializing in Medicare plans.  Liberty Medicare is one of those agencies.

The advantages working with independent agencies include:

  • Independent agents are NOT employed by any specific insurance company, but rather represent a wide variety of carriers. It allows them to work for clients by comparing numerous plans and selecting the most suitable plan for their needs.
  • Such agencies normally represent only well established and nationally known providers. They provide real time quotes, as well as options for online enrollment.
  • Independent agencies will guide you through the process and provide support for your needs after enrollment (such as monitoring policy changes on an ongoing basis and assisting you at renewal periods).
  • Because of their knowledge of medical underwriting guidelines for different companies, the independent agencies will advise you not to apply to insurance companies that might reject you. This is quite important because once the rejection is recorded, other insurance companies are far more likely to reject you as well.

Finally, there is no cost to you for independent agency services.  And there are no monetarily advantages to enroll on your own. Your premium will be EXACTLY the same no matter how you apply; whether directly or through the agency.

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For help finding the best Medicare or Individual Health Plan for you, please contact Liberty Medicare or call us at 877-657-7477.


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