Jim at the 2018 Philadelphia Inquirer 55+ Thrive Medicare Discussion and Q&A Panel
FAQ
sWhy should I get a plan through a broker?
Most of the reasons are laid out on our Home Page, but the key point is that our focus is on the “boomer” and “senior” markets and you get the benefit of his experience without having to do all the homework yourself. The expertise needed to understand the subtle differences in the plans and carriers can make all the difference. We separate ourselves from your other choices because we understanding the importance of service and support far beyond the initial sale.
How do I sign up for Medicare?
People who already are receiving Social Security retirement or disability benefits automatically will be enrolled in Medicare and do not need to complete an application. The Part B premium will automatically be deducted from your monthly benefit
If you are turning 65 in the next four months and not receiving Social Security benefits you will need to contact Social Security to enroll in Medicare Part A & B. You have two options: The easiest way is to apply online at www.ssa.gov. Click the Benefits tab, then Medicare and scroll until you see the box Apply for Medicare Only. The other way is to visit a Social Security office and apply in person or call and apply over the phone.
If you delayed enrollment into Medicare Part B (enrolled in Part A only) when you turned 65 and your (or your covered spouse’s) active employment is ending, you will need to enroll into Part B within 8 months, regardless of whether the group health benefits will continue. Social Security will require two forms. One is the Employer Verification Form (L564) and it needs to be completed and signed by your employer. It asks for dates of employment and health coverage to verify eligibility. The other is a simple Medicare Part B Application (40-B) and can be completed and signed by you. Once these forms are completed, drop them off at a Social Security office. The effective date will be the first of the following month or up to 3 months later, if requested. It may take up to 60 days to get your new card.
COVID-19 UPDATE:
The Part B Enrollment Application should be completed online through this link:
https://secure.ssa.gov/mpboa/medicare-part-b-online-application/
** the Employer L564 form (or other proof of coverage) can be uploaded as well
OR
Both forms can be faxed to 833-914-2016
I was told that I will be penalized if I do not get a drug plan at 65, is that true?
Perhaps. If you have credible drug coverage through an employer or the VA, then the penalty can be avoided. If you are enrolling into a Part D plan for the first time and you are over the age of 65, you are considered a Part D Late Enrollee. Your new Part D plan will be required to send you a form for you to complete and return in order to determine whether you should be penalized for time you were not in a Part D plan since you became Medicare eligible (Part A). Late enrollees can avoid the Late Enrollment Penalty (or LEP) by providing the required information and sending it back within the specified time frame.
Medicare is denying all my claims. How do I fix that?
Most likely, some other prior health or Worker’s Comp coverage is still listed on your record as being primary payer in Medicare’s system. A simple call to the MEDICARE COORDINATION OF BENEFITS hotline to remove any prior coverage from your file should fix the issue and straighten things out. Any denied claims can be resubmitted by your providers after 10 days of the call. The phone number is: 1-855-798-2627. Make sure you have your Medicare card handy for the call.
What are Part B Excess Charges and do I need coverage for them?
Medicare excess charges are also known as balance-billing. First, experiencing this issue is very rare. Medigap carriers report that less than 1% of all claims received are affected. According to the Kaiser Foundation, 97% of healthcare providers accept Medicare assignment. Meaning, they agree with Medicare’s payment terms and rates and bill Medicare accordingly. Only 1% of providers have opted out of Medicare completely and 50% of these providers are psychiatrists. The remaining providers have the option of billing in excess of the Medicare physician fee schedule. Eight states, (PA, OH, NY, CT, MA, MN, RI, and VT) have passed Medicare Overcharge Measures, meaning that providers that have not opted out of Medicare must accept assignment in full.
Medigap Plan G and Medigap Plan N account for 91% of all new Medigap (Supplement) purchases. Plan G includes coverage for Excess Charges, Plan N does not. In general, we do not believe this benefit (coverage for Excess Charges) should be an important factor in the plan letter decision, especially if you will receive most of your medical care in one of the 8 states listed above.
If you are enrolled in a Medicare Advantage (HMO or PPO) plan, Medicare's fee schedule is removed from the equation completely and insurance company's fee schedule takes over. If your provider is out of network for your plan, review your plans Summary of benefits.
Most of the reasons are laid out on our Home Page, but the key point is that our focus is on the “boomer” and “senior” markets and you get the benefit of his experience without having to do all the homework yourself. The expertise needed to understand the subtle differences in the plans and carriers can make all the difference. We separate ourselves from your other choices because we understanding the importance of service and support far beyond the initial sale.
How do I sign up for Medicare?
People who already are receiving Social Security retirement or disability benefits automatically will be enrolled in Medicare and do not need to complete an application. The Part B premium will automatically be deducted from your monthly benefit
If you are turning 65 in the next four months and not receiving Social Security benefits you will need to contact Social Security to enroll in Medicare Part A & B. You have two options: The easiest way is to apply online at www.ssa.gov. Click the Benefits tab, then Medicare and scroll until you see the box Apply for Medicare Only. The other way is to visit a Social Security office and apply in person or call and apply over the phone.
If you delayed enrollment into Medicare Part B (enrolled in Part A only) when you turned 65 and your (or your covered spouse’s) active employment is ending, you will need to enroll into Part B within 8 months, regardless of whether the group health benefits will continue. Social Security will require two forms. One is the Employer Verification Form (L564) and it needs to be completed and signed by your employer. It asks for dates of employment and health coverage to verify eligibility. The other is a simple Medicare Part B Application (40-B) and can be completed and signed by you. Once these forms are completed, drop them off at a Social Security office. The effective date will be the first of the following month or up to 3 months later, if requested. It may take up to 60 days to get your new card.
COVID-19 UPDATE:
The Part B Enrollment Application should be completed online through this link:
https://secure.ssa.gov/mpboa/medicare-part-b-online-application/
** the Employer L564 form (or other proof of coverage) can be uploaded as well
OR
Both forms can be faxed to 833-914-2016
I was told that I will be penalized if I do not get a drug plan at 65, is that true?
Perhaps. If you have credible drug coverage through an employer or the VA, then the penalty can be avoided. If you are enrolling into a Part D plan for the first time and you are over the age of 65, you are considered a Part D Late Enrollee. Your new Part D plan will be required to send you a form for you to complete and return in order to determine whether you should be penalized for time you were not in a Part D plan since you became Medicare eligible (Part A). Late enrollees can avoid the Late Enrollment Penalty (or LEP) by providing the required information and sending it back within the specified time frame.
Medicare is denying all my claims. How do I fix that?
Most likely, some other prior health or Worker’s Comp coverage is still listed on your record as being primary payer in Medicare’s system. A simple call to the MEDICARE COORDINATION OF BENEFITS hotline to remove any prior coverage from your file should fix the issue and straighten things out. Any denied claims can be resubmitted by your providers after 10 days of the call. The phone number is: 1-855-798-2627. Make sure you have your Medicare card handy for the call.
What are Part B Excess Charges and do I need coverage for them?
Medicare excess charges are also known as balance-billing. First, experiencing this issue is very rare. Medigap carriers report that less than 1% of all claims received are affected. According to the Kaiser Foundation, 97% of healthcare providers accept Medicare assignment. Meaning, they agree with Medicare’s payment terms and rates and bill Medicare accordingly. Only 1% of providers have opted out of Medicare completely and 50% of these providers are psychiatrists. The remaining providers have the option of billing in excess of the Medicare physician fee schedule. Eight states, (PA, OH, NY, CT, MA, MN, RI, and VT) have passed Medicare Overcharge Measures, meaning that providers that have not opted out of Medicare must accept assignment in full.
Medigap Plan G and Medigap Plan N account for 91% of all new Medigap (Supplement) purchases. Plan G includes coverage for Excess Charges, Plan N does not. In general, we do not believe this benefit (coverage for Excess Charges) should be an important factor in the plan letter decision, especially if you will receive most of your medical care in one of the 8 states listed above.
If you are enrolled in a Medicare Advantage (HMO or PPO) plan, Medicare's fee schedule is removed from the equation completely and insurance company's fee schedule takes over. If your provider is out of network for your plan, review your plans Summary of benefits.
