A non-government site powered by Medicare Specialist LLC, a health insurance agency
Jim at the 2018 Philadelphia Inquirer 55+ Thrive Medicare Discussion and Q&A Panel
FAQ
Why 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 within 3 months of your 65th birth month 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 Medicare on the top navigation bar, then Sign up for Medicare and scroll until you see the box Apply Online. You will need to sign in to your mySocial Security account. If you do not have one, I would consider doing this in advance. https://www.ssa.gov/myaccount/
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 the employer(s) you've had the coverage with. 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 a few weeks to get your new card.
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 (also known as balance billing) are very rare. According to the Kaiser Foundation, 97% of healthcare providers accept Medicare assignment. They agree to Medicare’s fee schedule (assignment) as payment in full. Of the 3% that are "non-participating".
According to Mutual of Omaha, only 0.03% of their Part B claims include Part B excess charges. Of that small fraction, more than 90% are for an amount under $30. This is on the data set of roughly 55 million Part B claims each year.
Eight states (PA, OH, NY, CT, MA, MN, RI, and VT) have passed Medicare Overcharge Measures, meaning that excess charges are illegal.
Medigap Plan G and Medigap Plan N account for 95% of all new Medigap (Supplement) purchases. Plan G includes coverage for Excess Charges, Plan N does not.
We do not believe this benefit (coverage for Excess Charges) should be essential to 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.
I received a letter or an invoice saying I will need to pay more for Medicare based on my previous income. Do I have to pay this?
Often times, no. Social Security looks at the household income from 2 calendar years prior.
If you've had a life-changing event (these include marriage, divorce, the death of a spouse, loss of income, and an employer settlement payment) that reduced your household income since then, you can ask to lower the additional amount you'll pay for Medicare Part B and Part D. Complete a SSA-44 form and get it to your local Social Security office. Fax, mail, or drop it off.
When should I apply for Social Security Benefits and how soon will they start?
Full disclosure, this is not our area of expertise. While the Social Security Administration handles enrollment in Medicare and determines what you will pay for it, Social Security Benefits is a completely differently animal and this decision can be a very complex. We recommend speaking to your Financial Advisor or talk to a fee-based resource like:
https://www.socialsecurityadvisors.com/
Latest newsletter from the SE PA Social Security office
| social_security_newsletter_-_march_2024.pdf |