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Reasons You Will Love Medicare

When you enroll in Medicare, you might find there are things you don’t love about it, like the out-of-pocket expenses of Part B or the lack of dental, vision, and prescription coverage. However, despite the bad rap it gets, a recent survey showed that 90% of beneficiaries are happy with the care it provides, and with their coverage choices. If you take the time to review all your coverage options, and find out how it differs from your employer’s coverage, you’ll find that Medicare has a lot to offer. Here are just some of the reasons why you will love it.

Lower Premiums

With Medicare, you’ll save money on monthly premiums. Medicare Part A (hospital insurance) premiums are free, as long as you meet the requirements of having worked at least 40 calendar quarters in a job where you paid social security taxes. Part B (medical insurance) premiums are about $144.60 a month. When you compare this to the cost of private insurance, you will find that you’ll be paying a lot less. Even for a healthy 25-year old, monthly premiums will cost around $300 a month under private plans.

Medicare prices also rise more slowly than health insurance plans because they are pegged to inflation. Since 2013, private health insurance premiums have increased 123%, while Part B premiums have only increased by about 25%. That adds up to even more savings the longer you are on Medicare.

You Have Choices!

Medicare also beats private insurance when it comes to plan choice and clarity. When you have employer coverage, you are stuck with whatever healthcare plan your employer offers you, and it can be difficult to change plans. There is also a lot of uncertainty in private plans about how much you will pay for deductibles, copays, and coinsurance.

However, once you enroll in Medicare at 65, you have the choice of enrolling in other plans that help with out-of-pocket costs, such as Medicare Supplement Plans and Medicare Advantage Plans. There are around 10 different Medicare Supplement plans alone to choose from, and with each you will know just how much you will be spending. And, if you find that you are unhappy with whichever Medicare Supplement plan you choose, you can switch your coverage.

Free Preventive Care

caucasian woman with a face mask on and white coat with a swab in her hand and googles on. — *Medicare offers free preventive doctor visits and screenings.*

Medicare offers free preventive care services to all people covered by Part B. These services include:

“Welcome to Medicare” Preventive Visit– This initial check-up can be scheduled within the first 12 months of your enrollment in Medicare Part B and includes a host of free preventive services. During this visit, your medical and social history is reviewed and you will get certain screenings, vaccines, referrals to specialists if needed, a vision test, body mass index (BMI) calculation, height and weight measurements, blood pressure measurements, depression screening, and a plan for future screenings you might need in the future.
Annual “Wellness” Visits– you are covered for one free annual doctor visit at least 11 months after your first wellness exam, then once every year after that. These visits will include services similar to those in the “welcome to Medicare” visit. Your doctor will also ask you to fill out a questionnaire called a “Health Risk Assessment.”
Screenings– You get free screenings for:
- Mammograms
- Cancer screenings for lung cancer, cervical cancer, vaginal cancer, prostate and colorectal cancer.
- Cardiovascular disease
- Alcohol Misuse
- Depression
- Diabetes
- Hepatitis C
- HIV
- Glaucoma
- Bone mass measurements for bone density
- Obesity screening
- Weight-loss counseling
Vaccines- Medicare Part B covers vaccines for pneumonia, the flu, tetanus, and hepatitis B.

Can Medicare Deny My Claims?

Medicare processes millions of claims each year, and some of them get denied. There can be any number of reasons why claims are denied, ranging from issues with billing codes to not meeting eligibility requirements. People make mistakes so billing errors can also happen. In these cases, beneficiaries can appeal the decision, or resubmit the claim. In order to avoid paying out-of-pocket unnecessarily, you should know the reasons why claims are denied and how to go about appealing denials.

Why Claims Can Get Denied

computer screen with codes on it. — *Your healthcare provider’s staff can make a mistake and put in the incorrect billing code.*

There are numerous reasons that a Medicare claim can get denied. These include:

Billing Errors– Your healthcare provider’s staff can make a mistake and put in the incorrect billing code for a service you have received. When this happens, medicare will deny the claim. For example, the “Welcome To Medicare” visit is covered 100%, but if the code put in reflects a normal visit, and not a covered wellness visit, then you will receive a bill in the mail.
Lack of Medical Necessity– Medicare requires doctors to provide proof that each service they provide is medically necessary. If Medicare does not deem a service necessary, then it will not cover the service. There may be times when a doctor will consider a service necessary for the patient’s needs, but Medicare might disagree and deny the claim. For example, a doctor may feel that blood work is necessary at a patient’s “Welcome To Medicare” visit. This service, however, is not generally covered by Medicare at this visit and so the claim will be denied.
Coordination Of Benefits– If a beneficiary has both an employer-based health plan and Medicare, then coordination of benefits is the process that determines which plan has the payment responsibility. Depending on the size of your employer, that plan will usually be the primary payer and Medicare will usually be the secondary payer. When you stop working or decide to drop your employer’s insurance, Medicare needs to be notified of the change. If Medicare is not notified by your employer, then Medicare will continue to be considered the secondary payer. Under these circumstances, any services you have that are billed to Medicare will be denied because they will still be considered the secondary payer.

Appealing A Medical Claim Denial

Denials for services that you feel should’ve been approved can be appealed. There are various legitimate reasons for appeal, such as billing mistakes. But there are limits on how long you have to file an appeal as well as procedures for how to file correctly.

When you get denied for a claim, you will receive a Medicare Summary Notice (MSN) listing the denied claim/s. You need to file your appeal within 120 days of receiving the MSN. First, you must circle the item that you are appealing on the MSN and then explain why you think it should be covered. Include any additional information supporting your appeal, including any supporting information from your doctor.

If your Medicare claim is denied, don’t panic. It could be a simple billing error. However, if you find you are receiving denials for services, make sure you are asking your healthcare provider about coverage at each visit. Your provider should be able to tell you what is covered and what is not and, if they can’t, they will need to provide you with an Advantage Beneficiary Notice of Noncoverage (ABN). This notice informs you that Medicare might not cover the claim, and if you agree to have services, then you agree to pay the non-covered charges. You then have the choice to either sign and receive the service or decline the service.

You can also call Medicare before receiving services to make sure they will be covered. And, if you do end up receiving a denial, you can always appeal it with supporting information. The more you know about how Medicare makes its decisions about coverage, the more likely you are to get the most out of your plan.

How Medicare Scope Of Appointment Forms Protect You

Enrolling in Medicare can be overwhelming. In addition to all of the new terms that you will need to learn, you will also need to learn about what is covered and how much you will pay for different services. For example, Medicare covers Part A (hospital insurance) fully as long as you meet the requirements,while with Part B (medical insurance), you will have to pay 20% of bills out of pocket. A Medicare Supplement Plan can help make up the difference. With all of the different options you will need to sort through, you may find that you want to go to an insurance agent for help. However, you should not feel intimidated into enrolling in a plan or paying for extra coverage. This is where a form known as the Medicare Scope of Appointment will be your saving grace.

red and white private propery sign — **This form will protect you from scams and unwanted solicitation from high-pressure sales people.**

Medicare Scope Of Appointment Form

A Medicare Scope of Appointment form is a federal form that is required by law when an agent sells you Medicare coverage. If you have decided to reach out and meet with an agent, or work with one to find out what your Medicare options are, then you will need to fill out one of these forms detailing what you would like to discuss. Your answers will help your agent get a better understanding of what exactly you are looking for, so that they can present you with your options and nothing more. This means that this form will also protect you from scams and unwanted solicitation from high-pressure sales people.

This form was created specifically for in-person meetings; however, you can choose to have a telephone meeting and consent to an oral agreement. The recording of your conversation will serve as a Scope of Appointment.

Form Options

When you fill out a Scope Of Appointment form, you check off what options you would like to discuss with an agent. The list of options to choose from on the form are:

Medicare Supplement Plans
Dental/Vision and Hearing Plans
Medicare Advantage Plans
Hospital Indemnity Plans
Stand-Alone Part D Drug Plans

Once you check the boxes on what you would like to discuss, you will sign your name on the “Beneficiary Signature” line. Your agent will then only be allowed to discuss the items that you expressed an interest in.

Not Sure What You Need?

In the beginning, the process of signing up for Medicare can be quite overwhelming, and you might not know where to start. You might not know what kind of coverage you want exactly or which boxes to even choose. At EZ.Insure, our team of experts will provide you with knowledge of all the different types of coverage options and which ones will best suit your needs. You will be assigned your own personal Medicare agent, and that agent will prepare quotes for all available options, for free. All of our services are free, because we just want to make sure you get the help and coverage you need. No obligation, no hassle. To get started, enter your zip code in the bar above, or to speak to an agent, call 888-753-7207.

How Does Medicare Work With Other Insurance?

Are you over 65, working, and on your employer’s insurance? Are you looking into enrolling in Medicare as well? You can have both employer-based health insurance and Medicare at the same time, as long as you are eligible to collect Medicare. However, when it comes to paying for medical services, it can get a little tricky. There are rules for how Medicare and other insurance plans work together. One has to be a primary and the other a secondary insurance.

Coordination Of Benefits

number one and number 2 in list form — *Insurers will have a coordination of benefits to decide which insurance pays a bill first. There is a primary payer, and a secondary payer.*

Insurers will have a coordination of benefits to decide which insurance pays a bill first. Your “primary payer” will cover the maximum amount your plan allows first, then your “secondary payer” will step in and pay the rest, or as much as your secondary plan allows. The rule of thumb when you have both employer insurance and Medicare is: if the employer has 20 or more employees, then the group health insurance plan will be the primary payer. If the employer has less than 20 employees, then Medicare will pay first. There are a few things to know about primary and secondary payers:

The second payer might not pay the rest of the uncovered costs.
If your employer’s insurance is the secondary payer, then you may need to enroll in Medicare Part B before your employer’s insurance will pay. This is because when Medicare is primary to your other insurance, your other insurance may not pay for costs until Medicare pays. Part B will help you avoid paying high out-of-pocket costs for your care.

Conditional Payment

If your employer-based insurance does not pay for services such as workers comp or liability claims first, then Medicare will make the payment so you do not have to pay the bill out of pocket. This is called a conditional payment on Medicare’s behalf. It is considered conditional, because the payment has to be repaid to Medicare if you get a settlement, judgement, or other kind of payment later.

hand with pen checking off a checklist. — *There is a checklist you must meet in order to qualify for Medicare and other insurance.*

The Standard To Have Medicare & Other Insurance

There is a standard to meet in order to have Medicare alongside employer-based insurance. If you do not meet the standard, then there is a penalty. In order to have both and avoid a penalty from Medicare, you must make sure that:

You are enrolled into Medicare by age 65- Generally if you do not enroll into Medicare Part B within the 7 month initial enrollment period (6 months before your 65th birthday, the month of, and 3 months following), you will face a lifelong penalty.
You are working and covered by your employer’s insurance- If your employer has 20 or more employees, then you can hold off on Part B, and will not have to worry about the penalty.

Medicare Supplement Plans

If you do not have employer-based insurance and are looking for extra coverage, then you may want to look into a Medicare Supplement Plan. These plans are sold by private insurance companies and are a secondary form of insurance that helps pay for Medicare Part B bills. Medicare will pay 80% of your Part B bills, leaving you to pay the remaining 20%.

Medicare and other forms of insurance can work together with a coordination of benefits rule. It can be confusing to understand how it all works. EZ.Insure will help make sure you are covered correctly without dealing with any unexpected penalties or bills. Whether it is to help deal with any issues related to Medicare, or to sign up for a Medicare Supplement plan to sustain Part B costs, EZ.Insure has you covered. At EZ.Insure we are trained to be on your side and get you the best plan in your budget. Get an instant quote by typing your zip code in the bar above, or speak with someone now. You can contact one of our highly trained agents by calling 888-753-7207. All of our services are free, because we just want to help you save money. No gimmicks, or obligations.

4 Vaccines That Medicare Covers

When people think of the word vaccines, they often think of babies and young kids. While immunizations are important for children, they are just as important for seniors. Older adults should get vaccines in order to prevent diseases as they get older. Certain diseases can lead to complications in seniors, and possibly death. Luckily, Medicare offers many free preventive care services, including vaccines.

middle aged caucasian woman blowing her nose into a tissue. — *Older adults are more at risk of dying from the flu than any other age group due to weaker immune systems.*

1. Flu Vaccine

Influenza, also known as the flu, is responsible for many deaths every year. Older adults are more at risk of dying from the flu than any other age group due to weaker immune systems. It is especially important for people with asthma, diabetes, or heart disease to receive the flu shot. Studies have shown that vaccinated seniors reduced their risk of flu hospitalization by 50%. There is also a stronger shot that is high-dose, Fluzone High-Dose, if you require more protection.

Medicare Part B covers one flu shot for seniors every fall/winter season.

2. Pneumonia Vaccine

Pneumococcal disease is another disease that seniors are at a higher risk for contracting. It causes severe infections of the bloodstream (bacteremia) and organs, and can result in pneumonia or meningitis. It kills almost 20,000 adults 65+ each year, so it is very important that you get vaccinated against it. It is recommended that people get two different types of vaccines, PCV13 and PPSV23, for more protection.

Medicare Part B covers both pneumococcal vaccines after the age of 65. PCV13 is given first, with the second PPSV23 recommended 6-12 months after.

needle going into a persons upper arm by a medical professional's ahnd with a glove on. — *Medicare Part B covers the tetanus vaccine in specific cases.*

3. Tetanus Vaccine

Tetanus, also known as lockjaw, is an infection that is not common in the U.S. If you contract tetanus, the bacteria gets under your skin, causing muscle spasms and affecting the muscles that control breathing. A person can get tetanus usually when traveling to a different country or from someone who has it.

Medicare Part B covers the tetanus vaccine in specific cases. For example, if a person has diabetes or neuropathy, then they are at greater risk of getting tetanus due to the open sores that can occur. So, you are more likely to get 100% coverage for the shot, as long as the shot is administered as a treatment for either of these illnesses or an injury caused by them.

4. Hepatitis B Vaccine

Hepatitis B, or hep B, is a contagious virus that causes an infection of the liver. There are two types of Hepatitis B: Acute, which mimics the flu, and Chronic, which is a long-term condition with no symptoms that can cause extreme liver damage or even death. If a senior has hemophilia, diabetes, or other conditions that lower resistance to infection, then their risk of getting Hep B is increased.

If a doctor feels like a person is at high or even medium risk of contracting hep B, then Medicare will cover the vaccine.

Getting vaccinated as you age is an important part of staying healthy. If you are at high risk for any of the diseases mentioned, then it would be smart to take advantage of the free vaccinations covered by Medicare.

Medicare Site Has Faulty Tool, Avoid Misinformation With EZ

Looking for Medicare quotes? Did you use Medicare’s Plan Finder Tool on their site, Medicare.gov? If so, you could’ve been given the wrong information, which could be costing you hundreds of dollars. The Medicare Plan Finder tool had some bugs that needed to be fixed, so, in August, the Centers for Medicare and Medicaid Services (CMS) updated it. However, the tool is currently still giving seniors incorrect price estimates, and wrong coverage information. You don’t have to worry about that with EZ. We give you accurate quotes, every time.

caucasian hands holding open an empty wallet. — *The misinformation the tool provides can lead Medicare beneficiaries to lose a lot of money.*

The Problem With The Tool

Even with the August revamp, Medicare beneficiaries have been just as confused as ever. The tool has been showing inaccurate premium estimates, incorrect prescription drug costs, and inaccurate coverage costs. Beneficiaries are at risk of choosing the wrong coverage because of this inaccurate information. They will then be stuck with this plan for the entire year, and will be losing money while they wait for the next open enrollment period.

One Medicare consultant in Wisconsin used the tool to research prescription drug plans for a client, and was shocked by the results. She started checking the plans’ websites, and came across two versions of the same high blood pressure medication. One was covered, while the other was not. The difference in price was $2,700 a month.

Accurate Quotes With EZ

red cartoon drawing throwing an arrow at a target towards the center. — *EZ.Insure uses state-of-the-art technology to provide accurate live quotes every time.*

Here at EZ, we make sure we do our research and homework. EZ.Insure uses state-of-the-art technology to provide accurate live quotes. This means that the quotes provided are the prices you would pay for the plan if you signed up today. Getting a live quote is important because as the market and personal situations change, insurance prices will also change.

Avoid all of the work of trying to find an accurate quote. Using the Medicare Plan Finder Tool can leave you with inaccurate quotes, and false information. If you’re not an expert in insurance, then errors, or simple ignorance, can cost you tons of money. It’s your health, and it’s important.

The CMS is currently working on fixing the issues with the Medicare Plan Finder Tool. In the meantime, if you are seeking Medicare advice, it would be best to contact a Medicare agent. An agent who is familiar with plans and the coverage they provide can help guide you in a better, more accurate direction. EZ.Insure has highly trained agents in your region that can offer you accurate quotes on plans available, and help you save. If you would like to speak to an agent, call 888-753-7207. Or if you would like an instant quote, enter your zip code in the bar above.

Tag: medicare insurance