Medicare is the nation’s health insurance program for seniors 65 and older. It also provides coverage for younger people who meet specific eligibility criteria. Medicare Parts A, B, C, and D cover a large variety of your major medical expenses. It’s a great program but it can be difficult to read through all of the plans, options, and rules. This can make it difficult to choose the right plan on time. Below we’ve outlined some of the most common Medicare mistakes so you know what to avoid and not wind up with penalties, coverage delays or gaps.
Signing Up Late
Medicare has specific deadlines to enroll. Your Initial Enrollment Period (IEP) happens when you first become eligible for Medicare. It starts 3 months before your 65th birthday, including your birth month, and then ends 3 months after you turn 65. This gives you 7 months to enroll. If you’re receiving Social Security benefits then you will be automatically enrolled and you don’t have to do anything or worry about the deadlines, Social Security handles enrollment for you. However, if you are not automatically enrolled you have to apply yourself during your IEP. If you miss the IEP you do have another opportunity between January 1st and March 31st called the General Enrollment Period (GEP).
Missing these enrollment periods is one of the most common and costly mistakes people make. If you miss both enrollment periods you can face late enrollment penalties for Medicare Parts A, B, and D. It’s important to note that there is a way to avoid these penalties. If you qualify for a Special Enrollment Period (SEP) then you will be able to enroll in Medicare penalty free with all the same benefits as when others enroll during the IEP.
SEP Types
Qualifying life event – If you have a qualifying life event then you qualify for a 2-month SEP where you have 2 months to enroll in Medicare. The most common qualifying events are:
You moved out of your current plan’s service area
Your plan no longer serves the area you are in
If you decide to switch from Medicare Advantage to Original Medicare within 12 months of enrolling in the Medicare Advantage plan.
You move into or out of a facility such as a nursing home
If you’ve lost Medicaid eligibility
Working past 65 – If you decide to continue working past 65 and have creditable coverage through your or your spouse’s employer’s health plan then once you leave your job you will open an 8-month SEP. This SEP does have a stipulation, if you want Part D you have to enroll in it within the first 2 months of your 8 month SEP, otherwise you still face penalties. Your 8 months begin the day you no longer have credible health coverage.
Medicare Part A Penalty
Some people qualify for Part A premium-free. If you’ve worked and paid into Social Security and Medicare taxes for at least 40 calendar quarters, then you are eligible for Railroad Retirement benefits (RRB), or have a spouse that qualifies for premium-free Part A then you will get Part A for free. However, if you don’t and have to pay for Part A, then you can face a 10% increase on your premium for missing the IEP. This penalty stays with you for twice the number of years that you were eligible and didn’t sign up. For instance, if you were eligible for Part A for 3 years and did not enroll, you’ll have the penalty for 6 years.
Medicare Part B Penalty
If you miss your enrollment period and don’t qualify for an SEP, you will face a Part B penalty. This penalty is a 10% increase for every year you did not sign up. For example, say you waited 2 years to enroll. You’re looking at a 20% increase in your premium, 10% for each of the 2 years you delayed. The standard Part B premium for 2023 is $164.90, plus adding the 20% will bring your premium up to $197.88 which will be rounded up to the nearest $.10, making it $197.90 for part B. That’s $32.98 extra every month that you could have saved by enrolling on time. Now that might not seem like a lot, but if you look at it on a yearly basis that is $395.76 a year!
Medicare Part D Penalty
The amount of the penalty depends on the length of time that you did not have Part D or a creditable prescription drug plan. Medicare determines the penalty amount by multiplying 1% of the national base beneficiary premium ($32.74 in 2023) by the number of full months you went without drug coverage. The penalty amount is then rounded to the nearest $.10 and added to your monthly premium. The national base beneficiary premium can vary from year to year, so your penalty will change with it.
For example, say you waited 14 months to enroll in Part D and didn’t have creditable drug coverage for any of that time. You’ll have to pay a 14% penalty. For 2023 that would be $4.58 rounded up is $4.60 extra on your premium.
Assuming Spouse Coverage
Assuming your spouse is covered by Medicare because you have it or vice versa is a big mistake. It could leave you or your spouse without insurance. Medicare doesn’t work the same as an employer group plan. Meaning it won’t cover your family, it only applies to the individual who enrolls. If you worked and paid your Medicare taxes for the last ten years then at most your spouse who is 65 will be eligible for premium-free Part A. If your spouse is under 65, they need to find their own coverage elsewhere, such as a plan from the Health Insurance Marketplace, their own group plan, or COBRA. Additionally, if your spouse is under 65 they still may be eligible under certain conditions. Medicare is available to anyone who receives Social Security Benefits for at least 24 months, has End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS).
Not Weighing Your Options
There are many options to choose from with Medicare. There’s Original Medicare, Medicare Advantage, and Medicare Supplement Plans. It’s important that you know the differences and their benefits. If you make the mistake of not weighing your options you can leave yourself with large gaps in your coverage or end up paying far more than you need. Below we’ve outlined these plans to give you a starting point.
Original Medicare
Original Medicare, also known as traditional Medicare, consists of only Parts A and B. Medicare Part A is hospital insurance, and it covers hospital inpatient care and skilled nursing facility care. Part A coverage typically includes the following:
Semi-private hospital rooms
Hospital meals
Inpatient lab tests and X-rays
Operating room and recovery room services
Drugs and medical equipment used while in the hospital or skilled nursing facility
ICU care
Skilled nursing services
Hospice care
Part B of Medicare covers your general medical expenses. Such as doctor’s visits, urgent care, and specialists. Typically Part B covers:
Doctor visits and services
Some preventative screenings and services
Ambulance services
Outpatient surgery services
Mental health care
Some durable medical equipment
Some medically necessary tests such as X-rays, MRIs, CT scans, and EKGs
Medicare Advantage
Medicare Advantage, commonly known as Part C, is a type of Medicare plan that is offered by private insurance companies. These companies have a contract with the Medicare program that ensures the plans they offer comply with Medicare’s regulations. Medicare pays a set amount to the insurers for each participant enrolled in the plan. Additionally, you will pay your medical bills directly to your insurance company while your insurance provider must follow Medicare’s regulations. They are allowed to set their own rules for out-of-pocket expenses as well as decide if you need a referral to see specialists.
Medicare Supplement Plans
Medicare Supplement Plans are plans that you can buy to supplement your Original Medicare. These plans fill in any gaps in coverage, ensuring you get the most coverage for all the medical needs you specifically have. You do have to pay a monthly premium for these plans, and you must enroll in both Part A and Part B to be eligible for a Medicare Supplement Plan. However you may end up paying less than you would overall with your Original Medicare because Medicare Supplement Plans all have benefits that cover a lot of the out-of-pocket costs for Part A and B. One of the biggest advantages with Medicare Supplement is the variety. There are 10 plans to choose from and all of them cover different benefits at different amounts. It’s important you look through these plans and compare to tailor your coverage specifically to what you need.
Working With EZ
In order to save as much as possible during your Medicare journey, it’s important to keep all of these mistakes in mind. You can rely on EZ if you have any questions or need help choosing your plans. Whether you’re looking for help enrolling, or just need some information. Give us a call today at 877-670-3608 to speak to your own Medicare Agent or you can get free instant quotes by entering your zip code in the box below.
If you are new to Medicare, then you probably have not heard of the 8 Minute Medicare rule. It is a phrase that many Medicare beneficiaries come across, but do not know exactly what it means or pertains to. If you are a seasoned Medicare beneficiary, then you might be familiar with Medicare’s 8-minute rule. It is important to understand what the 8-Minute Rule is because the term can be misleading and confusing.
What Is The 8-Minute Rule?
The 8-Minute Rule applies for outpatient services that are provided between 8 and 22 minutes.
The 8-Minute-Rule was introduced in December 1999 and became effective on April 1st, 2000. It is a stipulation that applies to time-based CPT codes (Current Procedural Terminology codes) for outpatient services that are provided between 8 and 22 minutes. A typical outpatient service in which the CPT code applies is physical therapy. It allows practitioners to bill Medicare for one unit of service if its length is at least 8 minutes but fewer than 22 minutes. A billable “unit” is the time interval for the service, and under the 8-Minute-Rule, you need the service to consist of 15 minutes each.
How Does the 8-Minute Rule Work?
The rule applies only to services when the practitioner has direct contact with the patient, so it has to be in person. If you have received more than one service, then Medicare will be billed based on the total timed minutes per meeting. If you are seen by the doctor for less than 8 minutes, then Medicare will not be billed for it.
Services are billed in 15-minute units, so if you are seen by a doctor for 20 minutes, Medicare will be billed for one unit, because the number falls between 8 minutes and 22 minutes. If you are there for let’s say23 minutes, then Medicare can be billed for two units. If the service takes 38 to 52 minutes, then the healthcare provider can charge for three units, and so on as the 15-minute interval pattern continues. The chart below can help guide you:
Outpatient providers that follow the 8-Minute-Rule include:
Private practices
Rehabilitation Facilities
Skilled Nursing
Home Health agencies
Hospital outpatient Departments
A Medicare Supplement Plan can help provide extra coverage and savings throughout the year.
Extra Coverage
Medicare Part B, which covers the costs of most medical services, only covers 80% of these costs. This will leave you with the remaining 20% to pay out-of-pocket, but a Medicare Supplement Plan can help you pay for the medical expenses that aren’t covered by Medicare Part B. One of these plans can help you save hundreds, or maybe even thousands of dollars each year.
There are 10 different plans to choose from, and depending on which plan you choose, you could get anywhere from 75% coverage of your medical expenses up to 100%. Each plan offers a range of coverage at different price points and can help save you money and keep you from stressing over medical bills, leaving you with more time and energy to focus on your health.
EZ can compare all 10 Medicare Supplement Plans and find the one that will meet your financial and medical needs. Our agents work with the top-rated insurance companies in the nation, which makes comparing plans easy, quick, and free – our services come at no cost to you because we just want to help you save money so you can focus on your health. To get free instant quotes on plans that cover your doctors, simply enter your zip code in the bar above, or to speak to a local licensed agent, call 888-753-7207.
September is Blood Cancer Awareness Month. We wanted to talk about this important topic this month especially because, according to a new report from the Leukemia and Lymphoma Society, while survival rates for older patients with blood cancers have been improving, rising healthcare costs have meant that less than half of newly diagnosed patients are receiving treatment for their cancer. And as with any cancer, early treatment is crucial to beating the disease. Find out how Medicare helps those who are dealing with blood cancer, and what patients can do to make the cost of treatment less of a barrier to receiving care.
What the Study Shows
The study mentioned above analyzed costs that are incurred by Medicare beneficiaries who have been newly diagnosed with acute leukemia, chronic leukemia, lymphoma, multiple myeloma, and bone marrow disorders, and found that older patients are at a disadvantage when it comes to the cost of care.
“Along with the substantial healthcare costs associated with the treatment of patients with blood cancer comes substantial OOP [out-of-pocket] costs for patients,” the researchers wrote in the report. “In particular, because of the Medicare Part A, B, and D benefit design, the OOP burden can be greater for Medicare beneficiaries compared to commercially insured patients.”
In fact, when expenses were the highest (generally in the month patients were diagnosed), the average amount spent by patients, depending on the type of blood cancer, was anywhere from almost $18,000 to $178,000.
These greater costs mean older adults aren’t getting the care they need. Of Medicare beneficiaries who are newly diagnosed with blood cancer, only 43.7% of them receive therapy within 90 days of receiving their diagnosis.
“In addition to the emotional impact of dealing with a blood cancer, patients and families often face extraordinary costs in the first year after diagnosis and beyond,” Louis J. DeGennaro, Ph.D., LLS president, and chief executive officer, said in a statement. “The Leukemia & Lymphoma Society hopes that the findings from this new study will prompt payers, providers, patient advocates, and policymakers to work together to address the financial burdens for patients.”
Medicare Coverage
Medicare helps pay for many of the expenses incurred when diagnosing and treating blood cancers, such as leukemia. But Medicare Part B, which covers the costs of cancer prevention and treatments, only covers 80% of these costs. This will leave you with the remaining 20% to pay out-of-pocket, but there is help. You can enroll in a Medicare Supplement Plan to help cover these costs. A Medicare Supplement Plan can help you pay the medical expenses that aren’t covered by Medicare Part B, helping you save hundreds, or maybe even thousands of dollars each year.
Medicare Supplement Plans can cover your Part A deductible and coinsurance costs, as well as your Medicare Part B copayment, coinsurance, and deductible. There are 10 different plans to choose from, and depending on which plan you choose, you could get anywhere from 75% coverage of your medical expenses up to 100%. Each plan offers a range of coverage at different price points; if you are battling cancer, your best option is to get the plan with the most coverage possible, so you will only have to worry about paying your Medicare Supplement Plan monthly premiums.
Medicare Supplement Plans can help save you money and keep you from stressing over medical bills for your cancer treatments, leaving you with more time and energy to focus on your health. EZ can compare all 10 Medicare Supplement Plans and find the one that will meet your financial and medical needs. Our agents work with the top-rated insurance companies in the nation, which makes comparing plans easy, quick, and free – our services come at no cost to you because we just want to help you save money so you can focus on your health. To get free instant quotes on plans that cover your doctors, simply enter your zip code in the bar above, or to speak to a local licensed agent, call 888-753-7207.
When you think of plastic surgery, the Kardashians or a Real Housewife of some random city probably come to mind, but what they’ve actually had is cosmetic surgery. There is a difference between the 2 and if you have Medicare, the good news is one of them may be covered.
Plastic Surgery vs. Cosmetic Surgery
Medicare will cover breast reconstruction after breast cancer surgery.
Plastic surgery is a procedure performed because it’s medically necessary. That means you need it for medical reasons to improve the health or function of your body. Plastic surgery is sometimes referred to as reconstructive surgery. You may need plastic surgery for medical reasons after an accident, infection, tumor, malformation of a body party or other disease, such as breast cancer. Some examples of medically necessary plastic surgery covered by Medicare include treatment for severe burns, facial reconstruction following a car accident, or a breast reconstruction after a partial or full mastectomy. Cosmetic surgery is a type of plastic surgery used to enhance the natural features of the body. Surgeons generally perform cosmetic surgery to reshape normal structures of the body to improve your appearance or enhance your self-esteem. These are generally not covered by Medicare. If you’re looking to get a breast lift, facelift, neck lift, or chemical peels covered, you’re out of luck because those are considered cosmetic and are not medically necessary.
Cosmetic Surgery for Medical Reasons
A cosmetic surgery may be covered by Medicare if it’s medically necessary.
Medicare may pay for a cosmetic surgery if you need it for medical reasons but you must obtain prior authorization. This means your doctor must send a prior authorization request to Medicare for approval before performing the procedure. If Medicare approves the request, you’ll pay your Medicare Part A and/or B deductible and coinsurance costs, depending on the setting of your plastic surgery, such as inpatient or outpatient. Some examples of cosmetic surgeries that may be considered medically necessary are botox to treat muscle disorders or a nose job to correct structural nose defects that affect your breathing. An eyelid surgery to remove excess tissue around your eye that may be impairing your peripheral vision would probably qualify as medically necessary as well. Only your doctor can determine whether your procedure is medically necessary so be sure to have a thorough conversation with them before going through with a procedure.
Find a Medicare Supplement Plan
Medicare Supplement Plans may help cover costs of certain types of plastic surgeries.
There are many reasons why you might need or want plastic surgery. Luckily Medicare Parts A and B may cover plastic surgery if you need it for medical reasons. If your plastic surgery is covered by Medicare, you may be able to find a Medicare Supplement Insurance plan that helps pay for some of your Medicare copays, deductibles and more and EZ can help. Our agents work with the top-rated insurance companies in the nation, which makes comparing plans easy, quick, and free. To get free instant quotes on plans that cover your doctors, simply enter your zip code in the bar above, or to speak to a local licensed agent, call 888-753-7207.
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
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.
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.
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.
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
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.
