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Don’t Let These Medicare Mistakes Ruin Your Retirement!

Retirement. A simple word that has so much meaning to it. You have been working your whole life looking forward to the day you no longer have to work. Now that the time has finally come, you can begin enjoying the next phase of your life by traveling, relaxing, and checking things off your bucket list. However, there is one thing that you have to get done the right way before you can fully enjoy your retirement. Whether you’ve already enrolled in Medicare, or you’re planning on enrolling soon, you need to avoid these simple Medicare mistakes.

Not Signing Up On Time

piles of coins going up in range with a clock in the background — *You will need to sign up for Medicare Part B during your initial enrollment period or face a penalty.*

The first thing you need to think about when it comes to Medicare is enrolling at the right time. You will need to sign up for Medicare Part B during your initial enrollment period, which is the 3 months before you turn 65, the month you turn 65, and the 3 months after you turn 65. If you opt out of Part B without a valid reason, such as still being on an employer’s insurance, and don’t sign up during your initial enrollment period, then you will end up paying a penalty fee. This means that, when you eventually do sign up for Medicare Part B, you will have to pay an extra 10% in monthly premiums for every 12 month period that you did not enroll.

For example, if you opt out of signing up for Part B benefits for 2 years, then you will face a 20% penalty fee added on to your monthly Part B premiums. If you opt out for 4 years, then you will pay an extra 40%, and so on. In most cases, you will have to pay this penalty for as long as you have Medicare.

Getting Taxed

If you’ve enrolled in Medicare, but still have money left in a health savings account (HSA), then beware of tax penalties. You can continue to use the money that is already in your HSA after enrolling, but if you contribute to your HSA while on Medicare, you will be subject to an income tax penalty on the amount you contribute. In order to avoid this penalty, you need to stop making contributions to your HSA 6 months before enrolling in Medicare.

Not Considering A Medicare Supplement Plan

Another mistake to avoid is assuming that everything is covered by Medicare, and that you don’t need a Medicare Supplement Plan. For example, Medicare Part B doesn’t usually provide much coverage if you travel overseas. So, if you are planning on taking advantage of your retirement and doing some traveling outside of the U.S., then it would be smart to consider getting a Medicare Supplement Plan.

A Medicare Supplement Plan will not only help pay for your Part B bills, but standard Medicare Supplement Plans C, D, F, G, M, and N also provide foreign coverage. These plans will cover emergency care during the first 60 days of your trip, and will pay about 80% of your bills. They will cover up to $50,000 in foreign medical bills after you meet your $250 deductible. This $50,000 coverage is available to you every time that you travel outside of the U.S. and its territories.

calendar with the date October 15 on it — Take the time during Medicare Annual Enrollment, which is every year from October 15 to December 7, to go over your coverage.

Missing Your Annual Period To Change Plans

Your plan’s coverage, costs, and benefits change from year to year. If you are enrolled in a plan, you may be tempted to stick with it and avoid the hassle of switching. However, this can cost you in the long run. Take the time during Medicare Annual Enrollment, which is every year from October 15 to December 7, to go over your coverage and make sure it fits your needs and budget. During open enrollment you can:

Switch to Original Medicare Parts A and B with or without a Part D plan from a Medicare Advantage Plan, or vice versa.
Switch from one Medicare Advantage plan to another.
Switch from one Medicare Part D plan to another.
Enroll in a Medicare Part D plan if you did not do so when you were first eligible, although a late enrollment penalty may apply.

The open enrollment period is a good time to look at all the plans in your area, find out what their premiums are, and calculate the share of costs. Make sure your pharmacy, hospital, and providers are within the new network if you do plan on switching. Review different Medicare Supplement Plans and see if there is a better fit for you.

Losing Your Medicare Supplement Plan

If you do decide to make a change when open enrollment comes around, make sure you know what you are getting – and what you risk losing. If you decide to switch to a Medicare Advantage plan, you cannot also have a Medicare Supplement Plan.

If you bought a Medicare Supplement Plan when you enrolled in Medicare, and then you decide to switch to a Medicare Advantage Plan, you will have to drop your Medicare Supplement Plan. Doing so means that you are at risk of facing underwriting, and if you have any pre-existing conditions then you can be denied coverage or charged more for your plan. The only time to avoid underwriting is when you first become eligible to sign up for Medicare, so be sure that you know what you are doing before you give up your Medicare Supplement Plan.

With there being so many Medicare Supplement Plans, comparing all of them can be time-consuming. EZ will provide you an agent to compare all the different Medicare Supplement Plans within minutes. They will go over all the plans with you, and advise you on which is the best plan for your health and financial needs. All of this will be done at no cost to you, that’s right, it’s free! Enjoy your retirement fully by saving more money. To get you free quotes, enter your zip code in the bar above, or to speak to an agent, call 888-753-7207. No obligation and no hassle!

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.

The New Telehealth Guidelines For COVID-19

On March 6,2020, Congress signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, which provides emergency relief to the nation during the current COVID-19 health emergency. In order to protect Americans and get ahead of the spread of the virus, the bill allows for expanded use of telemedicine services. The bill also includes waivers to certain Medicare restrictions to protect vulnerable seniors, allowing everyone to receive telehealth care covered by Medicare throughout this crisis.

caucasian man in bed with a tissue in one hand and thermomter in the other with a laptop on the bed and a doctor on the screen. — *Telehealth can be useful in many situations, especially when patients cannot get to their doctor’s office.*

What Is Telehealth?

Telehealth refers to the exchange of medical information using some form of real-time video chat. It can be useful in many situations, especially when patients cannot get to their doctor’s office. Health insurance companies and Medicare do normally cover some telehealth services, including doctor’s visits and consultations, but only in limited circumstances. Prior to the waiver signed in March, patients generally needed to live in a rural area to have their telehealth care covered. They also needed to be at one of the following locations:

A doctor’s office
A hospital
A critical access hospital (CAH)
A rural health clinic
A federally qualified health center
A hospital-based dialysis facility
A skilled nursing facility
A community mental health center

These restrictions obviously meant that patients would often have to leave their homes in order to access telehealth services, which is not ideal during a pandemic.

Changes to Telehealth Services

Not only will insurance providers now cover these visits, but there are other key changes that extend coverage during this crisis.

The Health and Human Services (HHS) Inspector General is allowing healthcare providers to waive cost-sharing requirements for COVID-19-related telehealth visits.
The CMS has waived reimbursement restrictions on practicing across state lines. However, doctors will still need a state licensure to deliver care in that state.
The US Drug Enforcement Administration (DEA) has eased restrictions on the types of controlled substances providers can prescribe during a telehealth visit.

Medicare will pay for brief (5-10 minute) “virtual check-ins.”
Medicare will pay for brief (5-10 minute) “virtual check-ins” with a patient’s normal doctor, no matter where they are located. The usual copay and deductible for these check-ins will be waived.
Providers can use popular apps for video chats, such as Apple FaceTime, Good Hangouts video, Skype, and Facebook Messenger video chat.
The HHS Office of Civil Rights will waive penalties for HIPAA (Health Insurance Portability and Accountability Act) violations against healthcare providers who use video chatting apps with their patients “in good faith.” This means they will not be held responsible for any claims of violations of privacy.

Temporary Medicare Regulations

As discussed above, telehealth coverage is limited under normal circumstances. However, we are now in the middle of a global pandemic and it is very important that seniors stay at home and avoid contact with others. COVID-19 is highly contagious and more deadly for older adults (as well as those with compromised immune systems), so going to a doctor’s office now can present serious health risks for people over 65.

The new legislation signed in March allows the Centers for Medicare and Medicaid Services (CMS) to expand telehealth services available to Medicare beneficiaries so that they do not have to travel to their doctor’s office. According to Medicare.gov, now “doctors and other health care providers can use telehealth services to treat COVID-19 (and for other medically reasonable purposes) from offices, hospitals, and places of residence (like homes, nursing homes, and assisted living facilities.” These visits will be covered at the same rates as face-to-face visits for the time being.

Telehealth services are being extended during the current COVID-19 pandemic in order to reduce the risk of infection in doctors’ offices. These changes will allow doctors to provide care without worrying about packing their offices with vulnerable patients, and patients to stay home and receive care without worrying about an unexpected bill.

Tag: medicare