Medicare FAQ’s

 


Does your agency charge for your services and if you so how much?

There is never a charge for advice or for obtaining coverage through our agency. The compensation is provided by the insurance company and even if you were to buy directly, the price is exactly the same.

Is there a charge for Medicare advice or services?

Again, we are not allowed to charge for our services and we offer free advice to anyone who seeks it out regardless if they buy through us or not. We try to help anyone who has questions. Medicare is very complicated. We simplify it for you.

What is the difference between Medicare Advantage and Medicare Supplements?

The Medicare Advantage plans are private coverage from an insurance company and replace Original Medicare. In Nevada HMO’s and PPO’s are offered. Both plans have networks. In the case of the HMO, you must use the services through their network of Doctors and Hospitals. If you go out of network, you pay all the charges. In the case of the PPO’s, you can go out of network but it will cost more to do so. These plans are subsidized by CMS so the premiums for both plans are very low.

Medicare Supplements are in addition to Original Medicare. These plans are not subsidized by the government. These plans are designed by the government so all like plans offer the same benefits. Once you buy the plan, it is guaranteed renewal regardless of your health or how much you use the plans. The providers are any Doctor, any hospital anywhere in the country as long as they take Medicare. You also have to obtain a drug plan to cover medications.

Why do I have to have a drug plan if I do not take any medications?

CMS requires you to have a drug plan even if you are not taking any medications.  CMS will fine you for the rest of your life if you don’t have coverage so having coverage is less expensive than not having it. There are inexpensive plans with a low monthly premium.

What happens when I move out of the county or state?

All you have to do is call social security and change your address. Once that happens you have 60 days to find new plans. This refers to Medicare Advantage plans only; like HMO’s, PPO’s or drug plans. All you do is call the Medicare Supplement carrier and tell them your new zip code. They will tell you the new price.

When can I change my Medicare Advantage and/or drug plans?

Medicare has an open enrollment period from October 15th through December 7th where you can change your advantage or drug plan. Once that period is over you are locked in for the next calendar year.

 Can I stay on my group health plan and not take Medicare?

There are some very specific rules governing when you go on Medicare and what you should do.

  1. Turn 65 and not working-must go on Parts A & B of Medicare and get a drug plan
  2. Turn 65 and working for a company larger than 20 employees. You can stay on your group health plan but should take Part A (Hospital) coverage from Medicare. When a group has more than 20 employees, the group plan pays first and Medicare pays second. That’s why you don’t need to get Part B until you retire from your job.
  3. Turn 65 and there are less than 20 employees in your company. You must take both Parts A & B on Medicare because in groups with less than 20 employees, Medicare pays first.
  4. In both B & C, you must have a creditable drug plan that is equal to or better than what Medicare offers. As long as your group health plan is not an HSA or health savings account, your group plan should be creditable. Play it safe and get a letter from your employer or group insurance company stating that your drug plan is creditable. Plan on asking for that letter yearly.

What if my Medicare Supplement plan goes away?

If you have a Medicare Supplement plan F or C, the plans are being retired as of 12/31/19. As long as you pay your premium, you can keep your plan. The other   exception is if you took Medicare prior to 2020 you can still get plan F or C after 2020 but you have to qualify medically.

What if I want to change my Medicare Supplement plan?

When you change your Medicare Supplement plan you have to prove you are insurable. The only times you don’t have to prove it is when you turn 65 and are within 6 months of getting Part B coverage or when you leave your company and take Part B for the first time. Each state decides what rules they want. In Nevada you can only get guaranteed issue with the circumstances mentioned about. In California there is a birthday rule allowing you to get guaranteed issue the month before your birthday regardless of your health. Several other states have similar rules while most states do not. Use a local broker who knows the marketplace to get the correct information about the state you live in.

 


 

 

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