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Medicare and Yes, I Have Choices

by Kristin P. Sinclair – Charlotte NC – August 15 2018

Other items to include in your decision making when it comes time think about health care.
Which Health Care practitioners(s) you wish to offer your health care during the year. Does the provider accept Medicare, if yes, then they will accept your Medicare supplement as well.

Next question, when the health care provider accepts Medicare, do they accept the Medicare Advantage plan you are considering. Well, you need to verify that before you make you plan decision. Health Care providers have the option to either accept a Medicare Advance Plan as an insurance option, or possibly they could make a choice to not accept Medicare Advantage plans. Many Advantage Plans are Network Based.  Many Advantage Plans have a geographic area that offer the particular plan design. The Providers that accept the Medicare Advance Plan will usually be geographically accessible to that specific plans area.

Original Medicare is a Federal Program, Insurance products which work with the Original Medicare follow both Federal and State Guidelines.  Original Medicare will provide coverage with in the United States. Medicare Part A offers coverage to help with the costs for a Medically necessary  in patient hospital stay(s), with applicable Deductible and Co-Insurance cost sharing. When you select  a  Medicare Supplement plan, you are selecting a plan to help fills the gaps in Original Medicare.
Medicare Part B is the out patient care portion of medicare, Medicare Part B has an annual deductible and co-insurance cost sharing as well, the Medicare Supplement plan you select will offer coverage  to help fill gaps in the Original Medicare.

Helping to fill the gaps in the Original Medicare is going to reduce your out of pocket costs associated with health care.

Medicare Advantage Plan often you must use providers who accept your plan, and the plan could have limits on where you can travel and still have access to benefits if not in an emergency situation. And If you travel away from home for a period of greater than 2 months, you might need to change your plan, because of the amount of time you have chosen to be away from home.  Medicare Advantage plans have specific geographic regions, states, or counties that they offer coverage. MA will have annual contracts with Medicare, they must be as good as Original  Medicare and they will have Out of Pocket limits annually which can change per annual period.  Often the MAPD (Medicare Advantage Prescription Drugs) will be one policy choice for Hospital, Out patient and Drug plan coverage.

Stand Alone Prescription Drug plans are approved  Federally,  Center for Medicare Services, and  are State specific.  Stand Alone Medicare Part D covers the medications which are not administered under Medicare Part A or Medicare part B, Medicare Part D medications will usually be the medications you fill at your preferred local pharmacy or the mail order service your Part D provider has in place for your benefit as a potential cost saving opportunity when you seek a 90 mail order alternative. Using your plans  Preferred Mail order provider might offer you savings through out the Annual Period. A Medicare Part D plan will help round out your coverage when you select a Medicare Supplement.

From Oct 15th though Dec 7th each annual period you have what is called the annual Enrollment period, also called the Open Enrollment period. This is a time that you will review various Medicare Part plan and various Medicare Part C plans to decide what change you will make for the coming year. If a change is indicated.

However, Medicare Supplement or MediGap plans do not have the Annual Enrollment Period.
You can keep your plan as long a you pay your premiums. You have the opportunity to change your Medicare supplement plan any time of the year. As long as you can pass any underwriting requirement which might be applicable.

If you move to another state, you have guarantee issue rights so long as you make your change within 63 days of the change of residents.  Always keep a record of which plan you have and keep your letters you receive from your plan pertaining to your rights. Medicare has protections in place for your benefit.  We live in a mobile culture. It is great that we have the protections available to us, especially after our life time of work. We certainly deserve the protections that Medicare makes available to us.

 

Kristin P. Sinclair (803)329-0615
Charlotte NC, Rock Hill SC and Charleston SC
August 15 2018

* For those under age 65 that have Medicare Coverage due to a disability, and suffer End-Stage Renal disease there may be limitations to their coverage options.

KPS: More information available at Medicare.gov

 

 

 

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