By Steven Buttice, Founder and President
Living By Your Design, Inc.
If you wonder if there is a Medicare Plan that better fits your needs and wants; next month begins Medicare’s “Annual Enrollment Period” (AEP) and is the time to make changes. Here are a couple of questions for you. Check your basic knowledge:
- Medicare is free? Yes / No ?
- One is automatically enrolled in Medicare when they become eligible ? Yes / No ?
- Disability - Some medical conditions allow for “Compassionate Allowance” to make application for Social Security Disability easier? Yes / No ?
- Is the Medicare eligibility date different than normal if one has: End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig's disease)? Yes / No ?
- Medicare Supplements are another name for Medicare Advantage (MA) Plans? Yes / No ?
- All Medicare plans are alike? Yes / No ?
- People on Medicare can make changes in coverage every year from 10/15 - 12/7? Yes / No ?
Question #1. No Medicare is not free. Medicare has four parts. Part A is for hospitalization, primarily, and is free if you or your spouse has worked 40 quarters. Part B is normally $144.60 per month but may be higher due to IRMAA (high income earners) up to $491.60 in 2021. Medicare Part C is where private insurance companies handle their client’s Medicare claims and service work. There may or may not be a premium for these plans, Medicare Part D are prescription drug plans and have premiums except for some low income/low asset enrollees.
Question #2 No – people are not automatically enrolled in Medicare. Those not drawing SS retirement or are not SS disability must apply for Medicare. The can be done online (www.SSA.gov) or by calling Social Security at 800-772-1213.
Question #3 Yes - some conditions allow for an easier and simpler application for Social Security Disability. The list for compassionate allowance can be found at: https://www.ssa.gov/compassionateallowances/conditions.htm
Questions #4 Yes – Medicare allows ALS people immediate eligibility for Medicare. ESRD usually have a 90 day wait until after dialysis begins.
Questions #5 No - Medicare Supplements and Medicare Advantage Plans are clearly different. In addition, an understanding of these plans can help you decide which option is best for you. Be prudent – do your research.
Questions #6 No - All Medicare Plans not alike. Medicare Supplements are usually open access where you can see any provider accepting Medicare patients. Medicare Advantage Plans have networks. While having a network is much like group insurance MA plan networks could be regional (much smaller). Plans including your primary doctor (PCP) work much better, than if they do not include your PCP. Also Part D – Prescription (PDP) plans can differ greatly from one company to another. There is a scientific method of considering PDP plans to confirm all of your meds are covered and how.
Question #7 Yes – People with Medicare plans can make changes to their plans each 10/15 – 12/7. Medical conditions change, situations change and prescriptions change. It is prudent to review your Medicare Plan(s) every year to be sure it still meets your needs. This especially applies to MA and PDP plans.
Well, how did you do? Here is an extra credit question: Which president initiated the Medicare program?
On October 15th through December 7th you can enroll into 2021 Medicare Plans. It is important to research if your present plan will work well for you in 2021. MA and PDP Plans can change every year. You should have received your “annual notice of change” from your insurance company in September. This information should be reviewed. To gather information on Medicare coverage and how it would work for you see the following resources www.medicare.gov or www.MRMS-INC.com. Feel free to contact our office for the answers to your questions or if you would like additional information concerning your situation. (BTW – President Lyndon Johnson initiated the Medicare program in 1965)