Enrolling in a Medigap Policy: Purchasing Supplemental Insurance

A Medigap Policy is insurance created to supplement your Original Medicare Plan. It helps to cover some limitations of the plan’s coverage.

Policies will, of course, vary by available plans, coverage, and price. Therefore, before enrolling, make sure you spend time researching the plans and providers available to you, and choose the one that best fits your needs and budget. After you’ve selected the plan and company you are going with, it’s time to apply.

To apply, contact the company directly. They are required to provide you with a coherent summary of your policy, so spend some time reading it and ensuring that you understand it. If you don’t, feel free to ask as many questions as you need to ask. Never sign anything without knowing exactly what you are agreeing to. Once you’ve read the summary and are certain you understand it, fill out the application fully. Be as truthful and thorough as possible. If someone else fills your form out for you, go over it and make sure it is completely correct.

After applying, your policy will usually start the first month after you apply. You can request a specific start date if you like as well. If you don’t get your policy within 30 days you should definitely call the insurance company, and if you still haven’t gotten in within 60 days, you should call the State Insurance Department in your area.

When you pay for your Medigap policy, you can use a bank draft, a check, or a money order. Don’t make your payment out to the agent who was helping you with your enrollment. Rather, make it out directly to the company providing you with your coverage.

Enrolling in a Medicare Prescription Drug Plan

Many Medicare beneficiaries choose to enroll in Medicare Part D in order to meet medication needs.  Part D is especially important for people who require significant prescription medication.  It can help reduce your out-of-pocket costs and make necessary drugs more accessible and affordable.

If you have the Original Medicare Plan, you may choose to enroll in a prescription drug plan to add coverage.  You can also enroll to add coverage to certain Medicare Private Fee-for-Service Plans, certain Medicare Medical Savings Account Plans, and certain Medicare Cost Plans.  Another way to gain Prescription drug coverage is to choose a Medicare Advantage Plan that includes this drug coverage.

When you enroll in a drug plan, you will usually pay considerably less for your prescriptions, although you will sometimes be required to cover copayments, coinsurance, or deductibles.  The overall cost of your plan will depend on a number of factors, such as whether or not you are eligible for extra help, if you are willing to forgo brand-name drugs, what type of drugs you require, the quantity of medication you need, what your plan coverage gap is, and, ultimately, what prescription drug plan or provider you choose.

To enroll in a prescription drug plan, you may want to call the plan directly.  That way, you can ask them any pertinent questions you may have about the plan you’ve chosen.  You can also call Medicare for assistance, at 1-800-633-4227. 

Part D Late-Enrollment Penalty

Your Medicare Part D is the component of your plan that will provide you with your prescription drug coverage. It is an essential element of many people’s health care, and if you have medication needs – or think you may in the future – it is strongly advised that you sign up as soon as you become eligible.

If you fail to sign up during your initial enrollment period, and if you don’t have prescription drug coverage for 63 days or more, you will likely be responsible for a permanent late-enrollment penalty when you later join. The late-enrollment penalty changes each year, and will be charged to you for the duration of your drug coverage.

To figure out roughly how much your penalty will be, take 1% of the “national base beneficiary premium” and multiply it by the number of the full months you didn’t join when you were eligible. The amount will be added to your drug plan monthly premium.

If you didn’t sign up for a Medicare Prescription Drug Plan when you were first eligible and you’d like help figuring out what your late-enrollment penalty will be, there are some sources available to you. You can call 1-800-MEDICARE for help, or contact your State Health Insurance Assistance Program.

Joining a Medicare Advantage Plan

If you are considering enrolling in a Medicare Advantage Plan, you need to meet a few specific requirements in order to be eligible to join. You need to have Part A and Part B – Hospital and Medical Insurance.  You also need to live in the plan’s service area.  You usually can’t have End-Stage Renal Disease, and it must be within the plan’s enrolment period.  

In many cases, you will need to pay your Part B premium in addition to your Medicare Advantage Plan premium.  It’s also essential that you follow your plan’s specific rules and are aware of necessary out-of-pocket costs, like deductibles and copayments.  

Sometimes, depending on the plan or company you choose, you might be required to use specific health care providers, belonging to the plan’s network – or be charged a higher fee if you don’t.  If you enroll in an Advantage Plan, you won’t be able to buy a Medigap policy – and you won’t really need one, either.

When you join a Medicare Advantage Plan, you are, of course, still in the Medicare Program.  Advantage Plans, although run by private insurance plans, still follow Medicare rules, are approved by Medicare, and receive funding from Medicare. They are not even considered supplemental insurance plans – they are a part of Medicare.  Consequently, when enrolled in a Medicare Advantage Plan, you have Medicare rights and protection, including privacy rights and the right to appeal.  You also will still receive Medicare Parts A and B, and can usually get prescription drug coverage through your Medicare Advantage Plan. It is important to note that you can’t join a Medicare Prescription Drug Plan with most Medicare Advantage Plans unless you cancel your Medicare Advantage Plan and sign up instead for Original Medicare. Signing up for a Medicare Advantage Plan also often affords you other optional benefits, such as dental or vision.   

To enrol in a Medicare Advantage Plan, fill out an application, call the plan, or visit them online.  

Out-of-Pocket Expenses in a Medicare Advantage Plan

A Medicare Advantage Plan is a privately run health plan, owned by private insurance companies, approved by (and working with) Medicare.  Medicare advantage plans, called MAs, or Part C, are required to follow rules set by Medicare and, in addition to your payments and fees, receive funding from Medicare.  

MA plans will provide beneficiaries with their Hospital Insurance (Part A) and Medical Insurance (Part B), all medically-necessary services covered by Original Medicare, and, in many cases, optional extra benefits such as vision, dental, hearing, and prescription drug coverage – for additional cost, of course.

In fact, many of your out-of-pocket costs in a Medicare Advantage Plan will vary significantly.  For instance, many MA plans will charge, on top of your Part B premium, another monthly premium.  Your costs will also vary depending on whether or not your MA plan has a yearly deductible or any other deductibles for certain health care services.  Costs can increase if your plan requires you to pay more for each doctor’s visit or health care service.  If you frequently require health care or if you need more costly services, this can also increase your out-of-pocket costs.  If you decide you want extra benefits, you can expect to pay more for these as well.   

There are, of course, some ways to reduce costs.  First – and perhaps most importantly – research available plans carefully.  Contact Medicare, at www.medicare.gov or at 1-800-MEDICARE – or call your local SHIP to find out more. Once you’ve selected a plan, be sure to familiarize yourself with your MA plan’s rules, and to follow them vigilantly. 

The right MA plan can allow you to receive the medical coverage you need.  However, unexpected costs can put a strain on your budget and, in some cases, even make receiving the care you need a significant hardship.  An awareness of the out-of-pocket costs involved in your Medicare Advantage plan can help you prepare for those expenses, and allow you to financially arrange for your future.

Understanding Assignment in the Original Medicare Plan

In the Original Medicare Plan, “assignment” is when you make an agreement between yourself, your healthcare providers, and Medicare.  It can be used to limit the amount of out-of-pocket costs you will be responsible for in your health care.  

How assignment in Medicare works is when you choose health care providers already enrolled in Medicare – and who will accept assignment – you then assign Medicare to pay those health care providers. 

A health care provider who accepts assignment will agree to be paid by Medicare and to accept the Medicare-approved amount for services.  They will also agree to charge you (or your other insurance providers) only the Medicare deductible or coinsurance.   

When a health care provider accepts assignment (and in certain situations, they are required to do so), they need to submit your claim directly to Medicare, and should not charge you for submitting the claim. 

If your health care providers do not agree to accept assignment, they must submit a claim to Medicare but can charge you more than the Medicare-approved amount.  Even if they don’t accept assignment, though, they are usually limited in what they can charge (referred to as a “limiting charge”).  This charge can be up to 15% more than the Medicare-approved amount.  Not all services and supplies have a limiting charge, and sometimes you’ll need to pay for supplies or services before being reimbursed later.  

If you need to find health care providers who accept assignment, an excellent resource is www.medicare.gov.

Survey Shows Higher Funding Does Not Increase Perceived Quality of Care

According to a recently published study, higher levels of regional spending on medical care don’t actually impact Medicare beneficiaries’ perception of quality of care.  The survey, administered by researches from the University of Massachusetts, showed that although spending per capita varies depending on region, this difference in spending doesn’t seem to be reflected in care quality responses. 

The study, acknowledging that there is a disparity between region spending, was designed to see whether or not regions with low expenditures see themselves as receiving lower quality of care than those in high-expenditure regions.  Surveys were conducted by both mail and telephone in 2005.  The survey asked three questions about perceived unmet need for care, four about the perceived quality of ambulatory care, and three about ratings of overall quality of care.  2515 people responded to the survey.

The survey showed that higher per capital spending was related to receiving more medical care, such as more ambulatory visits to physicians and more cardiac tests.  But the questions that measured perceived quality of care – 7 of the ten measures -  showed that there really was no strong correlation between greater spending and increased perceived quality.  In fact, at times, perceived quality of care was actually higher in areas with lower-expenditures. 

For some, the study asks the question as to whether or not more spending actually improves the Medicare experience of beneficiaries.  For others, it also raises the question – if increased spending doesn’t work to increase the perception of care quality, what are some other solutions? 

 The study can be found published in the May 28 issue of the Journal of the American Medical Association. 

Isabella County Warned About Fraudulent Calls

In Michigan, an Isabella County Sheriff is warning people to be wary of a telephone scam under the guise of a Medicare validation.

Apparently, people have been receiving fraudulent calls from someone claiming to represent Medicare. The Sheriff is advising citizens, particularly seniors and individuals with disabilities, to be cautious if asked for certain personal information over the phone.

According to the Sheriff, the caller will allege that they are calling from Medicare, and that the recipient’s Medicare card needs to be updated in the next 30 days in order to remain valid. The caller will assure the recipient that updating the card is free, and all that is required is the individual’s bank account, Social Security, and Medicare numbers.

However, be aware that Medicare shouldn’t ask you this information via a telephone call, and they don’t ask for payments over the phone. The caller is counting on victims not knowing Medicare’s privacy procedures or their own rights, and on being easy targets for financial or identity theft. Identity theft is when people use someone else’s information (without their consent) to commit crimes, including fraud. It can happen when people have access to someone else’s personal information.

To protect yourself, whether you live in Michigan or any other State, don’t ever give out personal information to unknown callers. Your social security number, Medicare number, banking account numbers, and credit card numbers/expiry dates can all be used to steal from you or to commit crimes using your information.

If you live in the Isabella County area and have received a call from someone asking for your personal information, call the Sheriff Department at (989) 772-5911.

If you live anywhere in America and you suspect you may be a victim of identity theft, call the Fraud Hotline at 1-800-447-8477, or the Federal Trade Commission’s ID Theft Hotline at 1-877-438-4338.

Medtronic Inc. Settles Fraud Allegations for $75 million

 

Medtronic Inc.’s spinal unit has agreed to pay the government $75 million in order to settle false claim submission allegations.  The allegations were originally against Kyphon Inc., which was purchased by Medtronic Spine in November.  Medtronic Spine bought Kyphon Inc. for $4.2 billion, even after the allegations had been made.  They were aware of the lawsuit allegations before acquisition.

The allegations were brought forward by two former Kyphon employees.  According to one, when he realized they were involved in Medicare fraud, he spoke with the company’s vice president of reimbursement – to no avail.  Eventually, he accepted another job at a different company, for less money. 

The specific fraud allegations involved Kyphon’s submission of claims for a number of kyphoplasty procedures.  The Kyphoplasty procedure is a treatment for spine compression fractures.  This treatment is normally an outpatient procedure and only minimally invasive.  Kyphon Inc., however, was accused of marketing this procedure as a more expensive inpatient treatment, causing Medicare to pay more for some of these surgeries. 

The lawsuit, filed under the Federal False Claims Act, will also award two whisleblowers in the case $14.9 million.    It also required Medtronic Spin to agree to follow Medicare regulations in all future claims.  Although Medtronic Inc. agreed to pay a settlement, the company admitted no wrongdoing.  

The Value of a Medigap Policy

Medigap policies are supplemental insurance policies which are designed to help you financially meet your health care needs.  While an Original Medicare plan will, of course, cover much of your essential health care, there are a number of supplies and services that won’t be covered.  By purchasing a Medigap policy, you can minimize some of these gaps.

Medigap policies, run by private insurance companies but approved by Medicare, are used along side of Original Medicare.  They cover some costs like copayments, coinsurance, deductibles, and, in some cases, extra benefits.  You usually need to have Parts A and B of Original Medicare in order to be eligible to purchase a Medigap policy. You’ll need to pay a monthly premium for this supplemental insurance policy, as well as continuing to pay your Part B premium.  You should also be aware of the fact that when you purchase a Medigap policy, it won’t help to cover any of your spouse’s Medicare coverage gaps. Medigap policies only cover one person per policy. 

Before purchasing a Medigap policy, however, spend some time looking into the various ones available to you.  Insurance companies will charge different prices for their policies, and some specific Medigap policies may not be sold by all companies. 

One of the great things about purchasing Medigap coverage is that, whatever company and policy you chose, you can have peace of mind, knowing that many of the gaps in your Medicare coverage will now be covered. 

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