News & Articles Category: Medicare
Medicare covers many preventive tests and screenings for women designed to identify serious problems early. Some of the services that you can take advantage of now include:
Test and Screenings
Annual wellness visit
Bone mass measurement
Cervical cancer
Mammogram
Cardiovascular Screenings
Pelvic Exams and Pap Smears
Medicare covers 100 percent of the costs of a pelvic exam that can help detect fibroids or ovarian cancers. The benefit also includes a clinical breast examination for the detection of breast cancer. Most women are entitled to receive one pap smear every 24 months that helps identify vaginal or cervical cancer. For those at high risk for developing these types of cancers and those who recently received an abnormal pap smear, Medicare pays for a new pap smear every 12 months.
Mammograms and Mastectomy
Part B pays 100 percent for a screening mammogram once every 12 months and 80 percent for a medically necessary diagnostic mammogram. If a mastectomy is needed, Part A covers the cost of surgically planted breast prostheses (less deductible and coinsurance) and Part B pays for external breast prostheses along with a post-surgical bra and breast reconstructive surgery (less deductible and coinsurance).
Heart Disease
Medicare covers many services designed to prevent, diagnose, treat, or manage heart disease in women. A thorough preventive visit and annual wellness check are covered 100 percent, followed by a cardiovascular screening once every 5 years and two diabetes screenings per year along with clinical lab tests. In addition, medical nutrition therapy and diabetes management support are covered by 80 percent.
Bone Mass Measurement
Part B covers one bone density test every 24 months for qualified women who are at risk for developing osteoporosis. If qualified, you pay nothing for these services. If your doctor or health care provider recommends services beyond what Medicare covers, you may have to pay some or all of the costs. Medicare pays for an injectable drug designed to treat osteoporosis. Some women may also be eligible for a home visit from a nurse to inject the drug. Part B deductible and coinsurance apply to the costs of the drug, but you pay nothing for the home visit.
Resources:
https://www.medicare.gov/coverage/mammograms.html
https://www.medicareinteractive.org/get-answers/medicare-covered-services/preventive-care-services/medicare-coverage-of-pap-smears-pelvic-exams-and-physical-breast-exams
https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html
https://www.medicare.gov/coverage/osteoporosis-drugs-for-women.html
https://www.medicare.gov/coverage/bone-density.html
https://www.medicare.gov/coverage/cardiovascular-disease-screenings.html
MUC64-2017-BCBS
News & Articles Category: Medicare
Here are the Top Ten Medicare mistakes in Illinois, and how to avoid them.
1. Enroll When Eligible
With more people working beyond the age of 65, it’s not uncommon to delay signing up for Medicare, and that’s okay. As long as you have health coverage after age 65 through an employer or a spouse, you can delay enrolling without paying a penalty. However, if you do not have group coverage, the right time to sign up is during your Initial Enrollment Period. This is the seven-month period of time that begins three months before your 65th birthday and ends three months after. There are also Special Enrollment Periods for those with unique circumstances. If you fail to sign up for Medicare when you are first eligible and delay Part B enrollment without proof of other health coverage, you could end up having a lifetime late enrollment penalty added to your premium.
2. Annual Enrollment
Medicare Annual Enrollment takes place each year between October 15 and December 7. This is the time for everyone to evaluate their current Medicare plan to see if changing plans makes sense. Cost and coverage can vary from year to year, and taking the time during Annual Enrollment to review your plan is smart. During Annual Enrollment, you can switch from your Original Medicare to a Medicare Part C plan, change from one plan to another, or return to Medicare. You can also join a prescription drug plan, change plans, or drop one that no longer meets your needs. Not taking advantage of this period means you could end up paying more for your plan or keeping a plan that doesn’t fit your changing needs.
3. Prescription Coverage
One of the biggest mistakes people make concerning Medicare is prescription benefits. If you are healthy and do not take medication, great! However, if you wait to sign up for Part D benefits until you need them, you risk paying a late penalty. if you cannot provide proof of creditable coverage for the time you went without.
4. Plan Based on Cost
Cost is a primary consideration when choosing the right plan. However, with prescription coverage, it is often as important to ensure the prescriptions you require are on the formulary. If you choose a plan based on cost alone and your medication is not listed, you may end up paying much more for what you need.
5. COBRA
After you turn 65, Medicare becomes your primary coverage, unless you have coverage through an employer. However, the coverage must be current, and COBRA benefits or retiree benefits are not coming from a job you still work, and are not considered primary coverage. COBRA benefits extend an employer’s health care benefits for eighteen months. However, you only have eight months, not eighteen months after your group coverage ends to sign up. If you do not sign up for Medicare during this time, you will have gaps in your coverage and may be responsible for paying a late enrollment penalty.
6. Same Plan as Spouse
It’s important to realize that you and your spouse likely have very different healthcare needs. When choosing a Medicare plan, whether it’s for prescription benefits or basic coverage, be sure to think about your unique needs and how the plan you’re considering can help you.
7. Waiting Too Long
You have a full six months after enrolling in Part B to join a Medicare Supplement plan with full protections in place. All recipients who enroll in a plan during this period are entitled to guaranteed issue rights. This means that no company can refuse to sell or charge you more because you have a pre-existing condition. Once this six-month period of time ends, these protections are no longer in place and you may not be able to get coverage.
8. Annual Notice of Change
The Annual Notice of Change that comes by mail each year is filled with critical information on any changes you will see in your Medicare coverage for the upcoming year. Changes in cost, network providers, and even formularies must be noted in this documentation. Read it fully to avoid being surprised by higher out-of-pocket expenses or limited access to health care providers.
9. Extra Help
Medicare has safeguards in place to help those with limited income afford prescription drug coverage. Unfortunately, many Medicare recipients are not aware that they qualify, and could save money on the same plans they pay for each month. Be sure to read about Extra Help and make notes on whether or not you are qualified.
10. Out-of-Network
Medicare Part C makes it easy for seniors to receive all of their Part A and Part B benefits as well as a few extras like prescription benefits and in some cases, vision and dental care. However, most plans have very strict requirements regarding network providers. Going to a doctor or hospital outside the plan’s network could end up costing you a lot more out-of-pocket.
References:
Delaying Part B: https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/should-you-get-part-b/should-i-get-part-b.html#collapse-3156
Special enrollment periods: https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html
Open Enrollment: https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html#collapse-3190
Part D Late Enrollment: https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html
Medicare and other insurance: https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/how-medicare-works-with-other-insurance.html
When to buy Medigap: https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html
MUC68-2017-BCBS
News & Articles Category: Medicare
If you’re looking to enroll in Medicare, understand your specific enrollment periods and avoid missing your deadline and possibly a penalty.
Initial Enrollment
For those who are turning 65 7 months to enroll is called the Initial Enrollment Period. This period begins three months before your 65th birthday and ends three months after you turn 65.
General Enrollment
For those who miss the Initial Enrollment, there is a General Enrollment, which extends from January 1st through March 31st each year. Enrollment begins on January 1st for coverage that begins on July 1st.
Open Enrollment
Changes can be made during open enrollment to change from a Part C to a Medicare Plus or switch from one Part D plan to another. This period is from January 1st to March 31st. Plan changes take effect the month after it is submitted.
Annual Enrollment
Medicare realizes that sometimes people want to make changes. Annual Enrollment is available from October 15th through December 7th.
Special Enrollment
Special Enrollment is available for people to enroll who are undergoing special life events or circumstances that make it difficult during designated periods.
References:
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-how-to-sign-up-for-part-a-and-part-b.html
MUC10-2016-SSI/CDIS
News & Articles Category: Medicare
Often, seniors choose to enroll in Medicare when they are first eligible, at age 65, during their Initial Enrollment Period. Working seniors often delay enrollment until retirement, preferring to rely on health coverage offered through work or spouse coverage.
Part A
As long as you receive Social Security benefits, Medicare Part A is free, and there are no restrictions on when you can sign up. While many seniors enroll during Initial Enrollment, if you didn’t, that’s okay. You can enroll anytime during or after your Initial Enrollment period without penalty.
Part B
If you’re over 65 without Part B coverage when you retire and your employer-provided benefits come to an end, you may be entitled to a Special Enrollment Period, an 8-month period of time to join without paying a penalty. This starts at the end of the month you stop working or lose employer insurance, whichever comes first. To be eligible for a Special Enrollment, your company must have at least 20 employees. If they do not, then you will need to enroll during General Enrollment. And you may pay an increased premium, and a lifetime late enrollment penalty for each 12 months you were eligible.
Retiring, Spouse Is Not
If you didn’t sign up for Part B because you had group coverage from an employer, that’s okay. Now that you are planning to retire, the same Special Enrollment applies and both you and your spouse will have a full 8 months without paying a penalty. If you retire but will be gaining group insurance coverage from your spouse, then you will still be covered under what Medicare defines as current employment and you do not need the coverage. Medicare does not classify COBRA and retiree benefits as current employment, and you will not be eligible for a Special Enrollment Period. If you are planning on taking retiree coverage from a former employer, you should enroll in Medicare.
References:
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/special-conditions/special-conditions.html
https://www.cms.gov/Outreach-and-Education/Find-Your-Provider-Type/Employers-and-Unions/FS4-Medicare-for-people-over-65-nearing-retirment.pdf page 2, 3, 4
MUC47-2017-BCBS
News & Articles Category: Medicare
Enrolling in a Part C or D plan outside your Initial Enrollment period involves using a Special Enrollment. Under certain qualifying events, you may be eligible for this unique enrollment.
Qualifying Events:
Loss of Coverage
Loss of coverage from employer or family member, or expect to in the next 60 days.
Medicare terminates your plan’s contract.
Household Size
Events like marriage, a new baby, adoption, divorce, or death.
Residence Status
Move to a new address that isn’t in your current plan’s service area or have coverage options available at your new residence. Moving in or out of a skilled nursing facility or long-term care facility. Becoming a U.S. citizen.
5-Star Plans
Medicare rates plan for quality and performance using a star system from 1 to 5, with 5 considered excellent. Customer satisfaction surveys and information from healthcare providers. Updates are made annually giving customers reliable information about plans they are considering. You may switch to a 5-star Part C or Part D plan if available in your area. You may only use this once from December 8 – November 30.
References:
https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances/join-plan-special-circumstances.html
https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/five-star-enrollment/5-star-enrollment-period.html
MUC8-2016-BCBS
