Medicare has been a godsend to over 60 million Americans under the plan. Federal health insurance was, at first, for individuals above the age of 65. But now the benefits extend to individuals with specific diseases. These include ALS and end-stage renal disease.
Those receiving Social Security Disability Insurance (SSDI) are eligible for coverage. That applies even if under age 65.
Medicare is under the administration of the Medicaid Service and Centers for Medicare. The insurance program comes in four parts. Medicare Original has Part A and B.
Part A covers inpatient hospital stays, hospice, and nursing facility care. Medicare Part B pays for patient care, doctor visits, and medical supplies.
Medicare part C also goes by the name Medicare Advantage. It allows for the private administration of Medicare benefits through insurance providers. You get the benefits of Medicare Original plus other services like dental or vision care. The final is Medicare Part D for prescription drugs and vaccines.
Our article explores some common mistakes to avoid when it comes to Medicare. It could mean the difference between receiving the full benefits or not.
1. Missing the Enrolment Window
As we stated, Medicare is a federal program that applies to all citizens of the United States. The rollout and benefits are similar for every state. Enrollment deadlines are the same for all the plans. But there is some flexibility with Medigap.
It helps to take note of the initial enrollment period (IEP). This will be three months before and after your 65th birthday. In essence, that gives you a total of 7 months. Failure to adhere to the time slot can result in penalties.
There is also the inconvenience of waiting until the next General Enrollment Period GEP) to apply. Medicare Florida GEP falls on 1st January to 31st March every year. You must then wait until 1st July for the Medicare plan to kick in.
You can avoid the late enrollment penalty with the Special Enrollment Period (SEP). But it only applies to those who have job insurance or eight months after the said insurance expires.
2. Not Understanding the Medigap Application Windows
You can also opt for the Medicare supplement plan (Medigap). With Medicare Original, there is no limit on what you can pay as out-of-pocket expenses. A separate Medigap policy will help cover medical costs outside of the original Medicare.
But, there is no federal Medigap mandate for annual open enrollment periods. Connecticut and New York, for example, issue Medigap all year round. Massachusetts only carries out enrollments between February and March.
Illinois, Nevada, Idaho, Oregon, and California follow birthday rules. You have 30 days after your birthday to sign up.
If you apply for Medicare in Florida, you can do so on the first month you took up Medicare Part B and are 65. Trying to sign up once the window closes can end up being expensive for you.
There could be an extra cost of underwriting. Yet, there is no assurance that you will get the coverage, thus locking you into the plan you already have.
3. Ignoring the Role of Your Current Insurance Cover
You may still be working and receiving health insurance from your employer after age 65. There are two things you need to know here. If the company has more than 20 employees, your primary cover is private health insurance.
Medicare will be your primary plan if the company has less than 20 employees. Now, why is it important to know this information?
Let's say you fall in part one, where your primary cover is private health insurance. Then you fall sick and assume Medicare will take care of your bills. This may not happen because it will be the secondary plan.
If the private insurer is the secondary plan, they may opt to take what they are liable for. Medicare will be responsible for 80%, while the private insurer will pay 20%. If they pay their 20%, per the negotiated Medicare rate, you will be liable for 80% or more.
It can sound confusing, so you need to talk to Medicare experts. They will explain the interplay between your private insurance cover and Medicare plans.
4. Assuming Your Medicare Covers Your Spouse
Do not assume that once you sign up for Medicare, the cover also extends to your spouse. Please note the federal plan does not operate like employer health insurance cover.
It is an individual plan, so your partner must sign up once they meet the eligibility criteria. That means age 65, SSDI recipient, or suffering from specific conditions.
5. Not Reviewing Medicare Coverage Options
A study finds that more than 57% of Medicare beneficiaries don’t review their options. Yet you have the open enrollment periods to change or switch plans if you wish. Please note that the plans often change from year to year.
Differences in benefits, formulas, premium payments, copayments, and deductibles may exist. This could expose you to extra costs you can avoid by reviewing available options.
The changes can also affect the level of service that healthcare professionals provide. Your doctor may, for example, opt out of the Medicare-approved network of health care providers.
The existing plan may also not cover some of the medications. You could find yourself without the necessary coverage when you need it the most.
We reiterate our earlier point of talking to the experts if you're unsure about the plans. They're also in the best position to advise you on the best covers depending on your needs.
You may also want to avoid signing up for automatic renewals. That way, you can keep up with checking if there are any modifications to the plan you are under.
To get the most out of Medicare, understand what the health insurance program covers. Do you know all there is to know about Medicare Original, Medicare Advantage and Medigap?
Also, find out what payments you are liable for. Familiarize yourself with terms like copayments, coinsurance, deductibles, and premiums.
It may seem overwhelming to have to educate yourself on all this. But there are tons of resources, both offline and online, that you can use. Also, seek more clarification from the Medicare agents to know what you are signing up for.