10 Facts About Medicare That You May Not Know

Video: 10 Facts About Medicare You May Not Be Aware Of

Whether you're just now aging into Medicare or have had it for years...here are some facts about the federal coverage that you may not be aware of. If you have questions...we're here to help.

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Hi there. Steve Thurmond here with Medigap Tennessee. Your source for Medicare Supplemental, Medicare Advantage, Prescription Drug and Dental plans in Tennessee & 29 other states.

And, here are 10 facts that you might not know about Medicare.

1.) On July 30th, 1965, President Lyndon B. Johnson signed the Medicare and Medicaid Bill of the Social Security Act in Independence, Missouri.

Former President Truman was at the bill signing and was also the first person to receive a Medicare card. President Johnson remarked: “We marvel not simply at the passage of this Bill but that it took so many years to pass it.”

2.) About 10,000 people per day are turning 65 and aging into Medicare.

The Baby Boomer generation is transitioning from the workforce into retirement and are taking advantage of the Federal program after paying into social security for the last 40+ years. If you were born between 1946 and 1964, you’re likely part of this group.

3.) Contrary to what you might think…not every doctor accepts Medicare, but the vast majority of them do.

It’s estimated that over 95% of doctors in the US accept Original Medicare as primary coverage.

4.) A doctor might accept Medicare, but not every doctor accepts Medicare Assignment.

Medicare Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Doctors that DON’T accept Medicare Assignment can charge extra fees in excess of up to 15% beyond what they get paid by Medicare. This is another reason why it’s important to have the right Medicare Supplemental plan to cover those excess Medicare charges your doctor or service provider may bill you for.

5.) You CAN be penalized for not participating in Medicare when you qualify.

In particular, those who don’t enroll in Medicare at their first eligible time generally have to pay higher premiums once they do join. For Part B medical coverage, your monthly premiums will rise 10% for every 12 months that you could have been on Medicare but chose not to be. In addition, there is a similar late-enrollment penalty for not taking Part D, prescription drug coverage when you are initially eligible. Medicare calculates the Part D penalty by multiplying 1% of the “national base beneficiary premium” ($34.10 in 2016) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium. The national base beneficiary premium may increase each year as well, so your penalty amount could also increase annually.

6.) Medigap Plans and Medicare Supplemental plans are the exact same thing.

Like Soda and Pop, they are just different words for the same product. Medigap plans pick up the other 20% that original Medicare doesn’t cover and they are often referred to as “secondary plans.” There are currently 10 different Medigap plans available from about 50 different private insurance companies. While all 10 plans are standardized by the center for Medicare and medicaid services, they all have different levels of coverage, different deductible amounts and their pricing IS NOT standardized, so companies can charge whatever they’d like for their Medigap plans. Prices can vary up to $150 dollars per month between two companies for the EXACT same level of coverage, so this why it’s important to shop around and compare when choosing a Medigap plan.

7.) You can CHANGE your Medicare Supplemental plan at ANY time during the year and switch to a more competitively priced Medigap plan from a different company.

However, there are only a few times when you can purchase a Medigap plan WITHOUT having to answer health questions and pass a company’s underwriting guidelines. One of those times is when you initially age into Medicare and start your Part B benefits. You’ll have your 65th birthday month and six months after your birthday month to purchase a Medigap plan of your choice without having to answer health questions and you can’t be turned down for pre-existing conditions. Outside of that window, there is only one other exception where you don’t have to answer health questions and that is called a guaranteed issue period. Guaranteed issue situations only apply to those losing creditable coverage such as involuntarily losing employee benefits or involuntarily losing a Medicare Advantage plan. But, if you’re healthy and can pass underwriting guidelines and health questions, you CAN initially purchase or change your Medigap plan at ANY time during the year for any reason, as long as you have Medicare Parts A & B. Most people change plans because they get a rate increase or because they find a different provider for the exact same level of coverage for much cheaper. If you’re healthy and think you’re overpaying for your current Medicare Supplemental plan, give us a call… we’ll help you find a better priced plan for the exact same or better coverage than you currently have.

8.) Medicare Advantage Plans ARE NOT Supplemental plans.

Medicare Advantage Plans ARE NOT Medigap plans. Medicare Advantage Plans ARE NOT Secondary insurance plans. Medicare Advantage plans are Managed Care plans and referred to as Medicare Part C. They consist of HMO and PPO plans and are available with or without Drug coverage. Medicare Advantage plans are administered by private insurance companies and they REPLACE Original Medicare as your primary coverage, so if you have an Advantage plan, you DO NOT have Original Medicare paying your bills. You cannot have Original Medicare AND a Medicare Advantage plan, so you’ll either have one or the other. When you have a Medicare Advantage plan, it is your primary coverage until you dis-enroll from the plan and go back to Original Medicare as your primary coverage. You can only enroll and dis-enroll from Medicare Advantage plans during certain times of the year. Oct. 15th-Dec 7th is the annual election period when you can enroll into or dis-enroll from your current Medicare Advantage plan. There are a few exceptions to this rule for individuals that get state subsidies like Medicaid, QMB, SLMB or “extra help” from Social Security. Unless you get a “low-income” state subsidy, you will still have to pay your Medicare Part B premium with a Medicare Advantage plan. This is so Medicare can pay your Medicare Advantage plan company to administer your healthcare coverage. If you haven’t figured this out already, it’s called having a “middle man”…or, to be politically correct, it’s called having Managed Healthcare. Medicare pays the Medicare Advantage plan company and the Medicare Advantage plan company pays your medical bills and handles every aspect of your healthcare coverage. Just remember…Medicare Advantage Plans are very different than Medicare Supplemental or Medigap Plans. Take a look at our “Medicare Advantage Pros & Cons” video for a more in-depth view on these specific products. They can be a good fit for some individuals, but they do have a lot of drawbacks to take into consideration.

9.) If you have Medicare and some form of Medicaid (such as TennCare or the pink QMB card) you qualify for what’s called a “Special Needs Plan.”

Special Needs Plans are specifically for low income individuals that have both Medicare from the Federal Government and some form of Medicaid from their state. These are zero premium Medicare Advantage Plans that include full drug coverage as well as many other added benefits that original Medicare and Medicaid don’t cover, such as comprehensive dental, yearly allowances for glasses or contacts, yearly allowances for hearing aids, monthly or quarterly allowances for over the counter products, transportation, personal emergency services like life-alert, and gym memberships like Silver Sneakers or Silver & Fit. These are zero premium plans and all of these extra benefits don’t cost anything if you have both Medicare and some form of Medicaid. You will continue to pay copays on your medication, however your copays will be as low as possible. There are several special needs plans in the market, so if you have Medicare and some for of Medicaid (like TennCare or the pink QMB card), give us a call and we’ll tell you all of your options. There are some great plans that could help you out immensely.

10.) Medigap Tennessee is your source for Medicare Supplemental, Medicare Advantage, Prescription Drug and Dental plans in Tennessee.

If you’d like an in-depth and unbiased look at all of your Medicare options or want to ask us some questions about these confusing products, just pick up the phone and give us a call for a free, no obligation consultation. We’ll spend as much time with you as you need so you can be sure you’re making the right decisions the first time.

Remember, Medicare doesn’t cover everything…so call us at 1-800-431-5431 and let us help you zap-the-gap!

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