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Monthly Senior Newletters!
Q: I will be turning 65, so I will be eligible for Medicare. I’m still working and have insurance through my spouse’s employer. Should I still sign up for Medicare?
 
A: In most cases, people should enroll in Medicare Part A when they turn 65, even if they have employer health insurance, because it is free for most people. 
 
Part A generally pays after your job’s insurance pays, meaning your job’s insurance is the primary payer. 
 
If you have health coverage through your or your spouses’ employer, you may not need all of Medicare when you turn 65. You can delay Part B or Part D and get them when you retire or if you lose your job-related insurance. You would be eligible for a Special Enrollment Period. 
 
Delaying Part B and/or Part D may save you money in this case. There is a monthly premium for Part B. If you already get health coverage through your job or your spouse’s job, you may not need Part B coverage. Check with your specific insurance plan details about your health insurance coverage. 
 
If you have health insurance through an employer, you can enroll in Part B: 
 
 Any time you’re still covered by an employer or union group health plan, through your or your spouse’s current or active employment, or 
 During the 8-month period that begins the month after the employer or union group health plan coverage ends, or when the employment ends (whichever is first). 
 
If you are under 65, disabled and receiving Social Security Disability payments and you also have health insurance through an employer, your employer coverage will be primary to Medicare coverage. This means your job’s insurance will pay first. 
 
If you get insurance from your (or your spouse’s) job, talk with your plan to see how your insurance may change when you get Medicare, even Medicare Part A. If you have a Health Savings Account (HSA), you may not want Medicare Part A right away because an employer may stop contributing to your HSA account when you enroll in Part A. It is really important for you to speak with your job’s human resources department to see how Medicare may change your benefits. 
 
You should start to think about these decisions at least 3 months before your 65th birthday.

JUST HELP FOR YOU!         

  (For old articles check the Archives 

 

JUNE:

 

Q: I have diabetes and usually buy my supplies through the mail. I was told that Medicare might not pay for them with the company I’ve been using. Is that true?

 

A: You can still use mail order for your diabetic supplies, but there’s a chance you may have to switch suppliers for Medicare to pay. Medicare has begun competitive bidding between suppliers to keep the price of durable medical equipment down. As a result, only certain suppliers will be allowed to be reimbursed by Medicare. This is all part of the new DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) Program. Starting July 1, 2013, you will need to make sure your supplier is a Medicare contract supplier. Medicare contract suppliers must always accept assignment on these items. Contract suppliers are required to accept the Medicare approved cost as payment and cannot charge any additional fees. The Medicare-approved cost for diabetic testing supplies will be the same for all suppliers. If you have Original Medicare, you will have two options for purchasing your diabetic testing supplies:

You can have your diabetic testing supplies delivered to your home by a national mail-order contract supplier, or

You can purchase supplies in person from any Medicare-enrolled supplier If you buy from a supplier, however, that does not accept assignment, you may pay more than the 20 percent coinsurance and any unmet deductible. Contract suppliers are required to carry the same range of products to Medicare beneficiaries that are available to non-Medicare beneficiaries. Your physician may prescribe a specific brand or type of delivery to avoid health issues for you. If your

practitioner does, he needs to document in your medical record the reason why this is necessary to avoid an adverse medical outcome. This documentation should include the following:

The product’s brand name or mode of delivery required;

The features this product or mode of delivery has versus other brand name products or modes of delivery; and

An explanation of how these features are necessary to avoid an adverse medical outcome.

If you have questions about buying your medical supplies while on Medicare, or anything else related to Medicare, www.medicare.in.gov.

 

JULY:

 

Q: How does Medicare coverage work for my husband and me when we travel? We are planning a few trips but want to make sure we’re covered if we have any health problems.

 

A: Summer’s finally here, and many people are traveling. Your Medicare coverage will vary depending on where you will be traveling—within or outside of the U.S and whether you have a supplemental plan. In most circumstances, Medicare doesn’t cover health care when you are traveling outside the U.S.

One exception is that Medicare may pay for services that you get while on board a ship within the territorial waters adjoining the land areas of the U.S.

Medicare may cover medically-necessary ambulance transportation to a foreign hospital only with admission for medically-necessary covered inpatient hospital services. You pay 20% of the Medicare-approved amount, and the Part B deductible will apply.

You must pay your deductible for any Medicare Part B services and supplies before Medicare begins to pay. If a doctor, health care provider, or supplier does not accept assignment, the amount you pay may be higher.

If you have Original Medicare and are traveling within the United States, you pay what you would normally pay under Medicare Part A.

Some Medigap policies offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. Check with your specific plan to see what coverage is offered.

When it comes to Medicare Advantage Plans, every plan is different. Often a Medicare Advantage plan will only pay for emergencies outside of its service area or would pay like Original Medicare without a Medigap policy. Be sure to find out what your plan offers before you travel.

There are different types of Medicare Advantage Plans:

Health Maintenance Organization (HMO) Plans cover all Medicare Part A and Part B services. Some HMOs cover extra benefits, like extra days in the hospital. In most HMOs, you can only go to doctors, specialists, or hospitals on the plan's list except in an emergency.

Preferred Provider Organization (PPO) Plans are available in a local or regional area in which you pay less if you use doctors, hospitals, and providers that belong to the network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

Private Fee-for-Service (PFFS) Plans allow you to go to any Medicare-approved doctor or hospital that agrees to treat you under the plan and that accepts the plan's payment terms. The plan decides how much you must pay for services.

Special Needs Plans (SNP) provide more focused and specialized health care for specific groups of people, such as those who have both Medicare and Medicaid, who reside in a nursing home, or have certain chronic medical conditions.

If you have questions about Medicare coverage, visit www.medicare.in.gov.

 

AUGUST:

Q: I have Extra Help, but I was told I might not always qualify for it automatically. How will I know if I do or not?

 

A: Extra Help, also known as LIS (Low Income Subsidy) is a program designed to help with prescription drug costs for people with Medicare. In 2013, to qualify for Extra Help, your annual income had to be limited to $17,235 for an individual ($23,265 for a married couple living together). These figures may change for 2014.

Even if your annual income is higher than the income limits, you still may be able to get some help. Some examples where your income may be higher are if you or your spouse:

 

  • Support other family members who live with you Have earnings from work
    • Why might I no longer automatically qualify for Extra Help?
      • Both Medicare and Medicaid (full-benefit dual-eligible)
      • Both Medicare and Medicaid with a monthly Spend-down – you must meet your Spend-down at least once after July 1 to automatically qualify for Extra Help for the next year.
      • Help from Medicaid paying Medicare Part B premiums (Medicare Savings Program)
      • Both Medicare and Supplemental Security Income (SSI) 

      • If you continue to automatically qualify but have a change in your copayment levels, you will receive an orange notification in the mail by early October.
      • Why might my co-payment level for Extra Help change?
        • Institutionalized with Medicare and Medicaid
        • Has Medicare and Medicaid
        • Has Medicare and Medicaid and a change in income level
        • Gets help from Medicaid paying Medicare Part B premiums (belongs to a Medicare Savings Program)
        • Gets Supplemental Security Income (SSI) 


Each year, Medicare and Social Security take a new look at your situation to see if you automatically qualify for Extra Help, also known as LIS (Low Income Subsidy).

If you do NOT automatically qualify for Extra Help, you should receive a grey letter in the mail notifying you by the end of September. An application will also be included with the notice. You can return the application to Social Security with the enclosed postage-paid envelope.

 

If you no longer have one of the following, you will not automatically qualify:

Your change in copayment level could happen when you change from one of these categories to another category:

 

If you have questions about Low Income Subsidy (LIS) visit www.medicare.in.gov.