Category Archives: Medicare Insurance Info

Medicare Enrollment Season

Medicare Enrollment Season is here again.

 It's time once again for you to start thinking about your Medicare enrollment. Enrollment starts Oct. 15th but you need to be aware that the deadline has changed to Dec. 7th instead of Dec.31 as it has been in recent years.

medicareWith all of the changes being made to Medicare it's very important that all of the 10,000 baby boomers who become eligible every day understand the facts of Medicare so that you can make the right decision about your health care coverage.


Boomers: What you need to know about Medicare enrollment

In order to make the best decision about your Medicare enrollment needs you need to have all of the information you can get about the changes being made. Following is an interview by Casey Dowd of FoxBusiness with Joe Baker, president of the Medicare Rights Center, a non-for-profit counseling organization in New York about the changes coming to Medicare:

Boomer: What changes and updates have been made to Medicare for 2012?

Baker: The first change is when you can make a change to your current plan. It now starts earlier, on Oct. 15th and it ends earlier on Dec. 7. In the past the enrollment period started in November and extend through the holidays and the end of the year. Folks in Medicare Advantage plans will be getting an annual notice of change about what might be changing in their plan, Part D plan or prescription drug coverage, by the end of this month.

When it comes to benefits and other costs, there’s some good news this year. If you are in a Medicare Advantage plan and have Part D as a separate prescription drug plan, or part of Medicare Advantage, premiums are not going up this year. The federal government announced that on average, Medicare Advantage premiums would probably decrease by 4%, and Part D prescription drug premiums would stay about the same.

This is good news if you are not looking to change plans, prices and benefits are remaining stable despite the volatility in the marketplace. With that said, you should still research your own individual plan, any notices that detail plan changes will be more general and won't be individualized for you. If you are taking a particular drug, or getting a specific type of treatment, be sure to check there are no changes that might impact them.  

Boomer: What impact has health-care reform had on Medicare if any?

Baker: The Affordable Care Act had a lot less of a negative impact than what was predicted, along with some expected good changes.

Negative first: Part of the reform significantly scaled back (starting this year) the level of subsidies or payments that Medicare Advantage plans received from the federal government. Many of the reform’s critics expected to see big premium increases, plans leaving the market and reduced benefits—all of which would be bad for consumers. The good news: those disaster scenarios did not occur. Some of the additional benefits the law enacted to Medicare will  further enhanced this year. For example, in the coverage gap (also known as the doughnut hole), you are still going to have a 50% discount for brand name drugs and the discount on generic drugs will increase to 14% from 7%, giving a little more relief on out-of-pocket costs.

In the government program, preventative care is going to be free of charge along with your annual wellness visit, mammograms and colonoscopies. That is also going to be in place for Medicare Advantage plans.

It is going to be a fairly stable year for folks in both the original Medicare and Medicare Advantage plans. Some of the improvements include in the health-care law will continue to be rolled out and enhanced over the year as well.

Boomer: What basic coverage is offered with Medicare?


Baker: Usually if you are in original Medicare you need supplemental coverage to pay coinsurance and deductible amounts. If you go to the doctor on original Medicare you pay 20% of the doctor’s approved fee, and most people get what is called Medigap or supplemental coverage to pay that 20% coinsurance or they have retiree insurance from their former employer that might cover those costs.

Most people also purchase prescription drug coverage under Part D. About 70 to 75% of people have the original Medicare, retiree insurance or Medigap insurance. The other 25% of people are in the Medicare Advantage, which includes a variety of plans. Most people are in what we call HMOs or Medicare health maintenance organizations that are run by private companies like UnitedHealthcare or Humana. When you sign up with a Medicare Advantage plan, you normally don't need supplemental coverage because the plan usually combines with extra benefits to cover some of what Medigap would and your Part D coverage.

It’s important to know that under a Medicare HMO, you can only use the doctors and hospitals that are in that plan’s network. With original Medicare you can go to any doctor and you may have out-of-pocket costs like deductibles and co-insurance and that can add up if you are sick. Be careful when choosing a Medicare Advantage plan: If you travel a lot or like the freedom of your doctor want, original Medicare may be the better option. If you don't mind having a more limited network of doctors you could save some money with a Medicare Advantage plan.

Boomer: What questions should consumers ask before enrolling in a supplemental Medicare health plan?

Baker: Medicare supplements are Medigap policies and you want to make sure you are dealing with a reputable company. These supplements are standard plans that are offered across the country and are highly regulated usually work well with Medicare. When choosing the right plan, make sure to consider price and services offered.

With a Medicare Advantage plan you have a much more complicated decision-making process. You want to make sure your doctor and hospitals are in the network. It’s a good idea to get your doctor’s opinions on the different offerings to see if they are a good fit, particularly if you have an ongoing medical condition. A lot of people just look at the price and that is not always a good idea, especially for those in need of medical care or currently in treatment. A cheaper premium may be attractive, but you may have higher costs of copayments, deductibles and co- insurance or less coverage, and those costs could be enormous.

You can call your state’s Department of Insurance and request a list of the Medigap insurers in your state as well as consumer satisfaction information.

Boomer: For people turning 65 next year, what steps should they take to get my Medicare?

Baker: Three months before your 65th birthday, either check out the medicare.gov website, visit your local Social Security office or can call 1-800 Medicare and enroll in Medicare. If you are still working or your spouse is still working and you have insurance through that spouse, you may be able to put off your enrollment, but you need to know the rules. It’s always a good idea to know the system early.  If you are of age and not working, you will want to enroll in Medicare because it is the only show in town for you. Your coverage starts on the first of the month on your 65th birthday.

Boomer: Are there any programs available to help pay Medicare costs?

Baker: The Medicaid program helps people with very low income cover health-care costs, and consumers can find information about this program from their state’s Department of Health or the Medicare agency in their state.

Medicare savings programs also help people with higher levels of income cover their costs. These programs pay for your Medicare Part B premiums. The Part B premium is deducted from your Social Security check–and we still don’t know what the premium will be in 2012, but it will be higher than the current $115.

There is another program called Low-Income Subsidy for Part D that will cover most of that premium if you fall under a certain income level (usually between $12,000 and $20,000). The plan also has a lower cost sharing or copay when you go to pick up your medication at the pharmacy.

As you can see from the above interview Medicare enrollment season is when you need to stay informed and ask plenty of questions before signing up for a Medicare plan.

Medicare Insurance Fraud

Medicare Insurance Fraud a Problem for Seniors

It is unfortunate that Medicare Insurance Fraud is still a big problem but if you follow the advice in the following article published by Amber Haumpton on Sooper Articles:

Medicare Insurance Fraud“Beware of a phone call from someone claiming to be a representative of Medicare. In reality they’re just trying to steal your identity. West Virginia Attorney General Darrell McGraw has raised the warning, saying he’s received reports from citizens of his state, and has learned that seniors in neighboring Kentucky have also been targeted.” (from Consumer Affairs)

This Medicare Insurance phone fraud is a variation on credit card frauds we’ve seen in the past, and you can be sure that if it’s taking place in West Virginia and Kentucky, it’s taking place in other states, too. These thieves use the guise of Medicare to get seniors’ personal information, which can lead to identity theft, financial theft, and more.

The folks over at Senior Corps have laid out the most basic way you can avoid this Medicare scam and any similar scam that’s going on:

“You can avoid Medicare insurance fraud by not giving your personal information to people who may come to your home or call you on the telephone. You should only give your personal information to those who are approved by Medicare or doctors. If you are not sure if the provider is approved by Medicare or not, then there are toll free numbers that you may call to find out this information. If you lose your card, then you should call to report it. Hotlines are available for you to call to report Medicare insurance fraud. Medicare insurance fraud is a serious crime.”

The Federal Bureau of Investigation website says that seniors are less likely to “report a fraud because they don’t know who to report it to, are too ashamed at having been scammed or do not know they have been scammed” Therefore we have provided a list of helpful resources that seniors can use to help identify medicare scams and where to report them.

  •     United States Senate has a Special Committee on Aging with a section devoted to Elder Fraud and Abuse
  •     U.S. Department of Health & Human Services Centers for Medicare & Medicaid Services provide a thorough step-by-step process on How to Report a Medicare Fraud
  •     National Committee for the Prevention of Elder Abuse, MetLife, Virginia Tech and Mature Market Institute provide a study on Elder Financial Abuse for 2011
  •     The National Consumer Protection Resource Center Devoted an entire website to Senior Medicare Patrols, with links to a Fraud Prevention Summit, Stop Health Care Fraud video and more.
  • Insuraprise Publications releases a monthly senior newsletter devoted to providing seniors timely news information regarding senior living, senior scam alerts, financial planning and medicare supplemental plans.

Medicare insurance fraud is a serious crime, and it needs to be reported. If you’ve been a victim (or an attempted victim) of Medicare fraud, you need to alert the proper authorities. A number of seniors never report that they have fallen victim to fraud. It’s understandable why, but one way to ensure that it doesn’t happen to somebody else is to make it known that it has happened to you. Read the rest of this article about medicare insurance fraud.

Medicare Insurance Fraud Summary

As you can see from the above information your best defense from medicare insurance fraud is to never give out any information over the phone or to someone you don’t personally know. Even if someone visits your home do not give out personal information until you check them out.