Are you prepared for the possible consequences of buying the Medigap Plan F high deductible option?

The main reason most people buy a Medigap policy is to protect themselves from high out-of-pocket expenses.

In fact, the biggest perceived benefit of owning a Medigap policy is to pay premiums as a (somewhat) fixed expense to eliminate any surprises.

The Plan F high deductible option flies in the face of most people’s idea of why they are buying a Medicare supplement. But there are a number of people who buy the high deductible plan and feel good about their decision.

There are also people who buy high deductible Plan F for the wrong reason… to have a lower monthly premium.

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When the Plan F high deductible option makes sense

First, a little discussion about Plan F. Plan F is considered to be the most comprehensive Medicare supplement you can buy. Plan F pays for:

• Medicare Part A deductible
• Medicare Part B deductible
• Medicare Part B coinsurance or copayment
• Medicare part B excess charges
• Part A hospice care coinsurance or copayment
• First 3 pints of blood
• Skilled nursing facility care coinsurance
• Foreign travel emergency
• Preventative care Part B coinsurance
• Part A coinsurance hospital costs up to an additional 365 days after Medicare benefits are used up

Plan F will not pay anything toward non-Medicare covered expenses, such as elective surgery or dental or vision care not covered by Medicare.

If you choose the Plan F high deductible option you will be subject to a $2000 annual deductible before you receive any benefits. The good news is that your monthly premium will be considerably lower than if you chose the standard Plan F.

There are generally two sets of circumstances that must be present for the high deductible plan to make sense. You should:

1. Be in excellent health and continue to make the right lifestyle choices to maintain that state.
2. Have assets available that would allow you to pay that amount (potentially yearly) without jeopardizing your finances or being emotionally bothered by the requirement.

What you are doing, in essence, is self insuring for the first $2000 of annual medical expenses that would normally be your share for covered services. Original Medicare will still pay its portion first. For example, a $100 doctor visit would require that you pay the $20 yourself. That $20 would reduce the balance of your deductible for the current year.

An alternative way to save money if you don’t fit the high deductible Plan F buyer profile

There have been cases where people who really had no business buying the high deductible option did, for all the wrong reasons. Some people just don’t do the research or are unable to understand the consequences of using the plan they choose.

There are also cases where a commission hungry insurance agent went for all the money on the table rather than discussing the option of choosing a Medicare Advantage plan. After all, buying a Medigap policy is not the right choice for everyone.

If you are uncomfortable with buying High deductible Plan F, there is another plan you should consider that may allow you to save money. Check out Medicare supplement Plan N. There are only a couple differences between Plan F and Plan N. These differences include:

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• You are responsible for the Part B deductible
• You may pay up to $20 for a doctor visit
• You may pay up to $50 for an emergency room visit
• Part B excess charges are not covered

Plan N generally has a lower premium that Plan F and if you are good health, you may realize some savings without exposing yourself to the possibility of paying a $2000 deductible.

Plan N is not offered by all insurance companies, but for those that do, the benefits will be identical as Medigap plans are
standardized.

If you fit the buyer profile for high deductible Plan
F, you may come out ahead. But you should also think about the future. If you need to change plans, there is a good chance that you will be subject to medical underwriting. If this concerns you, do a comparison between the Plan F high deductible option and Plan N.

Should you consider switching Medicare supplement plans?

The majority of people who purchase a Medicare supplement policy stick with it and endure the pain of premium increases. You may find yourself in a similar situation, where you are generally happy with your coverage but not happy that the premiums continue to rise.

There is also a small percentage of people who purchase a Medicare supplement based on the advice of a commission-hungry insurance agent with a limited number of offerings, and realize they have chosen the wrong plan.

If you fall into either one of these groups, you may be wondering whether switching Medicare supplement policies is a good idea. If you are unhappy with your current Medigap policy or if the premium increases are becoming untenable, exploring your options may be the right thing to do.

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Tips for switching Medicare supplement plans

The following tips are primarily for people who are not entitled to either an open enrollment period or guaranteed issue rights. Admittedly, the best time to choose a policy is during these times, but you are not limited to enrollment during these times either.

1. Recognize that a Medicare supplement is not the same as a Medicare Advantage plan, nor is it subject to the same enrollment periods and guidelines. If you are interested in switching Medicare supplement plans, there is no reason to wait until the Fall enrollment period that is in effect for Advantage plans and Medicare Part D.

2. Since Medicare supplement policies are not subject to the same guidelines as Medicare Advantage plans, you will probably be subject to medical underwriting.

3. You should educate yourself to the plans available and what benefits they offer. Comparing supplemental policies is much easier than comparing Medicare Advantage plans because supplements are standardized from company to company. For instance, Medicare supplement Plan F will include the same level of coverage no matter which company is offering the plan.

4. If your aim is to lower the premium, you can either shop different companies for the same plan or explore the option of a plan with less coverage or greater cost sharing such as Medicare supplement Plan N.

5. If you stay with the same insurance company and choose a lesser plan, you may avoid the underwriting process.

6. Compare several companies as premiums can vary widely.

7. Do not cancel your current supplement until you have been issued a new policy and are sure of its effective date.

Your options when comparing plans

You can generally compare Medicare supplement policies in one of two ways; you can contact a local insurance agent or do you shopping online.

When dealing with an insurance agent, it’s best to shop with an agent who represents several companies and can comparison shop companies for the best rate. If you are being shown rates from one or two insurance companies, it’s time to find a new agent.

Shopping for quotes
on supplemental policies online is often quicker and will generally give you a larger choice of companies and plans to choose from. If you are reluctant to enter your email address or phone number, consider calling the company yourself if a phone number is listed. This will put you in the driver’s seat.

It doesn’t hurt to explore your options of switching Medicare supplement plans and may actually save you some money or get you a more suitable plan.

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There are limits to Medicare nursing home coverage

One of the least planned for events is a nursing home stay. Couple this lack of planning with the high annual cost of long term care and you have the perfect recipe for financial disaster.

According to a Genworth Financial 2007 Cost of Care Survey the annual cost of a semi-private room was $65,985. Given the inflation rate for health related services and the increased demand due to the aging population, the figure is more likely greater than $70,000 in 2012.

Many people mistakenly believe that they have unlimited Medicare nursing home coverage as part of their original Medicare or supplemental benefits. But unless you have purchased a long term care insurance policy, your Medicare benefits for a nursing home stay are limited.

The following is a discussion of what your benefits are for nursing home stays as a Medicare beneficiary, what effect Medicare Advantage plans and Medigap insurance policies have on benefits and what you can do to protect yourself.

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Medicare nursing home benefits

The first point about Medicare nursing coverage that you should understand is that long term care or custodial care is not covered. Any covered stay in a nursing home falls under the Skilled Nursing Facility Care category.

Skilled Nursing Facility Care – Original Medicare

Medicare will cover a semi-private room, meals, skilled nursing and rehabilitative services that are medically necessary. These services are covered only after a 3 day minimum medically necessary inpatient hospital stay for a related illness or injury.

To ensure that a stay is covered, you must have your doctor certify that you need daily skilled care such as physical therapy or IV therapy. The fact that a stay in a skilled nursing facility would be more convenient for you and your family is not a reason to have Medicare cover the expense.

Here are the costs if you meet the above criteria:

• You pay $0 for the first 20 days of each benefit period
• You pay $144.50 coinsurance for days 21-100 of each benefit period
• You pay all costs after day 100 for each benefit period

 Skilled Nursing Facility Care – Medigap (Medicare supplement)

If you are enrolled in a Medigap policy that includes Skilled Nursing Facility Care you can either lessen or eliminate your share of the cost for Medicare covered expenses. But note that a Medigap policy will not extend the length of time a stay is covered.

Plans; C, D, F, G, and N will pay 100% of your coinsurance amount. Plan L will pay 75% and plans K and M will pay 50%. Plans A and B will not afford you any supplemental benefit related to a Skilled Nursing Facility stay.

Skilled Nursing facility Care – Medicare Advantage Plans

Medicare Advantage plans are not considered to be supplemental to Medicare, but are rather another way to receive your Medicare benefits. As such, benefits can vary between plans. You will generally not pay anything for days 1-20 and will likely pay less than $144.50 for days 21-100. Often times the coinsurance amount may be as low as $50 per day.

Once again, like a Medigap policy, an Advantage plan will not extend your benefit period. If you are enrolled in a Network-based plan such as a HMO, PPO or HMO-POS you may also be limited as to which facility you are able to receive services from.

Paying for a long term nursing home stay

According to staehealthfacts.org there were over 2.5 million skilled nursing home admissions for Medicare beneficiaries for 2010. Many of those admissions exceeded the maximum allowable length of stay and the resulting costs became the responsibility of the Medicare beneficiary.

There are basically three ways (or a combination of 3 ways) to pay for a long term nursing home stay.

1. Pay for the stay yourself.
2. Utilize long term care insurance that was purchased prior to your stay.
3. Spend down your assets and become Medicaid-eligible.

The average long term nursing home stay is 2.4 years and can be much longer. At over $70,000 per year and rising, it won’t take long to eat through some serious money. Depending on your assets, you may leave your spouse and other dependents without much to speak of.

Unless your employer or union offers group long term care insurance you should look into an individual long term care insurance policy. An individual policy generally requires that you are able to pass underwriting and are healthy enough to qualify. Waiting until it’s time to enter a nursing home is too late!

The unfortunate fact is that most people cannot pay for long term care or cannot pay for the full term of care and also have not purchased a long term care policy. When this happens, the only choice is to qualify for Medicaid. To qualify, the amount of assets you are able to retain is severely limited. And contrary to popular belief, you cannot merely sell assets or transfer them to someone else. Doing  so and trying to qualify for Medicaid under false pretenses constitutes Medicaid fraud. Not good!

Medicare Eligibility and Social Security Disability Guidelines

If you find yourself unable to pay for long term care you may benefit by consulting with an attorney who specializes in estate planning.  You will have to pay for care (spend down) until you meet the qualifications for Medicaid. Once you qualify, you may not have your first choice as to which facility you or your loved one is placed in. Also not good!

Your best course of action (if affordable) is to purchase long term care insurance. Many insurance experts recommend that you purchase a policy before age 60 when the premiums will be lower. It’s also wise to add a rider that will account for inflation and increase the amount of future benefits. It’s also wise to discuss the tax advantages of long term care insurance with your advisor.

The main point to take away, is that Medicare nursing home coverage is limited to the first 100 days. After that, your on your own.

You can enroll in a Medicare 5 Star Advantage plan anytime – but are they available?

One of the major complaints for people enrolled in a Medicare Advantage plan is that they are locked-in for the entire year. If you are unhappy with your plan there has been little opportunity to make a change outside of the annual Open Enrollment Period.

To remedy this situation and reward companies who offer plans that preform well CMS announced last year that beginning in 2012 a New Special Enrollment Period would be available.

The general idea is if you are enrolled in a Medicare Advantage plan that is rated at 4.5 Stars or less or are enrolled in original Medicare and meet the requirements for Medicare Advantage enrollment, you can switch or enroll in a Medicare 5 Star rated plan anytime during the year. You are able to do so one time. But, do you readily have 5 Star rated plans available in your County? And if so, does a 5 Star rating automatically make it a better choice for you?

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Finding Medicare 5 Star rated plans if you would like to switch

Barely a day goes by that I don’t receive a comment or an email asking me how to get out of a Medicare Advantage plan. Often times the comment includes a rant about how the company didn’t live up to expectations. (More about this later).

Here are the steps to determine if you have any Medicare 5 Star Advantage plans in your County:

1. Visit medicare.gov and click, Compare Drug and Health Plans
2. Enter your zip code and click, Find Plans
3. Step 1 of 4: Answer the two questions
4. Step 2 of 4: click, I Don’t Want to Add My Drugs Now… Skip Drug Entry
5. Step 3 of 4: click, I Don’t Want to Add Pharmacies Now…Skip Pharmacy Selection
6. Step 4 of 4: Choose plan type and click, Continue to Plan Results
7. Expand results to show maximum number of plans. Star rating is displayed on the right.

I recommend not adding your drugs and pharmacies initially, as you may waste a lot of time only to learn that no Five Star Medicare Advantage plans are available. It’s also important to expand the number of plan results, as it defaults to ten.

Now we come back to the question of whether or not you have any Five Star Medicare Advantage plans available. CMS routinely beats their own drum about how the Affordable Care act has had a positive impact on Medicare and Medicare beneficiaries, but little is available about the number of 5 Star plans.

A press release from CMS dated February 1, 2012 titled, “Medicare Advantage Premiums Down 7 Percent on Average, Enrollment up 10 Percent“, sheds some light on this lack of information about the number of 5 Star plans.

Some specific data reported includes:

• The average premium for 2012 is $31.54 down from $33.97 in 2011
• 2012 Advantage plan enrollment has risen to 12.8 million from 11.7 million in 2011
• There are an average of 26 plans per County nationwide
• 99.7% of beneficiaries have a plan available

The information about the number of 5 Star rated plans is less specific… “Not only are average premiums lower, but plans are better, with more beneficiaries enrolled in 4 and 5 star plans,” said CMS Acting Administrator Marilyn Tavenner.

Truth or spin?

The CMS Newsroom press releases read like a for-profit company informing you that their products are the best. But how much is spin?

For instance:

• If your premiums went down, did your benefits remain the same or does it cost more to use your plan in 2012?
• With 10,000 Baby Boomers turning 65 every day beginning in 2011 would you expect higher enrollment numbers?
• Are enrollment numbers up because beneficiaries have less disposable income to pay the higher premium of a Medigap policy?
• And why no specific data on the number of 5 Star rated plans? hmmmm….

I’m guessing that there are not very many 5 Star rated plans to choose from…. what do you think?

Why you need to get it right the first time

Back to the emails and comments about being unhappy with the Advantage plan chosen. The stakes are too high to enroll in a plan because the advertising is warm and fuzzy or because it’s the only plan carried by your favorite insurance agent. You have to do your homework. Here are the biggest complaints raised on this site and in emails about Medicare Advantage plans:

• Network restrictions
• Quality of doctors in the network
• Drugs not covered by plan
• No providers for ancillary benefits such as dental

All of these problems can be addressed prior to submitting an application. The time to learn about these possible short falls is prior to signing on the dotted line. Even though there exists a Special Enrollment Period for Medicare 5 Star rated Advantage plans don’t count on it as a guarantee that one will be available in your County.

Here’s when you have Medicare coverage outside the United States

If you plan on traveling outside the United States it’s important to know what Medicare coverage is available to you. The last thing you need are unplanned medical expenses or the inability to pay for any required care.

Medicare coverage when traveling outside the United States is limited, but there are times when you may be protected. You can also take proactive measures to make sure that you don’t run into trouble.

This article will address under which circumstances you have Medicare coverage when you travel beyond our borders and what steps you can take to ensure you are covered for Medical emergencies.

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Circumstances when Medicare will cover you outside the US

The general answer as to whether or not you are covered outside the US is, No… but there are a few exceptions. You may have Medicare coverage under these circumstances:

• If you live near the Canadian or Mexican border and a foreign hospital is nearer or easier to get to than a US hospital you may have coverage for emergency or non-emergency care
• If you are in the US and a foreign hospital is closer you may have coverage for an emergency
• If you are traveling directly to or from Alaska from another State your emergency care may be covered by a Canadian hospital

The bottom line is, care may be covered, there is no guarantee. You should be especially aware of this when you are not in a life threatening situation and a US hospital is not that much further away or more difficult to get to. It should be noted that an extended stay in Canada in the proximity between Alaska and another State will not afford you coverage at a Canadian hospital. The concept is travel without delay between Alaska and another State.

Steps you can take to protect yourself when traveling

If you are a frequent traveler or plan to travel outside the United States there are a few measures you can take to protect yourself. The option you choose should be weighed against your budget and other individual circumstances.

Medigap and Foreign Travel

Purchasing a Medigap policy that includes coverage for a foreign travel emergency may be your best option if it is affordable. Of the ten standardized Medigap policies, six include a foreign travel benefit.

You should note that coverage has its limits (typically $50,000) and coverage is for emergency situations only. Getting an annual while on vacation is probably the furthest thing from your mind anyway!

Medigap plans; C, D, F, G, M, and N all include coverage for foreign travel. If you require any medical attention you should seek that in the US prior to your trip and also be certain that you have enough medications for the duration of your travels.

Medicare Advantage

Many Medicare Advantage plans include benefits beyond what is available by original Medicare. Some Advantage plans may include coverage when you are traveling outside of the US. Coverage may be limited if it is available at all.

It’s your responsibility to read the plan’s Summary of Benefits to learn the extent of coverage available. Do not merely accept an agent’s statement that you will be covered when you travel.

Medicare Advantage plans can also change, delete or add benefits year to year. Be sure to review the Summary of Benefits for the following year’s plan during the Annual Enrollment Period.

Travel Insurance

There are plenty of companies selling trip insurance (although this is not considered Medicare insurance). Some are better than others. Always ask about an insurance companies ratings before making a purchase. The lowest price may not necessarily be your best deal.

Also, be certain that the policy covers medical emergency and is not merely trip interruption insurance. Read the policy so you know what’s covered and what’s not. You can often cut to the chase by reading the plan exclusions. You can also purchase trip insurance even if you have medical coverage through a Medigap policy or a Medicare Advantage plan.

Understanding your Medicare coverage outside the United States is your first step and following through and choosing an option for coverage should be your next if you plan to travel.

Not all diabetic supplies are covered by Medicare

If you are new to Medicare you may be surprised to learn that not all diabetic supplies are covered by Medicare. Knowing which supplies are covered and where to get them will allow you to maximize your benefits and relieve any strain on your budget.

You may also have questions about how different Medicare plans address diabetic supplies. For instance, is it better to be enrolled in a Medicare Advantage plan or insured through a Medicare supplement?

Other questions concern what is covered by original Medicare and what falls under the auspicious of Part D. This article will answer some of these questions and help you understand how different plans handle the costs for diabetic supplies.

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Diabetic supplies covered by original Medicare

When reviewing what’s covered and what’s not covered, it’s best to remember that Medicare was originally enacted to be a safety net and not a comprehensive solution to all health care costs.

Covered Expenses include:

• Blood glucose monitor
• Blood glucose test strips
• Lancet devices (pens, etc.) and lancets
• Glucose control solutions for checking monitor accuracy
• Therapeutic shoes or insoles

Keep in mind that there may be limits on the quantity of testing supplies you can receive in any given time frame. Also, you cannot submit claims for supplies yourself. All claims must be submitted by Medicare-enrolled pharmacies and suppliers. In addition, you must request refills on your supplies, as automatic shipments from suppliers will not be covered by Medicare.

Diabetic shoes and insoles must be prescribed by a podiatrist and supplied by a Medicare authorized provider. The supplier must have a Medicare supplier number in order to have expenses covered. If a supplier does not have a Medicare supplier number, even if the company is well known or a large department store, the costs will not be covered by Medicare.

You are able to get one pair of shoes or insoles once a year and shoe modifications may be substituted in lieu of new shoes or insoles. The cost of fitting new shoes is also covered.

As mentioned above, Medicare is not going to offer comprehensive benefits. As such, you will be responsible for 20% of the approved expense for the supplies listed above.

Non-Covered Expenses include:

• Insulin (unless used with an insulin pump)
• Insulin pens
• Syringes
• Needles
• Alcohol swabs, pads or bandages

Diabetic supplies covered by Part D

Many diabetics rely on Medicare Part D to help pay for their medications. While original Medicare doesn’t cover insulin and related supplies, a Part D plan will. But not all plans are created equal and you must compare plans to find the best benefits for your circumstances.

When comparing plans related to covering your diabetic medications, take the following features into account:

• The Part D formulary (list of covered drugs)
• Tier placement of medications related to competing plans
• Copays, coinsurance and any required deductibles
• Pharmacy network
• Mail order benefits

You can receive your Part D benefits in one of two ways; either join a Medicare Advantage plan
which includes drug benefits (MAPD) or join a stand-alone Part D plan. Many Medicare Advantage plans may also include some ancillary benefits that diabetics may find useful.

If you are receiving your health benefits from original Medicare or through Medicare and a Medicare supplement policy, you should enroll in a stand-alone Part D plan. Most often a Medicare supplement policy (Medigap) will pay the 20% of expenses that you would normally be responsible for.

When comparing the benefits of an Advantage plan versus original Medicare and a supplemental policy, be sure to consider the network restrictions as well as the difference in associated premiums and costs for using your plan.

No matter how you choose to receive your Medicare benefits, know which diabetic supplies are covered and how to receive them can help you get the most out of your Medicare benefits.

Welcome to Medicare check-up and  your yearly wellness visit

Any medical professional will tell you that one key to staying healthy is getting an annual physical. Diagnosing symptoms early and receiving helpful advice related to your lifestyle can eliminate or prolong illness or degenerative conditions.

When you become eligible for Medicare and enroll in Part B you have one year to receive a Welcome to Medicare Physical Exam. But this one time check-up should not be confused with an annual physical.

When you think of an annual physical you generally think of a comprehensive head to toe exam. Your welcome to Medicare Check-up and Annual Wellness visit is not nearly as comprehensive. During a physical you may receive testing or other labs to determine your state of health and you may receive a gynecological exam or prostate exam (you know which one you get!). But don’t expect these tests or procedures to be covered during your Welcome or Yearly visits.

This article will address what you can expect when you receive your Medicare-covered exams.

Medicare Vision Benefits – What’s covered

Welcome to Medicare physical exam

It’s important to schedule your Welcome to Medicare exam soon after you enroll in Part B. You must receive your exam in the first 12 months of having Part B. If you are seeing a new doctor you should bring all your medical records including a list of medications that you are currently taking.

The exam is designed to allow the doctor to gather information so you can be advised about any lifestyle changes or screenings that you may need. The scope of the exam is limited and if additional screening or testing is recommended it will not be considered to be part of the one time exam.

Here’s what to expect at your Welcome Exam:

• Your height and weight will me measured to determine your BMI
• Your blood pressure will be measured
• Your vision will be checked (basic exam)
• The doctor will review your medical history
• Referrals will be given if any additional testing is required

As you can see, this is merely a cursory visit. This visit is more of a fact finding exercise for your doctor to recommend lifestyle changes or additional testing. You will not be required to pay the Part B deductible, but if you are enrolled in original Medicare you will be required to pay 20%.

Yearly Medicare wellness visit

If you have had Part B longer than 12 months you can schedule a yearly wellness visit. The Medicare yearly wellness visit is not much different from the Welcome to Medicare visit. This visit is designed to update a personalized plan based on your current health in order to prevent disease and keep you healthy.

If your doctor accepts Medicare assignment, you will not have to pay for your yearly wellness visit. But, if additional tests or services are required during the same visit that are not covered as preventative benefits, you may have to pay the Part B deductible and 20% coinsurance.

If you are insured through a Medigap policy (depending on the plan) you may not have any out-of-pocket expense for additional services, as the Medigap policy will pay your share. In the event that you are enrolled in a Medicare Advantage plan, you should check the plan’s Summary of Benefits to determine if you will incur any costs for additional services.

It’s good to know what is covered and what is not covered for both the Welcome to Medicare Exam and the Medicare Yearly Wellness Exam so you can be prepared for any additional expenses. So if you are new to Medicare, get the ball rolling and schedule your first exam.

Here’s what you need to know about Medicare if you are receiving Social Security disability benefits

As of December 2011 there were 8,576,000 disabled workers receiving Social Security disability benefits. The average benefit amount was $1,110.50 per month. Although this safety net is surely appreciated by those receiving benefits, the amount is hardly enough for those who are unable to work. Couple that with a lack of medical insurance and you have a real problem.

Social Security disability recipients become Medicare eligible after they have received 24 months or benefits. For many, the wait is is slow downward slide into financial ruin. And once eligible for Medicare, there are a host of other issues to contend with that in some instances, seem like being under 65 and on Medicare qualifies you as a second class citizen.

This article will address your options related to becoming eligible for Medicare and your options related to supplemental plans.

Becoming eligible for Medicare when you are under 65

If you are entitled to Social Security disability benefits and have been receiving benefits for 24 months, you will be eligible for Medicare Parts A and B on the first day of your 25th month. Your enrollment is automatic. You do not have to complete an application or otherwise signal your desire to be enrolled in the Medicare program.

Your Medicare card will be mailed to you 3 months before your 25th month. You will automatically be enrolled in both Parts A and B. You can refuse Part B, but you should consider the consequences carefully. If you refuse Part B, you may save some money on monthly premiums but you:

• Will not be covered for outpatient services like testing and doctor visits
• May have to pay a 10% surcharge on Part B premiums if you enroll later but prior to turning 65
• Will not be able to enroll in a Medicare Advantage plan or buy a supplement (if available)

Should you cancel Part B you will automatically be re-enrolled when you turn 65 and will not be subject to a surcharge. You may decline Part B at that time and may qualify for a Special Enrollment Period later on.

Medicare Advantage, Part D and Medigap insurance

Once you are enrolled in Parts A and B you can join a Medicare Advantage plan. Advantage plans are another way to receive your Medicare benefits that generally affords you fixed copayments and coinsurance amounts for medical services. Many people choose this option to avoid Part A hospital deductibles and the 20% coinsurance required for all Part B services.

You can also enroll in a Part D plan as well. Keep in mind that many Medicare Advantage plans include Part D drug benefits. Joining a Part D plan or Medicare Advantage plan is as seamless as though you were 65. Your premiums will be the same and if a plan is available in your service area, you are able to submit an application. This is not necessarily the case with a Medicare supplement (aka Medigap insurance policy).

The rules for Medigap insurance are different than the rules for Part D and Medicare Advantage plans. It is determined by each State whether or not insurance companies must offer Medigap to beneficiaries under 65. Depending on your State of residency, you may or may not be able to purchase a Medigap policy. Some states will allow you to buy a policy but you may be limited to a specific plan or plans.

If you have the option to purchase a policy, expect to pay considerably more than someone who is Medicare eligible due to turning 65. Sometimes premiums may be up to 2 1/2 times the premium for someone 65 years old. The bottom line is insurance companies who sell Medigap policies would rather not have you as a client if you are on Medicare due to a disability. Their claims experience will be higher and you will statistically be likely to cost them more money.

If you are on Medicare due to a disability you may be better off enrolling in a Medicare Advantage plan. It’s an individual choice (if you have a choice at all!) but given the high premiums
and the often lower incomes of someone on Social Security disability it often makes sense to go that way.

Medicare vision coverage is very limited

As we age, the chances that we will require some type of corrective vision care increases. If you already wear glasses, you know that getting a routine exam and new glasses or contacts can be expensive.

If you were hoping that being enrolled in Medicare would mean that you could get a routine eye exam, glasses or contacts, you are going to be disappointed. Medicare vision coverage is very limited. Like Medicare dental coverage, Medicare vision coverage is geared more towards treating a disease or injury than providing routine maintenance.

This article will address what is covered and what is not. We’ll also look at alternative ways to get vision benefits, the costs of alternative care and the limitations of some vision programs.

Does Medicare Cover Dental?

Eye care that is covered by Medicare

The discussion of what is covered is related to what is covered by original Medicare. We’ll also take a quick look at coverage if you are enrolled in a Medicare Advantage plan or have purchased a Medicare supplement policy.

Here’s what’s covered:

• Glaucoma Screening once every 12 months. You must pay 20%.
• Eye Care after cataract surgery (even if surgery was be fore you were Medicare eligible) including cataract glasses, contact lenses or interocular lenses provided by an ophthalmologist. You pay 20%
• Treatment for macular generation is provided for some patients with age-related macular degeneration. You are responsible for 20%.
• Eye prostheses and maintenance is covered. You must pay 20%.

Refer to the Medicare and You Handbook or visit medicare.gov to get the specific details of coverage for the above listed procedures.

As you can see, there is no mention of routine eye exams and required glasses or contacts. If you are enrolled in original Medicare, you are on your own when it comes to paying for these products and services. You may be thinking to yourself that it’s not very fair that these services are not covered by Medicare. Keep in mind that when Medicare was first enacted it was designed to be a safety net not an all inclusive program. Like it or not!

Vision coverage with a Medicare Advantage plan or Medicare supplement

Most people either supplement their Medicare coverage by purchasing a Medigap policy or they receive their Medicare benefits by enrolling in a Medicare Advantage plan. Here’s what you can expect with either type of Medicare plan:

Vision Benefits with a Medicare Advantage Plan

When you enroll in a Medicare Advantage plan you are still enrolled in original Medicare but receive your benefits from a private insurance company that is contracted with CMS. Companies that offer Medicare Advantage plans have the latitude to provide benefits beyond what would normally be available with original Medicare. Vision coverage is often one of those benefits.

This does not mean that all Advantage plans include vision benefits nor does it mean that benefits are actually in the form of insurance. Benefits may be in the form of discounts on products or services. There is no standardization and it’s your responsibility to review benefits from plans you may be considering.

Vision coverage available from a Medicare Advantage plan may be included or may be available in the form of an optional rider that requires an additional premium. If a premium is required, the benefits are probably in the form of actual insurance (which is better) rather than merely a discount.

Vision Benefits with a Medicare Supplement (Medigap Policy)

When you buy a Medicare supplement, you choose from one of several standardized insurance policies that are designed to fill the gaps of original Medicare. But herein lies the confusion. The gaps are in the form of payment for services, not the services themselves. So the plan may pay the 20% portion of Medicare-covered services that would normally be your responsibility.

The key phrase is, Medicare-covered services. remember that routine vision care is not a Medicare-covered service. That said, Medicare
supplement policies generally do not cover routine vision. A company selling Medicare supplemtental insurance may include some ancillary vision benefits so as to sweeten the pot so to speak to give them a competitive edge in earning your business, but it’s not required.

For instance, when you purchase an AARP-branded Medicare supplement from UnitedHealthCare you often receive some vision benefits. These benefits are technically not Medigap benefits, but rather ancillary benefits. Either way… take them and use them!

Conclusion

Unless you are actually paying extra fro vision benefits, the coverage will often be limited and may only afford you a small discount. You will also normally be limited to a network of providers where you can utilize your benefits. The other option is to purchase stand-alone vision insurance. Should you choose to do so, review the limitations, waiting periods and deductibles. Often when you factor in the premiums and how often you would use such benefits, you may be better off self-insuring.

Hopefully this helps you understand what Medicare vision benefits are available and options on securing coverage. The limited nature of what eye-related coverage you have with Medicare is good reason to factor it into your budget as a regular expense, so when it arises it will be less painful.

Are you still working but have questions about signing up for Medicare?

If you are  eligible for Medicare and still working, signing up for Medicare may be on your mind. But your individual circumstances determine how you should approach signing up for Medicare.

Should you sign up for Part A only or should you sign up for Parts A and B? And what about Part D? Should you sign up even if you have prescription drug coverage at work?

These are all valid questions and there is not one answer that fits all circumstances. The type of group health insurance you have, the size of your employer and the type of prescription coverage you currently have all play a part in determining which is the best course of action.

The following Medicare sign-up tips will sort out some of the issues that you should consider and will allow you to make a more informed choice about your Medicare options.

Retirement Survival Guide Review

Should I sign up for Medicare Part A?

If you are eligible for Medicare and still working you should sign up for Medicare Part A. Even if you have insurance through your employer or union, Medicare Part A may cover some of your medical costs. As long as you have worked at least 40 quarters over your lifetime you will not have to pay a premium for Medicare Part A.

About the only time you should not consider enrolling in Part A is if you are still working and insured through your employer or union and have not worked 40 quarters. In this case, if your insurance coverage is adequate you may want to postpone enrolling in Part A until you have either accrued 40 quarters of work or until you retire.

Should I sign up for Medicare Part B?

This question is best answered by examining your individual situation. If you have adequate coverage through your (or your spouses) group insurance, you may want to postpone enrolling in Part B. Pert B requires that you pay a monthly premium. The monthly premium for 2012 is $99.90 for most people and more for those people with higher incomes. (More information on Part B premiums.)

Not only is Part B costly, but you may be duplicating coverage with little benefit. If you work for a company with more than 20 employees, the group policy is the primary payer. If you work for an employer with less than 20 employees, Part B is the primary payer. If the later is the case you may want to speak with your Human Resources department or benefits department to get their input as to whether or not enrolling in Part B would be beneficial.

Another big concern about enrolling in Part B before you really have to is your Medigap open enrollment period. During your Medigap open enrollment period insurance companies cannot use medical underwriting as a reason not to sell you a policy. Your open enrollment period begins on the first day of the month you are both 65 or older and enroll in Part B. The enrollment period lasts for 6 months.

Enrolling in Part B too soon could:

• Cost you money needlessly
• Duplicate your current coverage
• Disadvantage you by wasting your Medigap open enrollment period.

Should I enroll in Medicare Part D?

If you have insurance through your employer or union, you more than likely have prescription drug coverage. The key to whether or not you should enroll in Part D when you are first eligible is whether or not your prescription drug insurance is deemed to be creditable coverage by Medicare.

Your employer can tell you if your coverage is deemed to be creditable. If it is creditable and you feel your coverage is adequate you may want to hold off on enrolling in Part D to save money on Part D premiums. If, on the other hand, your coverage is not considered creditable, you should enroll in a Part D plan to gain better coverage and eliminate any possibility of paying a late enrollment penalty. If your coverage is creditable you will not be subject to a late enrollment penalty when you give up your employer or union coverage.

These Medicare sign-up tips reinforce the fact that there is no one-size-fits-all answer as to whether or not working seniors should sign up for Medicare. Certainly, if you are Medicare eligible and still working without group insurance coverage, you should enroll in Medicare, but if you’re still working, you should consider your situation carefully.