New To Medicare
What you need to know.
Patience is needed when you are learning about Medicare.
The topic can be overwhelming but if you have the right material and a coach available when you start, the process can be much easier.
We encourage you to follow the material on this page. Why? The courses presented here were prepared by CMS. They are easy to follow and understand. CMS is the authority on Medicare. We are here to help Idaho residents along the way.
Why? Because understanding Medicare’s rules and how this market works puts you in the driver’s seat. You will understand enrollment periods, avoid late enrollment penalties and the difference between Medigap and Medicare Advantage plans (and insurance companies).
You will also learn the differences between the individual plans and how the marketplace changes annually.
These changes can affect your health care choices, flexibility and pocketbook.
If you want help with this…
Read the information below OR call us.
If you call, I will explain the information you need to know and answer your questions. I am licensed with all of the Medigap plans, most of the Medicare Advantage and prescription drug plans available to Idaho residents. Read the particulars here.
I am a broker that specializes in Medicare AND an Idaho native. Idaho residents have benefited from my services since 2012. Learn more about me here.
Why Can’t I keep My Market Place Plan?
There is a wealth of information authored by Health and Human Services (HHS) and published on the HealthCare.gov website you need to read. If you are wondering if you can keep this plan and avoid joining Medicare, read the information available here. Hit your back icon on your browser to return to this page.
This will answer questions such as:
Can I choose Marketplace coverage instead of Medicare?
What if I am retired and don’t have Medicare?
Can I get a Marketplace plan in addition to Medicare?
New to Medicare: Getting Started.
Please take the time to read/review the document titled ‘Medicare and You’. You should have received a copy of this in the mail before turning 65; current copies are available here. This is well organized, easy to read and understand, and is up to date on the pertinent information you need to know.
When and How You Can Sign up.
If you are just turning 65.
There are important dates and circumstances you need to be aware of when you are about to turn 65. Making the right decisions in a timely manner will help you avoid monthly ‘late enrollment penalties’ if you miss these dates.
CMS recently updated their webpage on Medicare enrollment rules.
Medicare enrollment periods and how to enroll in Medicare are explained in a recently updated article on the CMS.gov website (available here).
If you miss your initial enrollment period for Part A, Part B, or Part D and choose to enroll at a later time, you may see a ‘late enrollment figure’ added to your monthly for these parts of Medicare. They will be in place for your lifetime. Learn about these costs here.
If you worked after age 65 and will be retiring in the next 6-months.
There is a section on the ‘Medicare and You’ booklet downloaded a few moments ago that goes over this. If you skipped reading this, please go back and review the current ‘Medicare and You’ document.
Learn why your Part B and D monthly premiums may be higher than other’s here.
If you are being charged the IRMA, you may be able to lower this figure. Learn more here.
Know your enrollment time frames for Part C, and Part D.
Enrollment periods for Part C (Medicare Advantage) and Part D (Medicare Prescription drug plans) have their own rules for enrollment. They are reviewed here.
Medigap (Medicare Supplement) plans have their own rules for Idaho residents new to Medicare…this is a ‘Must Read section.’
Medigap (Medicare Supplement) plans have their own rules for enrollment. Individual States can modify federal laws on Medigap plans. Be sure you are aware of these.
Why? In Idaho there is only one ‘open enrollment period’. If you miss this and want to enroll in one of the 10 Medigap plans, you may have to answer the questions on your health history. Based on your answers your application can be rejected.
If you prefer a Medigap plan, it is important to enroll in a Medigap plan during your single (one-time) ‘open enrollment period’. Learn more about Medigap enrollment periods here.
Medigap plans in Idaho also have ‘Guaranteed Issue’ enrollment periods. Learn more about these by reading pages 21-24 of the Medicare produced document found here.
What you should know about Medigap plans available in Idaho.
Keep these core features of all 10 Medigap plans in mind when you are deciding what is right for you. These are:
· Any doctor/hospital in the USA that ‘accepts assignment’ is considered in-network for you. This means you are not limited by the ‘network’ rules and increases costs found in HMO and PPO plans. Also, ‘prior authorizations’ are not an issue. Read this information to learn what ‘accepts assignment’ means.
· Be sure you understand Medigap plans. We suggest you read pages 6 – 24 of the ‘Choosing a Medigap Policy’ referenced above.
The key to understanding the differences between each of the 10 Medicap plans is on page 11 of the document titled ‘Choosing a Medigap policy’.
If you want comprehensive health care coverage when on Medicare, we feel Medigap Plan G is the preferred choice.
If you completed reading the ‘Medicare and You’ booklet, these descriptions of Part A and B covered services is much easier to understand.
Take a close look at the coverage differences between Plan G, Plan F, and Plan N.
Interested in Plan F? We suggest you focus on Plan G or Plan N.
If you have an interest in Medigap Plan F, we encourage you to focus on Medigap Plan G or Plan N.
Why?
If you are new to Medicare (Part A/B effective date is January 1, 2020 or later) you cannot enroll in a Medigap Plan F of C. This is a Federal law change.
With Plan G you will get the equivalent coverage for a lower annual out of pocket cost. How much can you save with Plan G when compared to Plan F? You can calculate the savings by simply multiplying the monthly premiums for both Plan G and Plan F by 12. Since Plan G requires the plan member to pay the annual Part B deductible, you have to add this figure to the annualized Part G premium. Now compare the annual out of pocket cost for Plan G to Plan F. Plan G is typically lower than any of the Plan F policies offered by any insurer in Idaho.
We Suggest Idaho Residents skip Medigap Plan K, L, and M.
We advise people to skip Medigap Plans K, L, and M because of their low national enrollment. When referencing the above mentioned premium chart, notice the number of companies offering these plans in Idaho. They plans really haven’t caught on with the insurance companies. If these plans do catch your attention, take a closer look at the Hi-deductible version of Plan G.
We Recommend Idaho Residents Avoid Medigap Plans With The Lowest Monthly Premium
Typically we do not recommend Medigap plans with the lowest monthly premiums and avoid insurance companies that have been in the Medigap business less than 4-years. To learn more about our thinking on the above read the material found here.
Residents living in Idaho Counties with a low population or only have a choice of Medicare Advantage plan(s) with a premium above $70/month.
We recommend Idaho Medicare beneficiaries that live in Counties that have either no Medicare Advantage plans OR plans with monthly premiums above $70/month focus their attention on the Medigap plans.
People that prefer to have access to all doctors/hospitals that ‘accept assignment’ throughout Idaho or the rest of the USA should also focus their attention on the Medigap health plan solution.
If you have questions on Medigap plans available in Idaho, call us.
New To Medicare: What you should know about Medicare Advantage plans
Keep these features in mind when you are new to Medicare and are considering a Medicare Advantage plan. They are:
Plan availability (in Idaho) is based on your County of Residence.
There are some Idaho Counties with no plans and some with over 45. Be sure you are aware of your choices and individual plan differences.
What can be different? The hospitals and doctors available to you, whether you need permission from your primary care physician to see a specialist, the out of pocket costs to use the different services that are covered by the plan (like inpatient hospital stays, MRI/CAT scans, cost to see a specialist, etc.). Pay attention to your plan’s ‘Maximum out of pocket limit’ and copays for ‘skilled nursing care’. Call if you want to confirm why understanding these features are important to know.
If you are considering a PPO plan be sure you understand the rules for using out of network doctors/hospitals AND what you pay for those services, etc.
We can help you navigate your way through all plans available to you. We are licensed with most all Medicare Advantage plans available in Idaho Counties.
Other items to be aware of.
· The same plan may be available in multiple Idaho Counties but their monthly premiums and copays/coinsurance may be different when you use plan services. Their networks may be different too.
· If you live in a rural Idaho County, we recommend you read this information.
· If a Medicare Advantage plan with a monthly premium above $70/month, catches your attention, please read this information.
Call us if you are not sure of the monthly premiums of the plans available in your County. We will go over your options with you.
· Be familiar with the commonly overlooked tid bits about Medicare Advantage plans.
Trial Rights.
· Be aware of your ‘trial right’. If you enrolled in a Medicare Advantage plan when you were first eligible for Medicare Part A at age 65 and are still within your first 12 months of doing you have a ‘trial right’. This means you could cancel your Medicare Advantage plan and get your Part A and B services by ‘Original Medicare’. When you do this you can also enroll in a Medigap and/or a prescription drug plan.
Remember, you can change Medicare Advantage plans annually between October 15 and December 7th each year. If you missed this time period, you could also change plans during the ‘Open Enrollment Period’. This starts on January 1 and ends on March 31. Learn more here. Why would you change plans?
The details of Medicare Advantage and Prescription drug plans can change annually.
Because next year’s version of your current plan (and all other plans available to you) can and often do change their monthly premiums, copays/coinsurance when you use plan services, which services require prior authorization, plan rules, the medications covered by the plan (and how much they will cost you for a refill).
Don’t forget the plan’s doctors/hospitals can change during the plan year as well as annually. You need to confirm each year your preferred doc’s and hospitals remain in your plan’s network.
Be aware your health history is NOT reviewed when you change plans. Insurance companies offering this plan type are required to accept all eligible applications irrespective of your health.
If a PPO plan catches your attention, be aware the 1st time you use ‘out of network’ services, your maximum out of pocket limit moves to the PPO out of network MOOP figure. This is typically higher and if you just use in-network services. if you go out of network to get major services done, this may be the easiest way for you to hit your plans MOOP for out of network.
We recommend you do some basic research on the quality of health care available from your plan’s in-network resources. An easy to do this is to check out your hospital’s Medicare star rating. We prefer 4 – 5 star rated facilities. Be aware this is a hospital rating, not necessarily a measurement of the quality of surgical work performed. Keep in mind medical care is making advances all of the time. As clinical trials prove new methods of surgery improve both survival rates and lower the impact on recovery times, these advances can take time to trickle down to local hospitals and physicians. For example, check out the recent improvements in knee replacement surgery found in this material. You may learn new questions to ask the surgeons on your short list.
Prescription drug coverage can be included in a Medicare Advantage plan.
· Many of the Medicare Advantage plans available in Idaho also include prescription drug coverage. The monthly premium for these plans is comprised of the health plan’s premium as well as the premium for the prescription drug plan’s. Their total is presented to you as a single premium.
· Some Counties have Medicare Advantage plans that do not include prescription drug coverage. If you receive prescription drug coverage from the VA or some other retirement plan that includes ‘creditable coverage’ (definition available here) this plan choice may be attractive to you. We can help you with this.
Do you want unrestricted access to doctors and hospitals in the US that accept Medicare?
We recommend you consider a Medigap plan if you prefer access to any doctor/hospital that ‘accept assignment’. This means in Idaho and the rest of the USA. Learn more about Medigap plans here.
There are annual reports which identify the top 50, 100 and 250 hospitals in the US by type of surgery. Being familiar with these hospitals may put you in a better position to ask questions to your local options. Learn more about this here.
If you want help understanding the differences between the Medicare Advantage plans available where you live and your Medigap plan choices, please contact us.
New To Medicare: What you should know about Medicare Prescription Drug plans.
Take a few moments and review he material here. This web page is updated annually and reviews the plans available to Idaho residents.
Be aware Medicare Star ratings can and do vary between plans and the star ratings can change annually for each plan. We encourage you to learn more about the star ratings.
Learn more about Medicare star ratings for prescription drug plans here.
One of the consistent concerns people I talk with have is ‘will the insurance company cover any new med I am prescribed’. If the med is not on the plan’s formulary, the plan can say ‘no’. You and/or your prescribing physician can file an ‘appeal’ with the plan requesting them to cover the med.
When you review the sub-components of the plan’s star rating, you will see how the plan typically responds in this situation. We prefer plans that work with their customers if they are in this situation.
We do not recommend any plan with a star rating below 3.
Why? We feel insurance companies offering plans with the low ratings are aware of the issues and have had plenty of time to resolve them…and have chosen not to do so.
Medicare Advantage plans with prescription drug coverage included.
· You cannot join a prescription drug plan available to people that stay with Original Medicare. People that choose to stay with Original Medicare (have not enrolled Part C), have a choice of several plans.
An important rule to be aware of is if you enroll in a Medicare Advantage plan with prescription drug coverage AND then enroll in a ‘stand-alone’ plan, Medicare will disenroll you from your Part C plan and your health care will be available via Original Medicare.
· Not all prescription medications are covered by Medicare prescription drug plans
· Medicare has a master list of drugs for which they subsidize our refill cost. This list is called a ‘formulary’. Each plan available to you can have its’ own ‘formulary’. Medicare has specific rules and regulations each company must follow when putting their own formularies together as well as other rules the insurance companies must follow.
Other important information you need to know.
· The number of plans available in Idaho can change annually.
· The details of Medicare prescription drug plans can change annually. What can change includes: monthly premiums; the covered medications; medications can be moved from one of the plan’s tiers to a different tier; the copays/coinsurance the plan charges to fill/refill medications; the plan’s deductible; management rules (prior authorization, step therapy, etc.).
When these features change, your annual out of pocket cost for the medications you take can change.
Should you change Prescription drug plans to save money?
· You can change plans annually between October 15 and December 7th. If are enrolled in one of these plans and choose to not switch plans during this time period, you are automatically re-enrolled in the same plan next year. If you choose to change plans, you do this by enrolling in another plan during this time period. Your new plan will be effective on January 1 of the following year. When you enroll in a plan you are agreeing to stay with the plan for the calendar year.
· We recommend everyone with Medicare prescription drug coverage compare their current years plan to next year’s version of all plans during the annual election period.
Why? Because next year’s version of your current plan may drop one or more of the med’s you take, may move medications you take from one drug tier to another (which could affect your out of pocket cost), their plan’s rules may change, or other adjustments can be made which will affect next year’s annual out of pocket cost for you. Other plans available to you may offer better coverage and value to you if you change plans. Call us if you want help with this.
Important plan documents to read every year.
Each plan provides its members with a document called the ‘Evidence of Coverage’. When you enroll in a plan, you will receive this. This document defines the relationship the plan has with its members as well as outlines the plan’s other rules. This document is a ‘must read’.
The Annual Notice of Change is a must read document.
On or about October 1 of every year your current insurer will send you a copy of their ‘annual notice of change’. Read this. Then verify if next years version of your current plan continues to cover all of your med’s. Also check to see your meds were placed in a different drug tier. Then look at how much fill/refill costs are by tier. Be sure and check to see if the plan added ‘management tools’ to the med’s you take. This includes ‘prior authorization’, ‘quantity limits’, or ‘step therapy’. If they did, learn what you have to do before you get your first refills for next year. Your annual out of pocket costs can easily go up if you do not check this out. There may be other plans available for next year with a lower cost. If you want help with this, call us.
Help is available for you to pay for your medications.
If you meet income and asset requirements, Medicare may help you pay for your plan’s monthly premium and medication refill cost. Learn more about this here.
To learn more about plans available in Idaho, we recommend you read the information found here.
What you should know about programs that help pay for your health care.
Medicaid is a Federal and State program that helps people (that qualify) pay for their health care costs.
If you feel you qualify for Medicaid and Medicare, call the Idaho Department of Health and Welfare. They are available on 1-877-456-1233. Let them know you would like to apply for Medicaid and/or ‘Extra Help’. ‘Extra Help’ is a government program that helps people pay for their prescription medications.
How we help you.
We help Idaho Medicare-eligible residents understand Medicare and the differences between plan choices. Other services include answering questions and help people enroll in the plan(s) they feel are right for them. We also check back annually to see if their coverage needs to be updated.
Our hours are 8am to 8pm Monday through Saturday. Our goal is to be available when you have questions or need help.
People in all 44 Idaho Counties benefit from our services. Residents in the Boise and other nearby area can meet with us face to face (covid guidelines are followed) or over the phone. People living in other parts of Idaho our work is done over the phone and using the internet as a tool to reference needed resources.
CMS is the author of the information we use as visual aids when talking with you on the phone. Having access to the internet while we talk will help you understand the information…and you can refer back to it later.
It is normal we talk with people at least twice and quite often more.
Our goal is simple. We help you understand Medicare and understand the differences between your health insurance choices. This means finding plans that fit your retirement budget and meet your needs. I am on Medicare myself and have been through what you are feeling.
You can learn more about myself here.
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