5 ways to save on Medicare - ForumDaily
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5 ways to save on Medicare insurance

Photo: depositphotos.com

Photo: depositphotos.com

Medicare is a complex and often incomprehensible program. says the author resource Time.Money and books about maximizing the benefits of social security in the US Philip Moller. Although everyone should understand it, given the significant impact of this health insurance program, which is used by more than 95% of Americans aged 65 and older, on life. According to the Kaiser Family Foundation, families with Medicare spend 15% of their budget on medicine, while the average in the US is 7%. Wrong choice of plan or skipping the deadline can cost you thousands of dollars, not to mention lost health.

Resource MONEY I chose five important tips from Mjoller's new book, “Take Yours from Medicare: Maximum Benefit, Low Cost” (Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs) - they will help to save money, while receiving the best quality of medical care.

  1. Know the real deadline

The transition to Medicare can drive into a stupor. It is often not entirely clear under what circumstances you need or do not need this plan after 65. An incorrect decision can lead to significant financial consequences.

Suppose you are 65 years old and you are using a group health insurance policy from the current employer — your or your spouse / s. In most cases, you do not need to subscribe to Medicare. The clock starts ticking only when your current working medical plan (or your spouse / s) is finished. After that, you have eight months to switch to Medicare.

When switching to Medicare at 65, the patient receives insurance in Part A (hospitals and other inpatient treatment) and Part B (doctors, outpatient treatment, and medical equipment). As a rule, you need to have these two parts in order to access other Medicare policies — for example, Part D, which covers prescription drugs.

However, not everyone who has health insurance from an employer at the time 65 has reached their age can avoid switching to Medicare. There are very important exceptions.

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If your employer less xnumx employees, then you need to buy Medicare when you reach 65 years, because for small businesses, Medicare automatically becomes the “main” payer of your insurance benefits. Insurance from an employer becomes a secondary source of insurance coverage and helps to cover only those expenses that are not included in Medicare - deductibles, co-payments and co-insurance.

The second exception is if you have retirement health plan from an employer who insures you or your spouse as an employee. As stated above, you must be in an active employer group plan in order not to need Medicare.

You also do not pass if you have legal health insurance COBRA, which allows people to stay on the plan of their employer, paying not only the employer's insurance premiums, but also the costs that he previously covered. If you switch to COBRA at the age of 65 and more, or if you are already on it when you are performing 65, then it is also time for you to switch to Medicare.

In all of the above cases, you may face various financial complications, ranging from 10% premiums higher for each missed year in Part B of Medicare for the rest of your life.

Worse, you can generally be left without basic medical insurance. In most cases, you won’t even guess about it until you get a bill for medical services. Pray for it to be small.

Фото: Depositphotos

Фото: Depositphotos

  1. Use policies Medigap ...

Medigap policies, or Medicare supplement plans, are private insurance plans that cover areas not covered by Part A and Part B (“Original Medicare”). Part B typically only covers 80% of the cost of services and medical equipment—you'll have to pay the remaining 20% ​​yourself.

There is a Medigap 10 standard policy sold by insurance companies. They are called the letters of the alphabet from A to N. According to different letters - different coverage. For example, only some policies (C, D, F, G, M, and N) pay for urgent medical needs for foreign travel — Original Medicare does not cover these costs.

All Medigap plans cover 100% co-insurance of Part A and hospital costs for up to 365 days after the expiration of Medicare bonuses. If you only have Original Medicare, but not Medigap, prolonged hospital treatment will cost you dearly. This simple property of Medigap will save everyone who buys it.

Medigap policies should have the same coverage in all insurance companies. However, the price of the policy of the company can be set at its discretion. They do that. For example, according to the Kaiser Family Foundation, in 2013, the monthly installment of Plan F, the most popular of Medigap, in different states ranged between $ 155 and $ 197.

Why buy Medigap: If you are on Original Medicare, you pay the $ 1 288 deductible for hospitalization. In 60 days, your costs get even bigger. The diagram shows the daily costs out of your pocket: for the days from 61 to 90 - $ 322; up to 60 "reserve days for life” - $ 644; after using reserve days - all costs are full. The numbers are in 2016 year. Source: Medicare.gov

Why buy Medigap: If you're on Original Medicare, you pay a $1 deductible for hospitalizations. After 288 days, your costs become even higher. The chart shows the daily out-of-pocket costs: for days 60 to 61 - $90; up to 322 “reserve days for the rest of your life” - $60; after using reserve days - all costs are full. The figures are for 644.
Source: Medicare.gov

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Since insurance premiums are different, when choosing a Medigap it is very important to compare prices.

After receiving Part A and Part B, you have six months of guaranteed access to Medigap. Insurers are obliged to sell you any of the cash plans they have at your request - they cannot deny you insurance due to the existing condition, nor can they charge you higher insurance premiums due to this condition. In addition, as long as you pay premiums, you can renew your Medigap policies under the same conditions. If you miss a payment, these guarantees disappear.

  1. ... or find for yourself Medicare Advantage

An alternative to Original Medicare (with separate Part D for drugs and Medigap) is Medicare Advantage plans. About a third of Medicare recipients have signed up for them, and their popularity has been growing over the past 10 years.

Medicare Advantage (AI) plans are offered by private insurance companies. They are easier to buy and use than Original Medicare. Moreover, they often cost less, despite the fact that insurance premiums are not paid instead, but together with part B. The premiums already include Part D (prescription drugs), and some pay for dental services. , hearing and vision treatments that are not included in Original Medicare or Medigap.

But the trick is that if you are covered by Original Medicare, you can use any medical company that accepts Medicare patients. And this is a big part of US medical facilities. But according to the plans of MA, you will have to look only for those companies that are included in the network of MA. According to this plan, a list of doctors, hospitals and other institutions is formed. If your doctor and preferred hospitals are included in this network, then great. But if not, you will have to pay an offline service charge or even the full cost.

About two-thirds of AI's plans are medical support organizations that will force you to apply for all medical services in their network (except emergency cases in emergency or out-of-district). Your therapist coordinates your every treatment and directs it to the right specialists. This is usually the cheapest AI plan.

The remaining plans of AI are lists of recommended specialists and medical institutions, which provide greater freedom of choice of doctors and hospitals outside their networks. As a rule, you do not need a referral from a therapist. As is the case with medical support organizations, if you want a Part D policy to pay for drugs, you will have to buy it along with an AI plan - they are not sold separately.

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It is not worth it - this is an urgent recommendation - you should not buy an AI plan, if your doctor and other specialists you have chosen are not in this network (or you are ready to change the doctor, then you can). If you do not know this, then the doctor probably knows. Ask his administrator.

Secondly, if you move several times a year depending on the season (for example, in warm states for the winter), then Original Medicare is more suitable for you, with piece-rate pay for services plus Medigap. In this case, your insurance will be valid where you are. With Medicare Advantage, such a scenario is impossible - their plans are tied to a local network of health services.

Фото: Depositphotos

Фото: Depositphotos

  1. Be prepared to change course if necessary.

Many people believe that once they buy Medicare, they will use it for the rest of their lives. It is not true. Especially in the modern economy, in which many people after 65 regularly work or not.

Let's say you are 65 years old, you happily retired and are insured by Medicare. And then one day you will be offered excellent work with bonuses, which include a good health insurance plan.

If you work actively and can take advantage of your employer's group insurance, you can cancel Medicare without penalty for renewal in the event of re-retirement. The same goes for your spouse if your new plan also covers their medical care.

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Refusing Medicare is a serious decision, so the government requires you to have an interview with a social service representative before filling out the required form. To start, make an appointment with a Medicare social worker. Contact information is on the website ssa.gov/locator.

The only caveat: the ability to opt out of Part D insurance to cover drug costs depends on whether the insurance covers “reliable” insurance coverage for your employer’s plan. “Creditable” is a code word in Medicare, which means that the insurance coverage offered is better or at least the same as Medicare. This information can be checked with the employer.

  1. Revise your drug plan

Part D insurance covering drug costs is optional. But if you are late with the purchase of this plan - within two months after the deadline for the purchase of Part B - then you will have to pay for the rest of your life. For each month of delay, you will be counted 1% of the penalties for Part D insurance premiums. That is, if you bought this insurance four years later, 48% overpayment shines you every month until the end of your life.

As soon as you buy Parts A and B, two ways will open up to Part D. You can buy a separate plan, also called PDP. Or buy Medicare Advantage with Part D — most of them are staffed with them. Such a plan is called MA-PD.

Фото: Depositphotos

Фото: Depositphotos

Useful Tips

What is the benefit of a drug policy if it does not cover the ones you need? The list of drugs that are included in a particular plan is called a formulary. This is the first thing to check when viewing Parts D, because the difference in the cost of a drug, if it is included in the formulary and if not included, can be huge. For example, the popular asthma drugs Advair Discus cost an average of $ 47 by formulary and $ 474 if they are not included. It is best to select a plan based on the medicines you need. service on the Medicare website.

When you enter the names of your drugs in the search plan, the program will look at all existing plans and give them an approximate cost for a year. You can return to your account and correct the list of medicines that interest you.

Using the Medicare plans search, be sure to include the pharmacies you usually use to find out if the plan works in your pharmacy and how it will affect your costs. Part D plans, as a rule, include the desired pharmacy network. Prescription drugs within this network will cost less than if you leave the network and use the services of another pharmacist. If you are limited to choosing a specific pharmacy, what will happen if you order medicines for your prescription elsewhere?

And you should not hope that the excellent plan in 2016 will remain the same in 2017. Cost, forms and other parameters, as a rule, change from year to year.

Medicare gives you the right to easily change not only medication plans, but also general medical plans each year during the open record period - from October 15 to December 7. Be sure to use this right and make sure that as of every January 1 you have the best possible plan. People, as a rule, are reluctant to change their medical insurance, despite the fact that changing the plan is not difficult and beneficial.

See also:

Registration for Medicare on 2017 has started in the USA

Who can get Medicare and Medicaid

Medical insurance in the USA: how to start a choice

5 health insurance tips for those who soon retire

health insurance Medicare Educational program US pension
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