Top 5 Common Medicare Mistakes

Common Medicare Mistakes

There are a few birthdays that are important to people in the USA. Every birthday until the age of ten is significant for a kid and their family. Then, the next big one is usually sixteen, where you finally get your “freedom” and can drive a car. Eighteen is the next big one, where you can officially say you are an adult. After that, turning twenty-one is the last big birthday for most people.


But, after the twenty-first birthday, the rest of your birthdays won’t be the same in terms of gaining new legal privileges like driving a car, or being able to go to a bar. Sure, your car insurance cost will decrease at twenty-five – but most people won’t be celebrating that!


Turning 65 is when most people will have to make a few big decisions that will affect them for years down the road. These are your choices regarding Medicare. As with any big decisions, it is very important to be informed to avoid any mistakes. But getting informed isn’t always easy, especially with everyone's busy schedules these days. So we’ve laid out the top 5 mistakes people make when turning 65, so you can be ready when the time comes. Continue reading below to see them.


1. Waiting too long to learn about the Medicare basics


This is the first mistake you should watch out for. If you wait too long to learn about Medicare, you can find yourself in a bad place. There are quite a few things to learn about, but the big ones are:


  • Medicare Advantage Plans
  • Medicare Supplement Plans
  • Medicare Part D Prescription Drug Plan


When folks come to us with questions, we recommend they start learning about these things about 3 months before their 65th birthday. By doing this, you make sure you’ll have time to make informed decisions and not be pulling your hair out at the last minute. Or worse, by waiting to learn about your options, you could easily end up on the wrong plan. If you are on a plan that isn’t right for you, it can be expensive down the road while also not providing you with the coverage you need.


2. Not taking Medicare Part B when you are eligible for it


Not enrolling in Medicare Part B when you are eligible for it may make sense for a few reasons. Sure, it may save you some money by not having to pay the Part B premiums. But when the time comes and you actually need your Part B coverage, you will have to pay a penalty in addition to your monthly premium, for the rest of your life. It is easy to see how expensive that can be.


Without Part B coverage (or any other health insurance), hospital visits and stays will likely result in very high medical bills. This can be avoided by simply enrolling in Part B when you are eligible.


3. Buying the Most Expensive Plan


This may seem like not a real mistake, but it certainly is. When it comes to Medicare plans and coverage, buying the most expensive plan and calling it a day is more than likely one of the worst decisions you can make.


Some plans that cost $150 /month, say a Medicare Supplement Plan F, can cost you $75 /month for the same coverage. In this case, you would be throwing away that extra hundred dollars every month.


Or, there may be a Medicare Advantage plan that costs $100 /month. In some cases, you could have gotten the same coverage for $40 /month, or even free!


This is why it is important to do your research and be informed, so you can get the best plan for your needs! At Idaho Elite Care, we want to get you the plan that will make sure you have exactly the coverage you need. Everyone’s needs are different, and we always take into consideration what your needs are and what you feel is important.


4. Taking Plan Recommendations from Friends/Family


When it comes to Medicare, there is no one-size-fits-all. Sure, a certain plan may have worked out well for someone you know, but they may not have the same needs as you.


The best plan for is more than likely different than the best plan for your friend/ co-worker/ neighbor/husband. Whether your health needs are more important, or if you are looking for something cost-effective, it is important to make choices that suit you.


5. Choosing the Wrong Type of Agent to Help You Enroll


While some folks will feel comfortable doing the research themselves and enrolling on their own, most people will end up asking a professional for help.


When you are looking at agents to help you enroll, there are a few types to avoid. The first are lazy agents that only will seek to sign you up when you turn 65. After the helping you with the initial enrollment, they never reach out to contact you or see how things are going.


And then in the future, when your plan changes and you have questions, you will have a hard time getting in contact with them to help you again. At this point, you will probably have to get another agent to help you start over.


At Idaho Elite Care, we give you all the information and guidance needed to get through your enrollment successfully, with exactly the coverage you want. And if you choose us to help you with your enrollment: we have a dedicated team that ensures that you are satisfied with your coverage, even if your needs change. We are always here to help.


The other types of agents are the kind that can only represent one company. These types of agents are called “Captive Agents.” Because these agents can only represent one company, they won’t be able to help you switch to a different company that may have a better plan when the time comes.


Sure, when you enroll, they may have a plan that fits you. But when it comes time to change your plan because your needs changed, they won’t be able to get you the best plan because they can only represent one company that provides Medicare plans. In other words, you don’t get to “shop around” for the best price if you choose to work with a captive agent for your Medicare.


Why Choose Monica Nelson in Idaho Falls, ID for Medicare help?


At Idaho Elite Care, we are independent. This means we can shop around to multiple carriers and get you the best plan for your needs, at the best price. We represent all of the top plans, and by doing so all of the best plans are available to you.

This also means that when your needs have changed, we can help you shop around for plans and get you on to a new one that you will be happy with.

Or, if you want some questions answered, simply get in contact with us by using the "Contact Us" page and we will reach out to you for a personal Q&A session! You can also use the Chat Function on our website to send messages directly to me

And of course, please share this article with anyone that you think will benefit from it!

How Can Your Current Medicare Plan Change Next Year?

By John Ellis • December 19, 2022
Many people are reluctant to change their Medicare Part D or Medicare Advantage plan coverage year-to-year. However, millions of Medicare beneficiaries will see significant changes in their Medicare costs and coverage. If you are staying with your current Medicare plan into next year, please be sure to review your plan’s Annual Notice of Change (ANOC) letter and use this list to help you look for important coverage changes that might impact your coverage next year. And remember, there are no health-related questions should you decide to change your Medicare Advantage plan or Medicare prescription drug plan (however, Medicare Advantage Special Needs Plans require that you meet the plan’s specific “need”). Your Medicare Plan May No Longer Be Offered Next Year Many folks are currently enrolled in a Medicare Advantage plan (MA or MAPD) that will no longer be available next year. We can help you determine what will be happening with the plans you are looking at, or the ones you are currently enrolled in. You May Be Automatically Reassigned to a Different Medicare Plan Next Year Every year, many people enrolled in Medicare Advantage and/or Part D Standalone plans are automatically "crosswalked" into another plan for next year. Normally, you will be notified if you are in this group but we are more than happy to help you know for sure. Your Medicare Plan May Change It's Name Sometimes, your Medicare plan (no matter what type it is) may be changing its name. Along with a name change, it could also have different features. Your Monthly Medicare Part D Premium May Be Increasing Many Medicare beneficiaries will see their monthly Medicare Part D premium increase 20% or more. Some people currently enrolled in a Part D plan will see their plan premium double next year. The good news is that there is a group of people that will see a premium decrease of 10% to 63% next year. Please keep in mind that in addition to lower-premium Part D plans, there may be low- or $0 premium Medicare Advantage plans (MAPDs) available in your area. Your Plan’s Initial Deductible May Increase Typically, the Medicare Part D deductible increases year-over-year. The exact amount can also depend on your situation. Your Medicare plan’s Initial Coverage Limit (ICL) may change Almost all stand-alone 2022 Medicare Part D plans use the standard Initial Coverage Limit (ICL), though some 2022 Medicare Advantage plans offer an ICL other than the standard — ranging higher and lower. Your drug plan’s ICL sets the boundary between your Medicare Part D plan’s Initial Coverage Phase and the Donut Hole or Coverage Gap. The ICL is measured by the total retail value of your prescription drug purchases. You can contact American Senior Benefits for detailed information on the Medicare Advantage plans that have an increased or decreased Initial Coverage Limit. Your Medicare Plan’s Cost-Sharing Can Vary Significantly Between “Preferred” and “Standard” Network Pharmacies Year-over-year, certain stand-alone Medicare prescription drug plans (PDPs) will use different cost-sharing for preferred vs. standard network pharmacies. As an example, your plan might have a co-payment of $0 for a Tier 1 medication at preferred network pharmacies and, for the same Tier 1 drug, a $5 co-pay when purchased at a standard network pharmacy. Your Medicare Advantage plan's Maximum Out-of-Pocket (MOOP) Limit May Change The Medicare Advantage plan MOOP threshold limits how much you will spend on co-payments and co-insurance for in-network, eligible Medicare Part A and Part B coverage. It can often change year-over-year for plans and it is important to be aware of these changes. The Bottom Line for Medicare Enrollees If you decide to stay with your current Medicare Part D or Medicare Advantage plan into next year– AND you understand how your Medicare plan is changing – you do not need to do anything – you will be automatically re-enrolled into your Medicare plan along with any changes your plan is making for the coming year. If your Medicare plan is being terminated in coming year and you are not merged or “crosswalked” to another Medicare plan, you may be without Medicare plan coverage on January 1st. We are always happy to clear up any confusion when it comes to these Medicare changes that you should be aware of, so please feel free to reach out whichever way is most preferable for you.

How to Compare Medicare Advantage Plans

By John Ellis • December 19, 2022
When it comes to Medicare Advantage plans, there are several factors to consider. Comparing these plans and knowing what to look at are crucial steps. Keep reading to learn more about Medicare Advantage plans, along with how they work and what you should consider when comparing the different plan options. A variety of benefits is offered by Medicare Advantage, which is also called Medicare Part C. Some people prefer the convenience offered by having all their drug and health benefits covered under one plan rather than enrolling in the stand-alone Medicare Part D coverage. Someone may also be looking for additional benefits that the original Medicare plan does not cover, like routine dental and vision coverage. Keep reading to learn more about Medicare Advantage plans, along with how they work, along with what should be considered when comparing the different plan options. What is a Medicare Advantage Plan? A Medicare Advantage plan is an alternative to Original Medicare, which includes Part A and Part B. Rather than having Medicare benefits provided through a government-run program, people who receive the coverage can obtain it through a Medicare Advantage plan, which is provided by private insurance companies that have been contracted with Medicare. For someone to be eligible to receive Medicare Part C, they must: Currently have Part A and Part B Medicare coverage Reside in the service area for the Medicare Advantage plan being considered Not be end-stage renal disease patients (there are a few exceptions) According to the law, all the Medicare Advantage plans are required to offer, at a minimum, the same amount of coverage as the original Medicare Part A and Part B Plans. However, some plans will cover other benefits, too, like dental, vision, hearing, prescription drugs, or specific health wellness programs. Unlike the original Medicare plans, if someone wants prescription drug benefits, which is provided by Medicare Part D, they should not enroll in a separate Medicare Prescription Drug Plan. A better option is to get the benefit from one of the Medicare Advantage Prescription Drug plans. Not all Medicare Advantage plans will include coverage for prescription drugs, so it is a good idea to double-check with the particular plan being considered. Tips for Comparing Medicare Advantage Plans Since Medicare Advantage plans are provided through any Medicare-approved private insurance company, the cost and the benefits may vary from one plan to another. Also, not all plans will be available in every location. When someone is comparing the Medicare Advantage plan options, there are several things they need to consider. Does the Monthly Premium Provide a Good Value? Some of the Medicare Advantage plans will have premiums that are $0; however, the individual must continue to pay their Medicare Part B premium, along with deductibles, coinsurance, and copayments, that the plan requires. What is the Annual Deductible for you? The annual deductible is another essential factor to consider. Is this something that you are comfortable paying? Are Any Additional Benefits Included? It is also important to consider if additional benefits are offered. This would include things like routine hearing, dental, vision, and other health or wellness plans. Also, find out if a prescription drug is included. Are the existing medications a person takes included with the plan’s formulary or the list of drugs that are covered? Is There a Provider Network Included If it does have a network, it is essential to find out if a person’s current doctors and their health care providers are included. What Is the Plan’s Star Rating? A star rating is one way to determine the performance of the Medicare Advantage plan. Every plan receives a rating of one to five stars. Five stars is the highest rating that a plan can receive. Medicare evaluates all plans based on the five-star rating system, and these scores are calculated yearly. Choosing the Right Medicare Plan for you Each person is unique. This means it is necessary to research each of the Medicare Advantage plan options available and how it works with a person’s budget and health needs. Remember, plan costs, provider networks, service areas, and benefits can all change from one year to another, so it is smart to review a person’s coverage regularly to ensure the plan still works. Take some time to shop around and choose a plan that will help you save the most money. I hope that you learned some valuable information from this article. Choosing a Medicare Advantage plan is a big deal, as you usually won’t be able to change it for up to a year. So you will have whatever coverage you choose for that period. If you find the plan doesn’t cover what you need, you will be stuck paying for it out of pocket. If you think you know someone who might benefit from this article, please share button it. If you'd like to talk about these things or anything else you might have questions about, please contact us whichever way is most comfortable for you.

What Are the Original Medicare Coverage Gaps?

By John Ellis • December 19, 2022
Original Medicare includes Part A and Part B coverage. It provides many medical and hospital services. While this is true, a person will also have to pay the cost-sharing amounts based on Medicare standards. There are some medical costs that Original Medicare will not cover. Coverage Gaps in Original Medicare One of the primary coverage gaps that occur in Original Medicare is coverage for prescription drugs. Some people do not realize that Medicare Part A and Part B coverage will not cover most of the prescription medications that are taken home. Usually, Medicare Part A will cover medications a person receives when they are an inpatient at a skilled nursing facility or a hospital. Sometimes, Medicare Part B will provide limited outpatient coverage for some of the prescriptions a person takes that they receive from the doctor’s office, such as chemotherapy or intravenous drugs. Keep reading below to see the costs that, in most cases, are not covered by Original Medicare. Usually, Original Medicare will not cover the following costs: Health coverage for individuals outside the country Routine vision services like contacts, glasses, or eye exams Nursing home care Routine hearing care services, including hearing aids Routine dental services like fillings, dentures, cleanings, or oral exams Routine foot care Cost Sharing with Original Medicare Even if you are receiving services covered by Medicare, there are limits to the coverage provided. It will be necessary for a person to pay out of their own pocket for these “gaps” in coverage. For example, with Medicare Part A, a person may receive full coverage for treatment from a skilled nursing facility for the initial 20 days of every benefit period. After that point, an individual must pay the daily coinsurance rate if the stay at the nursing facility extends from 21 up to 100 days. Past day 101, a person’s Medicare coverage is used, and a person must pay all related costs unless they have another type of coverage. Cost-sharing will usually include expenses such as: Part A deductible Part A coinsurance costs Part B copayment and coinsurance costs Part B deductible Medicare Supplement insurance plans may help offset some of these costs, but it is dependent on the plan that is purchased. It is also necessary to be aware that Original Medicare does not have any out-of-pocket limit during the year. There is no limit to the medical costs each year, even if the expenses result in hundreds of thousands of dollars in fees. What Are the Solutions to Medicare Coverage Gaps? There are a few options when someone is trying to avoid the coverage gaps seen with Medicare plans. For example, if a person wants to remain with their Original Medicare coverage by receive assistance with cost shaving along with coverage gaps, then Medicare Supplement insurance is a smart investment. Private insurance companies sell this, and the plans will work with Original Medicare plans to cover some out-of-pocket costs, such as deductibles and copayments. If you need assistance covering prescription drug costs, I can help you look into Medicare Part D coverage. This is a stand-alone plan that will help with medication costs. It is a good idea to enroll when someone is initially eligible for Part D, or someone may owe a late-enrollment penalty when a person signs up. Another viable option is to have Part A or Part B services provided through Medicare Advantage plans. This is an alternative method to receive the Original Medicare benefits, as these plans deliver both Part A and B benefits through a private insurance company that is Medicare-approved. Even if someone enrolls in a Medicare Advantage plan, they are still in the Medicare program. Some Medicare Advantage plans will also cover additional benefits, such as hearing services, dental care, vision care, prescription drugs, and specific wellness programs. An added benefit of Medicare Advantage plans is that they have a maximum out-of-pocket limit, which means there is a cap on the out-of-pocket costs. The limit could vary from one plan to the next. In many cases, Medicare will work with other insurance types, such as retiree insurance, employer-based coverage, and veteran benefits. The types of coverage may help and fill in some of the gaps present in Medicare insurance. Take time to consider all the factors mentioned here to find the right plan for a your needs and budget, as this is going to pay off in the long run. Don't leave your Medicare to Chance  Coverage gaps can be a scary thing, since they tend to surprise people who chose coverage without being fully informed. When you choose to work with my team, we take your needs and concerns as the first consideration. We show you plans that avoid coverage gaps and give you options based on what you need. If you feel this article helped you, please share it! And if you have any questions, you can contact me and I will personally answer any question you have.