Things You Need To Know Before Signing Up For Medicare
If you are approaching age 65 and are confused with your choices in signing up for Medicare, you are not alone. Here is some basic information you need to know in advance.
- The Medicare choices you initially make might lock you in later. One rare piece of information is that, if on turning age 65, you sign up for a Medicare Advantage Plan (such as an HMO, PPO, PFFS) and you later want to switch to a Medicare Supplement, also known as Medigap plan, you will likely have to go through underwriting for a determination that you are well enough to qualify. This could be a problem if your health deteriorates. On initial signup at 65, you do not need to prove you are healthy for a Medicare Supplement. So the safer choice, if you can afford it, may be to start with a Medicare Supplement. You can switch to a Medicare Advantage later without underwriting. Retirees who are offered only an HMO or a PPO might not initially have this choice.
- Not all Medicare Supplement plans provide the same level of coverage. I became aware of this issue when working with a client who had Medicare and a Medicare Supplement but still had high deductibles for days in a nursing home. I thought, with a Medicare Supplement why are the bills so high? The answer is that the lower level Medicare Supplement plans also can have high deductibles. Medicare Supplement plans “A,” “B,” and “C,” (not to be confused with Medicare A,B and D) while less expensive, provide less coverage. Medicare Supplement “F” has the highest level of coverage but is generally extremely expensive. Less expensive but popular and with good coverage are Medicare Supplement “G” which is “F” but with a small Part B deductible, and “N.”
- All Medicare Supplement (Medigap) Plans With the Same Letter Have the Same Coverage. The differences between companies are in the servicing and cost. If you buy a Medicare Supplement Plan from United Healthcare, for instance, and you compare it to a Medicare Supplement Plan from another company, as long as it has the same letter (Medicare Supplement “F,” for instance, Medicare Supplement “G” or Medicare Supplement “N”), it has the same coverage. Therefore, the differences are whether you believe the company has good customer service and how much it costs. If you want to know what each coverage is by the letter, check out www.medicare.gov.
- Generally speaking, Medicare Advantage plans can only be changed once a year. With Medicare Advantage plans, if you want to change from one Advantage plan to another Medicare Advantage plan you need to do this during the “Open Enrollment Period” which now begins October 15 and ends December 7 to take effect January 1. By the way, do not confuse this with the new health care exchanges which relate to health insurance for those under age 65.
- There is a wide diversity of coverage among Medicare Advantage (HMO, PPO, PFFS) plans. I learned this lesson while working with a client who lost PACE coverage and needed a plan. We spent almost two hours reviewing possibilities. There are not quite as many plans now as there were before the taxpayer subsidy to Medicare Advantage plans was scaled back and this might be a good thing since choice among policies with similar benefits is easier.
- It is important to know how prescription drugs and medical coverage work and the differences between Medicare Supplement and Medicare Advantage. When Medicare Part “D” went into effect for prescription drugs some years back, I discovered clients who, while intending to change their prescription drug coverage, actually changed their entire medical and health care coverage. This is how it happened. The client signed up for a Medicare Advantage plan for the prescription drug coverage not realizing that it was tied to the overall Medicare Advantage plan. His or her Medicare Supplement plan was lost as a result. Medicare Supplement plans do not have prescription drug coverage but rather are often marketed with a separate PDP or prescription drug plan (look for PDP or Rx on the card). Medicare Advantage plans usually come with prescription coverage.
If you are confused, get help. The Chester County APPRISE program staffed by volunteers, is excellent. It can be contacted at 610-344-6035.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.