Cobra Coverage From An Employer Plan
Federal and state law allows people who leave their jobs to continue their employer-sponsored health coverage for a period of time. Be aware of the following:
- You have an eight-month period after your employment ends to enroll in Medicare. If you dont enroll during that eight-month window, you might have to pay a penalty when you enroll.
- If youre in your Medicare initial enrollment period, you must enroll in Medicare during that time to avoid a possible penalty.
- If you dont buy a Medicare supplement policy during your open enrollment period, youll be able to buy some Medicare supplement plans within 63 days of losing your COBRA coverage.
Talk to your employer about COBRA and Medicare eligibility.
How Do You Get Medicare Money Back
You dont get Medicare money back in the traditional sense with a Medicare Part B Give Back plan.
The carrier doesnt send direct payments to beneficiaries. Instead, you pay less for your premium. The way this works depends on the way you make your Medicare payments. To illustrate:
- Premiums deducted from Social Security checks: Youll notice the rebate added to your monthly Social Security check. The Social Security Administration usually takes between 1 to 3 months to process your paperwork and apply your refund.
- Alternative payment method: If you use a different payment method, such as direct debit, you only need to pay your part of the Medicare Part B premium if the plan doesnt cover it entirely.
The 10 Standard Medicare Supplement Insurance Plans
There are 10 Medicare supplement insurance plans. Each plan is labeled with a letter of the alphabet and has a different combination of benefits. Plan F has a high-deductible option. Plans K, L, M, and N have a different cost-sharing component.
Every company must offer Plan A. If they offer other plans, they must offer Plan C or Plan F.
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Can Your Medicare Coverage Be Impacted By A Zip Code
Yes. While the standard Part A and B premiums and deductable apply to members regardless of where they live, Part C and D prices vary. Part C or Medicare Advantage Plans provide dental, hearing, vision, and other services to seniors, while Part D plans are designed to keep the price of prescription drugs down for members. These plans are designed by health care provides operating in those areas and thus the prices are rather wide-ranging.
This year the price of the Part B premium which is applied to almost all seniors who receive Medicare has increased from $148 to $171. This is one of the largest increases seen in years.
Open Enrollment For People Age 65 And Older
The open enrollment period for Medicare supplement plans is a six-month period during which you may buy any Medicare supplement plan offered in Texas. During this period, companies must sell you a policy, even if you have health problems. The open enrollment period begins when you enroll in Medicare Part B. You must have both Medicare parts A and B to buy a Medicare supplement policy.
You can use your open enrollment rights more than once during this six-month period. For instance, you may change your mind about a policy you bought, cancel it, and buy any other Medicare supplement policy.
Although a company must sell you a policy during your open enrollment period, it may require a waiting period of up to six months before it starts covering your preexisting conditions.
Preexisting conditions are conditions for which you received treatment or medical advice from a doctor within the previous six months.
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How Do Medicare Part B Giveback Programs Work
Medicare beneficiaries who are enrolled in Part B owe a premium of $164.90 per month. However, the Medicare giveback program offered by some Medicare Advantage plans helps to reduce or eliminate how much you’d pay toward the premium
The reduction could be less than $1, but it could be the full premium amount. Most people don’t get the full premium reimbursement, but some find that any reduction in the premium is helpful.
The important thing to know about the giveback benefit is that you don’t get any money back, you just pay a reduced amount. Then, you’re saving what you’re not paying.
For example, if you pay $164.90 per month but your giveback benefit is $25, you’d only pay $139.10. While you don’t get $25 back, you’re saving $25 by not having to pay it in the first place.
Most beneficiaries opt to have their Part B premium come out of their Social Security checks, and in this case, their lower payment would be reflected in the amount withdrawn from their check. For those who pay via check or a different way, the benefit would be credited to their monthly statement.
Medicare Part B Give Back Benefit
The Medicare Part B give back is a benefit specific to some Medicare Advantage plans. This benefit covers up to the entire Medicare Part B premium amount for the policyholder.
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The give back benefit can be a great way for beneficiaries to save, as the premium is deducted from their Social Security checks each month. However, not all Advantage plans offer this benefit.
Plan availability depends on your location as these plans are not available in every ZIP Code. Additionally, youll first want to know if a Medicare Advantage plan will provide the best coverage for your needs.
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Will Moving Increase My Medicare Premiums
Its possible that moving could increase your Medicare Supplement or Medicare Advantage premiums. But Medicare is a federal program offered nationwide, the costs remain the same as well as the benefits.
In some cases, moving could lower your Medigap or Medicare Advantage premium. Youll qualify for a Special Enrollment Period upon notifying Medicare and your plan of the move.
Once you know your new zip code you can start getting quotes so that you have coverage effective when you make the big move.
Can You Have Medicare In Two States
No, you cant have Medicare in two states. Youll need to choose a primary state for your residence, usually, the state you file your taxes in is the state where your Medicare is active.
If youre someone that travels between two or more states frequently, a Medigap plan could make sense for you. Medigap plans dont force you into a plan service area unless you have a MedigapSelect policy.
Since Medicare is a federal program, you dont need to worry about which state you reside in, coverage will be available. With Medigap, they cover their portion when Medicare approves the claim.
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Are Medicare Part B Give Back Plans Cheaper Than Other Medicare Plans
Since providers waive all or part of the Part B premium, they may be cheaper than other Medicare Advantage plans.
However, compared to Original Medicare combined with a Medigap Medicare Supplement plan, you may find that Medicare Part B Give Back plans have higher cost-sharing. Co-payments, co-insurance and deductibles for doctors visits and health services, particularly out-of-network, may cost you more than Part B premiums with Original Medicare plus a Medicare Supplement plan.
Consider also that High Deductible plans, with lower premiums than standard Medicare Advantage plans, may be more affordable than Medicare Part B Give Back plans for people who rarely make claims.
Research all your options to determine whether a Medicare Part B Give Back plan will be more affordable for you in the long run than another Medicare plan.
Is Medicare Different In Each State
Before we begin our discussion of Medicare coverage by state, letâs consider basic eligibility for Medicare. The Centers for Medicare & Medicaid Services reports that the following factors make you eligible for Medicare:
- Age. If you are 65 or older, you qualify.
- Disability. If you get disability income from Social Security or the Railroad Retirement Board , you’ll gain eligibility for Medicare once you’ve recieved your Social Security or RRB disbursements for 24 months. There are also special qualifying criteria for those with Lou Gehrig’s disease and end-stage renal disease which can eliminate waiting periods.
Assuming now that you are eligible, letâs address the questionâis Medicare different in each state? Since Original Medicare is a completely federal program, itâs equally available to residents in all U.S. states.
However, certain programs within Medicare vary from state to state in terms of rules, availability, and pricing. Two such Medicare plans are Medigap and Medicare Advantage. The coverage and features of these Medicare plans will vary depending on where you live.
Medigap, sometimes called Medicare Supplement, is available to Original Medicare beneficiaries. It works like an insurance policy to cover the âgapâ between what Original Medicare pays and what you owe in out-of-pocket expenses .
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Do You Need Medicare Supplement
Not everyone needs a Medicare supplement policy. If you have other health coverage, the gaps might already be covered. You probably dont need Medicare supplement insurance if:
- You have group health insurance through an employer or former employer, including government or military retiree plans.
- You have a Medicare Advantage plan.
- Medicaid or the Qualified Medicare Beneficiary Program pays your Medicare premiums and other out-of-pocket costs. QMB is a Medicare savings program that helps pay Medicare premiums, deductibles, copayments, and coinsurance.
If you have other health insurance, ask your insurance company or agent how it works with Medicare.
What Are Medicare Advantage Part B Buy Back Plans
Medicare Advantage plans are additions to your existing Medicare coverage. They can vary greatly in coverage amounts and premium prices. Some Medicare Advantage plans can come with a $0 premium or a low premium in addition to a Part B buy back .
If you pay your Part B premium automatically out of your Social Security check, this could feel like a bonus added to your monthly checks! Youll start seeing a bit more coming in, which is nice, assuming the plan you choose has the buy back option.
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Got Questions About The Medicare Giveback Benefit Here Are Some Answers
Can you really get a Medicare giveback from a Medicare Advantage plan?
A friend forwarded me an ad he saw online. The headline read, Seniors over 65 are getting huge benefits this year. See if you qualify for $144 a month. How can I get this? he wondered.
Another friend asked whether I saw the commercials for the Medicare giveback benefit of up to $144. How could I miss them? I replied.
Lets tackle some questions about the Medicare giveback benefit.
What is the giveback benefit?
The giveback benefit is officially the Part B premium reduction.
This benefit is making a big splash this year, but it first appeared in 2003. A Federal regulation allowed Medicare+Choice plans to receive a reduction in its payments, which in turn helps to fund the giveback.
How do I qualify for the giveback?
The first time I heard about this offer, I wondered whether there might be income-related criteria. In other words, did the persons income have to be below a certain level? But that is not the case. To qualify for a premium reduction, you must:
- Be a Medicare beneficiary enrolled in Part A and Part B,
- Be responsible for paying the Part B premium, and
- Live in a service area of a plan that has chosen to participate in this program.
How many plans provide this benefit?
Thats a good question. You qualify once you enroll in a plan but there are not that many plans participating.
Can I get the premium reduction with other benefits?
Does the plan send me a check?
Any words of wisdom?
Does Medicare Cost The Same In Every State
The federal program that is Original Medicare costs the same no matter which state you reside in. But Medigap and Medicare Advantage plan options will change depending on your location.
Some states have a higher cost of Medigap than other states, some zip codes offer $0 Medicare Part C options. On the contrary, there are zip codes with fewer plan options or higher premium plans.
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Does My Zip Code Affect My Medicare Coverage
The Centers for Medicare & Medicaid Services reports that, with Original Medicare , you can use any doctor or hospital that takes Medicare, anywhere in the U.S. Medicare plans like Medigap and Medicare Advantage are a different story, though. The pricing, rules, and availability of these plans vary by state, and even sometimes by zip code. Here, we cover what you need to know about Medicare coverage based on where you live, using the official U.S. government website for Medicare as a guide.
Which Companies Offer Medicare Part B Premium Reduction
A variety of carriers offer give back plans. However, the list of carriers with available plans offering this feature differs depending on your location. The most popular carriers that offer a premium reduction are Humana, Cigna, and Aetna among others.
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In the summary of benefits or evidence of coverage, youll see a section that says Part B premium buy-down. In this section, you can see how much of a reduction you receive from your plan. However, if you are not able to locate this, call the customer service number on the back of your card or contact your licensed agent to receive assistance in understanding the give back you will be receiving.
It is important to review all Advantage plans and carriers available in your area to maximize your chances of finding a give back plan to enroll in.
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How We Help Our Clients
We look at these Part B rebate plans for our clients who spend several months per year outside their home market and buy their drugs elsewhere typically outside the US. Even this has a potential penalty in the future which must be carefully considered against total beneficiary cost and risk in the future. Because there is no free lunch. As an example, we represent 29 different Part B plans here in Nashville, of which 4 have Part B rebates. We were busy this last selling season but did not find that these giveback plans were a good fit for any of our customers when weighed against the needs of the client and the benefits of all the available plans.
The takeaway message here is this Medicare Advantage plans can be great for certain clients, but any individual benefit of a plan must be considered against the medical needs of the beneficiary, the expected total cost of care in the benefit period, and the risks that the client should reasonably accept. Focusing on any single plan benefit is misleading at best and can cause real damage to beneficiaries.
Sorry, but there is no Medicare Santa.
How Much Do I Get Back With A Part B Give Back Plan
The amount you get back varies by plan. Amounts can range from $0.10 in some counties up to the full standard premium for the year.
The amount you get back will depend on the options available in your area. In some cases, policies of the same name will have different premium give back amounts depending on the county. Hence, it is important to understand your Medicare Advantage plan entirely before enrolling.
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What Is Medicare Part C
Original Medicare is made up of Medicare Part A and Part B . Medicare Part C plans are all-in-one alternative healthcare options to Original Medicare and include the same benefits as Medicare Part A and Part B plus additional coverage.
When you enroll in a Medicare Part C plan, the company you enroll with becomes your primary source of health insurance.
Medicare Part C coverage must at least match Original Medicare coverage. However, since there are several Medicare Part C plan types, costs for enrollees can vary widely.
Open Enrollment For Texans With Disabilities
People under age 65 who get Medicare because of disabilities have a six-month open enrollment period beginning the day they enroll in Medicare Part B. This open enrollment right only applies to Medicare supplement Plan A.
Note: People who have Medicare because of disabilities have another open enrollment period during the first six months after turning 65.
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Are There Any Concerns With The Part B Give Back
Weve been helping our clients understand their Medicare choices for over two decades. One plan does not fit all. The mistake consumers sometimes make is enrolling in a plan based on cost only. The benefits and network availability must also be considered.
While its tempting to choose a plan with a large giveback benefit, it might be unsuitable if your doctors or hospitals are not in their network. And you should also make certain any Advantage plan covers your most important prescriptions. Especially if you take anything expensive or on a higher Tier.
Also, you want to be sure youre comfortable with Medicare Advantage plans in general. Some people prefer the flexibility of a Medicare Supplement. And switching back and forth between the two is not guaranteed. There are many variables to consider when choosing a supplemental policy.
Why Are Healthcare Premiums Set By County
Healthcare premiums are typically set by county to account for a few different geographic factors: The general cost of doing business in an area. Rent as well as wages are higher in urban areas than rural areas, for example, which necessitates higher payments to providers to allow them to operate at a profit.
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