Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Medicare three sixty, where the world of Medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with host licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of Medicare, whether you
(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And Now Medicare three sixty.
Speaker 2 (00:45):
Welcome to today's Medicare three sixty show. I'm your host,
Jennifer Lee, and we are continuing our journey on the
Medicare New Handbook. Let's start with section three, page fifty
Original Medicare. So how does original Medicare work. Original Medicare
(01:07):
is one of your Medicare health coverage choices. You'll have
Original Medicare unless you choose a Medicare Advantage plan or
other type of Medicare health plan. Original Medicare includes two parts,
which is Part A hospital insurance and Part.
Speaker 3 (01:27):
B medical insurance.
Speaker 2 (01:30):
You generally have to pay a portion of the cost
for each service original Medicare covers.
Speaker 3 (01:37):
There's no limit to what.
Speaker 2 (01:39):
You'll pay out out of pocket in a year unless
you have other coverage like Medicap Medicaid.
Speaker 3 (01:47):
In California, it's medical.
Speaker 2 (01:49):
Employer, retiree, or union coverage original Medicare. Can I get
my healthcare from any doctor or other healthcare provider or
hospital In most cases, Yes, you can go to any
Medicare enrolled doctor or other healthcare provider, hospital, or other
(02:15):
facility that accepts Medicare patients anywhere in the US. Visit
Medicare dot gov, slash care compare to find and compare providers, hospitals,
and facilities in your area. Does it cover prescription drugs?
Part B doesn't cover most drugs, but there are some exceptions,
(02:40):
like immunosuppressive drugs page fifty two or drugs for pain
and symptom management for hospice care pages twenty six to
twenty seven. Part B may also cover some infuse and
injected drugs given any doctor's office, and insulin us with
a traditional pump, go to pages thirty four, forty four,
(03:05):
and forty seven. You can add Medicare Drug Coverage Part
B by joining a separate Medicare drug plan. Go to
pages seventy nine to ninety.
Speaker 3 (03:17):
Do I need to.
Speaker 2 (03:18):
Choose a primary care doctor?
Speaker 3 (03:20):
No?
Speaker 2 (03:23):
Do I have to get a referral to use a specialist?
In most cases, no, Keep in mind, like labs and
X rays and things like that, the labs usually want
you to get a referral or a work order from
your doctor because they just don't want someone to come
in and ask for a whole bunch of tests without
(03:47):
really being sent by the doctor. Okay, so no, Go
to page one nineteen to one twenty two for definitions
of Blue World words.
Speaker 3 (03:57):
Maybe I should you know your i'm my.
Speaker 2 (04:00):
Care doctor is a doctor that is primarily in charge
of your care, Okay, Like that's a general practitioner. And
then a referral is when your doctor tells you to
go to a specialist, and typically those need to be approved.
(04:25):
So let's go to page fifty eight. Should I get
a supplemental policy? You may already have Medicaid or employer, retiree,
or union coverage that may pay costs that original Medicare doesn't.
If not, you may want to buy a Medicare Supplement
(04:46):
insurance MEDICAP policy. If you're eligible, go to pages seventy
five to seventy eight. You could also check with your
state Medical Assistance Medicaid office to see if you're eligible
for Medicaid. What else do I need to know about
original Medicare? You generally pay set amount for your health
(05:09):
care deductible before Medicare begins to pay its share. Once
Medicare pays its share, you pay a co insurance or
co payment for covered services and supplies. There are no
yearly limit for what you pay out of pocket unless
(05:29):
you have other insurance like Medicap, Medicaid, or employer retireing
or union coverage. You usually pay a monthly premium for
Part B. This premium may change each year. You generally
don't need to file Medicare claims. Provider and suppliers must
(05:49):
fly your claims for the covered services and supplies you get.
Let's kind of go over that again. You generally pay
a set amount for your healthcare deductible. Okay, that definitely
does go up or down every single year before Medicare
begins to pay a share.
Speaker 3 (06:09):
For tony twenty five, it's two hundred and fifty seven dollars.
Speaker 2 (06:13):
Once Medicare page its share, you pay co insurance or
co payment for covered services and supplies. Typically it is
a twenty percent.
Speaker 3 (06:23):
Co insurance on Part B medical portion. Okay.
Speaker 2 (06:28):
There's no yearly limit for what you pay out of pocket. Okay,
that's the biggest thing, right, because you don't want to
have unlimited cost in your healthcare. I something catastrophic happens.
But of course, if you do have medagap, Medicaid employer
(06:49):
retire union coverage. And I want to add if you have,
you know, a medic care advantage plan, also there are
caps to that.
Speaker 3 (06:59):
Okay.
Speaker 2 (07:00):
You usually pay a monthly premium for a Part B.
This premium does change every year, so it could go
up or down. Of course, the trend is always up.
But during COVID and after did go down, but then
it did jump up again.
Speaker 3 (07:16):
Hey, you generally don't need.
Speaker 2 (07:18):
A file Medicare claims. Providers and suppliers must follow your
claims for the coverage, services and supplies you get. Just
notate on that review your bills. Right. You don't want
to be paying for something you're not supposed to do.
Or they build an air they had denied a claim
because they put the wrong code medical code, So things.
Speaker 3 (07:41):
Like that to watch out for. Okay, what do I pay?
Speaker 2 (07:47):
You're out of pocket costs and original Medicare depend on
whether you have Part A and R B.
Speaker 3 (07:54):
Most people have both, okay.
Speaker 2 (07:57):
Whether your doctor or other healthcare provider or suppliers accepts assignment,
go to page fifty nine to sixty. You know, sometimes
people don't have both Part A and B. Sometimes when
you have not worked here for more than five years,
you aren't issued a Part A. But there are ways
(08:19):
to get that. Either pay that premium. If you're on
Medicaid slash Medical, they can pay that for you. But
it is a process and reach out to us and
we can help you with that. The type of healthcare
you need and how often you need it. Okay, if
(08:40):
you choose to get services or supplies, Medicare doesn't cover
if so you pay all costs unless you have other
insurance that covers them. Biggest thing I would always ask
if it's covered by Medicare because sometimes there's like labs
that aren't covered.
Speaker 3 (09:00):
Different vendors that might So just.
Speaker 2 (09:03):
Be careful with that and make sure it's covered, whether
you have other health insurance that works with Medicare, go
to page twenty one. Okay, Whether you have full Medicaid
coverage or get help from your state to pay your
Medicare costs through Medicare savings program, go to page ninety
one to ninety two. Sometimes people on Medicaid medical they're like,
(09:26):
why do I need to get on Medicare. Medicare definitely
opens more doors to doctors and specialists and even hospitals
and facilities that don't want to just take a.
Speaker 3 (09:42):
Medcaid or medical so one and then just never know.
Speaker 2 (09:48):
Things are changing in a rapid pace. Medicaid and medical
qualifications are changing, have been changing sometimes even depending on
the administration. So I would definitely still get Medicare even
if you're on Medicaid and full Medicaid which pays for
(10:11):
your premiums and everything in your healthcare, which.
Speaker 3 (10:18):
This one says.
Speaker 2 (10:19):
Whether you have full Medicaid coverage or get help from
your state to pay your Medicare costs or a Medicare
savings program, go to page ninety one to ninety two.
Whether you have a Medicare Supplement insurance which is sometimes
called medigap, whether you and your doctor other healthcare provider
(10:40):
sign a private contract.
Speaker 3 (10:41):
Go to page sixty.
Speaker 2 (10:44):
How do I.
Speaker 3 (10:45):
Know what Medicare paid?
Speaker 2 (10:48):
If you have original Medicare, you'll get a Medicare Summary
notice that lists all the services built to Medicare.
Speaker 3 (10:57):
That MSN isn't a bill.
Speaker 2 (10:59):
It's shows that Medicare paid, what Medicare paid, and what
you may owe the provider. Review your MSN's to be
sure you got all the services, supplies, or equipment listed.
If you disagree with Medicare's decision to cover a service,
the MSN will tell you how to appeal. Go to
page ninety nine for information on how to file an appeal.
Speaker 3 (11:23):
I stress this again.
Speaker 2 (11:25):
Reviewing your bills making sure it's correct so you're not
paying more or less than you have to is something
that is important. You'll get this notice in the mail
every four months unless you sign up to get it electronically. Okay,
so we are on page fifty nine. If you need
(11:51):
to change your Medicare address on your MSN, visit SSA dot.
Speaker 3 (11:57):
Gov slash my contact.
Speaker 2 (12:00):
If you get Railroad Retirement Board RB benefits, call the
r B at eight seven seven seven seven two five
seven seven to two.
Speaker 3 (12:13):
Okay.
Speaker 2 (12:15):
Your MSN will tell you if you're enrolled in medic
in the Qualified Medicare Beneficiary.
Speaker 3 (12:22):
Q MB program.
Speaker 2 (12:24):
If you're in the QMB program, Medicare provides providers aren't
allowed to bill you for Medicare Part A and or
Part B deductibles, coinsurance, or co payments. Some cases, you
may be built a small co payment through Medicaid if
one applies. For more information about QMB and steps to
(12:47):
take it. If a provider bills you for these costs,
go to page ninety one. So for the Qualified Medicare
Beneficiary program. So let's say there are tiers on this
that are full Medicaid. So there's tiers, So understanding that
(13:09):
and learning learning that does help with your premiums, your copas,
your consurance, and your drug costs important. Get your Medicare
Summary notices electronically. Of course, we're trying to save trees right,
better for the environment. But I get it because sometimes
(13:31):
reading a piece of paper is better than getting electronically.
But they are definitely trying to persuade you to go
get it electronically. Get your Medicare Summary Notice electronically. Visit
medicare dot com to log into or create your secure
Medicare account. If you sign up for electronic MSNs, we'll
(13:54):
send you an email each month when they're available on
your Medicare account instead of paper copies of the mail.
As of late twenty twenty four, people who signed up
for the electronic emsens help save the Medicare program close
to forty two million. Okay, so that's definitely a big one.
Speaker 3 (14:15):
With fraud, waste and abuse.
Speaker 2 (14:16):
That's not fraudways and abuse, but look how much it
would save everyone forty two million to get no paper copies.
Keep that in mind. You have options for how you
get your Medicare claims information.
Speaker 3 (14:35):
Okay.
Speaker 2 (14:36):
You could check your MSN for claims information. You could
access your claims in your account on Medicare dot gov
and share this information with doctors, pharmacies, and others by
visiting check my claims. You could access your claims through
medicares connected apps. Connected apps are Medicare approved applications or
(14:57):
websites that a third party Medicare creates. Okay, let me
repeat that you could access your claims through Medicare connected apps.
Connected apps are Medicare proof applications or websites that a
third party, not Medicare creates. When you connect to an
app and log in what your Medicare dot gov account information.
(15:18):
You could use the app services without manually entering your
health information. You could use the app services without manually
entering your health information. Okay said that already these third
parties could also access your Medicare data if you choose
to share it with them. It's always your choice if
(15:39):
you want to connect or stay connected to a third
party app got a page one or nine has technology
and scams are just more rampant. Just be careful that
it is a vendor third.
Speaker 3 (15:53):
Party that is legitimate. What's assignment?
Speaker 2 (15:58):
Assignment means that your doctor, provider or supplier agrees or
is required by law to accept the Medicare proved amount
as full payment for covered services. Most doctors, providers and
suppliers accept assignment, but always check to make sure what
yours does. If your doctor provider supplier accepts assignment, you're
(16:24):
out of pocket costs maybe less Okay. They agree to
charge you only the Medicare deductible and coinsurance amounts and
usually wait for Medicare to pay share before asking to
pay your share. Sometimes there is definitely definitely a lag
time from like the claims from them billing you.
Speaker 3 (16:47):
It's just the nature of the.
Speaker 2 (16:49):
Beasts that sometimes it takes a long time to fow
these claims.
Speaker 3 (16:55):
Okay.
Speaker 2 (16:56):
They have to submit your claim directly to Medicare and
can't charge you for some of the claim. Okay, Never
seen that happen, but just in case. Some providers haven't
agreed and aren't required by law to accept assignment for
all Medicare coverage services, but they can still choose to
accept the assignment for individual services. The providers who haven't
(17:21):
agreed to accept assignment for all services are called non participating.
You might have to pay for their services if they
don't accept assignment for the.
Speaker 3 (17:33):
Care they provide to you.
Speaker 2 (17:36):
Here's what happens if your doctor provider supplier doesn't accept assignment. Okay, First,
you might have to pay the entire charge at the
time of service. Your doctor provider supplier is supposed to
submit a claim to Medicare for any Medicare coverage services
they provide you. If they don't submit the Medicare claim
(18:00):
once you ask them to call one hundred Medicare. That's
one eight hundred and sixty three seven. Okay, they could
charge you more than the Medicare proved amount. In many cases,
the charge can't be more than fifteen percent above the
Medicare proved amount. For the non participating healthcare providers, the
(18:25):
amount is called the limiting charge. Just be careful on this.
I've had clients, as example, have gone to the eyeglass
or the autaumetris and they charge them upfront and then
they get built again, and so things like that. Either
(18:45):
one the office or the place provider you want to
doesn't know how to bill, they did an error, or
even at times they know that they're just over billing
you and they don't think you're going to ask or
care about it to get a refund.
Speaker 3 (19:05):
So be smart. Just be careful on that.
Speaker 2 (19:09):
Okay, compare If you have original Medicare, could you can
use any provider you want that takes Medicare anywhere in
the US. And if you're in a Medicare advantage plan,
in most cases you'll need to use doctor and other
(19:29):
providers who are in the plans network. Find out if
someone accepts assignment or participates in Medicare Medicare dot gov,
slash care dash compare. Find out if a medical equipment
supplier accepts assignments Medicare dot gov slash medical equipment suppliers.
You could also call your state Health Insurance Assistant program
(19:54):
SHIP to get free help with these topics. Go to
page one fourteen to one seventeen for the phone for
your local ship. What I've been hearing about CHIP, though,
who knows if that might go away based on just budgets.
Speaker 3 (20:09):
And cutting that out, So I'm not.
Speaker 2 (20:12):
One hundred percent sure on that.
Speaker 3 (20:15):
I did want to go back and talk about.
Speaker 2 (20:22):
Medicare, but let's let's just go forward, and then after
this I'll talk about it in a little bit more detail. Okay,
what if I want to use a provider who opts
out of Medicare. Certain doctors and other healthcare providers who
don't want to work with the Medicare program may opt
out of Medicare. Medicare doesn't pay for any covered items
(20:44):
or services you get from an opt out doctor or
other provider, except in the case of an emergency or
urgent need. If you still want to use an opt
out provider, you and your provider can set up payment
terms that you agree both agree on two through a
(21:04):
private contract. A doctor or other healthcare provider who chooses
to opt out must do so for two years if
the choicer news automatically every two years, unless a provider
requests not to res you.
Speaker 3 (21:20):
Their opt out status. If you're ensure. If a provider has.
Speaker 2 (21:25):
Opted auto Medicare, check with them so you'll know ahead
of time if you need to pay them out of
your pocket. Pages ten to fourteen for an overview of
your Medicare options. So I do want to have some
commentary in regards to original Medicare, right, I definitely don't
(21:48):
want anyone to just be on original Medicare, because even
when someone says I am one hundred percent healthy, I
don't go to the doctor, I don't go to a specialist.
I don't take prescription drugs. You just never know, and
as you are growing older, something catastrophic may happen. And
(22:16):
then when something catastrophic happens, the bills could definitely pile up,
and you hear about medical bankruptcy and just you're already
dealing with your health concerns and conditions, and to top
it off with another, you know, financial burden, headache.
Speaker 3 (22:41):
It's not good. Okay, of course you're going.
Speaker 2 (22:45):
To have Medicaid medical that could help you pay if
you're like mentioned on a group health plan, retiree union
that will definitely work. But if you don't have that
or definitely want to compare those options, there is the
(23:06):
Medicare Supplement Plan, which is a Medicare gap plan. It
supplements your original Medicare and covers what original Medicare is
making you pay. Right, So that's a great option if
you do not want to replace.
Speaker 3 (23:27):
Medicare, okay, If you're.
Speaker 2 (23:30):
Okay replacing Medicare, if you want those all in one
packages so you're not worrying about paying your Medicare, your
Medicare supplement plan, your drug plan, your dental, your vision,
then the Medicare advantage plan might be a good option. Okay,
But of course it varies from every individual, and I
(23:53):
know some seniors are very biased on one or another
based on their individual experience or preference. But like I say,
it is good to listen to your your friends, your family,
your relatives that are on Medicare, right, but not all
(24:14):
things are equal. You are not equal to them, right.
Your health concerns, your prescription drugs, your preference, your budget,
they all are going to.
Speaker 3 (24:26):
Be very different.
Speaker 2 (24:28):
That's why it's great to talk to a licensed independent
insurance agent to.
Speaker 3 (24:33):
Help you with that.
Speaker 2 (24:34):
If you have any questions, please feel free to call us.
We're here just to be a resource to the community. Well,
today I'm ending the call on this.
Speaker 3 (24:46):
You have a call, it's not really a call, right, So.
Speaker 2 (24:50):
You have a wonderful day and I will see you
next time.
Speaker 3 (24:55):
Take care.
Speaker 1 (24:58):
Thank you for joining the program Medicare three sixty. Hope
you found today's episode insightful and empowering. Remember understanding your
Medicare options is key to making the right choices for
your health and financial well being. If you have questions
or topics you would like covered in future episodes of
Medicare three sixty, don't hesitate to reach out and speak
(25:21):
with our licensed insurance agent. Until next time, stay informed
and take charge of your healthcare journey. This has been
Medicare three sixty, your trusted source for all things Medicare.
Take care.
Welcome to Medicare three sixty, where the world of Medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with host licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of Medicare, whether you
(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And Now Medicare three sixty.
Speaker 2 (00:45):
Welcome to today's Medicare three sixty show. I'm your host,
Jennifer Lee, and we are continuing our journey on the
Medicare New Handbook. Let's start with section three, page fifty
Original Medicare. So how does original Medicare work. Original Medicare
(01:07):
is one of your Medicare health coverage choices. You'll have
Original Medicare unless you choose a Medicare Advantage plan or
other type of Medicare health plan. Original Medicare includes two parts,
which is Part A hospital insurance and Part.
Speaker 3 (01:27):
B medical insurance.
Speaker 2 (01:30):
You generally have to pay a portion of the cost
for each service original Medicare covers.
Speaker 3 (01:37):
There's no limit to what.
Speaker 2 (01:39):
You'll pay out out of pocket in a year unless
you have other coverage like Medicap Medicaid.
Speaker 3 (01:47):
In California, it's medical.
Speaker 2 (01:49):
Employer, retiree, or union coverage original Medicare. Can I get
my healthcare from any doctor or other healthcare provider or
hospital In most cases, Yes, you can go to any
Medicare enrolled doctor or other healthcare provider, hospital, or other
(02:15):
facility that accepts Medicare patients anywhere in the US. Visit
Medicare dot gov, slash care compare to find and compare providers, hospitals,
and facilities in your area. Does it cover prescription drugs?
Part B doesn't cover most drugs, but there are some exceptions,
(02:40):
like immunosuppressive drugs page fifty two or drugs for pain
and symptom management for hospice care pages twenty six to
twenty seven. Part B may also cover some infuse and
injected drugs given any doctor's office, and insulin us with
a traditional pump, go to pages thirty four, forty four,
(03:05):
and forty seven. You can add Medicare Drug Coverage Part
B by joining a separate Medicare drug plan. Go to
pages seventy nine to ninety.
Speaker 3 (03:17):
Do I need to.
Speaker 2 (03:18):
Choose a primary care doctor?
Speaker 3 (03:20):
No?
Speaker 2 (03:23):
Do I have to get a referral to use a specialist?
In most cases, no, Keep in mind, like labs and
X rays and things like that, the labs usually want
you to get a referral or a work order from
your doctor because they just don't want someone to come
in and ask for a whole bunch of tests without
(03:47):
really being sent by the doctor. Okay, so no, Go
to page one nineteen to one twenty two for definitions
of Blue World words.
Speaker 3 (03:57):
Maybe I should you know your i'm my.
Speaker 2 (04:00):
Care doctor is a doctor that is primarily in charge
of your care, Okay, Like that's a general practitioner. And
then a referral is when your doctor tells you to
go to a specialist, and typically those need to be approved.
(04:25):
So let's go to page fifty eight. Should I get
a supplemental policy? You may already have Medicaid or employer, retiree,
or union coverage that may pay costs that original Medicare doesn't.
If not, you may want to buy a Medicare Supplement
(04:46):
insurance MEDICAP policy. If you're eligible, go to pages seventy
five to seventy eight. You could also check with your
state Medical Assistance Medicaid office to see if you're eligible
for Medicaid. What else do I need to know about
original Medicare? You generally pay set amount for your health
(05:09):
care deductible before Medicare begins to pay its share. Once
Medicare pays its share, you pay a co insurance or
co payment for covered services and supplies. There are no
yearly limit for what you pay out of pocket unless
(05:29):
you have other insurance like Medicap, Medicaid, or employer retireing
or union coverage. You usually pay a monthly premium for
Part B. This premium may change each year. You generally
don't need to file Medicare claims. Provider and suppliers must
(05:49):
fly your claims for the covered services and supplies you get.
Let's kind of go over that again. You generally pay
a set amount for your healthcare deductible. Okay, that definitely
does go up or down every single year before Medicare
begins to pay a share.
Speaker 3 (06:09):
For tony twenty five, it's two hundred and fifty seven dollars.
Speaker 2 (06:13):
Once Medicare page its share, you pay co insurance or
co payment for covered services and supplies. Typically it is
a twenty percent.
Speaker 3 (06:23):
Co insurance on Part B medical portion. Okay.
Speaker 2 (06:28):
There's no yearly limit for what you pay out of pocket. Okay,
that's the biggest thing, right, because you don't want to
have unlimited cost in your healthcare. I something catastrophic happens.
But of course, if you do have medagap, Medicaid employer
(06:49):
retire union coverage. And I want to add if you have,
you know, a medic care advantage plan, also there are
caps to that.
Speaker 3 (06:59):
Okay.
Speaker 2 (07:00):
You usually pay a monthly premium for a Part B.
This premium does change every year, so it could go
up or down. Of course, the trend is always up.
But during COVID and after did go down, but then
it did jump up again.
Speaker 3 (07:16):
Hey, you generally don't need.
Speaker 2 (07:18):
A file Medicare claims. Providers and suppliers must follow your
claims for the coverage, services and supplies you get. Just
notate on that review your bills. Right. You don't want
to be paying for something you're not supposed to do.
Or they build an air they had denied a claim
because they put the wrong code medical code, So things.
Speaker 3 (07:41):
Like that to watch out for. Okay, what do I pay?
Speaker 2 (07:47):
You're out of pocket costs and original Medicare depend on
whether you have Part A and R B.
Speaker 3 (07:54):
Most people have both, okay.
Speaker 2 (07:57):
Whether your doctor or other healthcare provider or suppliers accepts assignment,
go to page fifty nine to sixty. You know, sometimes
people don't have both Part A and B. Sometimes when
you have not worked here for more than five years,
you aren't issued a Part A. But there are ways
(08:19):
to get that. Either pay that premium. If you're on
Medicaid slash Medical, they can pay that for you. But
it is a process and reach out to us and
we can help you with that. The type of healthcare
you need and how often you need it. Okay, if
(08:40):
you choose to get services or supplies, Medicare doesn't cover
if so you pay all costs unless you have other
insurance that covers them. Biggest thing I would always ask
if it's covered by Medicare because sometimes there's like labs
that aren't covered.
Speaker 3 (09:00):
Different vendors that might So just.
Speaker 2 (09:03):
Be careful with that and make sure it's covered, whether
you have other health insurance that works with Medicare, go
to page twenty one. Okay, Whether you have full Medicaid
coverage or get help from your state to pay your
Medicare costs through Medicare savings program, go to page ninety
one to ninety two. Sometimes people on Medicaid medical they're like,
(09:26):
why do I need to get on Medicare. Medicare definitely
opens more doors to doctors and specialists and even hospitals
and facilities that don't want to just take a.
Speaker 3 (09:42):
Medcaid or medical so one and then just never know.
Speaker 2 (09:48):
Things are changing in a rapid pace. Medicaid and medical
qualifications are changing, have been changing sometimes even depending on
the administration. So I would definitely still get Medicare even
if you're on Medicaid and full Medicaid which pays for
(10:11):
your premiums and everything in your healthcare, which.
Speaker 3 (10:18):
This one says.
Speaker 2 (10:19):
Whether you have full Medicaid coverage or get help from
your state to pay your Medicare costs or a Medicare
savings program, go to page ninety one to ninety two.
Whether you have a Medicare Supplement insurance which is sometimes
called medigap, whether you and your doctor other healthcare provider
(10:40):
sign a private contract.
Speaker 3 (10:41):
Go to page sixty.
Speaker 2 (10:44):
How do I.
Speaker 3 (10:45):
Know what Medicare paid?
Speaker 2 (10:48):
If you have original Medicare, you'll get a Medicare Summary
notice that lists all the services built to Medicare.
Speaker 3 (10:57):
That MSN isn't a bill.
Speaker 2 (10:59):
It's shows that Medicare paid, what Medicare paid, and what
you may owe the provider. Review your MSN's to be
sure you got all the services, supplies, or equipment listed.
If you disagree with Medicare's decision to cover a service,
the MSN will tell you how to appeal. Go to
page ninety nine for information on how to file an appeal.
Speaker 3 (11:23):
I stress this again.
Speaker 2 (11:25):
Reviewing your bills making sure it's correct so you're not
paying more or less than you have to is something
that is important. You'll get this notice in the mail
every four months unless you sign up to get it electronically. Okay,
so we are on page fifty nine. If you need
(11:51):
to change your Medicare address on your MSN, visit SSA dot.
Speaker 3 (11:57):
Gov slash my contact.
Speaker 2 (12:00):
If you get Railroad Retirement Board RB benefits, call the
r B at eight seven seven seven seven two five
seven seven to two.
Speaker 3 (12:13):
Okay.
Speaker 2 (12:15):
Your MSN will tell you if you're enrolled in medic
in the Qualified Medicare Beneficiary.
Speaker 3 (12:22):
Q MB program.
Speaker 2 (12:24):
If you're in the QMB program, Medicare provides providers aren't
allowed to bill you for Medicare Part A and or
Part B deductibles, coinsurance, or co payments. Some cases, you
may be built a small co payment through Medicaid if
one applies. For more information about QMB and steps to
(12:47):
take it. If a provider bills you for these costs,
go to page ninety one. So for the Qualified Medicare
Beneficiary program. So let's say there are tiers on this
that are full Medicaid. So there's tiers, So understanding that
(13:09):
and learning learning that does help with your premiums, your copas,
your consurance, and your drug costs important. Get your Medicare
Summary notices electronically. Of course, we're trying to save trees right,
better for the environment. But I get it because sometimes
(13:31):
reading a piece of paper is better than getting electronically.
But they are definitely trying to persuade you to go
get it electronically. Get your Medicare Summary Notice electronically. Visit
medicare dot com to log into or create your secure
Medicare account. If you sign up for electronic MSNs, we'll
(13:54):
send you an email each month when they're available on
your Medicare account instead of paper copies of the mail.
As of late twenty twenty four, people who signed up
for the electronic emsens help save the Medicare program close
to forty two million. Okay, so that's definitely a big one.
Speaker 3 (14:15):
With fraud, waste and abuse.
Speaker 2 (14:16):
That's not fraudways and abuse, but look how much it
would save everyone forty two million to get no paper copies.
Keep that in mind. You have options for how you
get your Medicare claims information.
Speaker 3 (14:35):
Okay.
Speaker 2 (14:36):
You could check your MSN for claims information. You could
access your claims in your account on Medicare dot gov
and share this information with doctors, pharmacies, and others by
visiting check my claims. You could access your claims through
medicares connected apps. Connected apps are Medicare approved applications or
(14:57):
websites that a third party Medicare creates. Okay, let me
repeat that you could access your claims through Medicare connected apps.
Connected apps are Medicare proof applications or websites that a
third party, not Medicare creates. When you connect to an
app and log in what your Medicare dot gov account information.
(15:18):
You could use the app services without manually entering your
health information. You could use the app services without manually
entering your health information. Okay said that already these third
parties could also access your Medicare data if you choose
to share it with them. It's always your choice if
(15:39):
you want to connect or stay connected to a third
party app got a page one or nine has technology
and scams are just more rampant. Just be careful that
it is a vendor third.
Speaker 3 (15:53):
Party that is legitimate. What's assignment?
Speaker 2 (15:58):
Assignment means that your doctor, provider or supplier agrees or
is required by law to accept the Medicare proved amount
as full payment for covered services. Most doctors, providers and
suppliers accept assignment, but always check to make sure what
yours does. If your doctor provider supplier accepts assignment, you're
(16:24):
out of pocket costs maybe less Okay. They agree to
charge you only the Medicare deductible and coinsurance amounts and
usually wait for Medicare to pay share before asking to
pay your share. Sometimes there is definitely definitely a lag
time from like the claims from them billing you.
Speaker 3 (16:47):
It's just the nature of the.
Speaker 2 (16:49):
Beasts that sometimes it takes a long time to fow
these claims.
Speaker 3 (16:55):
Okay.
Speaker 2 (16:56):
They have to submit your claim directly to Medicare and
can't charge you for some of the claim. Okay, Never
seen that happen, but just in case. Some providers haven't
agreed and aren't required by law to accept assignment for
all Medicare coverage services, but they can still choose to
accept the assignment for individual services. The providers who haven't
(17:21):
agreed to accept assignment for all services are called non participating.
You might have to pay for their services if they
don't accept assignment for the.
Speaker 3 (17:33):
Care they provide to you.
Speaker 2 (17:36):
Here's what happens if your doctor provider supplier doesn't accept assignment. Okay, First,
you might have to pay the entire charge at the
time of service. Your doctor provider supplier is supposed to
submit a claim to Medicare for any Medicare coverage services
they provide you. If they don't submit the Medicare claim
(18:00):
once you ask them to call one hundred Medicare. That's
one eight hundred and sixty three seven. Okay, they could
charge you more than the Medicare proved amount. In many cases,
the charge can't be more than fifteen percent above the
Medicare proved amount. For the non participating healthcare providers, the
(18:25):
amount is called the limiting charge. Just be careful on this.
I've had clients, as example, have gone to the eyeglass
or the autaumetris and they charge them upfront and then
they get built again, and so things like that. Either
(18:45):
one the office or the place provider you want to
doesn't know how to bill, they did an error, or
even at times they know that they're just over billing
you and they don't think you're going to ask or
care about it to get a refund.
Speaker 3 (19:05):
So be smart. Just be careful on that.
Speaker 2 (19:09):
Okay, compare If you have original Medicare, could you can
use any provider you want that takes Medicare anywhere in
the US. And if you're in a Medicare advantage plan,
in most cases you'll need to use doctor and other
(19:29):
providers who are in the plans network. Find out if
someone accepts assignment or participates in Medicare Medicare dot gov,
slash care dash compare. Find out if a medical equipment
supplier accepts assignments Medicare dot gov slash medical equipment suppliers.
You could also call your state Health Insurance Assistant program
(19:54):
SHIP to get free help with these topics. Go to
page one fourteen to one seventeen for the phone for
your local ship. What I've been hearing about CHIP, though,
who knows if that might go away based on just budgets.
Speaker 3 (20:09):
And cutting that out, So I'm not.
Speaker 2 (20:12):
One hundred percent sure on that.
Speaker 3 (20:15):
I did want to go back and talk about.
Speaker 2 (20:22):
Medicare, but let's let's just go forward, and then after
this I'll talk about it in a little bit more detail. Okay,
what if I want to use a provider who opts
out of Medicare. Certain doctors and other healthcare providers who
don't want to work with the Medicare program may opt
out of Medicare. Medicare doesn't pay for any covered items
(20:44):
or services you get from an opt out doctor or
other provider, except in the case of an emergency or
urgent need. If you still want to use an opt
out provider, you and your provider can set up payment
terms that you agree both agree on two through a
(21:04):
private contract. A doctor or other healthcare provider who chooses
to opt out must do so for two years if
the choicer news automatically every two years, unless a provider
requests not to res you.
Speaker 3 (21:20):
Their opt out status. If you're ensure. If a provider has.
Speaker 2 (21:25):
Opted auto Medicare, check with them so you'll know ahead
of time if you need to pay them out of
your pocket. Pages ten to fourteen for an overview of
your Medicare options. So I do want to have some
commentary in regards to original Medicare, right, I definitely don't
(21:48):
want anyone to just be on original Medicare, because even
when someone says I am one hundred percent healthy, I
don't go to the doctor, I don't go to a specialist.
I don't take prescription drugs. You just never know, and
as you are growing older, something catastrophic may happen. And
(22:16):
then when something catastrophic happens, the bills could definitely pile up,
and you hear about medical bankruptcy and just you're already
dealing with your health concerns and conditions, and to top
it off with another, you know, financial burden, headache.
Speaker 3 (22:41):
It's not good. Okay, of course you're going.
Speaker 2 (22:45):
To have Medicaid medical that could help you pay if
you're like mentioned on a group health plan, retiree union
that will definitely work. But if you don't have that
or definitely want to compare those options, there is the
(23:06):
Medicare Supplement Plan, which is a Medicare gap plan. It
supplements your original Medicare and covers what original Medicare is
making you pay. Right, So that's a great option if
you do not want to replace.
Speaker 3 (23:27):
Medicare, okay, If you're.
Speaker 2 (23:30):
Okay replacing Medicare, if you want those all in one
packages so you're not worrying about paying your Medicare, your
Medicare supplement plan, your drug plan, your dental, your vision,
then the Medicare advantage plan might be a good option. Okay,
But of course it varies from every individual, and I
(23:53):
know some seniors are very biased on one or another
based on their individual experience or preference. But like I say,
it is good to listen to your your friends, your family,
your relatives that are on Medicare, right, but not all
(24:14):
things are equal. You are not equal to them, right.
Your health concerns, your prescription drugs, your preference, your budget,
they all are going to.
Speaker 3 (24:26):
Be very different.
Speaker 2 (24:28):
That's why it's great to talk to a licensed independent
insurance agent to.
Speaker 3 (24:33):
Help you with that.
Speaker 2 (24:34):
If you have any questions, please feel free to call us.
We're here just to be a resource to the community. Well,
today I'm ending the call on this.
Speaker 3 (24:46):
You have a call, it's not really a call, right, So.
Speaker 2 (24:50):
You have a wonderful day and I will see you
next time.
Speaker 3 (24:55):
Take care.
Speaker 1 (24:58):
Thank you for joining the program Medicare three sixty. Hope
you found today's episode insightful and empowering. Remember understanding your
Medicare options is key to making the right choices for
your health and financial well being. If you have questions
or topics you would like covered in future episodes of
Medicare three sixty, don't hesitate to reach out and speak
(25:21):
with our licensed insurance agent. Until next time, stay informed
and take charge of your healthcare journey. This has been
Medicare three sixty, your trusted source for all things Medicare.
Take care.
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