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 were 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
(00:22):
you 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 Medicare three sixty. I'm your host, Jennifer Lee,
and today we are going over the Medicare New Handbook.
Where we left off was actually on long term care,
and I wanted to highlight that again. So we're on
page fifty six on the Medicare New Handbook. Paying for
(01:05):
long term care, Medicare and most health insurance including Medicare
Supplement Insurance MEDICAP don't pay for non medical long term
care services. Go to page forty three for home health services.
This includes personal care assistance like help with everyday activities,
(01:26):
including dressing, bathing, and using the bathroom. Non medical long
term care services may also include home delivered meals, adult
day healthcare, home and community based services, and others. You
may be eligible for some of this care through Medicaid,
or you could choose to buy private long term care insurance.
(01:50):
You could get non medical long term care services at home,
in the community, in an assistant living facility, or in
a nursing home. It is important to start planning for
non medical long term care now and maintain your independence
to make sure you get the care you may need
(02:11):
in the setting you want now in the future. Long
term care resources use these services. To get more information
about long term care, visit ACL dot gov slash LTC
to learn more about planning for long term care. Visit
the Eldercare locator at Eldercare dot ACL dot gov, or
(02:31):
call one eight hundred sixty seven seven one one six
To find help in your community. Call your long term
care budsmen or visit lt combutsman dot org for help
with services you need and to be advised of your
rights and to find an ombudsman program near you. Call
(02:53):
your state Medical assistance Medicaid office or visit Medicaid dot
gov and ask for information about long term care coverage.
Call your state health insurance Assistant program SHIP. Go to
page one fourteen to one seventeen for the phone numbers
for your local SHIP. Hearing they might do away with
that program because those really aren't people that are licensed
(03:17):
right or certified for Medicare. And there's more, it's some
more volunteer role, so they might do away with it.
From what I'm hearing, Call your state insurance department for
information on long term care insurance. Call one eight hundred
Medicare eight hundred and sixty thirty three four two two
seven To get the phone number. TTY users call eight
(03:37):
seven seven four eight six DASH two zero four eight.
Get a copy of Shoppers Guide to Long Term Care
from the National Association of Insurance Commissioner at content dot
ny IC dot org. Slash sites, slash defaults, slash files,
slash Publication DASH LTC, dash LP, Shoppers Guide Long Term PD. Okay,
(04:02):
let's take a little bit more to talk about long
term care. If you are actually at a hospital and
you can't quite go home yet, in most of the
time hospitals like to actually kick you out right. You
can go to a skilled nursing facility which technically has
(04:24):
some type of like care component right or like a
rehab facility which is covered through Medicare. But the biggest
thing is you know when you get home, who is
going to take care of you. That's the biggest thing
I see. That can get quite expensive and unaffordable for
(04:48):
a person, particularly if you're not on Medicaid or medical
in California. How are you going to get the extra help?
There are some plans that do cover some type of help,
but it's going to be very minimal. Some plans allow
(05:09):
for a relief of your caregiver or maybe from an
emergency or hospital stay when you go back home from surgery,
things of that nature, but it's not full extent, especially
if someone has maybe dementia, illness, Alzheimer's which needs more
(05:30):
care per se, versus someone that's mentally there and might
just need help with physical activities such as cooking, cleaning, bathing,
going to the bathroom and things of that nature. But
it is definitely a good thing to plan ahead, even
(05:51):
in your sixties or as soon as you can, because
maybe in the eighties or nineties, that's when you probably
would need care. And most long term care companies actually
have gone out of business for the ones that are
particular long term care insurance plans, because these long term
(06:13):
care insurance plans, they're kind of like a use it
or lose it probability, just like healthcare. Right, you're paying
into a monthly premium and in the case you use
it perfect, it will be there. But if you don't
use it, you don't need it, then all those premiums
go down the drain. I've also found that sometimes when
(06:37):
a husband and wife are gets a long term care
policy and they one is healthy ones not, there's like
really no rhyme and reason when sometimes one person's premiums
go up one doesn't. And sometimes it's just kind of
(06:58):
like those tiers of groups of people. So depending if
your group or teering has filed more claims, then the
insurance company increases your premium versus another group where no
claims are filed. So it's pretty stable, right, So sometimes
I will have like older spouse paying X amount of premium,
(07:23):
and for some reason, the younger spouse, which is actually
more healthy, has like a way higher premium than theirs.
So it's kind of like that you never know when
it comes to that type of insurance. There are hybrids
now where it's not particularly just long term care. So
(07:45):
there's hybrids where you could purchase life insurance and might
have a component not particularly long term care per se
or but will help with the file. Two out of
the five Living Basic Living Act activities to take money
out of your life insurance, So that's an option. And
(08:06):
there are annuities as well that have the option where
you get an annuity, you could get a writer or
something embedded where if something were to happen to you
and you need long term care, you're able to pull
out that money even maybe double triple and use it
for long term care. So things like that definitely give
(08:27):
us a call. We get to help you out with
that because there are different factors and different types of
products that you could get to help you with long
term care. I think that's a really big issue because
I know many don't want to depend on their kids
(08:49):
or burden their kids. I've been seeing it way more
and more, and it's just something that is going to
be an issue later on for more people as there's
rising costs for care. Okay, let's move on to Section three,
page fifty seven. Original Medicare. How does original Medicare work? Okay?
(09:13):
So original Medicare is your red, white and blue card
that's original if you didn't enroll in a supplemental plan
or a Medicare advantage plan. Okay, so let's talk about that.
Original Medicare is one of your Medicare health coverage choices.
You'll have Original Medicare unless you choose a Medicare Advantage
(09:34):
plan or other type of Medicare health plan. Original Medicare
includes two parts, which is Part A hospital insurance and
Part B medical insurance. You generally have to pay a
portion of the cost for each service Original Medicare covers.
There's no limit to what you pay out of pocket
(09:55):
in a year unless you have other coverage like MEDICAP,
Medicare paid employer retire, or union coverage. So really, I
do not recommend original Medicare because, like mentioned here that
there's no limit to what you'll pay out of pocket
in a year if you don't have an additional coverage
(10:20):
like the MEDIGAP, Medicaid, employer retire, or Medicare advantage plan. Okay,
original Medicare. Can I get my healthcare from any doctor
or other healthcare provider or hospital. In most cases, Yes,
you could go to any Medicare approved Medicare and RLE doctor,
(10:45):
other healthcare provider, hospital, or other facility that accepts Medicare
patients anywhere in the US. Visit visit medicare dot gov,
slash care dash compare to find and compare provider, hospitals
and facilities in your area. I would say most providers
(11:05):
will take Medicare right, it's easy to build for them,
they will take Medicare. What I don't see sometimes if
it's like a just a medicaid facilities, sometimes like it's
only medicator medical. Hey does original Medicare cover prescription drugs? Okay?
(11:27):
Medicare Part B doesn't cover most drugs, but there are
some exceptions, 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
infused and injected drugs given in a doctor's office, and
(11:49):
insulin used with a traditional pump. Go to pages thirty nine,
forty four, and forty seven. You could add Medicare drug
coverage party by joining US separate Medicare plan go to
pages seventy nine to ninety. Okay, so this is a
little bit confusing, I would say, because like Medicare Part
(12:10):
B does cover like drugs that are like ordered by
your doctor and is injected, say your doctor's office, right,
and then like on your original Part A and B,
there's no invisible like there's no d on there which
is drugs, right. And so you just have to know
(12:33):
that you do have to get a drug plan because
if you don't, you will be penalized for every month
that you weren't on it and had to be okay.
So that's why a licensed professional agent like me will
make sure that you go over your options right, because
(12:54):
there are some Medicare advantage plans that don't come with
a drug plan, and those tipic or if you do
have credible drug plan coverage somewhere else like maybe veterans
or Trycare or like a group plan, you're in right.
Like I hadn't met this lady. I was at a
client's house. She was a sister, and she's like, oh,
(13:16):
I already got this taken care of on the phone,
but of course, hey, let me review it just to
make sure everything's good. She told me that she was
getting surgery soon. But I don't take any medication, I
told the person on the phone specifically, I don't take medication.
I don't need a drug plan. Right, But first of all,
they put her on a plan that was way worse
(13:39):
than any other plans with a drug plan. Second, she's
gonna have surgery, so she probably will get medication that
she needs. Right. Third, she needs to get a drug plan.
She didn't have any other coverage, meaning she would have
been penalized one percent for every single year, that month,
sorry month that she was an it. So let's just
(14:01):
say I never met her. Two years go by without
a drug plan, so that's twenty four months, twenty four
percent off the average Medicare Part D costs. So do
not go with an agent that's an order taker that
clearly doesn't understand how these insurance work, because they totally
(14:24):
give her something so wrong, or didn't at least give
her the knowledge to make the proper decision for herself.
It's just so worse when you trust an agent with
something that you will be penalized for the rest of
your life. So just be careful on that. It's a
(14:46):
big thing. I would say, I don't know why what
person would do that? I mean an agent, not give
someone a drug plan just because they said I don't
need one, Right, I'm be someone's advisor, recommend or just
at least tell them the facts about the penalty. Just
(15:09):
mind boggles me. But I do hear from that from
time to time, So just be careful. Okay, do you
need to choose a primary care doctor? No? If you
are on original Medicare, you do not need to choose
a primary care doctor. If you're also on a supplemental plan,
which is called metagap, you also don't need a primary
(15:29):
care doctor. Do I have to get a referral to
use a specialist? In most cases? No? Okay. Sometimes, like
when you go to the lab, even if you're on
original Medicare and a supplement right, Like, the lab doesn't
just want to say, okay, let me run all the
tests on you, like they want a doctor's No, a
(15:52):
doctor's referral to run tests on you, right, So things
like that. Keep that in mind. Okay, should I get
a supplemental policy, you may already have Medicaid or employer,
retiree or union coverage that may cost that original Medicare doesn't.
(16:15):
May pay yeah, so that may pay the cost right.
If not, you may want to buy a Medicare supplement
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
(16:40):
original Medicare? Okay? So? You generally pay a set amount
for your healthcare 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's no
your limit for what you pay out of pocket unless
(17:02):
you have other insurance like metagap, Medicaid, or employer retire
union coverage. Usually pay for a monthly premium for Part B.
The premium may change each year, and it also could
change based on income. You generally don't need to file
(17:23):
Medicare claims. Providers and suppliers must file your claims for
the cover services and supplies you get. What do I pay?
Your out of pocket costs and original Medicare depend on
whether you have Part A and or Part B. Most
people have both. Whether your doctor, other healthcare provider or
(17:46):
supplier accepts assignment. Go to page fifty nine to sixty.
The type of healthcare you need and how often you
need it. If you choose to get services or supplies
Medicare does cover. If so, you pay all costs unless
you have other insurance that covers them. Whether you have
(18:06):
other health insurance that works with Medicare, go to page
twenty one. Whether you have full Medicaid coverage or get
help from your state to pay your Medicare costs through
a Medicare savings program, go to page ninety one to
ninety two. Whether you have Medicare Supplement insurance MEDICAP, Whether
you and your doctor other healthcare provider sign a private contract,
(18:29):
go to page sixty. How do I know what Medicare paid?
If you have original Medicare, you'll get a Medicare Summary
Notice MSN that lists all services built to Medicare. The
bill isn't a bill, It shows what Medicare paid and
(18:49):
what you may owe. A provider review your MSNs to
be sure you get all the services. Supplies are equipment listed.
If you disagree with metay Care's decision not to covery service,
the MSN will tell you how to appeal. Go to
page ninety nine for information on how to file an appeal.
You'll get this notice in the mail every four months,
(19:11):
unless you sign up to get it electronically. If you
need to change your address on your MSN, visit SSA
dot gov slash my contact. If you get Railroad Retirement
Board Benefits RRB, call the RB at eight seven seven
five seven seven two five seven seven to two. Your
(19:35):
MSN will tell you if you're enrolled in a Qualified
Medicare Beneficiary Program QMB. If you're in the QMB program,
Medicare provides. Providers aren't allowed to bill you for Medicare
A and RB deductibles, co insurance, or co payments. In
some cases, you may be built a small co payment
(19:57):
through Medicaid Fund applies from information about Q and B
and steps to take if a provider bills you these costs,
go to page ninety one. Okay, So, the easiest thing
in regards to what Medicare covers there is a Medicare app.
(20:17):
You could download it on your phone and then you
just type in whatever service you want, like hey, chiropractor
acupuncture is that covered? And it will give you an
outline and a detailed on that. So that's a pretty
handy app to use. Important Get your Medicare Summary notices
(20:38):
electronic get your Medicare Summary notices electronically. Visit Medicare dot
gov to log in to or create your secure Medicare account.
If you sign up for electronic MSNs, we'll send you
an email each month when they're available in your Medicare
account instead of paper copies in the mail. As of
late twenty twenty four, who signed up for electronic emsns
(21:02):
help save the Medicare program close to forty two million.
That's awesome. I will probably recommend that to clients because
that will help save money. Okay, you have options for
how you get your Medicare claims information. You could check
your MSN for claims information. You could access your claims
(21:25):
in your account on Medicare dot CoV and share this
information with doctors, pharmacies and others by visiting check my claims.
You could access your claims through Medicare connected apps. Connected
apps are Medicare proved applications or websites. That's a connected
that a third party, not Medicare, creates when you connect
(21:47):
to an app and log in with your Medicare DOTV
account information. You could use app services without manual entering
your health information. These third parties can all can only
access your Medicare data if you choose to share with them.
It's always your choice. If you want to connect or
stay connected to third party app go to page one
O nine. What's assignment? Assignment means that your doctor, provider
(22:15):
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 make sure yours do. If your doctor,
provider or supplier accepts assignment, you're out of pocket maybe less.
(22:37):
They agree to charge you only the Medicare deductible and
co insurance amount and usually want wait for Medicare to
pay share before asking you to pay your share. If
you have to submit your claim directly to Medicare and
can't charge you for some and can't charge you for
submitting the claim, okay, we are on page sixty. Some
(23:00):
providers haven't agreed and aren't required by law to accept
assignments for all Medicare covered services, but they still they
can't sell choose to accept assignment for individual services. The
provider who haven't agreed to accept assignment for all services
are called non participating. You might have to pay for
(23:24):
more of their services if they don't accept assignment for
the care they provide to you. Here's what happens. If
your doctor's provider or suppliers doesn't accept assignment, you might
have to pay the entire charge at the time of service.
Your doctor provider supplier is supposed to submit a claim
(23:45):
to Medicare for any Medicare cover services they provide to you.
If they don't submit the Medicare claim, once you ask
them to call one hundred Medicare one one hundred sixty
three three four two two seven, they can charge you
more than the Medicare proved amounts. In many cases, the
(24:07):
charge can't be more than fifteen percent above the Medicare
proved amount. For non participating healthcare providers, the amount is
called limiting charge compare. If you have original Medicare, you
could use any provider you want that takes Medicare anywhere
in the US. If you're in a Medicare advantage plan,
(24:28):
in most cases, you'll need to use doctors and other
providers who are in the Plans Network. I'd love to
talk about this more in detail on our next show.
Until next time, you have a wonderful day, look forward
to seeing you soon. Thank you, bye bye.
Speaker 1 (24:48):
Thank you for joining the program Medicare at 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
(25:11):
speak with our licensed insurance agent. Until next time, stay
informed and take charge of your health care 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 were 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
(00:22):
you 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 Medicare three sixty. I'm your host, Jennifer Lee,
and today we are going over the Medicare New Handbook.
Where we left off was actually on long term care,
and I wanted to highlight that again. So we're on
page fifty six on the Medicare New Handbook. Paying for
(01:05):
long term care, Medicare and most health insurance including Medicare
Supplement Insurance MEDICAP don't pay for non medical long term
care services. Go to page forty three for home health services.
This includes personal care assistance like help with everyday activities,
(01:26):
including dressing, bathing, and using the bathroom. Non medical long
term care services may also include home delivered meals, adult
day healthcare, home and community based services, and others. You
may be eligible for some of this care through Medicaid,
or you could choose to buy private long term care insurance.
(01:50):
You could get non medical long term care services at home,
in the community, in an assistant living facility, or in
a nursing home. It is important to start planning for
non medical long term care now and maintain your independence
to make sure you get the care you may need
(02:11):
in the setting you want now in the future. Long
term care resources use these services. To get more information
about long term care, visit ACL dot gov slash LTC
to learn more about planning for long term care. Visit
the Eldercare locator at Eldercare dot ACL dot gov, or
(02:31):
call one eight hundred sixty seven seven one one six
To find help in your community. Call your long term
care budsmen or visit lt combutsman dot org for help
with services you need and to be advised of your
rights and to find an ombudsman program near you. Call
(02:53):
your state Medical assistance Medicaid office or visit Medicaid dot
gov and ask for information about long term care coverage.
Call your state health insurance Assistant program SHIP. Go to
page one fourteen to one seventeen for the phone numbers
for your local SHIP. Hearing they might do away with
that program because those really aren't people that are licensed
(03:17):
right or certified for Medicare. And there's more, it's some
more volunteer role, so they might do away with it.
From what I'm hearing, Call your state insurance department for
information on long term care insurance. Call one eight hundred
Medicare eight hundred and sixty thirty three four two two
seven To get the phone number. TTY users call eight
(03:37):
seven seven four eight six DASH two zero four eight.
Get a copy of Shoppers Guide to Long Term Care
from the National Association of Insurance Commissioner at content dot
ny IC dot org. Slash sites, slash defaults, slash files,
slash Publication DASH LTC, dash LP, Shoppers Guide Long Term PD. Okay,
(04:02):
let's take a little bit more to talk about long
term care. If you are actually at a hospital and
you can't quite go home yet, in most of the
time hospitals like to actually kick you out right. You
can go to a skilled nursing facility which technically has
(04:24):
some type of like care component right or like a
rehab facility which is covered through Medicare. But the biggest
thing is you know when you get home, who is
going to take care of you. That's the biggest thing
I see. That can get quite expensive and unaffordable for
(04:48):
a person, particularly if you're not on Medicaid or medical
in California. How are you going to get the extra help?
There are some plans that do cover some type of help,
but it's going to be very minimal. Some plans allow
(05:09):
for a relief of your caregiver or maybe from an
emergency or hospital stay when you go back home from surgery,
things of that nature, but it's not full extent, especially
if someone has maybe dementia, illness, Alzheimer's which needs more
(05:30):
care per se, versus someone that's mentally there and might
just need help with physical activities such as cooking, cleaning, bathing,
going to the bathroom and things of that nature. But
it is definitely a good thing to plan ahead, even
(05:51):
in your sixties or as soon as you can, because
maybe in the eighties or nineties, that's when you probably
would need care. And most long term care companies actually
have gone out of business for the ones that are
particular long term care insurance plans, because these long term
(06:13):
care insurance plans, they're kind of like a use it
or lose it probability, just like healthcare. Right, you're paying
into a monthly premium and in the case you use
it perfect, it will be there. But if you don't
use it, you don't need it, then all those premiums
go down the drain. I've also found that sometimes when
(06:37):
a husband and wife are gets a long term care
policy and they one is healthy ones not, there's like
really no rhyme and reason when sometimes one person's premiums
go up one doesn't. And sometimes it's just kind of
(06:58):
like those tiers of groups of people. So depending if
your group or teering has filed more claims, then the
insurance company increases your premium versus another group where no
claims are filed. So it's pretty stable, right, So sometimes
I will have like older spouse paying X amount of premium,
(07:23):
and for some reason, the younger spouse, which is actually
more healthy, has like a way higher premium than theirs.
So it's kind of like that you never know when
it comes to that type of insurance. There are hybrids
now where it's not particularly just long term care. So
(07:45):
there's hybrids where you could purchase life insurance and might
have a component not particularly long term care per se
or but will help with the file. Two out of
the five Living Basic Living Act activities to take money
out of your life insurance, So that's an option. And
(08:06):
there are annuities as well that have the option where
you get an annuity, you could get a writer or
something embedded where if something were to happen to you
and you need long term care, you're able to pull
out that money even maybe double triple and use it
for long term care. So things like that definitely give
(08:27):
us a call. We get to help you out with
that because there are different factors and different types of
products that you could get to help you with long
term care. I think that's a really big issue because
I know many don't want to depend on their kids
(08:49):
or burden their kids. I've been seeing it way more
and more, and it's just something that is going to
be an issue later on for more people as there's
rising costs for care. Okay, let's move on to Section three,
page fifty seven. Original Medicare. How does original Medicare work? Okay?
(09:13):
So original Medicare is your red, white and blue card
that's original if you didn't enroll in a supplemental plan
or a Medicare advantage plan. Okay, so let's talk about that.
Original Medicare is one of your Medicare health coverage choices.
You'll have Original Medicare unless you choose a Medicare Advantage
(09:34):
plan or other type of Medicare health plan. Original Medicare
includes two parts, which is Part A hospital insurance and
Part B medical insurance. You generally have to pay a
portion of the cost for each service Original Medicare covers.
There's no limit to what you pay out of pocket
(09:55):
in a year unless you have other coverage like MEDICAP,
Medicare paid employer retire, or union coverage. So really, I
do not recommend original Medicare because, like mentioned here that
there's no limit to what you'll pay out of pocket
in a year if you don't have an additional coverage
(10:20):
like the MEDIGAP, Medicaid, employer retire, or Medicare advantage plan. Okay,
original Medicare. Can I get my healthcare from any doctor
or other healthcare provider or hospital. In most cases, Yes,
you could go to any Medicare approved Medicare and RLE doctor,
(10:45):
other healthcare provider, hospital, or other facility that accepts Medicare
patients anywhere in the US. Visit visit medicare dot gov,
slash care dash compare to find and compare provider, hospitals
and facilities in your area. I would say most providers
(11:05):
will take Medicare right, it's easy to build for them,
they will take Medicare. What I don't see sometimes if
it's like a just a medicaid facilities, sometimes like it's
only medicator medical. Hey does original Medicare cover prescription drugs? Okay?
(11:27):
Medicare Part B doesn't cover most drugs, but there are
some exceptions, 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
infused and injected drugs given in a doctor's office, and
(11:49):
insulin used with a traditional pump. Go to pages thirty nine,
forty four, and forty seven. You could add Medicare drug
coverage party by joining US separate Medicare plan go to
pages seventy nine to ninety. Okay, so this is a
little bit confusing, I would say, because like Medicare Part
(12:10):
B does cover like drugs that are like ordered by
your doctor and is injected, say your doctor's office, right,
and then like on your original Part A and B,
there's no invisible like there's no d on there which
is drugs, right. And so you just have to know
(12:33):
that you do have to get a drug plan because
if you don't, you will be penalized for every month
that you weren't on it and had to be okay.
So that's why a licensed professional agent like me will
make sure that you go over your options right, because
(12:54):
there are some Medicare advantage plans that don't come with
a drug plan, and those tipic or if you do
have credible drug plan coverage somewhere else like maybe veterans
or Trycare or like a group plan, you're in right.
Like I hadn't met this lady. I was at a
client's house. She was a sister, and she's like, oh,
(13:16):
I already got this taken care of on the phone,
but of course, hey, let me review it just to
make sure everything's good. She told me that she was
getting surgery soon. But I don't take any medication, I
told the person on the phone specifically, I don't take medication.
I don't need a drug plan. Right, But first of all,
they put her on a plan that was way worse
(13:39):
than any other plans with a drug plan. Second, she's
gonna have surgery, so she probably will get medication that
she needs. Right. Third, she needs to get a drug plan.
She didn't have any other coverage, meaning she would have
been penalized one percent for every single year, that month,
sorry month that she was an it. So let's just
(14:01):
say I never met her. Two years go by without
a drug plan, so that's twenty four months, twenty four
percent off the average Medicare Part D costs. So do
not go with an agent that's an order taker that
clearly doesn't understand how these insurance work, because they totally
(14:24):
give her something so wrong, or didn't at least give
her the knowledge to make the proper decision for herself.
It's just so worse when you trust an agent with
something that you will be penalized for the rest of
your life. So just be careful on that. It's a
(14:46):
big thing. I would say, I don't know why what
person would do that? I mean an agent, not give
someone a drug plan just because they said I don't
need one, Right, I'm be someone's advisor, recommend or just
at least tell them the facts about the penalty. Just
(15:09):
mind boggles me. But I do hear from that from
time to time, So just be careful. Okay, do you
need to choose a primary care doctor? No? If you
are on original Medicare, you do not need to choose
a primary care doctor. If you're also on a supplemental plan,
which is called metagap, you also don't need a primary
(15:29):
care doctor. Do I have to get a referral to
use a specialist? In most cases? No? Okay. Sometimes, like
when you go to the lab, even if you're on
original Medicare and a supplement right, Like, the lab doesn't
just want to say, okay, let me run all the
tests on you, like they want a doctor's No, a
(15:52):
doctor's referral to run tests on you, right, So things
like that. Keep that in mind. Okay, should I get
a supplemental policy, you may already have Medicaid or employer,
retiree or union coverage that may cost that original Medicare doesn't.
(16:15):
May pay yeah, so that may pay the cost right.
If not, you may want to buy a Medicare supplement
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
(16:40):
original Medicare? Okay? So? You generally pay a set amount
for your healthcare 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's no
your limit for what you pay out of pocket unless
(17:02):
you have other insurance like metagap, Medicaid, or employer retire
union coverage. Usually pay for a monthly premium for Part B.
The premium may change each year, and it also could
change based on income. You generally don't need to file
(17:23):
Medicare claims. Providers and suppliers must file your claims for
the cover services and supplies you get. What do I pay?
Your out of pocket costs and original Medicare depend on
whether you have Part A and or Part B. Most
people have both. Whether your doctor, other healthcare provider or
(17:46):
supplier accepts assignment. Go to page fifty nine to sixty.
The type of healthcare you need and how often you
need it. If you choose to get services or supplies
Medicare does cover. If so, you pay all costs unless
you have other insurance that covers them. Whether you have
(18:06):
other health insurance that works with Medicare, go to page
twenty one. Whether you have full Medicaid coverage or get
help from your state to pay your Medicare costs through
a Medicare savings program, go to page ninety one to
ninety two. Whether you have Medicare Supplement insurance MEDICAP, Whether
you and your doctor other healthcare provider sign a private contract,
(18:29):
go to page sixty. How do I know what Medicare paid?
If you have original Medicare, you'll get a Medicare Summary
Notice MSN that lists all services built to Medicare. The
bill isn't a bill, It shows what Medicare paid and
(18:49):
what you may owe. A provider review your MSNs to
be sure you get all the services. Supplies are equipment listed.
If you disagree with metay Care's decision not to covery service,
the MSN will tell you how to appeal. Go to
page ninety nine for information on how to file an appeal.
You'll get this notice in the mail every four months,
(19:11):
unless you sign up to get it electronically. If you
need to change your address on your MSN, visit SSA
dot gov slash my contact. If you get Railroad Retirement
Board Benefits RRB, call the RB at eight seven seven
five seven seven two five seven seven to two. Your
(19:35):
MSN will tell you if you're enrolled in a Qualified
Medicare Beneficiary Program QMB. If you're in the QMB program,
Medicare provides. Providers aren't allowed to bill you for Medicare
A and RB deductibles, co insurance, or co payments. In
some cases, you may be built a small co payment
(19:57):
through Medicaid Fund applies from information about Q and B
and steps to take if a provider bills you these costs,
go to page ninety one. Okay, So, the easiest thing
in regards to what Medicare covers there is a Medicare app.
(20:17):
You could download it on your phone and then you
just type in whatever service you want, like hey, chiropractor
acupuncture is that covered? And it will give you an
outline and a detailed on that. So that's a pretty
handy app to use. Important Get your Medicare Summary notices
(20:38):
electronic get your Medicare Summary notices electronically. Visit Medicare dot
gov to log in to or create your secure Medicare account.
If you sign up for electronic MSNs, we'll send you
an email each month when they're available in your Medicare
account instead of paper copies in the mail. As of
late twenty twenty four, who signed up for electronic emsns
(21:02):
help save the Medicare program close to forty two million.
That's awesome. I will probably recommend that to clients because
that will help save money. Okay, you have options for
how you get your Medicare claims information. You could check
your MSN for claims information. You could access your claims
(21:25):
in your account on Medicare dot CoV and share this
information with doctors, pharmacies and others by visiting check my claims.
You could access your claims through Medicare connected apps. Connected
apps are Medicare proved applications or websites. That's a connected
that a third party, not Medicare, creates when you connect
(21:47):
to an app and log in with your Medicare DOTV
account information. You could use app services without manual entering
your health information. These third parties can all can only
access your Medicare data if you choose to share with them.
It's always your choice. If you want to connect or
stay connected to third party app go to page one
O nine. What's assignment? Assignment means that your doctor, provider
(22:15):
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 make sure yours do. If your doctor,
provider or supplier accepts assignment, you're out of pocket maybe less.
(22:37):
They agree to charge you only the Medicare deductible and
co insurance amount and usually want wait for Medicare to
pay share before asking you to pay your share. If
you have to submit your claim directly to Medicare and
can't charge you for some and can't charge you for
submitting the claim, okay, we are on page sixty. Some
(23:00):
providers haven't agreed and aren't required by law to accept
assignments for all Medicare covered services, but they still they
can't sell choose to accept assignment for individual services. The
provider who haven't agreed to accept assignment for all services
are called non participating. You might have to pay for
(23:24):
more of their services if they don't accept assignment for
the care they provide to you. Here's what happens. If
your doctor's provider or suppliers doesn't accept assignment, you might
have to pay the entire charge at the time of service.
Your doctor provider supplier is supposed to submit a claim
(23:45):
to Medicare for any Medicare cover services they provide to you.
If they don't submit the Medicare claim, once you ask
them to call one hundred Medicare one one hundred sixty
three three four two two seven, they can charge you
more than the Medicare proved amounts. In many cases, the
(24:07):
charge can't be more than fifteen percent above the Medicare
proved amount. For non participating healthcare providers, the amount is
called limiting charge compare. If you have original Medicare, you
could use any provider you want that takes Medicare anywhere
in the US. If you're in a Medicare advantage plan,
(24:28):
in most cases, you'll need to use doctors and other
providers who are in the Plans Network. I'd love to
talk about this more in detail on our next show.
Until next time, you have a wonderful day, look forward
to seeing you soon. Thank you, bye bye.
Speaker 1 (24:48):
Thank you for joining the program Medicare at 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
(25:11):
speak with our licensed insurance agent. Until next time, stay
informed and take charge of your health care journey. This
has been Medicare three sixty, your trusted source for all
things Medicare. Take care,
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