Keep your Medicare card safe

You’ll usually need to show your Medicare card (or your Medicare Advantage plan card, if you choose Medicare Advantage) when you receive services. Bring it along when you go to the doctor.

Help prevent fraud

Your Medicare card and your Social Security number are valuable personal information. Keep track of your card. Handle it the way you would handle other valuable information, like a credit card.

If you suspect someone else is using your Medicare card or your Social Security number, call the Medicare Helpline immediately. (1-800-MEDICARE).

Choose you providers carefully

The quality of care may vary among doctors, hospitals and other providers.

To find quality information about providers in your area, visit Medicare.gov or Healthgrades.com or call the Medicare Helpline.

Understand how coverage works

In general, for Medicare to cover a service or supply:

• You must have joined the part (Part A or Part B) that provides that service or supply
• The service or supply must be medically necessary to treat a health condition or prevent it
• You must choose a provider enrolled in Medicare
• You must meet any conditions that apply (such as limits on how often the service can be provided)

If you have questions, ask

You have the right to information about how your Medicare benefits work, including information about what services are covered and their costs. You also have the right to an explanation when a service is denied to you.

Pay attention to the paperwork

When you receive a health service that Medicare covers, you will get a Medicare Summary Notice (MSN) in the mail. The MSN shows the service or supplies that have been billed to Medicare for your care. Check this list to make sure that you received all the services or supplies listed.

Know your rights

Smart consumers understand their rights. As a person with Medicare coverage, you have the formal right to complain, or appeal, about your treatment in certain situations.

For example, you have the right to appeal when your prescription drug plan doesn’t cover a drug that you and your doctor think you should have. As another example, you have the right to question the amount that Medicare paid for a service you got.

Your State Health Insurance Assistance Program (SHIP) can tell you more about how to file an appeal.

To Know About Medicare Plans

It’s that time of year again. Time to look at the benefits of your Medicare insurance plan and decide to keep what you have or make a change. Here are 10 important things to think about when evaluating a Medicare Advantage insurance plan.

1. You must have Medicare Part A and Part B to be eligible AND you must continue to pay your Part B premium.

2. Joining a Medicare Advantage plan may affect your current coverage. If you have existing coverage or employer- provided health insurance and plan to work past 65, be sure to check to see how joining a Medicare Advantage plan could affect your current coverage. A Medicare Advantage plan can sometimes be less expensive than your employer provided plan. Most Medicare Advantage plans in Orange County have a $0 premium.

3. Once you stop working and you are 65 or over, you must have Part B of Medicare even if you have a retiree plan sponsored by your former employer. If you don’t take Part B when you are eligible, you will have a penalty when you decide to apply later.

4. The use of a network of health care and pharmacy providers is typically required with Medicare Advantage plans. Using providers outside of the network may cost you more. Make sure your primary care doctor and specialists are part of the network. And make certain the hospital you prefer is also in the network. In an emergency, you can use any provider or any hospital.

5. Depending on your financial situation, you may qualify for some help paying your plan premiums or Part D medications. This “extra help” comes on a sliding scale, so if you have any questions it is always a good idea to ask.

6. A Part D late-enrollment penalty is an additional amount that will be added to your Part D premium if you go without Part D coverage for longer than 63 days in a row after your Initial Enrollment Period. 

7. A Medicare supplement plan (Medigap policy) is not a Medicare Advantage plan and is not a “PPO” plan. Medicare supplement plans are health insurance policies and are secondary to Original Medicare. When you purchase a Medicare supplement plan you also need to purchase a Part D plan. When you have a Medicare supplement plan you can see any doctor that accepts Original Medicare.

8. When you have a Medicare Advantage plan you use that member ID card and not your Original Medicare card when receiving services. This is another “advantage” of this type of plan; you no longer need to carry your Medicare card with your Medicare/Social Security number.

9. Even though Medicare Advantage plans are privately administered, you still have the same rights and protections as with Original Medicare; and, Advantage plans cover all the services that Original Medicare covers and usually offer additional benefits.

10. The Medicare Advantage plans provide a built-in financial safety net with an annual out-of-pocket maximum. This assures you will never pay more than a certain amount out-of-pocket in a given plan year for covered medical services.

To sum it all up, if you can say yes to the following five questions, then a Medicare Advantage plan is a good choice for you: Is your primary care doctor in the network? Are your specialists in the network? Is your preferred hospital in the network? Are your prescriptions drugs covered? Is the plan affordable? Call me today and begin saving money with a Medicare Advantage plan.