Entering into Medicare for the first time can be a challenge for most seniors. The truth is, this is the first time a lot of seniors have needed to purchase individual health insurance and Medicare is nothing like the insurance you find in the Healthcare Marketplace or employee insurance plans.
To make life simple for my Turning 65 people, I’ve composed a list of the most common questions I get asked about Medicare, Medicare Supplements, and Medicare Advantage.
*These FAQ’s are a constant work in progress. If you don’t see your question, please feel free to give me a call at 231-884-8161 for a non-salesy, unbiased answer*
Before we jump in, below is the basics concerning Medicare from A to D. This gives you a great level of baseline knowledge before you ask questions!
Table of Contents
Should I sign up for Medicare Advantage or Original Medicare?
This is the absolute most common question I get and the first major decision YOU have to make. Run away from anyone that tells you that you HAVE to buy a plan.
*There are times that I strongly suggest that someone should avoid a plan type, mainly due to prior health conditions. One plan type would be an incredibly poor fit for them and would cost them more they they think they’d save. However, ultimately it’s YOUR job to make a decision and my job to make you away of complications.*
The truth is there are a number of variables, including your tolerance to change, how flexible you are with your treatment plan, and if you’re willing to pay more when you use it vs up-front to get extra benefits and a lower up-front cost.
Some seniors are willing to pay more monthly for more freedom. Some seniors are willing to do more work for a lower up-front cost.
This decision is about 90% of getting your Medicare Private Insurance plan figured out.
I'm (or my spouse is) working and have an employee plan. Do I need to sign up for Medicare?
If you have a company under 50 employees, yes. Medicare becomes the primary insurance for you and you need to sign up.
If your company has more than 50 employees, maybe… but not likely. It’s important to speak with your HR department about if you need to sign up for Medicare or not. In most instances, if your work allows you to stay on their plan after 65, you don’t need to sign up for Medicare.
PRO TIP: If you don’t have an HSA (again, check with HR) and have premium-free Part A, it’s a great choice to go ahead and sign up. Medicare becomes a secondary insurance coverage AFTER your employer plan. With Part A (Hospital Care) premium free often won’t pay, as secondary insurance, but since there’s no cost to you it’s worth it in case it does.
Part B on the other hand, do not sign up if you have an employer plan if you aren’t forced to do so. There’s ALWAYS a premium with Part B and it will almost never pay out. Furthermore, by enrolling for Part B, you’re giving away the Open Enrollment/Special Enrollment period where you don’t have to go through Medical Underwriting for a Medicare Supplement.
As long as you have Creditable Coverage (Like you/your spouse’s work plan) there is no penalty for Parts B or D.
Will I be automatically enrolled in Medicare at 65?
Only if you are receiving Social Security Retirement, Railroad Retirement, Social Security Disability, or Railroad Disability will you be enrolled in Medicare at age 65. Any other time you *MUST* enroll yourself.
You have a 7 month window that starts 3 months before, and ends 3 months after, you turn 65. If you miss this window, you can only enroll during the General Enrollment Period (Jan 1-Mar 31) and your plan will start the next July.
Missing Initial Enrollment (Turning 65) may cause you to have a Part B and Part D penalty, depending on how long you wait.
PRO TIP: You can enroll yourself in Medicare three ways:
I'm not taking Social Security yet. How am I billed for Medicare?
You have two options:
1) Medicare bills you quarterly for your Medicare Part B premiums. You’ll get your notices in the mail and can pay by check.
2) You can contact your local Social Security office (or call 800-772-1213) and they can set you up for monthly autodraft.
Does Medicare cover Dental, Vision, or Hearing?
Non-routine care that is caused by a medical condition, possible. A good example where Medicare might cover your vision and glasses is after cataract surgery. But it would only be the follow-up exam and initial glasses, along with the surgery itself.
Medicare does not cover routine services for Dental, Vision, or Hearing. Routine is cleanings, fillings, root canal’s, crowns, glasses (except after cataract surgery), audiograms (usually) are considered routine. You would need to buy a stand-alone insurance plan for coverage.
You should talk to someone to decide if it’s worth it or not to buy it… Individual dental and vision plans don’t work the same as group (employer) plans.
Medicare Supplement Questions
What's the best Medicare Supplement company?
Honestly, I can’t answer that question without more information. Medicare Supplement companies all have different price points depending on plan, your zip code/county, if you’re a smoker or not, if you’re a male or female.
After a lot of research, there are a number of companies that I represent because they offer the best value. While each agent has their own criteria (some better than others) mine boils down to four things:
1) The company has to be in Michigan for at least 5 years- Companies enter and exit the state for Medicare Supplements every year. They start out at really low rates and then skyrocket as they get more claims experience. Around year 5 in the state, they stabilize.
2) They need to be some of the most competitive companies consistently (from age 65-75+) on price.
3) They need to be at least A- rated for financial stability.
4) They need to have good US-based customer service- You need to be able to understand them when you have a question, right?
Notice I don’t say anything about brand name? It’s because it’s irrelevant. Medicare Supplements work the exact same way, they pay out the same way, and the doctors take it if they accept Medicare (even if they haven’t hear of it.)
What's the average rate increase for Company X?
So, there’s a difference between the question you’re asking and the answer you want.
The real question is what can I expect in the way of annual increases?
So, I’m going to level with you here; because I think you want someone to be honest with you. Anyone that tries to make historical annual rate increases a selling point is lying to you.
It’s similar to going to a financial planner and asking how much GE’s stock is going to increase next year.
Here’s what I can tell you:
There are two types of increases:
- Attained age- Every year you get older you get an increase (about 3.5-4.5%)
- Claims Experience increase- This increase is impossible to know when, if, and how much it is until the insurance company releases it. There is no average.
What you should know is that rates do increase, and you should shop every 3-5 years to get the best value for your dollar.
Will my doctor take my Medicare Supplement?
If they accept Medicare, they will accept the Medicare Supplement anywhere in the US (regardless of the company.)
Medicare Supplements are standardized. That’s Medicare-speak for saying they work the exact same way, regardless of the company. Plan Letters cover the exact same benefits, doctors, and pay the same.
The only difference between a Plan Letter (F, G, N) between two insurance companies is price. Plan F is Plan F.
When can I sign up for a Medicare Supplement?
Insurance companies will allow you to complete an application for a Medicare Supplement 6 months before you turn 65. Even though you won’t get your Medicare card before 3 month before 65.
The Medicare Supplement effective date will be the month you turn 65.
It’s important to know that submitting an application does not lock you into a plan. What this means is you can change your mind at any time up to the effective date without a penalty.
What is the Medicare Supplement "Free Look" period?
This allows you to reject a Medicare Supplement company in the first 30 days.
This is not a cost-free provision.
Essentially, it allows you to carry two Medicare Supplement plans and pay the premiums while you try the new company.
During your 7-month Initial Open Enrollment Period, it preserves your ability to switch companies in case you want a different plan or find a better value with another company without medical underwriting.
It’s less effective outside of your Initial Open Enrollment period (or Special Enrollment Period if you’re signing up for Part B for the first time) because you have to pass underwriting to sign up for a new Medicare Supplement plan or company (usually.)
PRO TIP: A good agent is usually going to start your new plan a month after the application so you don’t double pay and have time to cancel your old plan.
Can I change Medicare Supplement plans? When am I allowed?
You can change Medicare Supplement plans at any time. However, you are required to pass medical underwriting and be accepted into the new company.
After your Initial Open Enrollment Period (unless you meet the criteria for a Special Enrollment Period, which is rare) you must pass underwriting to be accepted.
PRO TIP: It’s a good idea to shop your Medicare Supplement every 3-5 years to make sure you’re getting the best value for your plan. If you do decide to change plans to lower your monthly payment, don’t cancel your current plan until you receive approval from the new plan. A good insurance agent will help guide you through this process and tell you when it’s okay to cancel your plan.
Medicare Advantage Questions
What is Medicare Advantage?
Medicare Advantage (or Part C) works similarly to your employee plan. Medicare pays private insurance companies to administer Medicare benefits. Unlike Original Medicare (Parts A & B, federally administered) the insurance company can and do have cost-saving measures, such as:
- Networks and prior authorizations for specialists
- Co-pays and Co-insurance
- Managed care (step treatment)- Example, Physical therapy before surgery.
Can I change Medicare Advantage plans?
YES! However, unlike Medicare Supplement plans, you can only change them at certain times of the year. This includes the following time periods:
- Annual Open Enrollment (October 15- December 7)
- Medicare Advantage Open Enrollment (January 1- March 31)
There are also Special Enrollment Periods that you can change a Medicare Advantage plan anytime during the year for a set time frame. Usually it’s when you move outside of your current service area.
What is the Medicare Advantage Trial Right?/Can I move back to Original Medicare?
Essentially, it’s a try it period where you can move back to Original Medicare and a Medicare Supplement without underwriting (called Guaranteed Issue.) It lasts 12 months from when you first sign onto your first Medicare Advantage plan.
After the first year, you can’t move back to Original Medicare unless you’re in the Annual or Medicare Advantage Open Enrollment Period AND you must pass Medical Underwriting to be accepted to a Medicare Supplement plan.
What's the BEST Medicare Advantage plan?
Lawd, if it were just that easy. There are a number of variables to evaluate prior to making a decision on a Medicare Advantage plan.
- What’s your zip code?
- Who’s are your doctors?
- What medications are you taking?
- What pharmacy do you like to use?
Medicare Advantage plans can work differently from county to county, even if they have the same name and the same company. They can also change annually.
The fluctuation in Medicare Advantage plans is why you can make changes annually, vs Medicare Supplements that work the exact same way, no matter what.