Plan F was the most popular Medicare Supplement plan in the past. MACRA legislation that becomes effective on January of 2020 has a big impact on that. People new to Medicare beginning January 1, 2020 and after, cannot own a Plan F under the new MACRA Legislation. Congress does not want folks to own a plan with $0 deductible and has enacted the law to prohibit those folks from owning one. For the new to Medicare Folks the plan now to own is Plan G. Identical to Plan F with the ONLY exception being that with the Plan G you must pay the Medicare Part B deductible which was $185 in 2019. Those who had Medicare prior to December 31, 2019 are grandfathered and can own and purchase a new Plan F for years into the future.
If you want to keep working and stay covered by your employer plan there are two possible answers.
1) If there are 20 or more emplyees there you will want to pick up part A of Medicare Only – it is free. Medicare will be secondary to your employer plan.
If you know in advance call me about three months before you retire and I will walk you through how to add part B of Medicare with no penalty and help you get set up with a Medicare Health Plan.
You DO NOT want part B of medicare because it will just lay there and do nothing and cost you money to have it. When you add part B of Medicare later it triggers a new open enrollment period and protects your insurability.
2) If there are fewer than 20 employees there – You MUST have both parts A and B of Medicare as under this scenario Medicare is Primary to employer coverage.
NOTE – if this is you, I strongly suggest that you not stay on the employer plan and enroll in a Medicare plan right away since your open enrollment period ends six months after your Part B effective date and you would have to prove insurability to add a Medicare Supplement Plan after that open enrollment period ends.
When you are new to Medicare part B (first six months) a company has to take you and they have to pay for you. After that six month open enrollment window, they can ask the medical quesitons and turn you down. NOTE that if you have something that needs to be fixed - once it is fixed and you have the all clear from the doctor you become insurable once again. (for Cancer you must be cancer free for 2 years to be insurable once again)
For those who start Medicare after January 1st 2020 – they cannot purchase a Plan F.
For those who start Medicare before January 1st 2020 – they will be able to purchase a plan F after
January 1, 2020.
Therefore, if you choose a Plan F now you can change carriers and get a new plan
F later on as you would be grandfathered in.
No there is not – you pay the same premium if you have an agent as a go between to troubleshoot any problems that may arise as you would had your purchased directly from a company. Remember that purchasing directly from a company provides no service support like you get with an agent.
NO – you can see any doctor that takes Original Medicare.
If you enroll in a Medicare Advantage plan you may be limited to a subset of providers that take
that company’s plan.
NOTE – Medicare Select Plans have facility Resrictions such as which hospital you can use – I
Strongly recommend that one stays away from Medicare Select plans and stick with Traditional
Medicare Supplement plans to avoid this problem.
Absolutely NO referrals are required for ALL Medicare Supplement plans. You get to see who you want when you want to see them with NO Gatekeepers.
YES – but after six months pass from your Medicare Part B effective date the open enrollment window closes and you would have to prove insurability to move up in coverage. The Medical Underwriting is easier than one might think, but there are plenty of situations that would cause a company to decline such a move.
Once you are six months past your Medicare part B effective date you would have to pass
underwriting to move to a Medicare Supplement Plan.
There are a few common exceptions:
If you enroll in a Medicare Advantage Plan for the first time when you are new to
Medicare – this triggers a new 12 month open enrollment period to move to a Medicare Supplement plan. Medicare understands that the Medicare Advantage plans are lesser coverage and give you 12 months to give them a test drive and still be able to go back to Original Medicare and add a Medicare Supplement plan in the first 12 months.
If a plan leaves the marketplace – it triggers a special enrollment period to move to a Medicare Supplement plan with no questions or preexisting conditions.
Just to be safe – I recommend that you ask your doctor to call the phone number for providers on the back of your prescription drug plan ID card before he prescribes a new med for you. By doing this 1- he makes sure he is prescribing a covered drug and 2- he takes care of all the prior authorizations ahead of time so there are no surprises at the pharmacy.
When you are new to Medicare (first 12 months) you are allowed a “Welcome to Medicare
Physical” Be sure that you schedule it and tell the doctor when you are there that you are there for
the “Welcome to Medicare Physical” YES this is covered.
After 12 months have passed you are allowed an annual preventative exam (No Touching, shake
hands talk with doctor only) basically how are you doing – ok – great see you next year exam.
If you schedule an annual Physical – Medicare Says NO EVERY time and tells your supplement to
say no too. Important to schedule those exams when you call for the appointment as either the
“Welcome to Medicare Physical or the annual Medicare wellness exam. If you schedule it as a
physical it will be billed wrong EVERY time.
If you take any meds at all – call and schedule the exam to monitor whatever you take the meds for
and it will be billed right every time.
YES we believe in good old fashioned service.
All of our clients will hear from us once per year talking about
Medicare Supplement Rates and how their plan stacks up.
All of our clients get our annual newsletter in the fall telling of upcoming changes to Medicare and
details about Prescription drug plan changes.
Yes there is.
For a chart of the costs for Part B of Medicare use this link:
https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html
For a chart of the costs for Prescription Drug coverage use this link:
https://www.medicare.gov/part-d/costs/premiums/drug-plan-premiums.html
Most doctors take Medicare.
There are many doctors now who are not taking new patients on Medicare.
To get around this look in your social circle and ask who they see – write a letter “PERSONAL AND CONFIDENTIAL” to the doctor and tell them you have heard great things about them and understand they are not taking new patients on Medicare – ask if they would make an exception since you have heard such great things about them and do not want to see another doctor. Most will grant an exception the trick is to get past the billing clerk – thus the letter directly to the doctor’s attention.
For specialists if they are not taking new patients on Medicare – ask your doctor to refer you to them and you can usually get in.
YES! There are several plans that cover what are commonly known as the three holes in your head not covered by Original Medicare. You can get one of those plans to go along with Original Medicare and a Medicare supplement Plan or to go with a Medicare Advantage Plan. You will find those stand-alone plans to offer benefits that are better that those offered within the Medicare Advantage Plans.
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