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Can you change from a Medicare Advantage to a Medicare Supplement?

Wanda No Comments

Unless someone turning 65 has lifetime health benefits from their or their spouse’s employment, they usually have two choices on how to receive their Medicare coverage. They can enroll in a Medicare Supplement and a separate prescription drug plan or in a Medicare Advantage Plan with drug coverage. If they have drug coverage from previous employment or military service, they also have the option to enroll in only a Medicare Supplement or a Medicare Advantage with no drug coverage.

Typically the premiums for a Medicare Advantage Plan are much lower than a Medicare Supplement. In the Research Triangle area (Raleigh, Durham and Chapel Hill) there are numerous Medicare Advantage Plans that have a zero premium. My experience is that the majority of seniors who sign up for these plans are very satisfied with the benefits and coverage. However, as we all know, life is unpredictable. When your health suddenly takes a turn for the worse having a plan that requires you stay in a network of medical providers or allows you to go out of network, but at a substantially higher cost, can create anxiety. This is why understanding the rules for change are important.

When you first turn 65 you have what is called a “trial right”. This term means you can try Medicare Advantage for one year. At any point during this 12 month period you can drop your Medicare Advantage Plan and return to Original Medicare. Once you drop your Medicare Advantage plan, you have 63 days to enroll in a Medicare Supplement without going through medical underwriting (answering health questions). If you wait longer the insurance companies that market Medicare Supplements will require medical underwriting and can decline you for coverage. You also have 63 days to enroll in a drug plan. If you don’t enroll during the 63 day period you will be required to wait until Annual Enrollment (October 15 through December 7th). The plan you enroll in during this period will not begin until January 1st of the following year. Unless you have a very low income, this will cause you to pay a penalty for going without creditable drug coverage for several months. This penalty will continue as long as you are enrolled in a prescription drug plan.

For folks that are already on a Medicare Supplement there is also a “trial right”. This allows them to drop their Medicare Supplement and try a Medicare Advantage for one year. However, their “trial right” is more restrictive. They can enroll in Medicare Supplement Plans A,B,C,F,K or L without medical underwriting, but the not the popular Plan G.

In 2019 during the Open Enrollment Period, which is from January 1 through March 31, one can change from a Medicare Advantage to a Medicare Supplement and a drug plan. However, unless they are in their first year of Medicare or are enrolled in a plan which is ending, they will be required to go through medical underwriting to obtain a Medicare Supplement.

Sometimes an insurance company will decide to terminate one of their Medicare Advantage plans. This is called a SAR (Service Area Reduction). When this happens they are required to send a letter to each person on this plan. In addition to explaining when the plan will end, the insurance company must provide details on the time period for obtaining new coverage and one’s options during this period. Instead of choosing another Medicare Advantage plan, the policy holders of the terminated plan can choose a Medicare Supplement. This letter is their proof that they are in a “guaranteed issue period”, which allows them to enroll in Medicare Supplement Plans A, B, C, F,K or L without going through medical underwriting.

There are also situations where CMS (Centers for Medicare & Medicaid Services) forces a Medicare Advantage Plan to terminate for not adhering to government rules. This type of termination gives the policy holders the same “guaranteed issue rights” described above.

 

 

 

 

Six Smart Steps for choosing Medicare Insurance that is Right for You

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Choosing Medicare Insurance

Baby Boomers turning 65 in North Carolina have an abundance of choices with regard to their Medicare insurance. My customers who have been buying their own health insurance and don’t qualify for a government subsidy are thrilled to be able to choose from many policies that are much more affordable. Their challenge is sorting through these numerous policies and choosing what is right for their lifestyle, health needs and pocketbook. If you are uncertain which plan or plans are best for you, here is a step by step guide to ensure you make a wise decision: Read More

Why enrolling in COBRA can be a costly Medicare mistake

Wanda No Comments

If you (or your spouse) lose or quit your job with health insurance when you are eligible for Medicare it is unlikely COBRA (Consolidated Omnibus Budget Reconciliation Act) will be your best choice for health insurance. Medicare does not recognize COBRA as creditable coverage as they do group health insurance.  Medicare eligible individuals have 8 months to sign up for Medicare Part B once they lose their group health insurance. However, if one chooses COBRA instead and stays on it 18 months, they will be required to enroll in Part B between January 1st and March 31st. To make matters worse their Part B coverage will not begin until July 1st. Since you are not allowed to buy a Medicare Supplement or Advantage Plan without Part B, it means they will go several months with only Part A (hospital) coverage. Read More

What is the Donut Hole?

Wanda No Comments

If you’re turning 65 or becoming Medicare eligible, one of your challenges is choosing a drug plan. Many are confused by the term “Donut Hole” (also called the Coverage Gap). Medicare Prescription Drug Plans have four parts or phases, Initial Deductible, Initial Coverage, Donut Hole and Catastrophic. To understand the Donut Hole it’s important to understand each of these parts. Read More

New to area and need a doctor?

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If you have recently moved to the Raleigh Durham area and need assistance finding a Duke primary care or specialist doctor, the Duke Consultation and Referral Center can help. They are opened  Monday through Friday from 8:00 AM until 6 PM. Call 1-888-ASK-Duke (275-3853) to request an appointment or visit them on-line at dukehealth.org.

 

Save on Fertility Services if you have a BlueCross BlueShield of North Carolina policy

Wanda No Comments

BlueCross BlueShield of North Carolina (BCBSNC) now offers discounts on fertility services through a partnership with WINFertility. The highlights include 10% to 40% savings on fertility services which include intrauterine insemination, in vitro fertilization treatments and medications. Participants have access to a proven physician network, financing options and free consultations.

For more details members can go to www.bcbsnc.com/blue365. If you are a BCBSNC policyholder and have not joined Blue365 it’s easy to join and offers great deals to improve your health. From the www.bcbsnc.com website click on “Go to Blue365”.

This is important to know if you’re almost 65 & on a small group health plan

Wanda No Comments

Unlike large employer group plans,  employees on small group plans (fewer than 20) are required to enroll in Medicare Part B when they turn 65. Part B helps cover the cost of doctor visits, outpatient care, some preventative services, home health care and durable medical equipment. Once you enroll in Part B you have 6 months to purchase a Medicare Supplement without going through medical underwriting (being required to answer medical questions). If you have concerns about being declined or charged a higher premium due to your health status you should purchase your own plan before the end of this six month window.

Are you paying a penalty for not having health insurance?

Wanda No Comments

If you’ve just discovered that you’re paying a penalty for not having health insurance it might not be too late to buy it. Although Open Enrollment ended on February 15th, there is a Special Enrollment Period from March 15th until April 30th for individuals who attest they will owe a fee and did not understand the implications of the penalty until after Open Enrollment ended.

Five More Fallacies of ObamaCare

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obamacare

As I pointed out in my ObamaCare video, we are constantly bombarded with misinformation about the Affordable Care Act(ACA) or ObamaCare. Here are five more examples of these fallacies:

fallacy #1:All health insurance must be purchased from the Marketplace. Read More

Avoiding COBRA Confusion

Wanda No Comments

COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) allows workers and their dependents to purchase group coverage for 18 months (or sometimes longer) when the worker is voluntarily or involuntarily terminated. Workers who elect this coverage can pay up to 102% of the premium that the employer pays for coverage. The employer has 44 days to notify the terminated employee of his or her COBRA rights and the employee has 60 days to respond. To avoid COBRA confusion individuals should be aware of the following key points:

  1. Although the former employee has 45 days to make the initial payment, they must pay back to the date the coverage ended. Therefore, if their coverage ends on February 28th, they receive their COBRA letter on March 5 and elect the COBRA on April 30th; they must pay for March, April and May.
  2. Even though the former employee does not have health insurance during the COBRA election period he can purchase COBRA for all or one family member if there is a medical emergency.
  3. A former worker can accept COBRA for a family member with health problems even if he does not accept it for himself.
  4. Normally the former employee can purchase dental COBRA for 18 months even if they decline the Medical.
  5. Former workers are not required to stay on COBRA for 18 months.
  6. Instead of accepting COBRA you may be eligible for a Marketplace Plan with a government subsidy to help you pay for your health insurance.
  7. Finally, since COBRA is not recognized as credible coverage by Medicare, it is unlikely that this is your best option if you or your spouse are Medicare eligible unless you expect to get a job with health benefits very soon.