Medicare Mistakes You Need To Avoid

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Many retirees spend more money out of their pocket for medical care. One source concluded that nearly 90% of Medicare beneficiaries pay more out of pocket than they need.

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it is not surprising. Medicare is a complex program. Since Medicare Open Enrollment is here (October 15-December 7), here’s my review of the key steps people should consider and mistakes to avoid.

Open a “My Medicare” account. You can open an account at Medicare.gov.

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The account gives you access to Medicare’s Plan Finder tool and allows you to customize it and save the results to your account. This is especially helpful when you take multiple medications and are searching for the best Part D prescription drug plan.

You can also see when claims are being processed under Original Medicare. Not only does this keep you updated about their progress but it’s also a fast, easy way to check if someone is making unauthorized use of your Medicare number.

You will also be able to review the list of preventive services you are eligible for and print a copy of your Medicare card, among other useful features.

Get help from SHIP. Each state offers trained volunteers to help you with Medicare. The program is not associated with insurance companies or health plans. It is officially the State Health Insurance Assistance Program (SHIP), although some states give it different names. The Medicare Web site has contact information for various state programs.

There are no income or money restrictions on users of the program, and it is a free service. SHIP can help you compare plans, join plans, learn details about Medicare, and help with various Medicare and billing problems.

Decide which Medicare you need. You can choose between Original Medicare and Medicare Advantage.

Medicare Advantage is the comprehensive coverage under which you receive Original Medicare, coverage of most gaps in Original Medicare, prescription drug coverage, and generally more.

One downside of Medicare Advantage is that you can’t choose your own medical providers and approval is usually needed for treatments and medications. Also, if you move, the same plan or comparable plan may not be available in your new area. You have to start again.

Original Medicare lets you choose your doctor, and you don’t need approval to see a doctor or get treatment.

But coverage of Original Medicare has a number of drawbacks. It is highly advisable to purchase both a Medicare Supplement (Medigap) policy and a Part D prescription drug policy.

When you first become eligible for Medicare, you are guaranteed to be able to purchase a supplemental policy. After that if you want to change the policy or buy for the first time, the insurer can do a medical underwriting and either deny coverage or charge higher premium.

There are 10 Medicare Supplement plans or policy types. They are regulated so each insurer has the same coverage for each plan. Plan G has the widest coverage. You should buy a Plan G policy unless you need to pay lower premiums and get less coverage in return. The next most comprehensive plan is Plan N.

Shop, shop & compare. People do not like to shop for insurance. As a result, many people pay more than they need to. Studies have shown that premiums for similar Medicare Supplement and Part D policies differ by up to 100%.

Don’t pay too much attention to television commercials or mail promoting various Medicare coverage. You will pay those marketing costs.

In most areas, you can find insurance brokers who specialize in the Medicare market and work with multiple insurance companies. Work with one or more of these insurance brokers. And don’t hesitate to speak with a shipwreck volunteer.

But don’t automatically go with the lowest priced policy. You want an insurer that has been offering policies for years, has few consumer complaints, and has a history of nominal rate increases. Some insurers reduce policies to increase market share, and then increase premiums or exit the market when policies are unprofitable. With Medicare supplemental insurance, you do not want to switch insurers and are not subject to medical underwriting.

Be skeptical about the benefits of an additional advantage plan. Medicare pays a fixed amount per enrolled beneficiary to each Medicare Advantage provider or insurer. Medicare also allows each provider to develop a package of benefits within constraints.

Some Advantage plan providers advertise free additional services that are not available in Original Medicare, such as meals, transportation, personal household assistants, bathroom protective equipment, and others.

When you read the description of the plan, you will find that most of these benefits are limited. For example, a member can usually choose only one of the additional benefits. You won’t get them all. Also, other benefits of the plan are often curtailed in order to pay for the additional free benefits.

Don’t be fooled by Medicare plans by celebrities or hard-to-sell television commercials.

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