Five Positive Facts About Original Medicare

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Knowledgeable Aging

For more information about the author, click to view their website: Knowledgeable Aging

Posted on

Oct 05, 2023

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Florida - Southwest

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The transition to Medicare is a wonderful opportunity to enjoy health care benefits when you are 65 and older, or have a disability or medical conditions that provide you with coverage when you are under the age of 65. To help you learn more about this program and prepare for enrollment, here are five positive facts about Original Medicare that you may enjoy discovering.

You Can Access Original Medicare Healthcare Benefits Throughout the United States and Its Territories

If you have Original Medicare, medical coverage is available in all 50 states and the District of Columbia in the U.S., and in its inhabited territories, including American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. In the event you require medical care while traveling, it’s important to know that most doctors and hospitals accept Original Medicare within these areas. If you’re outside of the United States, you may not get the same coverage. Original Medicare typically doesn’t cover any medical treatment you receive while outside of the United States, except under the following circumstances:

  • You require emergency medical care in Canada while you are traveling a direct route between Alaska and another contiguous state, and the closest medical center is in Canada.
  • You board a cruise ship and require medical care while you are in U.S. territorial waters. This includes the ship docking in a U.S. port or being within six hours of arrival or departure from a U.S. port.
  • You require non-emergency medical inpatient services in a foreign hospital, and the nearest foreign hospital is closer to your residence than the nearest U.S. hospital.

In these instances, Original Medicare may cover your medical care outside of the United States. Make sure you have this information handy before traveling abroad.

You Do Not Need Referrals for Covered Services Under Original Medicare

One of the biggest benefits that comes with Original Medicare coverage is that there is no need for referrals. Since Original Medicare encompasses Part A hospital coverage and Part B outpatient/medical coverage, beneficiaries can select any doctor that accepts Medicare for their treatment needs. Therefore, under your Original Medicare plan, you’re free to select the doctors and specialists you consult with at the hospital or healthcare facility of your choice for your medical needs. As long as the selected practitioner accepts Medicare, you’re good to go.

Beneficiaries Can Select and Change Medicare Benefits Every Year

There are two annual periods when Medicare beneficiaries can change their benefits: the Annual Enrollment Period (AEP) and the Open Enrollment Period (OEP). During the AEP, which runs from October 15th to December 7th, Medicare beneficiaries can:

  • Change from Original Medicare to a Medicare Advantage plan
  • Change from a Medicare Advantage plan to Original Medicare
  • Change from one Medicare Advantage plan to another
  • Enroll in Part D prescription drug coverage
  • Change from one Part D prescription drug plan to another
  • Cancel their current Part D coverage

Any changes made during AEP will take effect on January 1st of the next calendar year.

OEP, on the other hand, is a little bit different. The Medicare Advantage Open Enrollment Period, which applies to those currently enrolled in a Medicare Advantage plan, runs from January 1st through March 31st. During the OEP, Medicare beneficiaries can:

  • Enroll in a new Medicare Advantage plan (with or without Part D prescription drug coverage)
  • Disenroll from a Medicare Advantage plan and return to Original Medicare and enroll in a stand-alone Part D prescription drug plan

Medicare Allows Coverage Adjustments When Major Life Events Occur

In addition to AEP and OEP, Medicare also includes a Special Enrollment Period (SEP) that allows beneficiaries to delay initial enrollment in Parts B and D without incurring a late enrollment penalty (LEP) or change coverage outside of designated enrollment periods without incurring penalties or gaps in coverage. Special circumstances that allow for SEP include:

  • Loss of employer coverage
  • Moving out of your Medicare plan’s service area
  • Residing or moving in/out of a skilled nursing facility
  • Losing or gaining eligibility for Medicaid coverage

In these situations, an SEP grants delayed enrollment without penalty or Medicare coverage changes to assist beneficiaries in enrolling and managing their Medicare benefits. Documentation of said circumstances is required to create the Special Enrollment Period. It is highly recommended that you verify your eligibility for an SEP.

Medicare Can Be Less Expensive Than Previous Healthcare Coverage

You Could Save Money by Enrolling in Medicare If You Are Working Past 65 for a Large Employer (Over 20 Employees)

Medicare costs, premiums, deductibles, copays and coinsurance can oftentimes be less than many employers anticipate. It is important to carefully compare your current plan premiums, deductibles and maximum out-of-pocket costs to get an accurate assessment of both options.

For most, Medicare Part A is premium-free due to paying taxes while working. However, Part B requires a monthly premium; this cost can increase with your income. Understanding the Part B surcharge, known as Income Related Monthly Adjustment Amount (IRMAA), is important since added costs up to $450 per month.

For out-of-pocket costs, Medicare Part B has a very low deductible of $226 for 2023, and the coinsurance after this is just 20% for the Medicare beneficiary. However, it is important to note that Medicare Parts A and B do not have an out-of-pocket maximum limit, so considering a Medicare supplement plan can be helpful in covering your exposure to claims. Even without an out-of-pocket maximum, Medicare is still a cost-effective choice that can offer beneficiaries savings when compared to large employer-sponsored heath coverage plans.

If you need individualized assistance with your transition to Medicare or to a different plan such as Medicare Advantage or Part D prescription coverage, you’re in the right place. Contact Medicare Portal today for one-on-one help exploring suitable plan options – schedule a virtual, phone or in-person consultation with one of our licensed Medicare insurance agents today.

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Veterans Benefits for Assisted Living Care

Did you know there are financial assistance programs available to veterans who need assisted living care? Our veterans made numerous sacrifices to uphold the freedom we enjoy today while their families kept the home fires burning. They are entitled to many benefits in appreciation for all they endured for America.Veterans benefits for senior living are available for qualifying veterans and their surviving spouses, as long as the veteran served at least 90 days of active duty, including at least one day during a wartime period, and received an honorable or general discharge.Veterans Aid and Attendance for assisted living careOffered through the Department of Veterans Affairs, Aid and Attendance is a monthly pension benefit that can help cover the costs of assisted living care. It is available for wartime veterans and their spouses who have limited income and require the regular attendance of a caregiver.Aid and Attendance is designed for individuals who need assistance from another person to complete everyday activities such as bathing, dressing and assistance with other daily activities. A veterans need for this benefit does not need to be the result of their military service.Funds received from Aid and Attendance benefits can offer a monthly benefit to help pay for assisted living and long-term care for a qualifying veteran and their spouse. The actual monthly benefit is determined by the veterans assets, income and medical expenses and conditions.Contact your local county Veterans Services office with questions on how to apply by visiting www.benefits.va.gov/vso.MedicareMedicare will pay for short-term care at nursing and rehabilitation facilities for seniors who need these services after an illness or injury that requires hospitalization. Medicare does not cover the cost for assisted living, home care or other senior living services.Long-Term Care BenefitsThe Veterans Administration provides both short- and long-term care in skilled nursing settings for veterans who cannot care for themselves. This benefit does not cover assisted living or home care.Housebound BenefitsVeterans confined to their homes and requiring assisted living care may be best suited to receive Housebound benefits. This program provides an increased monthly pension amount for those confined to their home due to a permanent disability.Applying for BenefitsThe Veterans Administration has regional offices that provide Veteran Service Organization representatives who may be able to answer simple questions about assisted living benefits, as well as provide free, basic advice on the application process.Many veterans seeking advice on applying for assisted living benefits hire a qualified attorney accredited by the VA or an accredited claims agent, who has passed a written exam about VA laws and procedures.The application process for assisted living benefits is often very lengthy. It is important to be thorough when completing the application and have all required documentation gathered and ready to submit.There are additional financial options to pay for assisted living care for individuals who do not qualify for veterans benefit. Click to find out more about financial options for senior living.Country Meadows offers affordable assisted living or personal care on its nine campuses in Pennsylvania and one in Frederick, Maryland. Our friendly co-workers are always available to help! Contact us today for more information.

Identifying Medicare Scams

Research shows that seniors are common targets of scammers. One of the most common ways that criminals try to get information is through Medicare scam calls. In fact, your Medicare number is often more valuable for criminals than your social security number or credit card numbers/banking information.The caregivers at Gentle Shepherd Home Care in Colorado Springs can help you identify these scams. We offer a variety of in-home senior care services from companionship to medical care.In this article, well explain what you need to know about common Medicare scams.Does Medicare Ever Call Recipients?There are only two reasons that Medicare will ever call you, according to the Medicare website:Health/drug plan provider may call if you are already a member or the agent who helped you join may contact youCustomer service representative may contact you if youve left a message or received a letter stating that you will receive a phone callTop 7 Medicare ScamsFraudsters are getting smart with their scams. However, if someone calls you claiming to be from Medicare with the following pitches, its a scam.Your old Medicare card is invalid- you will be getting a new cardThis is one of the most common Medicare scams. 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These offers require that you provide information such as your Medicare number, social security number, and other personal details. Most of these start out as text messages or robocalls. The caller will offer you special access if you pay out of pocket.Truth: Medicare will never ask for you to pay out of pocket to get special treatment.You must confirm your appointment for genetic testingIn some cases, scammers will call offering free genetic testing to screen for a variety of health conditions. When you agree, they will steal your information and will bill Medicare for the test. In some cases, you may be sent an at-home test to complete along with a request for your information.Truth: Medicare will not call or send an at-home kit to offer you testing that you have not requested.You are eligible for free medical suppliesIf a scammer is aware of a specific health condition, such as diabetes, they may offer you free medical supplies or medications. 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6 Questions to Get Your Medicare Right

Reviewing your Medicare plan doesnt have to be complicated. These questions can help you assess your plan and make any changes you need.1.   Have your health care needs changed in the past year? For example, did you sustain an injury that requires ongoing care, or were you diagnosed with a chronic illness?2.   Are your doctors still considered in-network? If you have a Medicare Advantage plan that only covers a specific list of providers, facilities, and/or pharmacies, you'll want to have the most up-to-date network information. Covered providers can change from year to year.3.   Will your prescriptions be covered under your current drug plan? Make a list of the medications you take and check them against the formulary for your Part D or Medicare Advantage plan with prescription coverage.4.   Do you need additional benefits such as transportation, dental, hearing, or vision? These services are usually not covered under Original Medicare. If you think you'll need these additional coverages, you may want to look into a Medicare Advantage plan that offers them.5.   Will you be traveling long term next year? If you have Original Medicare, you're covered nationwide to see any provider that accepts Medicare. If you have a Medicare Advantage plan, some plans restrict your coverage to a certain geographic area.6.   Have your financial needs changed? Consider how your plan fits into your current budget, and whether you need something more affordable. In addition to the monthly premium, you'll want to consider deductibles, coinsurance, and co-payments. Theres no one-size-fits-all Medicare plan and no carrier that is right for everyone. Everyones needs and situations are unique. Thats why its essential to do your homework before enrolling in a Medicare plan even if its one recommended by your family or friends. A local, experienced agent can help you compare the plans in your area to find the one that suits you. For more information visit: aismedicareandmore.com Editors Note: This article was submitted by Jolynn Allen, of AIS Medicare & More.  She may be reached at 719-404-3202, or by email at info@aismedicareandmore.com

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