Why You Should Review Your Medicare Supplement Plan
When you turn 65 or first enroll in Medicare Part B you have 6 months to choose any Medicare Supplement Plan you want, from any company you want, without answering any health questions. In most cases, after those 6 months, if you wish to change your supplement company, insurers can ask health questions and will decline your application if they are not satisfied with your health history.
There is only ONE REASON to change a Medicare Supplement Company… PRICE! The plan will not change, your coverage will not change, but you should be up to date on the premiums that other companies are charging for the same exact plan. You cannot mess up the coverage, no matter the company you choose. But you CAN mess up what you pay to have the coverage. That is the only difference from company to company.
You can change your Medicare Supplement company at any time of the year. There are no Annual Enrollment Periods for Original Medicare and a Supplement. You can shop and change ANYTIME you want. There is only 1 reason to change – Price… but you will have to answer health questions to change from one company to a less expensive one. Each company has varying requirements to your health condition and medications you take that they will either deny or accept. Just because you have a health issue doesn’t mean that you will not be able to make a change to save money. My Team will find the companies that WILL approve your application based on your health. If we can save you money on the premiums knowing the companies that will approve your application, we can help you make the change.
Considering that each company has their own list of medical questions… they are not all the same. Some are very strict on what medications you use or what health condition you have, while some are more lenient. Some companies have no limit to the diabetic medications, blood pressure medications, or depression medications, while others do. Some will allow dosage changes in some medications within the last 2 years while others will not. Whereas, they all will agree on the health condition they will decline.
Our Supplement Review Manager, Melissa, is an expert in the underwriting of supplement companies and has personal relationships with several of the top carrier’s underwriting departments. She is very good at sorting out the company options and matching your health to a company that will accept you. It only takes a few minutes to discuss better premium options with her by phone to see if there are savings to be had. Give her a call, and you will be happy you did.
Melissa in my office can be reached at 270-776-9660. She is not a salesperson, so there is no obligation to see what’s available for you.
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Medically Necessary
According to Medicare.gov, “medically necessary” is defined as “health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.” In any of those circumstances, if your condition produces debilitating symptoms or side effects, then it is also considered medically necessary to treat those.
Medicare uses certain criteria from National and Local providers to deem certain procedures either Medically Necessary or Non Medically Necessary. Contrary to popular belief, Medicare is NOT trying to find a reason NOT to cover something. The reverse couldn’t be more true. What they are doing is trying their best to weed out the abuse of Medicare by PROVIDERS, not Patients. Some things happen that just shouldn’t, and Most if not all of the Non Medically Necessary items are just things that the taxpayer should not have to pick up the bill for. Here are some examples:
- Times where your hospital service surpasses the Medicare-approved stay length
- Physical therapy treatment that surpasses Medicare’s usage limit
- Hospital-administered treatment that could have been delivered in a lower-cost setting
- Prescription of drugs to treat fertility, sexual or erectile dysfunction, weight loss or weight gain, and cosmetic purposes
If you have Original Medicare and a supplement (or Medigap coverage) your supplement has to pay its part if Medicare deems a procedure Medically Necessary. On the contrary, if Medicare doesn’t pay because a procedure is Non Medically Necessary, your supplement will not either.
The important thing to consider here is the Provider. No matter the procedure, or reason for the office visit, Providers are well versed in the difference of Medically Necessary versus Non. It is VERY important to ask questions to your doctor about procedures and how you insurance will cover it. The Provider can tell you right up front if Medicare will approve the claim or not. Or, at least they should. Don’t be afraid to ask questions of your provider. Talk to the insurance biller in the Doctors office if you need to. If for some reason your Doctors office or hospital cannot tell you if your recommended procedure is Medically Necessary, you should not agree to the procedure until you find out whether it is or isn’t.
A vast majority of the time, Medically Necessary just means common sense. If your Provider is wanting to perform a Non Medically Necessary procedure, I would certainly consider a 2nd or 3rd opinion.
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The Scoop on Dental and Vision Insurance
A lot of folks that turn 65 and qualify for Medicare don’t like the fact that Medicare doesn’t cover Dental or Vision services. The main reason being that the insurance they had before turning 65 was a Group Employer Based Plan that had a Dental and/or Vision insurance option. Most opted into the Dental and Vision because it would provide coverage for their entire family for a very low monthly premium, and it was easy to pay – directly from their paycheck.
Most folks don’t really know what Dental and Vision is, what it covers, or what it doesn’t cover. Group dental and vision plans are based on the group participation, so the premiums are less. There really isn’t much coverage there when you look close. Let’s do that: Dental Insurance plans are all basically the same with minor differences in coverage from company to company.
All Dental plans have:
-Waiting periods for major services coverage such as root canals, bridge work, crowns, et cetera)
-Limited coverage on cleanings and x-rays that are typically limited to one or two visits a year with a co-payment.
-An annual maximum benefit typically between $1000-$1500. There’s no coverage after that amount.
-Limited networks of Dentists.
-Very little to no Orthodontic or Oral Surgery coverage.
Vision Plans aren’t much better. One question I get in EVERY workshop usually goes like this, “If Medicare doesn’t cover Vision – Is there any coverage for Cataracts, or eye diseases?” Well, the truth is that Vision Insurance is only “good” for one thing – Eyeglasses. Medical issues with your eyes, be it Cataracts, Glaucoma, Macular Degeneration, Astigmatism are ALL covered by Original Medicare and your supplement. Or, if you have a Medicare Advantage Plan, you are covered there too.
Vision insurance gives very limited coverage on eyeglasses and contacts. Also, it will give you limited coverage on the refraction portion of an eye exam. The medical portion of the eye exam that checks for diseases, damage, retina, et cetera; are all covered by Medicare.
I like to put it this way – The taxpayer will make sure your eyes are healthy, but they will not buy you the most expensive pair to Ray-Bans. Although, Medicare will pay for a pair of glasses for beneficiaries after cataract surgery. Usually a prescription will change after that so Medicare will foot the bill on eyeglasses then.
Private Dental and Vision plans are typically costly when compared to what you are paying for. Premiums are usually between $20 and $50 per month. Most folks only use it to have their teeth cleaned twice a year. In that event, you are paying much more in premiums that you would be if you just paid the dentist direct.
Vision services are on a changing trend as well. Here in Bowling Green, we have two different eye centers that provide very inexpensive plans. Like $59 for an eye exam and 2 pair of glasses. You cannot purchase insurance for that, and your copay’s are more than $59 usually with the coverage. These specialty shops are popping up all over our area and doing well.
In my opinion, you should really talk to one person before purchasing dental coverage – your dentist. If your dentist feels that you may be looking at long term major dental work, it may be right for you. If you go for a few cleanings a year and an x-ray, you may be better off just working something out with the dentist.
I do carry a number of the most popular plans for dental and vision. I do have several clients that carry that type of coverage. I just don’t think it’s something that EVERYONE needs or should have.
If you have questions or want an explanation of dental and vision coverage, look at the following:
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Why are there 4 “Parts” to Medicare?
Most folks turning 65 and preparing for Medicare are totally confused from the start, because of the “Parts” to Medicare. You open your mail box, and the stuff falls out all over the place. You finally get everything gathered up and take it inside. You open 1 “informational” packet, and the first thing you read is that there are 4 “Parts” to Medicare. Then you open another and it says the same thing, and already – the confusion starts.
Think about this –
Do you have Health Insurance right now, that’s not Medicare? Does your current health insurance provide coverage for you if you were to go into the Hospital? Will it provide coverage for you for a Doctor visit, medical testing, surgical procedures? What about prescription drug coverage at a pharmacy?
You may not realize it but the health insurance you have now is also split into parts—they just don’t sell it to you in parts, they bundle it all up. That’s because prior to turning 65 and getting Medicare, you need ALL Parts. You need Hospital Coverage, Medical Coverage, and Prescription Coverage. (Parts A, B, and D) But, when you get on Medicare, depending on YOUR situation, you may NOT need EVERY part. Here are some examples:
- Actively employed and covered under a group employer based health plan? You only need Part A until you do retire.
- Your spouse is Actively employed and you are covered under their employee health plan? You only need part A until they retire.
- Are you a veteran? You wouldn’t be required to take Part D because VA Prescription Benefits are creditable to Medicare.
- Retired State employee or Retired Teacher (in KY)? You only need Parts A and B.
Those are just some examples.
So, Medicare doesn’t split Health coverage up in parts to confuse you. It is split into parts to help you, because not everyone who needs Medicare needs all Parts.
To find out what parts of Medicare you need, contact me, or someone you can trust about your Medicare. I will help you and make sure you get the Parts you need for YOUR situation.
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