How to get the care you need at
the lowest cost
by Dena Bunis, AARP, October 9, 2019
En español |
There's no getting around it. Medicare is a complicated program and every
decision you make will have consequences – for your health and your wallet. To
help you get the most out of your benefits — whether you are signing up for the
first time or taking stock of your choices during open enrollment — AARP
interviewed experts for their advice on how to get the most out of Medicare.
Mind the calendar
The first and most important step is enrolling on
time. Miss that deadline and it'll cost you — potentially for the
rest of your life. Your Initial Enrollment Period (IEP) is the time you MUST
sign up to avoid hassles. It spans seven months —from three months before you
turn 65 until three months after. Here's what you need to know about enrollment
timing for Medicare's parts.
Part A. This covers hospitals. Most people don't have a premium, so
missing the deadline just means you won't have hospital coverage until you
enroll.
Part B. This covers doctor visits and other outpatient services,
like blood tests, X-rays, etc. If you don't have health insurance and don't
sign up during your IEP, you'll pay almost $6,500 more in premiums over the
next 20 years based on this year's $135.50 monthly premium. That's because
Medicare will increase your premium by a 10 percent penalty for every 12 months
you don't enroll when you should have.
The government penalizes you for not meeting
the sign-up deadline because it doesn't want people waiting until they get sick
to seek coverage. Insurance programs, like Medicare, only work if healthy and
sick people are all in it together.
Part D: This covers prescription
drug costs. Miss your IEP time and your monthly premium may be
1 percent higher for each month you aren't enrolled. The average monthly Part D
premium for 2019 is $31.83. So, if you don't have good drug coverage and wait
24 months to sign up, you'll pay almost $8 a month more for your prescription
drug plan for as long as you have drug coverage.
Choose doctors carefully
You have a doctor who has taken care of you
for many years and you want to keep seeing her. You've just retired to a new
community and need a physician. You're satisfied with your current provider but
would be open to change.
Whether you are new to Medicare or are
evaluating your coverage during open enrollment, picking the best doctors for
your needs and budget is how you make Medicare work best. Here are three things
to consider:
1. Do they accept Medicare? There are several
ways a provider can be part of the program:
·
Participating. These
providers agree to accept what's on Medicare's fee schedule as their full
payment from the program. You or your supplemental insurance will still be
responsible for 20 percent.
·
Non Participating.
These providers still take Medicare's approved payment, but they are allowed to
charge you 15 percent more than that. This is known as a limiting charge.
·
Opt out. Buyer beware.
These providers can charge patients whatever they want.
·
Medicare Advantage
plans have networks of doctors. If you see a provider outside the network,
you'll pay more.
2. Interview your prospective doctors
“People get a lot of their information about
doctors by word of mouth,” says Deborah Dunn, a gerontological nurse
practitioner from Livonia, Michigan. But she advises people to meet a new
doctor and listen for what she calls “geriatric sensitivities.” For example:
·
Are they asking what's
going on in your life, like have you suffered the loss of a child or
grandchild? That grief could bring on physical ailments, like trouble
breathing.
·
Have they asked you
what kind of support system you have at home? Do you live alone? Do you feel
safe at home?
3. Looking for a geriatric practice?
The Health in Aging Foundation has a website (healthinaging.org) that lets you search
for geriatric specialists by state and zip code.
Avoid surprise bills
Nothing stings like getting medical
bills for services you thought were covered by Medicare or your
supplemental insurance. Here's how to avoid that ... and what to do if it still
happens.
Avoiding surprise bills:
·
Check in advance if
Medicare covers the treatment or procedure you're having. For instance, if
you're getting an MRI or having your gall bladder removed, no sweat, Medicare
most likely covers it. But if it's a tummy tuck you want, you're on your own —
Medicare doesn't cover any elective cosmetic surgery. You can you go Medicare.gov and see a list of what's
covered and what's not.
·
Ask up front about
your provider's Medicare status so you know if they accept what Medicare pays
or don't participate in Medicare and can charge whatever they want.
Dealing with surprise bills
Don't pay it right away. “Most of the time
what's happened is the provider hasn't sent the bill to the insurance company
or they billed it but used the wrong billing code,” says Dunn. “I always tell
people: If you get a bill for a lot of money, don't pay it. Ask
questions."
·
Check with your
provider to see if they've billed insurance correctly.
·
Call your Medigap
insurer to see why they haven't paid
the charges.
·
If Medicare or your
supplemental insurance has rejected a claim, file an appeal.
·
If all else fails,
negotiate with the provider for a lower amount.
Know your rights
If Medicare denies a claim, you can appeal.
And there are people who can help you. Casey Schwartz, a senior counsel at the
Medicare Rights Center, says if you're on Medicare and want to appeal a claims
decision, you can call the center's hotline at 800-333-4114. “We have materials
that can walk people through how to put together an appeal and people who can
talk through the process on the phone. In some cases we can represent people.”
You can also ask your local State Health Insurance Assistance Program (SHIP)
for help.
Here's what you need to know about the
Medicare appeals process:
·
You can designate
someone to represent you in an appeal — and it doesn't have to be a lawyer. It
can be a relative, a friend, an advocate, anyone you want.
·
You can appeal anytime
you're denied a service, piece of equipment or a prescription drug whether you
are on Original Medicare or have a Medicare Advantage plan.
·
You can also appeal a
discharge from a hospital or nursing home. You'll be able to stay in the
hospital at no extra charge — other than the copays and coinsurance — while
your case is being reviewed.
·
Get your doctor or
other health care provider on your side. Ask them to put in writing a
justification for why you need, or needed, the service or medication or
equipment.
·
If you or your doctor
are worried your health could be seriously harmed by waiting for an appeals
decision, you can ask for a quick answer within 72 hours.
Take advantage of benefits
Wellness visits, nutritionist meetings,
telehealth ... There are lots of services Medicare pays for that the average
person doesn't know about. Don't leave free care on the table.
Here are some tips to mastering the Medicare
smorgasbord of care:
·
Annual wellness visit
– Every year you're entitled to see a doctor to review your medical history,
what's changed in the past year and some basic screenings, like weight and
blood pressure. This isn't a full physical, but it's a good, quick check-in.
·
Eyeglasses – While
Original Medicare doesn't cover routine eye check-ups and eyeglasses, it will
pay for the first pair of glasses you may need after cataract surgery. Some
Medicare Advantage plans also have vision coverage.
·
Telehealth – Have
trouble getting to and from your doctor's office? Medicare now pays for virtual
check-ups with your doctor or other provider by phone or video chat.
·
Nutrition counseling –
If you have diabetes or kidney disease or have had a kidney transplant in the
past 36 months, Medicare will pay for you to get a nutrition assessment and
participate in individual or group counseling.
·
Smoking – Medicare
also pays for eight counseling sessions to help you quit.
To find the full array of services Medicare
covers, go to medicare.gov.
Keep good records
Most of us know to carry a list of our
prescriptions with us to show to a new doctor or in case we wind up in the
emergency room. But to take your use of Medicare to the next level, experts
suggest you keep a running diary of your medical history – from any chronic
conditions you have to what medical procedures or tests you've had.
Here are some tips for keeping your medical
history up to date:
·
Create a one-page
summary of your basic health care information and take it with you to each
doctor appointment. Give it to your provider at the beginning of each visit. It
helps refresh your health care provider on your health status.
·
Here's what your
health record should include:
o Any conditions you have, including when they
were diagnosed.
o Any hospital stays, including dates and any
procedures done.
o If you've had physical or occupational therapy
and what it was for.
o Your prescription drug list, including dosages
of each medicine.
o Any medical equipment you're using, including
oxygen, CPAP or insulin delivery devices.
o List of all your providers, including
specialists, eye doctors and dentists. Include their phone numbers.
o Pharmacy information – where you regularly get
your prescriptions filled.
o Your insurance information, including
supplemental insurance.
o Your emergency contact and whether you have a
Durable Power of Attorney or health care directive.
·
Be sure to keep your
list up to date by getting a summary of your visit after each medical
appointment and by adding any new diagnoses and updating medications.
Be open to change
You may be perfectly happy with your current
Medicare benefits. You like your Medicare
Advantage (MA) plan. Or you're in Original Medicare because you
like the freedom of seeing whatever doctor you want. You haven't had any
problems with your Part D prescription drug plan. Doesn't matter. During every
open enrollment you should do your homework to see if you can get a better
deal.
"Taking the time to figure out which
plans are likely to cost more or less can literally save thousands of dollars,”
says Tricia Neuman, a senior vice president at the Kaiser Family Foundation and
director of its Medicare policy. “It's not much fun to do this work, so
people's inclination is to just keep the same plans from year to year."
Here are some tips on how best to make this
decision:
·
If you're in a
Medicare Advantage plan, shop around. Compare the networks of doctors and
hospitals in the plans in your area. Check out the list of prescription drugs
that are covered.
·
Consider using an
insurance broker or agent, but be smart about it. Neuman says many people rely
on insurance brokers and agents to help them make Medicare choices, but they
get commissions, she says, so don't be shy about asking what their financial
stake is.
·
If you're in Original
Medicare, revisit your decision on whether to buy a supplemental, or Medigap,
policy.
·
Think about whether
you want to switch from Original Medicare to an MA plan or leave Medicare
Advantage and go to Original. If you're uncertain, you may want to consult your
local SHIP counselor. Go to shiptacenter.org to
find a neutral counselor who can help.
·
If you have a Part D
prescription drug plan, shop around. Most people have dozens of plans to choose
from in their area. It's common for the drugs available on these plans and the
preferred pharmacies that give you the best deal to change from year to year.
·
If you have a retiree
health plan that complements your Medicare, check with your former employer to
make sure it hasn't changed over the past year. Neuman says a growing number of
employers are shifting their retirees into MA plans, and often retirees don't
realize it.
https://www.aarp.org/health/medicare-insurance/info-2019/tips-for-medicare.html
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