If you are already enrolled in a Medicare plan you can sit back and relax!

Or should you?

Your insurer will already have advised you that your plan needed renewing by December 15^th and, in many cases, will have re-enrolled you on the same or similar plan.  Your first reaction was probably a relief. One less thing to worry about! But did you check the Medicare Star Rating?

You may be missing an opportunity

Between January 1^st and March 31^st, you have the opportunity to change your Medicare-approved plan, whatever the star rating, to an alternative Medicare 5-Star plan. You may not be able to reduce your service level (e.g. from silver to bronze) but you will be free to consider the opportunity to switch to another insurer, and/or to a 5-star rated Medicare Advantage plan or to a Medicare Prescription Drug Plan.

MEDICARE STAR RATING

What does the STAR RATING tell us?

Like most five-star Quality Rating Systems (QRS) the overall rating (5* is best) reflects the performance in key areas of the service being delivered.

In this case

1. Medical care
2. Member experience
3. Plan Administration

If the plan includes prescription drug benefits

• Accuracy of pricing information and patient safety

The Quality Rating System (QRS) will provide you with easily understood information to compare the quality and overall performance of comparable health care plans available on exchange websites. The ratings give you a common platform on which to judge competing plans.

For further information on QRS, the 5-Star ratings, read the TrueCoverage article:-

“NEW FOR 2020, ACA Compliant Health Plans WITH *STAR QUALITY*”

The most frequently asked FAQ is: what happens if my needs change during the plan period?

Generally speaking, you will have to wait for Open Enrollment, (October 15^th – December 7th every year) before you can change your plan or insurer unless you qualify for a Special Enrollment Period.

Usually, there will be a delay between your need to change and when you can alter your plan or take out supplements. This can be life affectingly expensive – unexpected medical treatment, hospitalization, extended prescription drug needs.

Five Star Plans provide the opportunity to change your plan at almost any time (December 8^th – November 30^th).  Of course, there are some limitations.  You may only switch plans once during the plan’s life (annual) and between 5* plans at the same or higher level.

That said, the QRS enables you to select a 5* plan which meets your needs at an equivalent or lower premium than other less highly rated plans.  The security of being able to switch as necessary is a bonus.

Don’t miss the opportunity to switch to a 5* plan.  If you do nothing else, log in to the TrueCoverage web site to check your options.  There will plans on your screen for you to compare, within moments! If you need to need to talk to one of our specialists, just enter your contact number.  During the working day we will ring back within 30 seconds.  Out of hours? We will call you during the first hour of the next working day.

In this article, we suggest some questions you need to ask yourself about how to sign up for Medicare at age 65 and where to go for advice.

Signing up for Medicare for the first time? You need to be sure of what you are signing up for.

Medicare is the health insurance underwritten by the Federal government for: Senior citizens 65 or older and for younger people already receiving certain Disability Benefits or already enrolled.

As we shall see, Medicare plans provide Hospital Insurance (Medicare PART A), which is normally free and Medical Insurance (Medicare PART B) paid for by premiums offset by tax relief and state subsidies.

The program is designed to be flexible enough to allow individuals to tailor plans to meet their specific individual and family needs.

Medicare – First Time SignUp?

Medicare (Part C) plans allow users to design a custom plan that can be more closely aligned with their medical needs.

These plans combine parts A&B, and supplements can be added e.g. dental and vision to tailor plans to meet individual and family needs.  These plans, ADVANTAGE PLANS, are run in cooperation with private insurance companies to provide some of the coverage. Advantage Plans may include prescription drugs coverage or you may choose Medicare Part D.  WARNING: you cannot have prescription drugs coverage from more than one plan.

This is a broad description of the way that Medicare works with private insurers to deliver quality assured health insurance coverage.

NEXT, ask yourself what has changed since your last (ACA) enrollment. Perhaps you were covered by your employer’s insurance.  Would it now be your personal plan of choice?

Check your recent history of medical service usage e.g. doctor visits, prescription drugs. Reflect this in your Medicare planning.

Do you anticipate hospital visits (planned surgery), dental or hearing treatment?

When do you sign up for Medicare for the first time?

Generally, in the period three months before the month of your 65th birthday and the three months following.  It may be expensive to miss this first opportunity.

Talk to your employer first if you are leaving a group plan

Check with your local Social Security office to make sure of your position and consider the alternatives. Original Medicare (A and B) are mandatory but you can choose the plan type that suits your needs.  You can add the Medicare advantage plan (C) and if you anticipate the regular use of prescription drugs you should consider plan D.

If you or your spouse have been paying for your Social Security benefits for ten years (or 40 quarters), you will be automatically enrolled in Medicare Part A when you turn 65.

When you are nearing your 65th birthday make sure you check on this at your local Social Security office and also learn about additional coverage.

How much does it cost?

Part ‘A’ of Medicare is funded by the Federal Government from taxes. Part ‘B’ covers specified treatments and services. You would be liable for any costs outside these limits. The average premium (Part B) costs about $110 pm.

The Affordable Care Act (ACA) defines eleven (11) supplementary plans (MEDIGAP) which offer the opportunity to insure against potentially life-affecting outcomes. The exact amount will depend on the plan you choose and the benefits it offers. Make sure you go through the Summary of Benefits and understand the fine print.

Medicare Advantage plans may cost no more than Original Medicare but may offer additional and more flexible coverage.

Once you have been accepted on a Medicare plan you cannot be refused continued coverage regardless of your circumstances.

How do I judge the Quality of the plans on offer?

All plans offered through an exchange (Federal, State or Private) must display a STAR rating (1 – 5).

The star ratings (5 is best) give a clear guide to the quality of the plan; the premium and the coverage will give you a guide to value.

Where should I go for advice?

It may seem complicated but the most important facts are your birthdate and your previous health insurance status.

The exchanges exist to give you free, unbiased access to Medicare insurance plans which match your needs.

TrueCoverage offers free online tools to compare the widest choice of various Medicare plans and give you quotes and advice on premium tax relief and the benefits available in your state.

You can enroll online yourself and at any time request help from one of our trained advisors.

We hope this article has helped you understand how to sign up for Medicare at age 65.

If you are approaching 65 or are entitled to enroll in MEDICARE approved prescription drugs plan and have not done so,

There are three vital questions to ask yourself

1. Do I need to enroll in a prescription drug plan?
2. When should I enroll in a prescription drug plan?
3. What type of plan is right for me?
4. ‘Creditable’ prescription drug coverage

OR

• Medicare Part D

OR

• Medicare Advantage Prescription Drug plan

Note: You may not have coverage from more than one of these categories at any one time.

Do I Need To Enroll In a Prescription Drugs Plan?

The short answer is YES!

Although Part D and Advantage Prescription plans are ‘optional’ there are time-related late-enrollment penalties, and when you do apply for cover, your premiums will be higher for the duration of your coverage. In the meantime, and more importantly, you will be entirely responsible for the cost of prescription drugs not covered by Medicare (Parts A&B).

When Should I Enroll?

The short answer is Now or As soon as you are eligible!

If you are approaching retirement or working beyond the age of 65(and have your health insurance through your employer or other group schemes) you should check with your employer to confirm the date on which your ‘credible’ prescription drug coverage ceases. From that date, you have 63 days to enroll in Medicare.  Check that your ‘credible’ insurance meets your anticipated needs. Take advice, but normally you should keep your group coverage as long as possible.

OR, if you not part of a group insurance plan, your 65^th birthday is the key date.  This defines the enrollment window that is your opportunity to review your health insurance strategy. You have three months before your birth month and the three months following to enroll. Your research should start now!  Talk to a Health Exchange adviser for free independent advice.

As a minimum you must be enrolled for Medicare Part A.  If you (or your spouse) have paid Medicare taxes for ten years the Medicare premium will be zero but remember this does not include prescription drugs coverage.

If you do not enroll during your Initial Enrollment Period (IEP) you may face penalties, In the case of prescription drug coverage, this may result in increased premiums for as long as you have Medicare part D.

What Happens If I miss (have missed) My IEP?

If you have not enrolled on a prescription drug coverage plan at the first opportunity make sure you do so at the next.

The Annual Election Period (AEP) or Open Enrollment Period (OEP) for Medicare Advantage and Medicare prescription drugs plan coverage runs from OCTOBER 15^th – DECEMBER 7^th each year.

This window provides you with the opportunity to enroll in a Medicare prescription drugs program or a Medicare Advantage prescription drugs program.  Take the opportunity to make sure that any penalties are minimized.

Once you have enrolled, the same window (October 15^th– December 7^th) gives you the annual opportunity to

• Switch from one Medicare prescription drug plan to another Prescription drug plan
• Switch from a Medicare Advantage plan which does not include drugs coverage to one which does

It makes sense to review your health insurance at least once a year; your circumstances change, the terms of your plan may have changed, there may be alternative plans on the market. Your anticipated prescription needs may be different.  It pays to re-assess. You can compare plans in confidence, on-line or talk to an advisor to assess any changes.

You may take advantage of the NEW 5-Star rating system which grades all plans offered on the Health Exchanges.  If you are considering a 5-star plan you may exercise your option to change at any time but you may do so only once in the plan year.  Remember, the Star rating is a reflection of Quality and Value underwritten by the CMS and a requirement for all plans made available through Health Insurance Exchanges.

If you do nothing else, make a note in your calendar.  These dates are FIXED.  There are some personal events that qualify you for a special election Period (SEP).

Special Election Period

There are some less predictable events that create a time-limited period in which Medicare-eligible citizens can apply for, change or opt-out of their existing medicare prescription drugs plan.

Examples are: –

• You move out of your current plan’s service area
• Your insurer ceases to be contracted to Medicare
• Your‘creditable’ prescription drug coverage ends or the coverage is no longer considered ‘credible’
• If you move to a caring environment such as a nursing home

You may also be entitled to SEP if for financial reasons you qualify for Extra Help.

What Type of Plan Is Right For Me?

Our first advice is, take advice!

Any exchange FEDERAL, STATE or PRIVATE will freely give you impartial advice.  Take advantage, either by calling or on their websites, to check out your options.

• Medicare Part D provides Stateside coverage but offers no ‘out of pocket’ limits
• Medicare Advantage plans offer cost-effective health insurance coverage tailored to family needs.  You can establish ‘out of pocket limits’

When we know what you need, we can put choices at your fingertips within moments!