Medicare Enrollment – What do I need to know?

If you or someone close to you is nearing age 65, then you are probably trying to figure out Medicare.  Medicare is the national health insurance program in the United States administered by the Centers for Medicare and Medicaid Services. It is health insurance for Americans 65 years and older and younger people with some disability status as determined by the Social Security Administration.

Your initial enrollment period (unless you qualify based on a disability) for Medicare Part A occurs 3 months before you turn 65 and three months following. Each year following between October 15 and December 7 you can change plans for the following year. Signing up for Part B occurs from January-March of each year. There are also penalties if you don’t buy Medicare Part A when you are first eligible. For more information about enrollment, visit this page on the Medicare website.

Medicare Part A premiums are waived if you are 65 or older and a United States Citizen or have been a permanent legal resident for five continuous years, and you or your spouse has paid Medicare taxes for at least 10 years. If you paid Medicare taxes for less than 10 years or 40 quarters there are monthly premiums you need to pay. Medicare Part B costs $148.50 (2021) or higher depending on income. For more information on Medicare costs visit Medicare’s website. There are other costs such as deductibles and co-insurance as well. 

So if you are confused when I use terms like Medicare Part A or B, let me provide you with a brief explanation. 

  • Part A is known as hospital coverage. 
  • Part B is your medical coverage such as visiting your doctor. 
  • Part C is private insurance in place of Part A and B. 
  • Part D is prescription drug coverage. 

The plans are required to offer the same coverage as Medicare Part A & B, but often provide additional coverage. Premiums will vary depending on the coverage provided. Another decision you need to make is whether you want additional coverage if you have Medicare Part A and B. This is often referred to as Medigap coverage. For more information on the various parts visit the Medicare website.

If you are still confused, don’t worry. There are a lot of resources out there for help. Each state also runs a SHIP (State Health Insurance Assistance Program) program. To find a SHIP representative in your state, visit the State Health Insurance Assistance Programs National Network. You can also visit the Medicare website for information.  

University of Maryland Extension in partnership with University of Delaware Cooperative Extension will offer a workshop on October 25, 2021 and November 8, 2021. To register for either workshop, click on the date.

Do I Need a Different Insurance Plan?

Health insurance can be confusing. We are often asked in a short period of time to commit to a plan for an entire year. We are confused with terms such as premium, deductible, and co-pay and plan types such as a PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization). In most cases you only have once a year, during open enrollment, to change plans. It helps to start thinking about your current plan and future needs early to be prepared to make those changes during the open enrollment window. 

I will share a few reasons why you may consider changing plans. 

Health Care Providers/Doctors – Depending on the type of plan you have, health insurance companies enter into agreements with health care providers and doctors, which involves pre-determined prices for services. Health care providers/doctors in this agreement are referred to as “in-network.” If you see a provider that is not in-network, or “out-of-network,” you often pay higher prices. In some cases, you may have a provider that you like to use which is not in your network. If that is the case, you may decide to change plans during the next open enrollment.

Premiums/Deductibles – Some people choose a plan based on how much it costs them on a monthly basis. Those monthly payments are referred to as premiums. Deductibles are how much you need to pay before the insurance plan begins to pay. Deductibles vary in amount depending on the plan type. Typically, lower premium plans have a higher deductible, and higher premium plans have lower deductibles. Individuals that don’t use their plans often choose a low premium/high deductible plan. You may change a plan based on how you used the plan in the previous year or how you anticipate using a plan in the coming year.

Plan Type – There are four different plan types which offer various levels of flexibility in the healthcare providers you use. Information about the types of plans can be found here.  Some require that you stay within the plans network while others provide more flexibility. Some plans require a referral to see a specialist and others may not. The level of flexibility you want in your health insurance will determine which type of plan you select.

Change In Use – We typically select plans based on the information we have at the time. Over the course of a year, the reasons you chose that plan may change. Changes in your health or in needs for life like planning for a family, may affect when and how often you use your insurance plan. You may anticipate using the plan more often than the previous year and decide you want a plan with a lower deductible as a result. You may want to see a doctor that is not in-network and decide to change plans to ensure you visit your preferred doctors.  

It is not uncommon for someone to change plans. Just make sure you select a plan that best meets your needs. The Health Insurance Literacy Initiative at University of Maryland Extension developed resources to guide you through the process.  

National Insurance Awareness

Monday, June 28, 2021 is National Insurance Awareness Day. Insurance comes in many forms for our health, our cars, our homes and property, even our lives.

Insurance tends to be one of those things that we don’t think about until we need it, but knowing what your insurance covers and being aware of when and how you can use it is important.

Health insurance can be some of the most confusing for individuals and families to understand. In 2012, University of Maryland Extension and University of Delaware Cooperative Extension collaborated to launch the Health Insurance Literacy Initiative (HILI). HILI has produced evidence-based, empowerment programs intended to reduce confusion, increase capability, and increase the confidence of consumers to make a smart choice and use decisions about health insurance. HILI teaches folks how their insurance can work for them, helps people make good choices about their health insurance needs, and use their benefits wisely.

Take time this month to review your current insurance benefits, research different types of plans, and decide if you are using the right plan for your healthy lifestyle. Learn more and find more helpful tools at https://extension.umd.edu/programs/family-consumer-sciences/health-insurance-literacy.

We’ve Missed You!

While Breathing Room has been on something of a short hiatus for the past few weeks, we were diligently working behind the scenes developing a brand new University of Maryland Extension website, complete with an improved user navigation and more ways to help Marylanders find the answers they need.

The UME Family and Consumer Sciences team offers numerous programs and educational opportunities, even above and beyond the scope of this blog. Our experts specialize in health, financial wellness, food safety, health insurance literacy, nutrition, mental wellness, and community outreach.

Visit the new Extension website to learn about them and the wide variety of educational opportunities the Family and Consumer Sciences program offers!

Understanding Medicare

Have you thought about health care in your retirement years? Health insurance in your senior years is something you need to plan for when you stop working a full-time job with benefits. In 2016, the average person with Medicare spent $5,460 out of their own pocket annually (Kaiser Family Foundation). Hospitalizations or medical procedures will cost much more. Most of us don’t think about these issues until we hit that magic number of 65 and are eligible for Medicare. This is the health insurance program for people 65 and older. There are some exceptions to qualify early, but that is not the focus of this article. 

There are four parts to Medicare:

  • Part A – your hospital insurance; 
  • Part B – your medical insurance, which covers outpatient services like your doctor visits and lab work;
  • Part C – Medicare Advantage, which I will explain later in this blog; and
  • Part D –  your prescription drug coverage. 

You have a seven-month window to sign up for Medicare (three months before you turn 65, the month of your birthday and three months after). You should receive something in the mail prior to 65 from the Social Security Administration about Medicare enrollment. If not, I suggest you contact them. For most people, there is no charge for Part A. Part B will have a monthly premium which currently is $144.60 (or higher depending on your income). 

This enrollment period is when you need to make a decision. Do I want traditional Medicare (Parts A and B) or Medicare Advantage (Part C)? Medicare Part C or Medicare Advantage plans are health benefits from a private insurance company that is approved by Medicare. These plans operate like a HMO or PPO. About 34% of Medicare beneficiaries sign up for Part C (Kaiser Family Foundation). You will need to decide what best meets your personal needs. Medicare Part C will cover hospital, medical and sometimes dental and vision services too. Each plan is different so you really need to shop around.

The other aspect you need to consider if you enroll in Parts A and B is a Medigap policy. Because Parts A and B typically cover 80% of the costs of medical care — the Medigap policy fills the financial gap. There are several different types of Medigap policies, so let me direct you to some resources. Medicare has a site (How to compare Medigap policies) that provides a comparison of the different plans. This is the short version. The detailed explanation of Medigap policies is called, Choosing a Medigap Policy.

Finally, you have Part D, your prescription plan. Part D is offered by private insurance companies, so you will have options. In some cases, it is included in your Medicare Advantage plan or your Medigap plan. 

There are exceptions to everything I just shared. For example, if you are still working, you can keep your work insurance.  I want to share with you some resources so you can make the best decisions for your own situation. There is also a program called SHIP (Senior Health Insurance Program).  Your SHIP representative can answer all of your questions about Medicare. 

Additional Resources

Get The Most Out of Your Health Insurance by Using Your Essential Benefits

Health insurance is not a favorite topic for many people, but there is no denying that it’s important. Especially now, it is important to pay attention to our health insurance policies and make sure that we are using them in the best way we can to stay healthy. 

To stay healthy, you should know what benefits your insurance provides and how to use them.

What are health insurance benefits? 

Under the Affordable Care Act (ACA), all health insurance plans were required to cover ten essential health benefits. These benefits are: 

When you pay your monthly premium, you are paying to make sure you have access to all these services. 

  • Preventive and wellness services 
  • Lab tests
  • Hospitalization
  • Prescription drugs
  • Services and Devices  for injuries, disabilities or chronic conditions
  • Outpatient care
  • Maternity and newborn care
  • Mental and Behavioral Health treatment
  • Pediatric care
  • Emergency room services

How can I use my benefits during COVID-19? 

Although testing for COVID-19 has been provided at no cost to the patient, many people have been using their health insurance to get treated. However, it is important to keep in mind that there are many reasons to use health insurance which are not related to COVID-19! For example, check-ups, vaccines, screenings, and smoking cessation assistance are all covered under preventive care. 

Currently, people may not be accessing these services due to concerns around COVID-19. It can be difficult to figure out if all of the care people require needs to continue during COVID-19, or if it should wait until the care can be provided in a safer way. If you are trying to make a decision about keeping, rescheduling, or cancelling doctors’ appointments, you might find this article helpful. In general, the advice from the article is to stay in contact with your doctor and get their help with deciding what medical care you need and what can wait. 

What does it mean to stay in contact with my doctor? 

Staying in contact with your doctor during COVID-19 can take many forms. Hopefully, you have a primary care doctor. If not, check out this information about how to find one. 

You can stay in contact by calling your doctor’s office — most offices have an option to call and speak with a nurse when you have a medical question. Your doctor’s office may also have a system where patients can send electronic messages to their doctor through a secure system. You can use that system to message your doctor with any questions you might have. Your doctor might advise you to use telehealth services for a virtual visit, come to the office for a regular visit, or even delay your visit until it is not as risky to be seen. 

But the most important thing to keep in mind is that these answers will depend on your health status, age, location, internet connection, and many other factors! There is no one size fits all answer, so staying in contact with your doctor is a must! 

Much of this information comes from the Smart Choice Smart Use program. For more resources, check out our website at https://extension.umd.edu/insure/consumer-resources. You can also learn more by participating in an upcoming training on getting the most out of your insurance by registering at https://go.umd.edu/health_insurance.

Choosing A New Doctor

Doctor suggesting hospital program to patientStarting a new job, moving to a new location, or changing insurance plans can lead you down the path of having to choose a new doctor. Choosing a new health care provider can be stressful, but here are some things to consider:

  • Does new health care provider accept your insurance?
    • One of the most important things to do when searching for a new doctor is making the doctor/provider is considered in-network with your insurance plan. An in-network doctor has contracts with your insurance company to provide services at a lower cost to clients. Most insurance companies will have a website that provides a list of doctor offices that are  compatible with your insurance. If you are not sure, ask a representative from the doctor’s office and they will let you know. In-network doctors are a better option because in most cases, using an out-of-network doctor will cost you more money.
  • Diverse People Listening to the Doctor's PresentationAsk questions, lots of questions.
    • Knowing which doctor to select can be tricky but one good tip is asking people you trust such as co-workers or friends for recommendations. When asking people you trust keep in mind that just because they like the doctor doesn’t mean you will, so it’s best to ask the right questions. Another great tip is using websites such as www.ratemds.com or www.healthgrades.com. You can also interview a potential primary care provider. Call the doctor’s office and be prepared to ask questions to the office staff and the doctor. Asking the right questions can help to make sure that the doctor’s office is a good fit for you. 
  • Know your insurance policy on switching health-care providers.
    • Many of us have had negative experiences with a doctor’s office. It’s best to make sure that you know what your insurance provider’s policies are about switching doctors.  You can find this information in the Evidence of Coverage document. The term sounds technical, but it is just the agreement between you and the insurance company. It provides information of what your plan actually covers, how it works, and what you’re supposed to pay. You can get a copy of this document when you enroll in a new insurance plan, but most insurance companies have a copy on its website.  
  • Call the insurance company.
    • My final piece of advice is when in doubt, call the insurance company.  You should have received a wallet sized insurance card from your insurance company.  Somewhere on the card will be a phone number you can call with any questions. Remember that you are the customer, if you have questions you should be able to get them answered.

If you want more information, visit the Insuring Your Health website.  There is an article that provides greater insight on this topic. 

Time for a (Health Insurance) Check-Up

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You have probably heard the expression, “New Year, New Me.” For most people, it is also “New Year, New Deductible.” It’s time for an annual check-up on your health insurance deductible! 

For most of us with health insurance, the plan year ends on December 31.  With the period ending soon, now is the time for some end of year health care financial planning. 

What is a Deductible? 

Your deductible is the amount you owe each year for health care services. It is a payment you make that ensures the coverage of health care services before your health insurance plan begins to pay. Despite this being a part of your health insurance plan, the deductible may not apply to all services.  

For most, the deductible will reset on January 1, 2020, therefore, it’s good to do a little planning which can be a smart financial move. 

What if I haven’t reached my out of pocket maximum?
If you have had enough health care expenses this year to meet your deductible but have not reached your out of pocket maximum for the year, most health care visits will require you to pay a small portion, but not all, of the cost of care. This is the copayment or coinsurance

What if reached my out of pocket maximum?

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If you have already paid your maximum out of pocket costs for the year, most covered care will not cost anything until next year. If you have not yet reached your deductible for the year, and care is not urgent, you may benefit from waiting until the new plan year to schedule visits to your providers. Any costs incurred in the new year will all go toward meeting your new deductible.  

Important points to remember: 

  • First, if you become sick or injured, do not delay treatment.  Postponing care can make you sicker, possibly risk your future, and/or end up costing much more in the long run.  
  • Many preventatives services that help you stay healthier are free!  Check-ups, vaccines, and screenings often cost you nothing so there is no need to delay important preventative care.
  • Health insurance policies vary. Check your own health insurance policy and make sure you are using all of the benefits it provides.

Any care that you need should be scheduled before the end of the year to save you money.  Don’t delay! Providers’ appointment schedules fill up, and getting the care you need helps you stay healthier.  As you begin to create your spending and savings plan for the new year, it is also a good time to reflect on your present health and health costs.  Use this handy guide to assess your health needs and estimate your potential costs for the coming year.

Health Insurance Terms to Know:

Out-of-Pocket Maximum/Limit – The most you pay during a plan year (12 months) before your health insurance or plan begins to pay 100% of the allowed amount.

Copayment – A fixed amount you pay for a covered health care service, usually when you get the service. You may have to meet your deductible first.

Coinsurance – Your part of the costs of a covered health care service. This is a part of the allowed amount for the service. You pay this amount once you have met your deductible.