Does Medicare cover me outside the U.S?

Planning to take a cruise where you will be stopping at ports outside the U.S.? Before you go on your trip, ask your agent about your coverage.

You may be surprised to learn that Original Medicare does not pay for health care services or supplies you get outside the U.S. except in very limited situations. Medicare considers the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa to be a part of the U.S. 

On your cruise for example, Original Medicare may cover medically necessary health care services you receive on board the ship within the territorial waters adjoining the land areas of the U.S. However, Medicare will NOT pay for health care services you get when a ship is more than 6 hours away from a U.S. port when you receive the services, regardless of whether it’s an emergency.

Original Medicare will provide coverage for out of country travelers only if their situations meet very specific exceptions as outlined in your Medicare & You Handbook. If your circumstances do not match the allowable exceptions, you will be responsible to pay the full cost to the health care provider. If your situation matches one of the allowable exceptions, you still pay the coinsurance or copayments and deductibles you would normally pay if you received these services or supplies in the U.S.

Medicare drug plans (Part D) cannot cover prescription drugs you buy outside the U.S. so be sure to bring a sufficient supply of your prescription medications with you.

If you have a Medicare Advantage Plan or Medicare Supplement, you may be entitled to additional coverage for health care services you receive outside the U.S. Advantage Plan coverage may vary so it’s best to give your insurance agent a call and ask them about your coverage before you begin your trip.

While I make every effort to provide you with up to date, accurate information, these are general guidelines. Your situation or circumstances may be different. For answers to your life, health or Medicare plan questions please contact me at Mutsko Insurance Services, LLC, 440-255-5700 or email me today. 

Does Medicare cover expenses the same as my health insurance?

Although Original Medicare is comparable to traditional health insurance, there are some very important differences that many people are not aware of. For example,

1.     Each Part of Medicare has its own separate deductible. Part A covers you in the hospital, Part B covers medical expense outside the hospital, and Part D covers your prescription costs.

2.     In general, Part B pays 80% and you pay 20% of the Medicare-approved amount for the doctor or health care provider services. The Part B deductible also applies.

3.    Original Medicare does not limit the amount you may have to pay out of your pocket for your share of medical services each year.

4.    Deductibles for Part A are not tied to a calendar year like traditional health insurance. It’s tied to a benefit period that starts when you go to a hospital and ends when you haven’t received hospital care for 60 days in a row.

5.    Original Medicare doesn't cover prescriptions unless you pay extra to purchase Part D coverage. 

Your share may be different if you choose a Medicare Advantage Plan (Medicare Part C) instead of Original Medicare. Advantage Plans are offered by private insurance companies but regulated by the government. They must provide the same coverage as Original Medicare and will often offer additional benefits such as an annual cap on out-of-pocket expenses, prescription drug coverage, vision and dental coverage, health club memberships and more. Some Medicare Advantage plans cost nothing more per month than original Medicare, while others come with a higher monthly premium. Contact me and I can help you find the Medicare Advantage Plan that meets your health care needs and budget.

For more answers to your questions on Medicare, please join me for my class, Getting Started with Medicare. This is an opportunity for you to gain a basic understanding of Medicare, Medicare Advantage Plans and Medicare Supplements. For a list of all my upcoming classes, visit my website at www.mutskoinsurance.com/seminars. (Pre-registration is required. These events are only for educational purposes and no plan specific benefits or details will be discussed.)

Medicare mistakes like these can cost you for years to come

The decisions you make about enrolling in Medicare now will have a lasting impact on your future health-care costs. Before you delay signing up, you should be aware of the consequences.

It is important to enroll in Medicare Part A during your initial enrollment period. Part A is premium-free if you or your spouse worked and paid taxes for ten years or more. If you do not qualify to receive it premium-free, the penalty for waiting to enroll is 10% of the Part A premium for twice the number of years you delay enrolling.

If you don’t enroll in Medicare Part B when you’re first eligible or you drop it and enroll at a later time, you may have to pay a penalty of an additional 10% of the Part B premium for every 12 months that you put off enrolling. In most cases, you will have to pay this penalty every month for as long as you have Part B coverage.

You can delay enrolling in Parts A and B without a penalty if you or your spouse are still working at age 65 and have health insurance through a current employer. Once your qualifying insurance ends, you and your spouse would be able to sign up for Part B without a penalty.

The Medicare Part D late enrollment penalty depends on how long you go without Part D or creditable prescription drug coverage. Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($33.13 in 2015) times the number of full, uncovered months you didn't have Part D or creditable coverage. You will pay this penalty for as long as you’re enrolled in a Medicare Part D plan.

You may delay enrolling in Medicare Part D without penalty if you have other prescription drug coverage at least as good as Medicare. The penalty may also apply if you go for more than 63 days without creditable coverage.

If you have limited income and assets, you may be eligible for assistance through the state with your Medicare Part A, B & D coverage.

Got questions on health, life or Medicare plans? Contact me at 440-255-5700 or email. I’ll answer your questions and help you find the right insurance plan for you.

Ambulance service? Helicopter transport? What will Medicare pay?

Medicare helps pay for emergency transportation when you've had a sudden medical emergency, and your health is in serious danger because you cannot be safely transported by a car, taxi or other means.

For example, Medicare covers emergency ground ambulance services to a hospital, critical access hospital (CAH), or skilled nursing facility (SNF) when you’re in shock, unconscious, bleeding heavily or you need skilled medical treatment during transportation.

Medicare may also pay for emergency ambulance transportation in an airplane or helicopter if your health condition requires immediate and rapid transportation that cannot be provided by ground services. For example, a life threatening car accident.

Medicare will only cover ambulance services (ground or air) to the nearest appropriate medical facility that’s able to give you the care you need. Coverage for emergency transportation depends on the seriousness of your medical condition and whether you could’ve been safely transported by other means.

Non-Emergency Ground Transportation. Medicare may provide limited, medically necessary non-emergency ambulance transportation if your situation meets the following three conditions: (1) ambulance transport is needed to obtain treatment or diagnose a health condition (2) other transportation would endanger your health and, (3) you have a written order from your doctor stating that ambulance transportation is necessary because of your condition.

For each type of covered ambulance transportation, Medicare pays 80% of the Medicare approved amount after you meet the yearly Part B deductible. Medicare's payment may be different if you get services from a hospital-based ambulance company. All ambulance providers must accept Medicare assignment, meaning they must accept the Medicare-approved amount as payment in full.

Lack of access to alternative transportation alone will not justify Medicare coverage. Medicare will never pay for ambulette services (a wheelchair-accessible van that provides non-emergency transportation for people with disabilities.)

If you have a Medicare Advantage Plan, Supplement or other Medicare health plan, what you pay and the rules for ambulance coverage may be different.

For more information on Medicare, join me for my class, Getting Started with Medicare where we cover all the basics. You’ll find a complete list of dates and times at www.mutskoinsurance.com/seminars.The classes are for educational purposes only and no plan specific benefits or details will be presented. I hope to see you there.

Credit monitoring for Anthem customers

Earlier this year, Anthem discovered that the personal information of many of their customers had been accessed by cyber attackers. As a fellow Anthem customer, I share your concerns, but I want to assure you that Anthem has the situation well under control. Anthem responded immediately, strengthening their security measures and arranged the following steps to protect your identity.

Anthem has engaged AllClear ID to protect the identity of their customers for two (2) years at no cost to the customers. If you are or have been an Anthem customer, the services of AllClear ID are automatically available to you with no enrollment required. 

AllClear SECURE is standing by if you need identity repair assistance. If a problem arises, simply call 1-877-263-7995 and a dedicated investigator will do the work to recover any financial losses, restore your credit and make sure your identity is returned to its proper condition.

AllClear PRO offers additional layers of protection including credit monitoring and a $1 million identity theft policy. In addition, for a child under age 18, AlllClear ID ChildScan identifies acts of fraud against children. You will need to enroll to use the AllClearPro services. For more on this, visit https://www.AnthemFacts.com and click on the AllClear ID link.

As a further safeguard, do not open emails that are designed to appear as if they are from Anthem and contain a “click here” link for credit monitoring. These emails are NOT from Anthem. Anthem is not calling members regarding the cyber-attack and is not asking for credit card information or Social Security numbers over the phone.

Please contact Anthem at 877-263-7995 if you have additional questions concerning the security of your personal information.

Check out my newsletter today

Our April Newsletter was posted today on our website. Please click here to read it online and learn more about steps being taken by Anthem concerning their security breach, my plans to help seniors with caring for their pets, the Vetsnet program and more.

http://mutskoinsurance.com/newsletter

While you're there, sign up to receive future issues via email.

Do you know all you should about Medicare?

Do you know what's covered and what's not?  

Do you know the difference between Medicare and a Medicare Advantage Plan?

We'll cover these and so many other important topics at my class, Getting Started with Medicare, a 90 minute interactive workshop. It is especially helpful for people turning 65, those going on Medicare for the first time or anyone who wants to make the most of their Medicare benefits. 

Plan now to attend. For a complete list of upcoming seminars, please visit our website at www.mutskoinsurance.com.   

Preregistration is required. Please register by calling the phone number listed for the class you wish to attend. These events are only for educational purposes and no plan specific benefits or details will be shared. Some venues charge a nominal fee. 


Thursday, April 16, 2015
Polaris Career Center – Berea High School
6:30 pm – 8:30 pm
165 E. Bagley Rd., Berea, OH 44017
440-891-7600

Monday, April 20, 2015 
Lorain County Community College, Elyria Campus
6:00 pm – 8:30 pm
1005 N. Abbe Rd., Elyria, OH 44035
440-366-4148

Wednesday, April 22, 2015
Hudson Community Ed & Rec
6:30 pm – 8:00 pm
2440 Hudson-Aurora Rd., Chagrin Falls, OH 44022
330-653-1210

Monday, April 27, 2015
SELREC – Brush High School
7:00 pm – 8:30 pm
4875 Glenlyn Road, Room D105, Lyndhurst OH 44124
216-382-4300

Tuesday, April 28, 2015
Kenston Community Education-Middle School
6:30 pm – 8:00 pm
17425 Snyder Rd., Chagrin Falls, OH 44023
440-543-2552 x 2566

Tuesday, May 5, 2015
Mandel JCC
6:00 pm – 8:00 pm
26001 South Woodland, Beachwood, OH 44122
216-831-0700

Thursday, May 7, 2015 
Lorain County Community College, Lorain Campus
6:00 pm – 8:30 pm
102 Erie St., Lorain, OH 44035
440-366-4148

Monday, May 11, 2015
Willoughby Hills Library
6:00 pm – 8:00 pm
35400 Chardon Rd., Willoughby Hills, OH 44094
440-942-3362

Tuesday, May 12, 2015 
Chagrin Falls Community Education
7:00 pm – 8:30 pm
342 E. Washington St., Chagrin Falls, OH 44022
440-247-5375

Thursday, May 14, 2015
Polaris Career Center - Strongsville High School
6:30 pm – 8:30 pm
20025 Lunn Road, Strongsville, OH 44149
440-891-7600

Tuesday, May 19, 2015
Lorain County Community College – Brunswick Campus
6:00 pm – 8:00 pm
50 Pearl Road, Brunswick, OH 44212
440-366-4148

Thursday, May 21, 2015
Andover Library
2:00 pm – 4:00 pm
142 W. Main Street, Andover, OH 44003
440-293-6792