Why do I need Medicare if I'm covered at work?

In most cases, once you become eligible for Medicare, most retiree policies from an employer or union will require you to sign up for Medicare. In general, retiree insurance plans act as supplemental insurance and pay after Medicare, filling in some of the gaps in Original Medicare’s coverage.

How your specific retiree group health plan coverage will work will depend on the terms of your plan.  It’s best to talk to your human resources staff or your health insurance plan administrator to find out how Medicare and your plan coordinate. Here are a few things for you to ask about:

1.      Find out if you are required to sign up for Medicare Part A, Part B or both to get the full benefits from your retiree coverage. Some retiree coverage might not pay your medical costs during any period in which you were eligible for Medicare but didn't sign up for it.

2.    Ask what your plan covers that’s not covered by Medicare. Does it cover deductibles or co-insurance? Can you see any doctors you choose or are you restricted to a network of doctors and health care providers? Does it cover extra days in the hospital? Does it include coverage for vision, dental or prescription drug coverage?

3.    Don’t assume that your coverage and costs as a retiree will be the same as an employee. Verify this. If you have a spouse, check whether he or she will also be covered. Employers aren't required to cover retirees, and they may provide different benefits, premiums, or even cancel coverage.

4.     Find out if your retiree plan provides ‘creditable coverage’ for prescription drugs. If it is not creditable coverage (as good as, or better than Medicare Part D) you will be charged a penalty should you need to enroll in Medicare Part D (drug coverage) in the future.

Your decisions about health care coverage are some of the most important choices you’ll make in the retirement planning process. I invite you to learn more about Medicare and the options you have. Please join me for my class, Getting Started with Medicare, presented at local colleges, libraries and community centers. For a complete list of upcoming dates and times for classes, you can click here to visit my website. . I look forward to seeing you in class.

Does Medicare cover rehab after a heart attack?

While heart disease is the leading cause of death every year in the U.S. for men and women, it can often be prevented when people manage their choices and health conditions.

If you have already had a heart attack, you and your physician should discuss a comprehensive Cardiac Rehabilitation Program (CR) that includes exercise, education, and counseling. This program is covered by Original Medicare Part B.

Medicare Part B also covers Intensive Cardiac Rehabilitation (ICR) programs that, like regular Cardiac Rehabilitation programs, include exercise, education, and counseling. ICR programs are typically more rigorous than CR programs. These programs may be provided in a hospital outpatient setting (including a critical access hospital) or in a doctor's office.
People with Medicare Part B are covered, but must be referred by their doctor and have had any of the following conditions:

• A heart attack in the last 12 months
• Coronary artery bypass surgery
• Current stable angina pectoris  
• A heart valve repair or replacement
• A coronary angioplasty or coronary stent  
• A heart or heart-lung transplant
• Stable chronic heart failure

Intensive Cardiac Rehabilitation (ICR) programs are also covered if your doctor orders it or if you have had any of the conditions listed above, with the exception of stable chronic heart failure, which applies only to CR programs.

Those with Original Medicare will be responsible to pay 20% of the Medicare-approved amount if you get the services in a doctor's office. If you receive care in a hospital outpatient setting, you will be responsible to pay the hospital a copayment. The Part B deductible applies.
     
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them
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If you have questions concerning insurance including Life, Health, Vision, Hearing or Medicare Advantage Plans, contact me at 440-255-5700 or Lmutsko@mutskoinsurance.com. I look forward to assisting you.

Do you really know how Medicare Supplements work?

A Medicare Supplement plan, sometimes referred to as a Medigap plan, can be purchased at any time throughout the year. You must already have Medicare Parts A and B to purchase a Medicare Supplement. People who have a Medicare Advantage plan cannot purchase a Medicare Supplement.

Here’s how Medicare Supplements work:

Medicare Parts A and B provide basic medical coverage. But they only cover about 80% of your costs. They do not pay for everything. Medicare Supplement plans are insurance plans sold by private companies to help close this gap in coverage.

Supplements pick up many of the out of pocket costs not covered by Medicare Parts A and B such as copayments, coinsurance, and deductibles. Medicare supplements also give you the freedom to see any doctor of your choice who accepts Medicare patients rather than being locked into a specified network of doctors, hospitals and providers. Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S.  

When you have a Medicare Supplement, Medicare will pay its share of the Medicare-approved amount for covered health care costs and then your Medigap policy pays its share. Medicare Supplements do not cover long-term care, vision, dental, hearing aids, or private nursing. Plans sold today do not cover prescription drug coverage.

Supplements are identified by letters A - N and each standardized Medicare supplement plan must offer the same basic benefits, no matter which insurance company sells it. Cost is usually the only difference between Medicare supplement plans with the same letter sold by different insurance companies.

If you are considering purchasing a Medicare Supplement plan, the best time to do so is during your six month Medigap open enrollment period. This period automatically starts the month you turn 65 and are enrolled in Medicare Part B. During this time, you can buy any Medigap policy at the same price a person in good health pays even if you have health problems. If you buy a Medicare Supplement policy outside this window, there is no guarantee that you'll be able to get coverage or that your rates won’t be higher if you do get covered.

If you have group health coverage through an employer or union because either you or your spouse is currently working, you may want to consider waiting until you enroll in Medicare Part B. When your employer coverage ends, you can enroll in Part B which means your Medigap open enrollment period will start when you're ready to take advantage of it. 

Please call me for more information on Medicare Supplements. We’ll review your options and I’ll help you find a plan that suits your needs. Contact me at 440-255-5700