CDISNM Blog
Each fall, if you are enrolled in a Medicare Advantage plan or a Medicare Prescription Drug Plan (Part D), you will receive a “Plan Annual Notice of Change” (ANOC) in the mail. If this is your first notice, or you’re unsure what you are supposed to do with this information, you may find this article helpful. Here is some background information on the Medicare ANOC, and what you should do when it comes in the mail in September.
Annual Notice of Change
In late September, members of Medicare Advantage and Part D will receive a “Plan Annual Notice of Change”. The ANOC is sent by your plan to inform you of any changes in coverage, costs, or service area that will take effect in January. All Medicare plans are required to send this document no later than September 30, or 15 days before the start of the Annual Enrollment Period. The ANOC is usually mailed with your plan’s Evidence of Coverage (EOC), or documentation that goes into more detail about all of your plan’s cost, coverage, and benefits—beyond any new changes.
What You Should Do
In September, when you receive your ANOC in the mail, you should review any changes to make sure your plan will continue to meet your needs for the upcoming year. Plans often make annual changes to costs and benefits, which means that your copay could change, as well as which providers are in-network or out-of-network. When reviewing your ANOC, be sure of the following:
Providers, services, and drugs you use are still available and covered under your plan.
Any out-of-pocket cost for care and services is understood.
If you decide that upcoming changes to your plan will not fit your needs, you may want to change your Medicare coverage during Annual Enrollment (October 15 – December 7). This is your time to review available plans to find one that meets your individual needs best. Of course, if your plan isn’t changing, or new changes will not affect you, you don’t need to do anything at all and you will continue to receive the covered services and care you have now.
Note: If for some reason you do not receive this document by September 30, contact your plan immediately.
References:
https://www.medicare.gov/forms-help-and-resources/mail-about-medicare/plan-annual-notice-of-change.html
MUC60-2017-BCBS
CDISNM Blog
Many seniors enjoy warm weather living year-round by maintaining a dual residence or living for part of the year in two different states. The dual residence is nothing new, and “snowbirds” have been fleeing to southern states in winter for generations. But how does dual residence impact your Medicare options, will you still be covered if you live in two states?
Original Medicare Benefits Work Anywhere Within the United States
With Original Medicare (Part A and Part B), you can travel anywhere within the United States and still be covered—as long as you choose providers who accept Medicare. This is good news for anyone planning to spend part of the year in one state and part of the year in another. Whether you are in Florida or Michigan, any doctor or hospital that accepts assignments will honor your Part A and Part B benefits.
While in most cases, Medicare does not cover care you receive outside of the country, it does include:
All 50 states
The District of Columbia
Puerto Rico
The Virgin Islands
Guam, American Samoa
The Northern Mariana Islands
Medicare Supplement Insurance Is Not Restricted By Service Networks
Like Original Medicare, Medicare Supplement Insurance, or Medigap, does not rely on service networks, and as long as the doctor or hospital you choose accepts Medicare, you’re covered. As a senior with homes in two states, you can travel freely with the peace of mind and confidence that when you need medical care, you can get it and your Medicare Supplement Insurance plan will be applied. Note: if you are a dual resident considering Medigap, be sure to compare policies offered by each state to learn about any differences that may impact your coverage.
Medicare Advantage and Part D Plans Don’t Always Extend Across State Lines
For Medicare Part C and D, the rules for out-of-state coverage are different and your plan may not cover your care while you travel within the United States. With many plans, you need to be a permanent resident of the state where you originally enrolled and you must live in the service area of your plan. In some cases, you can receive out-of-network care, but it will likely cost you more money. In addition, your plan may have specific rules you need to follow, such as needing prior authorization before receiving care that can impact your coverage. With all Medicare plans, Original Medicare, Medicare Advantage, and Medigap, you are covered in any state if you need emergency medical care or urgent care out of network.
References:
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/switching-plans/switch-medigap-.html#collapse-2514
https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/original-medicare/how-original-medicare-works.html#collapse-3111
MUC58-2017-BCBS
CDISNM Blog
Whether or not you take prescription drugs, you may want to consider your options carefully when it comes to joining Medicare Part D. Unless you have other, creditable coverage offered through work or a union, going without prescription drug benefits may end up costing you money. Do you have to join Medicare Part D to avoid extra fees? Part D coverage is optional, but without the right guidance, you could end up paying a higher premium from a late enrollment penalty. Here’s some information on Part D coverage and what you should know if you are approaching your Initial Enrollment Period.
Avoid the Part D Penalty
Joining Medicare Part D, or prescription drug coverage is optional. However, joining late may trigger a penalty. How do you avoid the Part D penalty?
Join Part D when you are first eligible, during your Initial Enrollment period.
Maintain creditable coverage (other prescription drug coverage) through an employer, union, or other health insurance provider.
If you do not currently have prescription drug benefits through an employer or other source, the best time to join Medicare Part D is when you are first eligible, during your Initial Enrollment period. Even if you do not need medications now, joining during Initial Enrollment ensures you avoid paying a late enrollment penalty.
Not everyone needs to join Medicare Part D when they are first eligible, and many seniors delay enrollment without paying a penalty. Many employer-provided health insurance plans offer drug coverage that is considered “creditable” by Medicare.
If you do have drug benefits, as long as you are covered, you do not need to join Medicare Part D. However, if you lose coverage (employer benefits end or COBRA ends) you only have a certain amount of time to join Part D without penalty.
Your health insurance provider will let you know if your coverage is creditable. Be sure to keep this documentation safe as you will need to show it to Medicare when you are ready to join Part D. Without proof, you may end up paying a late enrollment penalty.
If You are Penalized, Here’s How to Calculate Your Premium
If you go without a Medicare prescription drug plan (Part D) or other creditable coverage for 63 days or more after your Initial Enrollment period ends, you may owe a late enrollment penalty. Penalties are calculated by multiplying the Part D premium amount by the number of full months you went without Part D or creditable drug coverage. Penalties are added to your monthly Part D premium for as long as you have coverage. For example, if you went 6 months without creditable coverage, your penalty would be .06 (for 6 months without coverage) times 35.63 (Part D premium) for a total of 2.13. Medicare rounds to the nearest .10, making your penalty $2.10 added to your Part D premium. Note: penalties are recalculated as annual premiums increase.
References:
Part D Penalty: https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html
MUC56-2017-BCBS
CDISNM Blog
As a Medicare-eligible policyholder, you have the right to know whether or not your current drug coverage meets the standard Medicare prescription drug coverage, and is considered ‘creditable’. If your current prescription drug benefits are provided through an employer, union, or another source, understanding what ‘creditable coverage’ means and how it applies to you will help you make an informed decision—potentially saving you money. The good news? All companies offering prescription drug coverage are required by law to notify you about the status of benefits and whether or not your drug plan meets or exceeds the standard Medicare Part D Prescription Drug plan.
Creditable Coverage
For prescription drug coverage to be creditable, the plan must expect to pay (on average) as much as the standard Medicare prescription drug coverage. How is this determined?
Creditable coverage does the following:
Provides coverage for brand name and generic prescriptions.
Provides reasonable access to retail providers.
Pays an average of at least 60 percent of a participant’s drug expenses.
Satisfies at least one from below:
No annual benefit maximum.
An expectation is that the amount payable by the plan will be at least 2,000 annually.
For integrated coverage: No more than $250 deductible per year, no annual benefit maximum, and no less than a $1,000,000 lifetime combined benefit maximum.
Why It Matters
Of course, there’s a good reason why it makes sense to maintain creditable prescription drug coverage. Medicare beneficiaries who decide not to sign up for Part D prescription drug coverage when they are first eligible, but enter the program late often have to pay more. People signing up late for Medicare Part D without creditable drug coverage may be subject to a 1 percent monthly premium penalty for late enrollment. However, if you have drug benefits through an employer—and it’s creditable—you can stay with your current plan instead of enrolling in Medicare Part D and avoid paying higher prices when you do enroll. In other words, as long as your current drug benefits are as good as Medicare, or ‘creditable’, you can continue to use them and will not pay higher prices when you decide to enroll in Part D at a later date.
What You Should Know
As long as you maintain drug coverage through an employer or union, you should receive a notice by mail each September informing you whether or not your coverage is ‘creditable’. Be sure to keep this documentation—you may need it should you decide to move to a Medicare drug plan later.
References:
https://www.cms.gov/medicare/prescription-drug-coverage/creditablecoverage/index.html
https://www.cms.gov/medicare/prescription-drug-coverage/creditablecoverage/downloads/whatiscreditablecoverage.pdf
https://www.medicare.gov/forms-help-and-resources/mail-about-medicare/notice-of-creditable-coverage.html
MUC55-2017-BCBS
CDISNM Blog
For many seniors, travel is an exciting part of a retirement plan. Whether you’re planning a continuous exploration of faraway lands or a simple one-week trip abroad, foreign travel is a reality for many after leaving the nine-to-five lifestyle behind. But, what about your health care needs? Will your Medicare coverage come with you on your journey?
Medicare Supplement Plans That Offer Coverage
Some Medicare Supplement Insurance plans offer foreign travel coverage—medical benefits as you travel out of the country. The 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa are considered part of the United States—domestic travel, and foreign travel benefits are not necessary.
For all other travel outside of the United States, foreign travel emergency care coverage is provided by six available supplement plans: Plan C, D, F, G, M, and N. If you purchased Medicare Supplement insurance before 2010, and you have plans E, H, I, or J, your foreign travel benefits will still be valid, even though these plans are no longer offered for sale.
What Is Covered
With any of the above plans, you will have foreign travel emergency care that begins during the first 60 days of your trip. Your supplement plan will pay 80 percent of the billed charges for necessary medical care outside of the U.S. after you pay a $250 deductible. There is a lifetime limit of $50,000 for all foreign travel emergency care.
If you’re undecided as to whether or not you should buy coverage, here’s something to think about: Medicare Supplement plans are available with no underwriting only during your Initial Enrollment period. If you think you may be traveling abroad during retirement, you may want to plan by choosing a plan that offers foreign travel benefits.
In Rare Cases, Original Medicare Pays for Foreign Care
Typically, Medicare does not pay for treatment outside of the United States and Medicare Prescription Drug plans do not cover medications purchased abroad. However, in some rare cases, Medicare may pay up to 80 percent for services covered under Original Medicare even while you are out of the country. Note, that foreign hospitals are not required to submit claims to Medicare. More than likely you will need to submit an itemized bill to be reimbursed.
Original Medicare may pay for inpatient care, ambulance services, or dialysis treatment outside of the U.S. if:
You are in the United States when a medical emergency occurs and a foreign hospital is closer than a U.S. hospital.
You are traveling through Canada en route to Alaska and a Canadian hospital is closer than a U.S. hospital.
You are on a ship within territorial waters adjoining lands of the U.S. but within 6 hours of a U.S. port.
You live in the U.S. and have a medical emergency, but a foreign hospital is closer than a U.S. hospital.
References:
https://www.medicare.gov/supplement-other-insurance/medigap-and-travel/medigap-and-travel.html
https://www.medicare.gov/coverage/travel-need-health-care-outside-us.html
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