When is the best time to enroll in Medicare?
The best time to enroll in Medicare is during your Initial Enrollment Period, which is a 7-month window that includes the 3 months before your 65th birthday month, your birthday month, and the 3 months after. Enrolling during the first 3 months ensures your coverage starts the month you turn 65 with no gap in […]
Is Medicare Coverage available for People with Disabilities?
Under the age of 65, certain people with disabilities are eligible for Medicare. Social Security Disability benefits must have been received for 24 months, or the individual must have ESRD or ALS, commonly known as Lou Gehrig’s disease. To collect Social Security Disability benefits, a beneficiary must wait five months after being determined to be […]
How do I file a Medicare complaint (grievance)?
To file a Medicare complaint, you have several options depending on your issue. Call 1-800-MEDICARE (1-800-633-4227) to speak with a representative who can help you file your complaint directly. You can also file online by logging into your Medicare.gov account and selecting the complaint option under your plan details. For quality of care issues, contact […]
What happens if a Medicare Advantage denies a claim or pre-authorization request?
When your Medicare Advantage plan denies a claim or pre-authorization request, you have the right to appeal through a five-level process. Start by requesting reconsideration from your plan within 60 days of receiving the denial notice. The plan must respond within 72 hours for expedited requests or 30 days for standard requests. If your plan […]
What is an attained-age Medicare policy?
Your attained age is based on the current year, and the years you’ve lived. So if you were born on December 2, 1952, your attained age in the summer of 2022 would be 69 years. But on your actual birthday during the same year, your attained age would be 70. Some insurance companies use a […]
Can Medicare Take Your Assets to Pay For Hospice?
Medicare cannot take your assets to pay for hospice care. Medicare is a federal health insurance program that does not have any legal authority to seize your home, bank accounts, or other assets for any medical services, including hospice care. When you qualify for Medicare hospice care, Medicare covers all related costs including medical equipment, […]
What is the downside to Medicare Advantage plans?
Medicare Advantage plans have several significant downsides that beneficiaries should carefully consider. The most notable drawback is unpredictable costs. Unlike Original Medicare where prices are standardized nationwide, Medicare Advantage plans feature variable copayments, coinsurance, and out-of-pocket maximums that can lead to substantial expenses during serious illness or frequent medical care. Network restrictions create major limitations. […]
What Are Medicare Dual Eligible Special Needs Programs?
Dual Special Needs Plans (DSNPs) coordinate care for individuals eligible for both Medicare and Medicaid — otherwise known as dually eligible. Dual Special Needs Plans (DSNPs) are specific Medicare Advantage plans made for duals or dual eligibles. Due to the often-complex nature of social, mental and physical care needs for duals, DSNPs help centralize the […]
How does the Social Security Income-Related Monthly Adjusted Amount (IRMAA) affect me?
If your income is above a certain level you may be required to pay an additional amount called “The Medicare Income-Related Monthly Adjustment Amount (IRMAA)” This is added to your Part B or Part D premiums. The Social Security Administration (SSA) sets four income levels used to determine if you must pay an IRMAA. This […]
What is the Medicare Plan Annual Notice of Change (ANOC)?
The Annual Notice of Change (ANOC) is a notice you receive from your Medicare Advantage or Part D plan in late September. The ANOC gives a summary of any changes in the plan’s costs and coverage that will take effect January 1 of the next year. Review this notice to see if your plan will […]