Medicare

Q&A: Revisiting a Medicare penalty

June 13, 2022 By Liz Weston

Dear Liz: As a county employee of 44 years, I was offered the option to contribute to Social Security in the mid-1970s. It was not mandatory and I declined. When I retired in 2004, I did not apply for Medicare as I wrongly assumed that I would not qualify. I have since learned that I can apply for Medicare but that I would have to pay $499 per month as a late enrollment penalty on top of the monthly premium. Do you know any way that I can get a portion of the late penalty waived?

Answer: As your situation shows, not getting sound advice about Medicare can be expensive. Failing to sign up for Part B coverage, which pays for doctor’s visits, can incur penalties of 10% for each 12 months you were eligible but didn’t enroll. The penalties are typically permanent.

There is an appeals process, but your chances of success may not be great unless you can prove that you delayed enrollment because of bad advice you got from a government representative. Medicare has more information on its site.

Q&A: More about Medicare choices

October 25, 2021 By Liz Weston

Dear Liz: I’ve enjoyed your columns about choices between traditional Medicare and Medicare Advantage. I have a terminology question: What is the difference between a Medigap policy and a supplemental one? I have traditional Medicare and a supplemental plan, which covers the deductibles and copayments that Medicare doesn’t cover. According to your article, it seems a Medigap policy does the same. Please clarify and keep up the good work.

Answer: Medigap and supplemental policy are two terms for the same product: an insurance policy sold by private insurers to cover the “gaps” in Medicare coverage. If you have traditional Medicare (also known as original Medicare), it’s generally advisable to have a Medigap supplemental policy as well.

You can’t get a Medigap policy, however, if you have Medicare Advantage. Medicare Advantage is also provided by private insurers but is meant to be an all-in-one alternative to traditional Medicare, rather than a supplement to it.

Q&A: Medicare Advantage questions

October 18, 2021 By Liz Weston

Dear Liz: You posted a letter against Medicare Advantage plans. The letter suggested that you had to go to their doctors, which is false. You can go out of network with a higher deductible. I will also tell you that most of those same doctors accept your in-network deductible. I do this all the time when I’m at my summer home.

Answer: As mentioned earlier, Medicare Advantage plans are offered by private insurers as an alternative to traditional Medicare. The plans can differ in what they cover and how.

For example, if your Medicare Advantage plan is a preferred provider organization, you may indeed have some coverage if you use a medical provider outside the plan’s network. If the Medicare Advantage plan is a health maintenance organization, the plan may not cover out-of-network care except in an emergency. HMOs also may require you to get a referral to see a specialist.

Contrast that with traditional Medicare, which allows you to see any medical provider that accepts Medicare (which is most of them). One of the downsides to traditional Medicare is the co-insurance, including deductibles and copayments. However, you can purchase a supplemental, or Medigap, policy from a private insurer to cover those. There are a number of Medigap plans, but what they cover is standardized.

Medicare Advantage plans often pay for things that Medicare does not, such as hearing, eye care and dental. Many people who sign up for Medicare Advantage are, like you, pleased with their coverage. Others are not, though. Read on:

Dear Liz: Regarding the pros and cons of traditional Medicare versus Medicare Advantage options, I want to share a personal horror story about my parents. Both are now deceased, and I went through hell dealing with their Medicare Advantage plans.

These plans often send classy color brochures in the mail to seniors approaching 65, inviting them to a free lunch to hear all about the excellent care that they supposedly will receive when signing up with these health plans — all with no extra monthly premiums! Both my parents fell for the promises offered by these “free” plans.

As you wrote in your response, there are serious and inconvenient limitations to the quality of care and the hospitals and doctors covered in these networks. It was frustrating.

My mother’s primary care doctor always seemed exhausted and never explained anything correctly. He seemed to be annoyed when we asked him to repeat information. My dad’s plan told him it was not contracted with the hospital closest to him and referred him to a hospital much farther away. His primary care physician was rude, disrespectful and uncaring.

As my father’s health advocate, I was always arguing with his insurer. My dad became depressed at the poor quality of care and the lack of support from this company. I think he just gave up. He passed away in 2018 of prostate cancer, which had spread into his lower back. Had he received proper testing when it was supposed to be done, the cancer may have been caught early and treated. It was too far gone to treat by the time it was diagnosed.

If you stay with traditional Medicare, there are supplemental health plans that cost a few hundred dollars a month. I have heard from friends and relatives that the care is better through paid supplemental plans.

Bottom line: You get what you pay for. Probably best to stick with plain old Medicare; you might just live longer.

Answer: Like all private health insurance, Medicare Advantage plans can vary dramatically in quality. You can’t assume that one person’s experience with Medicare Advantage will be the same as another’s.

You can assume, however, that any insurance with lower upfront costs will have higher costs or more restrictions, or both, if you need a lot of care. If you want more freedom to choose your medical providers and you can afford the premiums, traditional Medicare with a supplemental policy may be a better fit.

Q&A: Medicare Advantage plan downsides

September 27, 2021 By Liz Weston

Dear Liz: You recently wrote about Medicare Advantage plans, which often cover things like dental care, hearing and vision that traditional Medicare does not. You mentioned that the plans have networks of providers, but people should know that those networks don’t always include the experts they may need if they develop serious health issues. The plans themselves can have copays that make it expensive to get sick. If people want to switch to traditional Medicare and get a supplemental Medigap policy, they may face medical underwriting that could increase their costs.

Answer: Medicare Advantage plans are sold by private insurers as an all-in-one alternative to traditional Medicare. The plans are certainly popular — the percentage of Medicare beneficiaries who sign up for Medicare Advantage has been steadily increasing over the years, in part because these private plans seem to cover more. But the plans can vary widely in the breadth of their networks and how they share costs with beneficiaries.

Once you’ve signed up for Medicare Advantage, switching to traditional Medicare can be problematic, as you noted. Insurers aren’t required to cover you the way they are when you first enroll. Some may decline to offer you a Medigap policy or may charge you more, based on your health.

Q&A: Medicare is complicated. Here’s how it works

September 20, 2021 By Liz Weston

Dear Liz: My husband and I are in our 50s and have widowed moms in their 80s. We always understood that when you begin taking Medicare, you are required to choose a plan such as SCAN or Blue Shield and to follow that plan’s benefits and limits. However, my friend who works in a hospital told me that you can elect to have straight Medicare and have no plan limits. Can you explain this?

Answer: What you’re asking about is known as traditional or original Medicare, which consists of two parts. Part A is usually premium-free and covers hospitalization. Part B covers doctor visits and has a standard monthly premium of $148.50.

Traditional Medicare is administered by the federal government and is accepted by the vast majority of medical providers but doesn’t cover everything. For example, beneficiaries must pay deductibles, 20% of Part B services and a portion of hospital stays. For that reason, many people with traditional Medicare also buy supplemental or “Medigap” policies from private insurers to cover these costs. Most Medigap plans, like traditional Medicare itself, don’t have out-of-pocket limits.

By contract, Medicare Advantage plans, also known as Medicare Part C, do have out-of-pocket limits. Medicare Advantage plans are “all in one” coverage provided by a private insurer rather than the government. These plans provide everything covered by Parts A and B of traditional Medicare, and may cover other costs such as vision, hearing and dental that traditional Medicare doesn’t. The plans typically have networks of doctors and other medical providers. If you get care outside that network, you would pay more and sometimes all of the cost.

The final part of Medicare is Part D, prescription drug coverage. That’s purchased from private insurers and may be included in Medicare Advantage plans.

Obviously, Medicare can be complicated, but you can educate yourself at Medicare.gov and download or request the handbook “Medicare & You.”