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Foreign Travel With Medicare May Be Problematic

Do you travel a lot? If so, make sure you check whether or not Medicare is in force when you are abroad.

Read over your insurance policy and find out what it does and does not cover. If, at any point you do not understand what the document encompasses, talk to a qualified insurance agent and have them walk you through your policy before you start to travel with Medicare.

You may not know that Medicare Advantage Plans and Original Medicare do cover urgent or emergency medical services anywhere in the United States and its territories. So if you have a Medicare Advantage Plan, you are getting urgently or emergency medical care that:

  • Limits on how much the plan bills you by being out of network
  • Must cover follow-up care in relation to the emergency if delaying it puts your health in danger
  • Your plan cannot demand you see an in-network provider
  • You can appeal if your plan denies care costs
  • You do not need a referral
  • That if the condition was not an emergency but looked/felt like it was, Original Medicare/ Medicare Advantage must cover care

What happens if you are denied coverage of an urgent or emergency medical assistance because you went to an out-of-network provider without an OK or a referral? Appeal the denial and get the physician to provide the appropriate documentation that the medical services rendered were urgently needed or in response to an emergency. Your State Health Insurance Assistance Program can help you in putting together an appeal.

Medicare does not cover medical costs while you are travelling outside of the United States. However, the plans must cover care in certain circumstances, including: paying for care received on a cruise ship while that vessel is in U.S. territorial waters; paying for E.R. services in Canada while traveling a direct route between Alaska and another state and the nearest treating medical facility is in Canada; and in certain limited cases, Medicare may also pay for non-emergency inpatient care in a foreign hospital.

There are a few Medigap policies that offer coverage for travelers’ abroad and they include Medigap plans C through G, M and N and offer 80 percent of the cost of emergency care.

If you do not know what your plan does and does not cover, check your policy for specific rules, and if that is not clear, contact the insurance agent and ask them to discuss the relevant sections and what they mean when you are travelling outside the United States.

Posted on Friday, May 31st, 2019. Filed under Medicare.

Open Enrollment Period for Medicare and What to Consider

Did you know there was a special enrollment period for senior citizens from January 1 until the end of March? It is supposed to be the same for next year, so mark it on your calendars.

The most important thing to remember about this special three-month period is that it offers beneficiaries a window during which they can switch some of their Medicare arrangements. During this time, it is not a bad idea for seniors to consider their options regarding their Medicare plans. This is even more crucial if you are soon to be turning 65.

Around enrollment time, solicitations for Medicare Advantage come flying into mailboxes with light speed, each offering something special, unique. All the information is intended to inform readers that if they have a Medicare Advantage plan, they can switch to another Medicare Advantage plan or drop a plan, return to the Original Medicare and buy a Part D stand-alone drug benefit. There seems to be quite a bit of flexibility for seniors looking to make changes in their Medicare plans.

A word of caution, along with all the things that seniors can do, beware there is one thing you cannot do, and that is if you happen to have traditional Medicare partnered with a stand-alone drug plan, you cannot switch to a new drug benefit that may save you money on prescriptions. That may only be accomplished during open enrollment in the fall. So, the special enrollment period is actually a second chance for seniors to save on drug costs – one of the most sought after benefits in this age of expensive pharmaceuticals.

Remember though, if you choose to divest yourself of a Medicare Advantage policy and cut over to traditional Medicare, you might find it difficult to buy a Medigap policy to plug the holes. In fact, there are only four states that offer guaranteed issue Medigap insurance, even if beneficiaries have pre-existing conditions – Maine, New York, Massachusetts and Connecticut. This may not be possible in other locations.

The little known trick to getting good drug benefits that actually saves money is to shop ahead of needing a drug plan benefit and find out which one can save the most. If you research that information before you hit the next special enrollment period, you could end up saving upon switching plans. Research and asking a lot of questions are two of the most important things seniors need to do when it is time for special enrollment.

Posted on Friday, May 17th, 2019. Filed under Medicare.