6. You should re-shop your coverage. The annual enrollment period for Part D and Advantage programs runs from October 15 to December 7 each year. This is the opportunity for seniors already signed up for Medicare to re-shop their coverage – and you should do it annually. Insurance companies often change their offerings year-to-year in ways that can increase drug costs by thousands of dollars, or make it more difficult to get certain drugs. At the same time, your drug needs may have changed since the last plan selection period in ways that make a plan less beneficial for you. Check my guides to shopping prescription drug and Advantage plans for more details.
7. The Affordable Care Act improved Medicare. The Affordable Care Act (ACA) isn’t primarily focused on Medicare. But despite what you’ve heard, the law improves Medicare, rather than harm it. The law shrinks the prescription drug program’s catastrophic-level coverage gap – known as the “donut hole” – and added a free annual preventative check-up. For retirees not yet 65 years old, the new insurance exchanges provides an important new guarantee that insurance coverage will be accessible – the law prohibits insurers from turning away applicants with pre-existing conditions. Insurers also can’t put lifetime limits on the dollar value of coverage or rescind coverage if you become ill.
8. Don’t confuse Medicare and the ACA. Annual enrollment for Medicare and ACA marketplace exchanges overlap. Medicare prescription drug (Part D) and Advantage (Part C) enrollment runs from Oct. 15 to Dec. 7 each year; shopping for ACA exchange policies run from Nov. 15 to Feb. 15. Consumer assistance groups report that some Medicare enrollees mistakenly think they must also enroll in the ACA exchanges (they do not). And for people with ACA plans who are turning 65, the transition to Medicare can be tricky. Here’s my rundown of key red flag issues for seniors.
9. Long-term care isn’t covered (much). Medicare does cover the first 100 days of care in skilled nursing facilities for patients who were first formally admitted to a hospital for three consecutive days. It also covers some home health services and hospice care. But Medicare doesn’t cover ongoing nursing home or assisted living charges. This page at the Medicare website details what is covered.
10. Costs are accelerating. Medicare program costs (and premiums) moderated quite a bit during the recession, but are on an upward trajectory again. The Part B premium stayed at $104.90 for 2016 for most beneficiaries due to the way that Part B premium is calibrated with Social Security’s cost-of-living adjustment (COLA). Their Part B premium can’t be increased beyond a point that would yield a net reduction in Social Security benefits—the so-called “hold harmless” rule. But For those not held harmless,monthly premiums rose to $120.70, plus a $3 surcharge. All indications are that there will be upward pressure on premiums for the foreseeable future.
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