Ten Things You Should Check Before You Purchase Your Medicare Policy
#YourMedicareHack 
 

A lot has changed since last year.  When you buy your Medicare Policy you need to be careful to check that the coverage you purchase meets your expectations.  Here is a list of things you should check before you purchase:

1.     If You are Buying a Medicare Advantage Plan, Verify Whether the Services You Need are Covered.  Check how long they have to get back to you on things that need approval and/or preapproval.  

They say they pay for everything, but, remember, the policy you are buying is from an insurance company, not directly from the government. The insurance company has to make money.  Each year, they get a fixed amount for covering you.  This is where the motto “Delay, Deny, Die!” comes in.  If payment can be delayed or denied, it is in their best interest to do so.    

 

2.     Check for Travel Coverage.  

Most Medicare Advantage programs only cover you for care in the state in which you purchase the product.  If you travel out of state and get sick, you are typically covered for emergency room care only. If you are admitted, need to see a doctor for follow up, or get a test, these expenses are not covered.  You must pay for them.

 
3.     Out of Network Coverage Often Means “Out of Pocket” Coverage.  

This is critical.  If you are lucky, the coverage for out of network care is limited.   You can be on the hook for 100% of the cost of care if you are not careful.  If you go to a hospital and/or have surgery, you must verify the hospital, the doctors, the anesthesiologist and the drugs you get are covered. Medicare Advantage Programs have extremely limited coverage for out of network services. Often, they must be preapproved. Without preapproval, you pay. If you are given non-generic or drugs that are not covered, you pay.  If your hospital is in-network, but your anesthesiology is not, you pay for the anesthesiologist.  Check to see if your physicians, local hospital, Urgent Care, medical service providers, therapists, etc.,  etc. are in-network.

 

4.     Check Rules and Requirements for Preapprovals / Approvals.  

Pre-approvals are required for almost everything nowadays.  Medical procedures, tests, certain drugs, and treatment by certain doctors and/or types of doctors often require preapproval before an insurance company will pay for the treatment.  This can be true, even if you see your primary care doctor and the doctor has authorized the test, drug, or procedure. If the insurance company does not give its approval, your coverage for that treatment has been denied.  If you have it done anyway, even if you needed it to save your life, you are on the hook for the bill.  You will have to fight to get the bill paid.  This process is often arduous.

 

5.     Before You Buy Anything, Check to See If Your Drugs are Covered and Whether the Coverage Has to be Preapproved.

Many drugs you were able to purchase before you were 65 are not covered by Medicare Drug Plans.  Medicare plans often require that the drugs you take be preapproved before they are covered.  If you switch plans or change drugs, you must go through the approval process again, for each and every drug you take.  If you need them and the pre-approval process has not been completed, you will have to pay for them. In addition, Medicare often only covers the generic version of a drug. If you need a non-generic version of one of these drugs, you must go through an approval process before you can be reimbursed for them; even if this drug is life-saving and/or essential for you to live.  You will often have to pay more for each prescription.  

 

6.     To Keep Your Part F Coverage, Make Sure You Know and Follow Your Renewal Terms.  

Part F coverage is no longer available for those who sign up for Medicare in 2020.  Those who purchased Part F in previous years may be “grandfathered” in.  This means that to keep it, you “must” buy Part F coverage from the same provider.  There are a few exceptions, but they are rare.  If you try to get the coverage from a different provider you probably won’t be able to.

 

7.     For Each Policy, You Look Review, Find Out How Much Your Estimated Out of Pocket Expenses Will Be. 
 
Out of pocket expenses include co-pays, co-insurance payments, deductibles, out of network coverage, anticipated drug charges, and other expenses you can anticipate that will not be covered by Medicare.  For example, if you need glasses, hearing aids, or other similar items, you have limited coverage.  Only basic hearing aids are covered.  Glasses may or may not be covered. If you have a walker or other appliances, the ability to replace those is limited and repairs are often not covered.  

 

8.     Check to Make Sure Your Local Providers Accept Your Medicare Plan.

Many doctors that used to accept Medicare are deciding to opt-out. Not only are they not participating as “preferred” or “in-network” providers, but they also are not accepting Medicare insurance at all. This means that if you want to see this doctor, you will have to pay cash.  Doctors who have opted out are not just primary care doctors, many specialists have opted out as well.    While a doctor may accept Medicare in general, they may not take the insurance company sponsor of your Medicare plan.  They might not accept your type of insurance and/or are out-of-network.  Again, you may have to pay cash to see the doctor of your choice. 

 

9.     Check Your Coverage Limits.  

There are limits on things like physical therapy.  Check the Limits for the services you use.

 

10.   Watch for Newly Imposed Government Limits.  

The government is imposing limits on care in order to save money.  Age-based limits are a favorite.  If you are over 75 and get prostate cancer, you will probably have to pay for your own treatment.  If you need a mammogram, too bad.  Even a history of the disease does not always exempt you from exclusion.  With each passing year, new diseases are being added to the exclusionary list.   It will only get worse.   With certain diseases, even though you may be eligible for care, the drugs you may need are often not covered.  If you have a pre-existing condition, need long term care for a chronic illness, or have aged out of certain treatments, renewal time is a great time to check to see if you are still covered.
 

 

 

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