Medicare Scare TacticsCategory:

What is Medicare?  A basic question.  Or rather, why should anyone care about Medicare?   The reason people should care is that most bankruptcies are medical bankruptcies.  In other words, if you wish to protect your retirement nest egg from bill collectors, Medicare is important to know about.  There are few things that are more disturbing than a pile of medical bills sitting on the kitchen table.  The golden years could be tarnished with worrying about actual or potential medical expenses.  Medicare–if implemented proper–will protect you from a potential catastrophe.  It is critical for people entering into retirement to understand what is Medicare.

What is Medicare?

Medicare is a Federal health insurance program for people who are 65 and older (or on Social Security disability).  It began in 1965 when President Johnson signed it into law.  It was designed to provide medical covered to the elderly at a reasonable price.  In 1965, few people had health coverage once they stopped working.  As a result, many seniors fell into poverty because of burdensome medical expenses.  Medicare was a solution to a national problem.

Medicare Part A

Medicare is divided into two parts: Medicare Part A and Medicare Part B.  Medicare Part A has everything to do with the hospital.  It doesn’t cost anything because you paid for it during your working years.  It was one of the deductions in your payroll taxes.  Medicare Part A covers a 100% of the medical expenses incurred in the hospital, but there is deductible that many people are not aware of.  The Medicare Part A deductible is currently $1,288.  This is NOT an annual deductible.  It is a deductible per benefit period, and a benefit period is 60 days.  So each event has a deductible, and the time for the event is 60 days.  In other words, you could have multiple events and pay multiple deductibles because the event is not limited to just a 60 day period.  Each new event, even if it overlaps with another event, has its own 60 day timeline.  While rare, it could happen, and probably more importantly, you could pay the Part A $1,288 deductible more than once in any given year.

Medicare Part B

Medicare Part B, however, does cost something.  For most people going on Medicare and Social Security in 2016, the Medicare Part B premium is $121.80 per month.  It is generally taken out of your Social Security check.  Medicare Part B covers doctors’ visits and outpatient procedures, such as X-rays, blood work, emergency room visits, etc.  Medicare Part B covers 80% of the cost.  Your portion is 20%.  The 20% coinsurance, however, is unusual.  There is no cap.  There is no maximum out-of-pocket.  Most group plans you were ever on probably had a maximum out-of-pocket.  It may have been $1,000, $2,000, even $10,000, but at some point, you stopped paying and the insurance company covered everything.  Medicare Part B does not have that, so 20% of a big number will be a big number.  You keep paying your 20% coinsurance as long as the bills come in.

These are the basic building blocks to what is Medicare.  You must understand Medicare, Medicare Part A, and Medicare Part B to understand the rest that follows.  In the next blogs and videos, we will cover how to get Medicare, how to cover the Part A deductible, and how to fill the unlimited 20% gap in Part B coverage.

Delay Medicare Enrollment

Many people work past 65.  They continue on with them employer group coverage.  They delay Medicare enrollment.  At 66+, they wonder what to do about Medicare.

How to Enroll after 65

Here is what to do.  Go to Medicare.gov.  Click on “Forms, Help, Resources” on the top right. Then click on “Medicare Forms” on the left middle.  You will see the enrollment forms in the middle of the page in PDF form.  There are two forms: one to enroll in Medicare Part B and a second for your employer to sign off on your coverage.  You fill out the enrollment in Part B.  Give the second form to your employer.  Your employer will verify that you have had health coverage as good as Medicare since you turned 65.  They will sign the form.  It is important for you to write in the date that you wish your Medicare Part B to start.  Give yourself enough time to find a Medicare plan and prescription drug plan.  (There are much shorter and restrictive time limits when you have delayed Medicare Part B enrollment.)  Drop the forms in the mail or hand deliver them to the local Social Security office.

Medicare Employer Enrollment Forms

Why do you want to involve your employer with your enrollment in Medicare Part B?  If you do not have your employer verify that you had health coverage from the time you could have enrolled in Medicare until the time you did take Part B, Medicare will assume you did not have creditable coverage and will asset a penalty.  The penalty is a 10% increase in Part B premium for every year you did not have coverage.  That can be significant over time and completely unnecessary.  Delay Medicare enrollment at your own risk.  Get the form.  Your employer is required to verify.  The human resource department will know exactly what to do.  It is a very simple matter.

At Omaha Insurance Solutions, we help clients who delay Medicare enrollment all the time.  We can get this done quickly and easily.  Give us a call 402-614-3389.  We can email you the forms, walk you through filling them out, and explain what to do.

A distressed prospective client told me that Medicare did not cover mental health treatment.  I stammered a bit because the subject had never come up before,  and I was surprised.  I said that it did.  She had read that it only covered a one time welcome visit to Medicare.  I then showed her in the Medicare & You Handbook on pages 40 and 59 where it detailed the coverage.  There is the welcome to Medicare screening, an annual screening, and complete medical coverage.  She was surprised and relieved there was Medicare mental health care.

Seniors Need Mental Health Care

Mental health is a serious problem in society, and it is growing among seniors.  The World Health Organization documents how important among seniors this issue is.   Depression is under reported, little recognized, and often an untreated illness; but Medicare mental health cares for beneficiaries with mental health concerns, like depression.  It probably does it better than most employer plans do.

Medicare Mental Health Part A

Medicare Part A deals with the hospital.  The same rules around hospital deductibles and co-insurance apply to psychiatric hospitals as to other hospitals.  There is, however, one difference.  Medicare only allows a lifetime amount of 190 days for  a stand alone psychiatric hospitals.

Medicare Mental Health Part B

Medicare Part B covers psychiatrists, counselors, treatment groups.  Again the same 20% co-insurance applies as to any other Part B doctor visit.  If you have a long standing relationship with a psychologists before Medicare, you may keep that relationship going after you go on Medicare if the medical professional takes assignment for Medicare.

Medicare Supplements will cover Medicare mental health issues and professionals the same as other fees in accordance with your particular Medicare supplement plan.  Medicare Advantage will have the same co-pays for psychiatrists and psychologists as for other specialists.

No need to be stressed or depressed about Medicare mental health.  You are covered.

The Big Lie

The “Big Lie” is a phrase and idea that Adolph Hitler and then Joseph Goebbels promoted in their propaganda war.  They observed that if you told a lie about the opposition, made the lie an outrageous claim, and repeated the claim, people would believe it.  This technique existed before the Nazis and will continue on to the end of time.  Some politicians and sales people are particularly adept at this technique.  Center for Medicare & Medicaid Services (CMS) refer to phenomena such as this as Medicare scare tactics.  CMS dictates client and agent interaction and strongly discourages insurance agents and companies from engaging in Medicare scare tactics.

Medicare Scare Tactics

Some insurance agents who offer Medicare supplements and plans use Medicare scare tactics to promote their themselves and their products.  They will make outrageously negative claims about opposing companies, products, or agents.  “That company had a 40% rate increase.”  “That company uses lower initial rates; then jacks them up when you are older.”  Some agents who only offer Medicare supplements will dump on Medicare Advantage plans.  “Those co-pays will bankrupt you.”  Some agents who offer Medicare Advantage plans exclusively will rip on Medicare supplements.  “Why waste your money on premiums when you hardly go to the doctor.”  I’ve seen agents falsely accuse another agent of illegal or unethical business practices.  “He is not even properly licensed” or “he got himself into trouble.”  The more outrageous the accusation, the more it is believed by some.

Counter with Facts

Facts, however, are stubborn things.  To counter Medicare scare tactics, ask them to show you the facts from a reputable third party source.  I show my clients the insurance company’s history of rate increases.  I show clients BOTH supplement and advantage plans side by side.  They make the determination which is better for them.  All licensed insurance agents are listed on the insurance department website  by all states.  You can check them out and see if that person has any complaints.  When a person makes accusations, have them produce the evidence.

Scare Tactics are Flashing Signals

Medicare scare tactics, a.k.a., trash talk, is a signal.  It is like someone who gossips about a co-worker.  You know they will be gossiping about you when you walk away.  Agents who talk trash about other companies, agents, agencies, and products don’t really have something better to offer.  There is no need to talk someone or something down if you are offering something better.  Let the facts speak for themselves.  The process of selecting a Medicare solution should be an educational process, not propaganda.

If someone is trying to scare or rush you, they probably don’t want you to really see who they are or what they are offering.   Cut through the noise.  Brush aside the smoke.  Look for the facts.  “The Truth will set you free.”