Medicare RegulationsCategory:

Medicare has lots of rules and regulations. The insurance companies and the State Insurance Commissioners have even more laws. The Medicare supplement 30-day free look period is one of those rules.

Medicare Supplements are called Medigap policies because filling in the gaps is precisely what they do. They fill in the gaps in Original Medicare. Supplements fill in the Part A deductible and Part B coinsurance.

medicare supplement policy free look period

You pay a monthly premium for a Medicare Supplement, and as you age and medical costs increase, the private insurance companies that provide Medigap policies raise rates.

Some companies raise rates higher and faster than other insurance companies, so you may want to change policies. There are rules around changing Medigap policies, and knowing the regulations is essential, like the Medicare supplement free look period.

Medicare Open Enrollment Rules

People often think “Open Enrollment” or “Annual Election Period,” which is from October 15th—December 7th, is when you need to change your Medicare Supplement. You may change then, but it is not a particular time for that purpose. A person will still need to undergo health underwriting to qualify for the new supplement. Preexisting conditions may prevent the person from passing underwriting.

medicare supplement policy free look period

The Open Enrollment for Medicare Supplements is when you turn 65 and/or activate your Medicare Part B. During that period, you are exempt from answering health questions. The insurance company needs to offer you a supplement at the best possible rate no matter your health condition at the time.

The other time you can change Medicare Supplements is by filling out an application and answering the health questions. Most people pass underwriting, but not all. A recent heart attack, stroke, or bout with cancer is an example of why an insurance company would deny new coverage. There are other preexisting conditions that will disqualify an applicant. Of course, you can remain on your current supplement if you continue to pay premiums. Medigap policies are guaranteed renewable.

Medicare Supplement Free Look Period

When you change to a Medicare Supplement, you have a 30-day free look period. During that time, you can cancel the policy without any reason, and the insurance company must return your entire premium without question. If you have another Medicare Supplement, you may wish to continue paying the premium simultaneously. If you cancel the original plan, you may have to go through underwriting to reinstate it.

Medicare Free Look: No Fear

The free look period for a Medicare Supplement, like any insurance product, is to encourage the consumer to purchase because of less fear about changing one’s mind.

There are a few other instances when someone might change to a new Medicare Supplement, and the free look period would also apply in those instances.

Guaranteed issue is when someone is coming off an employer’s group health plan and already has Medicare Part A & B. You have 63 days to enroll in a Medicare Supplement without underwriting.

Another situation is enrolling in a Medicare Advantage plan for the first time. You have a 12-month window when you can change to a Medigap plan without underwriting.

Another rare situation is when an insurance company closes its Medicare Advantage plan in your service area. You are afforded a guaranteed issue opportunity for a Medicare Supplement.

Certain states have laws specific to them. You can change your Medicare Supplement on your birthday without underwriting (California, Oregon, Idaho, Nevada, Illinois, Louisiana), on your anniversary without underwriting (Missouri), and year-round without underwriting (New York, Connecticut, Massachusetts, and Washington). There is no such regulation in Nebraska or Iowa for Medicare Supplements.

free look period for medicare supplement policies

Again with any of these transitions, the Medicare Supplement 30-day free look period applies.

Over the years, I have had clients change their minds at the last minute. To change with them, the Medicare Supplement, free look period, makes the process easier and less cumbersome.

You have 30 days to look. No fear.

free look period for medicare supplement policies

Medicare has had an exciting history with prior authorization. Medicare prior authorization has become controversial over the years because of Medicare Advantage.

Have You Always Been Subject to Prior Authorization?

Health plans started using prior authorization in the 1960s. Hospital admittance grew after the creation of Medicare and Medicaid. At the same time, more employers began offering employees health insurance as part of their compensation package. Medical costs grew significantly, particularly hospital stays.

medicare pre authorization form

Insurance companies began implementing utilization reviews in the 1960s. Utilization reviews were a process to reduce the overutilization of resources and identify waste. Registered nurses initially performed utilization reviews in hospital settings. The skillset gained popularity within the health insurance industry as research grew around medical necessity, misuse, and overutilization of services.

medicare prior authorization form

Health plans reviewed claims for medical necessity and hospital length of stay. Health plans began to require physicians to certify the admission and subsequent days after admission to help contain costs. Prior authorization originated from the use of utilization reviews.

Fast-forward to the present day. You were subject to prior authorization when you entered the workforce and received employer-provided group health insurance as a benefit. The insurance company determines if it is “medically necessary” and covered by the policy your company purchased when you have any medical procedure. Then there is further discussion about the appropriate charges. Whether or not you were aware of it, prior authorization has always been part of your health insurance coverage.

Why Do Insurance Companies Use Prior Authorization?

Prior authorization is a medical management tool. Doctors and insurance companies work together to ensure that a specific treatment or service is the best option for the patient’s needs.

The purpose of prior authorization is to identify and discourage unnecessary and costly low-value services to reduce wasteful spending without impeding quality healthcare services.

Prior authorization, supervision, audits, and other compliance tools help identify and root out fraud, waste, and abuse in the healthcare system. The ultimate purpose is to reduce costs for the consumer and prevent unnecessary treatments.

The Department of Justice announced today (Feb 17, 2021) criminal charges against 138 defendants, including 42 doctors, nurses, and other licensed medical professionals, in 31 federal districts across the United States for their alleged participation in various healthcare fraud schemes that resulted in approximately $1.4 billion in alleged losses.  

The charges target approximately $1.1 billion in fraud committed using telemedicine, $29 million in COVID-19 healthcare fraud, $133 million connected to substance abuse treatment facilities or “sober homes,” and $160 million connected to other healthcare fraud and illegal opioid distribution schemes across the country.

medicare pre authorization form

While most doctors, medical professionals, and medical facilities are honest and act with integrity, an element will always and continually seek illicit gain costing consumers and taxpayers untold amounts. This results in higher insurance premiums and medical costs. It is naive to believe all are good actors and that every recommended treatment and service is the best fit.

Why Does Original Medicare Not Use Prior Authorization?

In part, the Medicare prior authorization controversy is that “Original Medicare” does not require prior authorization for most procedures, and Medicare Advantage does. (Original Medicare is just Medicare Part A and Part B. The payment structure is called fee-for-service. Medicare Advantage (or Part C) is Medicare administered by a private insurance company contracted and approved by Medicare.)

At first glance, you probably ask, ‘Why does Original Medicare not require prior authorization’ because prior authorization is common practice in the health insurance world? No company will leave the decision to spend potentially tens of thousands of dollars, even millions, to one person without some oversight.

When Medicare was established, Congress included certain arrangements and excluded others. In Section 1862(a)(1)(A) of the Social Security Act:

“No payment may be made under Part A or Part B for any expenses incurred for items or service which . . .. are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed member . . ..”

The key phrase is “reasonable and necessary.” “Reasonable and necessary” has been interpreted over the years very broadly. If a submitted claim is in an allowed category and not excluded, the submission is “reasonable and necessary.”  

The doctor authorizes an MRI of the shoulder because the patient complains of problems. MRIs are covered. This procedure is “reasonable and necessary” because it is not an uncommon practice, even if there may be less expensive diagnostic procedures or treatments.

As you can probably guess, this broad interpretation with no oversight or accountability will result in large amounts of fraud, waste, and abuse.

Why Is Medicare Advantage Prior Authorization So Controversial?

The short answer to why is that Original Medicare doesn’t require prior authorization. The controversy is some believe beneficiaries are being denied essential medical services and treatments. Beneficiaries and medical professionals do not even attempt to overturn denials because they believe the appeal process is so burdensome.

The facts, however, do not paint such a sad picture. The Office of the Inspector General reviewed a large number of Medicare Advantage Organizations (MAO), reviewing 448 million preauthorization requests in 2016. Of those, MAOs denied about 1 million preauthorization requests for a denial rate of 4 percent—4 percent is tiny.

The September 2018 Office of Inspector General report found that Medicare Advantage Organizations (MAO) overturned 75 percent of their own denials from 2014-2016, overturning approximately 216,000 yearly. During that same period, independent reviews discovered additional requests that had been inappropriately denied.

The most surprising finding, however, is that only one percent of beneficiaries and providers appealed their denial, which raised the question: how many were denied necessary treatment because the process is so arduous?

Unfortunately, the study does not give a coherent explanation of the denials. From my experience of doing Medicare planning for a decade with thousands of beneficiaries, doctors’ offices do not always submit requests with detailed documentation in support. When the request is denied, they blame the insurance company, and the effort stops unless the patient pushes the issue.

The other reason I find for denial is the doctor’s office uses the wrong billing code. Quite often, the insurance company does not give any explanation in those cases. The response is “denied.” The solution requires the doctor’s office to call and talk with the claims department about billing codes, documentation, and supporting tests. In the absence of these items, nothing happens.

Unfair Statistics and Sensational Journalism

The Department of Health and Human Services Office of Inspect General (OIG) conducted a study of Medicare Advantage Organizations’ (MAO) denial of prior authorizations during one week (June 1-7, 2019). In that week, there were 250 denials. The OIG discovered that 13 percent of these prior authorizations were incorrect. This amounted to 33 cases.

Later in the same report, they admitted the usual national average is 5 percent. No reason was given why the study was not expanded when the conclusions from their study did not coincide with other long-standing evidence, particularly when the study was so microscopic–one week and 250 cases.

medicare prior authorization form

In the same study, they did not review the cases where the prior authorization was approved when it should have actually been denied. There was also no control group to compare against. The OIG did not study fee-for-service Medicare billing for fraudulent or wasteful claims or denials on their part.

The New York Times piled on in an April 2022 article. They presented a very slanted view of the study, beginning the article with “Medicare Advantage plans often deny needed care, federal report finds.” Only toward the very end of the article did the author get into any of the facts of the report. The general impression during the first half of the article is Medicare Advantage denies its clients the necessary medical care they need.

Why Are Medicare Prior Authorization Denials Overturned?

Denials may be overturned for many reasons. First, there were errors on the part of the insurance company. The decision was incorrect.

medicare prior authorization form

Errors on the part of the doctor’s office or medical facility. They did not include sufficient documentation or incorrect information. The denial is reversed, then. The provider may add new information from additional tests in the appeal process that contributes to an overturn.

The overturn does not necessarily mean the MAO acted inappropriately, but the process and extra steps critics claim create friction in the system. Patients may wish to avoid going through the trouble of appeal. Doctors may not make recommendations because of a history of denials.

Did Medicare Ever Use Prior Authorization?

The Medicare practice of accepting bills from providers at face value without question as “reasonable and necessary” was an established and haloed practice from the beginning of Medicare. All parties who benefited the most—except U.S. taxpayers—were unmotivated to change until the wheelchair scandal.

In 1999 it was discovered that Medicare spent $8.2 billion to procure power wheelchairs and “scooters” for 2.7 million people. A large portion was paid to scammers because they discovered that Medicare not only did not require prior authorization for wheelchairs, but Medicare did not even review the authenticity of the claims.

A Washington Post article published in August 2014 highlighted the massive fraud of Medicare’s resources. The article chronicled the sensational scams and trials of many Medicare swindlers. The outrageous theft of public funds and the massive fraud shamed CMS to amend its regulations to finally require preauthorization for some “durable medical equipment,” i.e., electric wheelchairs.

Bureaucrats inside CMS admitted they knew how the wheelchair scheme worked as early as 1998. But it was not until 15 years later that officials finally did enough to curb the practice significantly. Durable medical equipment—electric wheelchairs—is the only exception to the “reasonable and necessary” practice. They must be preapproved.

medicare pre authorization

Consequently, hundreds of millions of false and unnecessary claims were paid over many years in a massive Medicare fraud.  Once the bureaucratic problem was fixed, and claims were more thoroughly reviewed, an enormous shift occurred.  Medicare reimbursements for motorized wheelchairs fell from $32 million every month to $7 million78 percent decrease

The Medicare Claims System Is Designed for Fraud, Waste, & Abuse

By law, Medicare must pay most of its claims within 30 days. In that short window, it is supposed to filter out the fraud and uncover claims where the diagnosis or the prescription is bogus.

medicare pre authorization

The system attempts to ameliorate the damage through a “pay and chase” policy. The bill is paid, then it is reviewed. Only a tiny fraction of claims — 3 percent or less — are reviewed by a live person before they are paid. The rest are reviewed only after the money is spent. If at all.

The whole Medicare claims process is set up as an honor system for the richest program managed by the U.S. government. It is a thief’s dream.

Medicare Prior Authorization Test Program

In March 2017, CMS (Center for Medicare & Medicaid Services) designed a test program for preauthorization for fee-for-service Original Medicare. In the month of March, the GAO (U.S. Government Accountability Office), in a Senate report, estimated a savings of $1.1 to $1.9 billion when preauthorization was used that month. The report estimated the federal government made an estimated $36.2 billion in improper payments for the Medicare fee-for-service program from July 2015 to June 2016.  

The committee’s recommendation became the report’s title— “CMS Should Take Actions to Continue Prior Authorization Efforts to Reduce Spending.” The prior authorization programs created to monitor and measure improper payments were discontinued and never recommissioned.  

Original Medicare Fee-For-Service vs. Medicare Advantage

The government created Medicare in 1965. It had been a long-time project of the Democratic Party. CMS (Center for Medicare & Medicaid Services), Department of Health & Human Services, and Social Security Administration are government agencies. Politicians of all political parties exercise control and funding over these agencies and programs. The agencies are staffed by thousands of bureaucrats and government union workers. A tremendous amount of various and conflicting self-interests, power, and money are all mixed together.

medicare pre authorization

To save Medicare from ballooning budgets and to offer an alternative to citizens, the same politicians, programs, and agencies partnered with private insurance companies to control spending and improve patient care. What is now known as Medicare Advantage began back in the 90s.

The two ways of doing government healthcare for seniors are in competition. Politicians view the world through different ideologies and support policies and programs based upon their political views. Those who support the various political ideologies will support or attack these two platforms accordingly.

It is vital to find all the relevant facts, make your own comparisons and analysis, and determine where lies the truth and the better path.

When I meet with prospective clients, I begin with a brief explanation of Medicare. Then move on to the hundreds of plans. Drugs are next. This is hard. Clients must lay down their cards; some hold a straight flush of costly medications.

The Inflation Reduction Act of 2022 is a long-awaited solution to improve Medicare drug plans and make Part D affordable for those on costly medications.

Medicare reduction 2022

Inflation Reduction Act of 2022 Deals with Medicare Drug Changes

When Medicare Part D was first established, Medicare contracted with private plan sponsors to provide the prescription drug benefit. The private insurance company created the Part D Prescription Drug Plans (PDP), sold the PDPs, and managed the PDPs. Each company negotiated separately with the pharmaceutical companies the price of the medications and which medications would be included on the plan formularies–the list of authorized drugs.

The insurance companies had the leverage of their brand and how many customers they would bring to the pharmaceutical companies. They were also competing with the other insurance companies to get more medications at the lowest cost. The pharmaceutical companies, of course, were trying to maximize their revenues and profits.

Ideally, it was hoped that the competition and freedom of the market would keep prices low. However, patent laws create a temporary monopoly for pharmaceutical companies that develop these very effective and popular new drugs. The patent, and the consequent monopoly, benefit the nation and the world with the newest and best medications. Unfortunately, it is a substantial financial burden for those who need the medication.

The Inflation Reduction Act Creates Leverage for Medicare

When Part D was created in 2004, a law was established known as “non-interference.” Non-interference means that the Secretary of Health and Human Services (HHS) cannot negotiate drug pricing with pharmaceutical companies, pharmacies, and insurance companies. Instead, the prices would be determined exclusively between the insurance companies, pharmaceutical companies, and pharmacies competing amongst one another.

With the Inflation Reduction Act of 2022, Medicare changes the law. The Secretary of HHS is granted a narrow exception to the non-interference clause. The HHS Secretary can negotiate on behalf of the 84 million Medicare and 76 million Medicaid beneficiaries for the lowest prices for a very limited number of costly prescriptions. The category of medications is single-source brand-name drugs or biologics without generic or biosimilar competitors.

Inflation Reduction Act of 2022 Effects Medicare Change in 2026

inflation reduction act 2022 Medicare

The Drug Price Negotiation Program begins in 2026 and is limited to 10 Part D drugs. Another 15 Part D drugs will be added in 2027, 15 Part D in 20228, and 20 Part in 2029. The HHS Secretary will select the drugs from among the 50 highest total cost Part D medications.

The timeline for the negotiation process will span roughly two years. For those companies that do not comply, there is an excise tax. The tax penalty starts at 65% of the product sales in the U.S. and increases by 10% every quarter to a maximum of 95%. The other option is that company can remove all its medications from the Medicare and Medicaid market.

Is the CBO Accurate, Reliable, & Trustworthy?

The Congressional Budget Office (CBO) claims HHS Secretaries’ ability to negotiate prices with Part D producers will significantly reduce what Medicare spends over the next ten years. The CBO also claims that reducing the revenue to pharmaceutical companies will have little effect upon developing new and better drugs. These are all projections and opinions to support the policy change. There is no evidence.

Drug Manufacturers Are Penalized for Inflation

The Inflation Reduction Act of 2002 adds another Medicare change. The Act requires drug manufacturers to pay a rebate to Medicare if prices for single-source drugs covered under Medicare Part B and nearly all covered frugs under part D increase faster than the rate of inflation reflected by the Consumer Price Index (CPI). The rebate dollars will be deposited in the Medicare Supplementary Medical Insurance (SMI) trust fund.

Cap Out-of-Pocket Part D Spending

Medicare Part D currently provides catastrophic coverage for high out-of-pocket drug costs. Still, there is no limit on the total amount beneficiaries pay out of pocket each year. Under the current design, Part D enrollees qualify for catastrophic coverage when the amount that they pay out of pocket plus the value of the manufacturer discount on the price of brand-name drugs in the coverage gap phase exceeds a certain threshold amount. Enrollees with drug costs high enough to exceed the catastrophic threshold must pay 5% of their total drug costs above the threshold until the end of the year. This can be huge.

The Inflation Reduction Act of 2022 amends Medicare’s design of Part D. For 2024, the law eliminates the 5% coinsurance requirement above the catastrophic coverage threshold, effectively capping out-of-pocket costs at approximately $3,250 that year.

The legislation adds a hard cap on out-of-pocket spending of $2,000 per person in 2025. How this will be funded, other than with savings, is still being determined.

Inflation Reduction Act of 2022 Puts Medicare Insulin at $35

How much Medicare increase 2023

Insulin is probably the most common high-dollar medication that burdens many Medicare beneficiaries. Most plans relieve several insulin products, beginning with the Trump Administration and now Biden.

Currently, Medicare beneficiaries can choose to enroll in a Part D plan participating in an Innovation Center model in which enhanced drug plans cover insulin products at a monthly copayment of $35 in the deductible, initial coverage, and coverage gap phases of the Part D benefit.

Participating plans do not have to cover all insulin products at the $35 monthly copayment amount, just one of each dosage form and insulin type (rapid-acting, short-acting, intermediate-acting, and long-acting).

While Medicare is incredible health insurance, Part D prescription drug plans are the weakness because of the light coverage for higher-end medication. The Inflation Reduction Act of 2022 helps Medicare better service citizens with more reasonably priced medications.

We can ensure you have the plan that best covers your prescription drug needs at the lowest possible cost.

Call 402-614-3389 to speak with an experienced and licensed agent and insurance professional.

omaha Nebraska medicare insurance agent

Medicare Part D deductible for 2023

January begins a new calendar year for Medicare. What does that mean for your Medicare drug deductibles in 2023?

For most Medicare members with a Medicare Part D prescription drug plan, you have a deductible. The Medicare drug deductible for 2023 is currently $505. The Part D drug deductible for 2022 was $480, which means a 5% increase. The deductible is the amount you initially pay out of your pocket before the insurance plan begins paying for the prescriptions. Deductibles are vital because they keep the overall cost of medications low. Deductibles also prevent members from overusing Part D drug plans for trivial or unnecessary purposes.

2023 Medicare Drug Deductible Shock!

I mention the Medicare drug deductible for 2023 because I get distressed phone calls at the beginning of the year. Clients go to the pharmacy in January, February, and March and are shocked. They have a huge unexpected bill. I hear cries of ‘I can’t afford $500 every month for their medications!’

I remind clients that they are in the deductible phase of their Medicare drug plan. Once they meet their drug deductible, the medication cost will decrease significantly to around $45 per month per medication.

Since it is an entire year from the last time clients paid their drug deductible, it is understandable they forget.

For those paying the deductible all at once in January and for the first time, the deductible experience will be a new and eye-opening surprise.

Medicare drug deductible 2022

Plan For the Unexpected

I don’t know about you, but $505 is a lot of money to pay out all of a sudden, especially if you were not planning on it. I’m usually all tapped out by January. My trophy wife, high-maintenance step-children, and grandchildren require a lot of maintenance around Christmas time.

Once you have met your Medicare Part D deductible for the year, your Tier 3, 4, & 5 medications will be the amount listed in your handbook during the initial phase before the Gap. Please, consult my other blogs about the GAP / Donut Hole.

Most people, however, will not fall into the Gap and will simply pay minimal copays for the remainder of the year. It is the deductible that is the big obstacle.

Clients ask, ‘Are there other Part D plans without a deductible?’ There are a few, but the monthly premiums are much higher, like $100 per month, and the copays are generally higher too.

Medicare drug deductible 2023

Lowest Total Annual Medicare Drug Cost

When I run clients’ drugs through the Medicare Part D medication calculator, I look primarily at the total annual cost. The winning drug plan is the plan with the lowest total annual cost and with at least a 3 Star Medicare rating.

The calculator combines the monthly premium, deductibles, copays, and gap–if applicable–and spits out a total number for the year. That is the plan you want to use.

Look For Stars

As for the Medicare star rating, you want to have at least three stars. More stars are better. There is no point in having the cheapest Medicare drug plan if you never get your medications or the insurance company is so painful to deal with you need additional drugs to handle them.

Most Have A Medicare Drug Deductible

Medicare Part D deductible 2022

January to March is when Part D plans remind most people they have a deductible. Don’t be upset. There is nothing wrong. You must meet the Medicare drug deductible to get to the lower cost for your medications for the remainder of 2023.

If you have paid payroll taxes (FICA) for 40 quarters (or 10 years), you are eligible to apply for Medicare in Nebraska for 2022. You are eligible for Medicare Part A at zero premium and may purchase Part B at the current cost if your income is below the IRMAA (Income Related Monthly Adjustment Amounts) amounts.

The Easy Way To Apply For Medicare in Nebraska For 2022

If you are currently receiving Social Security benefits, you will be automatically enrolled in Medicare Part A for the hospital and Part B for doctor visits and outpatient services. You will then be given the option to cancel Part B if you wish.

How to apply for Medicare in Nebraska for 2022

You cancel Part B by signing the red, white, and blue Medicare card on the back and mailing it back to Medicare. Otherwise, Medicare Part A and B will start on the effective dates printed on the bottom right corner of the card. The Social Security Administration (SSA) will also start deducting the Medicare Part B premium from your monthly Social Security check.

Applying for Medicare in Nebraska in 2022 is easy that way. It is automatic. The other way is more challenging.

Online Application For Medicare in Nebraska for 2022

Applying for Medicare in Nebraska, Iowa, and throughout the country has become more difficult and complex with each subsequent month. The pandemic pushed the process almost entirely online. Social Security personnel were absent at Social Security Administration Offices throughout Nebraska, Iowa, and the whole country during that time. Offices were closed, and most employees were working remotely.

Identity theft, cyber security, and HIPPA regulations have pushed the Social Security Administration (SSA) to add more and more levels of security to the Medicare application.

I help my prospective clients apply for Medicare all the time. While eligibility for Medicare and Social Security benefits in Nebraska begins at 65, most people are not getting their Social Security benefit checks until much later. Instead, they are waiting until the full benefit age, which is around 66 and 8 months or older. So they need to apply for Medicare online.

How to apply for Medicare in Nebraska

I probably average helping five people a week apply for Medicare in Nebraska and Iowa. The level of difficulty each person experiences is amazing. I don’t know how other people do it on their own.

How Do You Apply For Medicare Benefits in Nebraska Online in 2022?

Enroll in Medicare online in Nebraska

If you are eligible for Medicare in Nebraska, type ssa.gov into your address bar. Do NOT Google ssa.gov. You will end up at all kinds of websites trying to sell you Medicare plans. The Social Security Administration logo will be in the top left corner if you are successful.

Click on Menu in the top right section of the website. Go under Benefits and click Medicare. Then, scroll down the page until you see a bright blue button that says “Apply for Medicare Only.” Click on the button that will take you to a page with a gray button that says, “Start New Application.” Click it.
Follow the prompts. The most crucial part is your My Social Security login. This is the tricky part.

Hundreds of people swear they never set up an online Social Security account. Then, when we start the enrollment process, we discovered they have a My Social Security account, and SSA requires us to use it.

Logging in to your My Social Security account may become an insurmountable obstacle if you need to provide personal verification information, like the answers to the three security questions you had set up previously. At that point, you will be stopped out and need to call or go to the Omaha, Lincoln, or Council Bluffs Social Security Administration office to get access to continue applying for Medicare in Nebraska in 2022.

If you do not have an online My Social Security account, you create one. In creating the account, you will need immediate access to email and text. With that, you will be able to set up an online account.
Follow the prompts to set up the account.

Second Form of Identification When Applying for Medicare in Nebraska for 2022

Giving SSA a second form of identification, such as your driver’s license, is vital. SSA will text a link to your phone. Then you take a photo of your driver’s license to verify who you are. Taking the photo so the system receives it can be problematic. This is the most difficult part of applying for Medicare.

Your phone’s camera software may not work well with SSA’s system, the cellular or internet connection may be weak, or the SSA system may be in a bad mood that day. Many factors can go into making the system unworkable. Be warned.

How to Apply For Medicare In Nebraska For 2022

If you cannot set up a second means of verification, you will probably have to wait for a verification code to be mailed to your physical address. Then you go back in to complete the enrollment process.

More than half of the time, the system works. We get the text verification and complete the My Social Security online account setup.

When you enter your My Social Security online account through the Medicare prompts, the system pulls up the application for Medicare. Fill in the details and complete the application. The application process will assume you want Medicare Part A for the hospital since it is free. The system will ask if you want Medicare Part B for doctor visits and outpatient procedures. Medicare Part B costs something. You have the option to say yes or no.

Check On Your Online Medicare Application

When you have completed the application, you can go back in and check on your Medicare application status. A newly created box is in your My Social Security account for Medicare. There will be three grey horizontal bars going across the page. When you complete the application, one bar will be blue. When all three bars are blue, a comment underneath will say you are approved. Congrats!

Above will be a “Verification of Benefits Letter” link. Click on the link. A letter will open up. In the body of the letter will be your Medicare number (MBI), which is made up of eleven digits consisting of a combination of numbers and letters. The letter will also have the dates when your Part A and/or Part B will start.

Sometimes clients tell me they want to wait for the Medicare card to come in the mail. Bad decision. It may take over a month for your Medicare card to show up in the mail, significantly decreasing your time to select, enroll, and get your medical cards from the insurance company before your start date.

Online Medicare Application Problems

How to enroll in Medicare online

Check your account two weeks after you apply for Medicare online, and keep checking it until you have a Medicare number.

If your account says your case was sent to Salinas, CA, for processing, you need to call your local SSA office to find out why. Salinas, CA, is a black hole.

There is a problem with your application that needs to be solved sooner rather than later, and the folks in Salina, CA, are not very proactive or even active in solving your problem–whatever it may be.

All of this above-said information works if your personal information is in good order with SSA. There may be problems of which you are only aware once you enroll. For example, your name is misspelled with SSA, your birthday is wrong, your address is out-of-date, your maiden name was not changed to your married name or back after a divorce, and your naturalization date or number is incorrect. You could also be flagged as a terrorist, Russian mole, or affiliated with the opposing political party–just kidding.

I’ve experienced all of these with clients–except the terrorist one. Making corrections takes lots of time. I had a gentleman born at a Japanese civilian hospital instead of the U.S. military hospital on the base where his father served, which created a whole set of problems that plagued him throughout his life.

Getting the correct documentation takes time if it can be found. Then SSA takes time to verify the documentation and may ask for more. Then there is the processing time, which could result in you missing your intended start date. That is why you start applying for Medicare in Nebraska as early as possible in 2022.

Calling the SSA Office

You, of course, can call the SSA office or stop in to apply for Medicare in Nebraska for 2022. If you contact them too early, they will not talk with you. Too early is more than 3 months before you turn 65. Then, when they talk with you, SSA generally will set the appointment a month or two later, so you are right up against your birth month and start date. This will work if there are no problems and everything else works smoothly, but this situation usually causes anxiety for most people.

How to Apply For Medicare In Nebraska For 2022

My Experience Helping Clients Apply for Medicare

I’m an insurance agent. I am not an employee of the SSA, but I feel like an unpaid auxiliary staff member. My clients need help, so I’ve learned to navigate the SSA Medicare enrollment system through trial and error. It is a system that is continually evolving.

How to Apply For Medicare In Nebraska For 2022

I’m happy to help my clients. The process creates a tremendous amount of empathy for my clients for what they have to go through. Not only are they confused with all the information and choices that come with going on Medicare, but they have a government bureaucracy that is an unfriendly and confusing obstacle to overcome. I try my best to help and give encouragement when I can’t do specific tasks for them, like finding an original birth certificate with a raised seal.

As the bugs get worked out of the SSA/Medicare system, and Medicare beneficiaries become more tech-savvy, the process for applying for Medicare in Nebraska for 2022 will become more efficient–I hope.

Until then, use this guide to navigate and find your way to the end of the Medicare application maze.

What Does A Medicare Insurance Agent Do?

When you sign up for a Medicare plan or Medicare supplement, you use a licensed insurance agent.  An agent is a person who acts on behalf of someone.  That someone may be the client or he may be the insurance company.  He is licensed which means that the state certifies he has passed some basic testing and has rudimentary knowledge about insurance that allows him to represent a company or person.  Medicare insurance agents come in many different types.  What type of Medicare insurance broker is near you?

Medicare broker near meWhat Is A Captive Medicare Insurance Agent?

A captive Medicare insurance agent is the opposite of an independent Medicare insurance broker.  He has a contract to represent one insurance company.  He is not an insurance broker.  Depending on the level of captivity, he must sell a certain amount of the company’s insurance products to remain an agent and continue to receive renewal commissions.  He may or may not be able to sell any other insurance company’s products.

The difficulty with dealing with a captive agent who offers Medicare insurance products is a lack of selection and objective evaluation.  He will probably say his products are “the best!”  However, you have no way to compare and evaluate based upon the product information he shares.  He is a one-trick pony.  Physician Mutual agentsBlue Cross Blue Shield of Nebraska Agents.

From what clients have reported to me, many captive agents do not honestly represent themselves as exclusively with one company.  They lead prospective to believe they can represent many companies when that is not the case.  Some captive agents do not disclose they are in fact captive.

What Is A Medicare Supplement Insurance Agent?

Some agents sell almost exclusively Medicare supplements or Medigap policies.  For those who sell over the phone, Medicare Supplements are the only Medicare products they can sell because of very strict regulations around Medicare Advantage and Medicare Part D.  Medicare rulesMedicare Insurance broker near me and regulations prohibit unsolicited calls to consumers about Medicare Advantage.

Medicare insurance broker near meConsequently, these agents sell against Medicare Advantage constantly.  They point out weaknesses in the product–whether real, exaggerated or imagined.  Medicare Supplements are the best, of course, because they cannot offer an alternative.

With auto-dialers, Med Sup agents dial 10 to 15 prospects simultaneously.  Call centers in Florida, South Carolina, and California carpet bomb the U.S. with millions of phone calls each day.  During Annual Election Period (Oct. 15th–Dec 7th), the Med Sup call centers recruit a bunch of agents for the season.  You will probably never talk with the agent again after he signs you up.

Other agents who sell Medicare Supplements exclusively face-to-face are controlled by agencies, managers, or marketing groups.  If they sell a lot of one or two companies, their commission is higher.  They can win sales trips abroad and bonuses.  That is the motive behind their exclusivity.  They are not truly Medicare insurance brokers.

What Is A Medicare Advantage Insurance Agent?

Some agents sell just Medicare Advantage plans.  They are likewise semi-captive to an insurance company that feeds them leads.  The insurance company may have a large market presence.  Lots of consumers call in because they are familiar with the brand name and trust it.  They enroll in the  Medicare Advantage plan over the phone or online with an insurance agent at the company.

Some people, however, want to talk with a live person.  The insurance company will send an agent out to the person’s home to explain the product in greater depth and enroll them in person.  The agent, however, is obliged to just offer that company’s products in the most favorable light and not the competition.  That is why the insurance company supplies the leads to the agents.  These are not Medicare insurance brokers.

Independent Medicare Insurance Brokers Near Me

Independent Medicare brokers represent both sides of Medicare–Medigap policies and Medicare Advantage.  Independent Medicare insurance brokers represent multiple companies, not just a hand full.  He should be showing quotes and brochures from many different insurance companies.

Insurance companies that offer Medicare Advantage pay the agent the same amount, so there should be no preference based upon commission.  An independent agent should receive the same percentage on the supplement side as well.

Medicare insurance brokers are only paid when you are a client.  To keep you a client, you need to remain a happy client.  A conscientious independent insurance agent should keep in touch and make sure his clients are happy with their current Medicare plans and change them when not.

Medicare Insurance Broker Near Me

Local Broker Vs. Call Center Agent

When you turn 65, that is when you first become Medicare eligible.  You will be inundated with mail, phone calls, and even door knockers trying to sell you some Medicare insurance product.  I hear complaints from my clientsMedicare captive agents all the time about the oodles of phone calls and the blizzard of junk mail.  They need to go into witness protection to avoid the solicitors.

Most solicitations will come from persons you will never meet.  You do not know them.  They are strangers calling from far away states.  They may have been insurance licensed for only a year, a month, or just a week.  The average insurance agent doesn’t last in the business even a year.

Do you want to share your personal information over the phone with a complete stranger?  Someone you will never meet in person.

There is something reassuring about dealing with someone who is established in the local community.  Proven.  They will not disappear in a month.  Connected to people and institutions you know.  At least a Cornhusker!

How to Find Medicare Brokers In My Area?

You can use Google to find Medicare insurance brokers.  Google seems to know everything.  It is not a bad start.

An agent’s website gives you a feel for the agent and agency.  Blogs and videos demonstrate his knowledge and expertise–or the lack.

Google reviews from clients–hopefully not family and friends–give some proof of professionalism and quality of service.  Google is a 3rd party, so the reviews are not cherry-picked.

Referrals are another way.  Most of my clients now come from my existing clients.  So ask a friend, but check the person out.  Go to the Better Business Burea and check the rating.  Again, visit the website.

One new client told me she was at a work function.  She’s employed in the healthcare field.  Three other ladies–fellow nurses–were chatting around a table.  She mentioned she was turning 65 and going on Medicare.  She complained how the endless phone calls and junk mail made the whole process a headache.  Immediately the three nurses volunteered “their Medicare guy” to her to help solve the dilemma.  All four were surprised when they realized I was the Medicare agent for each of them.

Medicare Insurance Brokers Near MeHow to Choose An Independent Medicare Broker Near Me?

The most important criterion I believe is experience.  Being in the insurance industry, I have seen hundreds of agents come and go since I became an agent back in 2003.  Like anything–stock trading, medicine, law–you need practice.  While it may be very nice to help out a friend or nephew who is getting started in the business, your health insurance is a serious matter.  You want a professional handling your money, your body, and your assets to have time in harness.

Let the market pick your Medicare broker.  If the agent makes lots of people happy with his work, he is successful and stays in the business.  Time in service with lots of clients is the first key.

While my doctor is younger than me for the first time, she didn’t just get out of medical school.  I know she had a lot of practice before I showed up.  I think Medicare insurance brokers near you need to have lots of years in the business and lots of clients.  That way they are not practicing on you, and they will be there for you for years to come.

Again, visit their website, read their materials, list to their presentation.  It is like listening to good or not so good music.  After a while, you can tell whether it rings true.

 

Medicare Changes for 2022Needed Changes to the Medicare Enrollment Process 2022

I have been a licensed insurance agent since 2003.  I’ve seen a lot of changes to Medicare over that time.  One of the problems that always baffled me was how difficult it was to enroll in Medicare.  Let me put you in the front seat of the upcoming changes to Medicare for 2022 and 2023.

Non-Stop Complaints About Medicare

More than 11,000 persons turn 65 each day and become Medicare eligible.  That is a lot of people enrolling in Medicare.  The problem that Congress created a number of years ago was moving the full Social Security retirement age from 65 to 66 and so many months.Medicare changes for 2022

People are also living longer.  Retirement is being pushed off because people don’t have enough saved.  Consequently, many continue to work past 66 to just survive, so they remain on their employer’s group health plans.  But, when they turn 65, they need to do something about Medicare enrollment.

How to Enroll with Upcoming Changes to Medicare in 2022 & 2023?

When you start your Social Security, Social Security enrolls you automatically into Medicare Part A and Part B when you turn 65.  You have the option then to decline Part B.  Many do if they are still working and have adequate health insurance from their employer.

Many people are not taking Social Security at 65, so Social Security does not automatically enroll them in Medicare.  That number is even smaller than a few years ago.

So, people must actually choose to enroll in Part A at 65.  If they are going on Medicare entirely and delaying Social Security, they must actively choose to enroll in Part A and Part B.  A lot of people call Medicare complaining because of how hard it is to enroll in Medicare.  Upcoming changes to Medicare in 2022 and 2023 will make the enrollment process simpler.

Enrolling in Medicare Enrolling in Medicare at The Social Security Administration Office

Enrolling in Medicare is a challenge, to put it kindly.  I do this for a living.  I like to think I have above-average intelligence and some good computer skills.  However, I still find the Medicare enrollment process unnecessarily difficult and complicated.

Before the pandemic, you could go to your local Social Security office to enroll in Medicare.  Depending on the office’s busyness and the staff’s competency, it was more or less complicated and very time-consuming.  The primary issue was the time involved—driving to the office, waiting in line, being at the office during regular business hours when you are still working.  Those were the usual challenges.  As of the writing of this, the local Social Security offices are closed to visitors because of COVID.  The only option now is to enroll online.

Apply For Medicare Online OnlyChanges to Medicare in 2021

The other option for enrollment, which has become pretty much the only option now, is enrolling online.  Enrolling online is not easy, even if everything goes smoothly.

In the past two years, the online process has evolved.  A few months ago you took a photo of your state driver’s license.  Social Security scanned your license into their system through your smartphone.  The purpose was to identify you if you did not already have an active MySocialSecurity account.  It was not a bad improvement over the old way, which was answering credit questions.  That was an amazing bureaucratic mess in itself.  I’m glad the credit questions are gone, but the technology for taking the photo of the driver’s license was faulty.

The latest method is a combination of email and text confirmation codes.  This method works if there are no issues with your personal information.

Enrolling in MedicareThe major challenge with this newest method is some of my clients do not have email or do not get emails and texts on their phones.

Challenges, however, go beyond just the mechanics of getting enrolled with Medicare.  The problems are with when you can enroll, penalties when you don’t follow the rules, confusion about the rules, and penalties that are imposed as a result.  Frustration has built over time as more and more baby boomers run into the wall called Medicare enrollment.

Someone must have heard that consumers were not happy because Congress made some significant changes to the Medicare enrollment process for 2022 and 2023.

What Are the Upcoming Changes to Medicare for 2022?

In December 2020, Congress passed the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act of 2020. Parts of this legislation will be effective beginning in January 2023.

The changes are in five areas:

  • GEP (General Election Period)
  • Part B Enrollment Exceptions
  • IEP (Initial Enrollment Period)
  • Advanced education for Medicare enrollment
  • Expanded Kidney transplant patient coverage

What Are Medicare General Enrollment Period Changes For 2022 & 2023?

Sometimes people miss their Initial Enrollment Period (IEP), which occurs when they turn 65.  If you do not have health insurance from 65 onward, you cannot enroll in Medicare until the General Election Period (GEP), January 1st—March 31st.  The delay is part of the punishment for missing your IEP.  You may also incur the 10% permanent late enrollment penalty.

The problem with the rules around GEP is that Medicare Part A and/or Part B does not start until July 1st  after you enrolled sometime from January 1st–March 31st.  Consequently, a person cannot get a Medicare Supplement or Part D plan until then.  Medicare Part C/Medicare Advantage plans are delayed even further until Annual Election Period (AEP) in October.  You are without comprehensive health coverage for many months after an already delayed enrollment.

The BENES Act changes GEP (General Election Period).  Congress moved GEP from the first three months of the year to the last three months of the year—October 15th—December 31st—to coincide with the Medicare Annual Election Period (AEP), which is October 15th–December 7th.  The hope was to reduce confusion and enable a newly enrolled beneficiary to get maximum coverage right away.  For example, if you enrolled in November during the GEP, your Medicare would start on Dec 1st.

Enroll in Medicare Part B Medicare Changes in 2022 Allow For More Exceptions

Medicare enrollment periods are very restrictive and precise.  The handbook that agents must learn runs to many pages for Medicare election periods when someone can enroll in Medicare or make changes to a Medicare plan.  Often I cannot enroll someone in a plan or change their plan, even when the situation is terrible, because of the restrictive enrollment election criteria.

The new law allows the Secretary of Health and Human Service to initiate a particular enrollment period for Part B when exceptional circumstances arise.  Of course, we all can think of the pandemic as the perfect example.

The Last 3 Months of The Initial Enrollment Period

Many people know that your Initial Enrollment Period (IEP) is three months before the month of your birthday, the month of your birthday, and the three months afterward.  What people do not realize about this rule is there are additional rules for the last three months.  This provision has been the bane of my existence—as well as a few clients—for years.

Staggered Medicare Start Dates Change in 2023

Sometimes people will delay enrolling in Medicare when they turn 65 to coincide with a spouse turning 65, a retirement date, the end of a school year, etc.  The problem with enrolling after you turn 65 is the start dates are staggered.

For example, you are turning 65 in July, but your spouse is turning 65 in October and needs you to remain on the employer health plan so she can have health insurance.  You want to enroll in Medicare for an October 1st start date so it coincides with your spouse, but you can’t.

If you enroll in August, your Medicare will start in September.  If you enroll in September, your Medicare will start two months in November under the current rules.  You will need to enroll in Medicare in August, so your Medicare starts in September.  Your spouse will enroll during the three months before, so it starts on October 1st.  You will need to double pay for insurance for one month because of the unusual Medicare rules.Enrolling in Medicare

The upcoming changes to Medicare in 2022 and 2023 do away with the silliness.  Joe can enroll in September for October and not have to pay double for health insurance.  I can’t tell you how many times this has been an unnecessary burden for my clients going on Medicare.

This change will allow people retiring at the end of their IEP (Initial Enrollment Period) to have a smoother transition from employer coverage to Medicare without a lapse in coverage or double paying.

Medicare Part B after 65

I find that Medicare does not explain very well how Medicare works when you work past 65 or beyond and have an employer health plan.  I hear the standard response from Medicare and Social Security bureaucrats.  They encourage people to enroll only in Part A and stay on their employer’s health plan as long as they are working.

In the past, that standard answer may have worked, but when more and more people are working past 65 and full Social Security retirement is 66+, reality changed.

Also, employer plans have steadily declined in quality during the past fifteen years.  Health plan costs have increased and coverage has decreased significantly.  I find the vast majority of employer health plans are inferior to Medicare Advantage or Original Medicare and a supplement.

Medicare Enrollment Deadline & Penalty

The most common issue around Medicare is initial enrollment, which is when people turn 65.  Some people claim they didn’t know about their Medicare enrollment.  I’m not sure how that is possible because most people’s mailbox is jammed full of mail announcing they are turning 65 and need to get signed up for Medicare.

The real issue around 65 is should I enroll in Medicare, and how do I quickly do that?  I find a lot of legitimacy around that question.

The upcoming changes to Medicare in 2022 & 2023 through the BENES Act will include notifying people of Medicare eligibility.  The notifications will start at ages 60 to 64. Medicare will send information to explain rules such as Medicare eligibility, timeframes for enrollment, Medicare penalties, delaying Medicare without penalty, Part B coordination of benefits, and other online resources will be included on the notice.  The purpose is to alert beneficiaries, so no one misses their opportunity.

If your mailbox was not full enough when you turned 65, it will be stuffed to overflowing now.

Medicare For Kidney Transplant Patients

Medicare and End Stage Renal DiseaseEnd-Stage Renal Disease (ESRD) is one of the ways you qualify for Medicare before age 65.

If you are under 65 and diagnosed with ESRD, you can enroll in Medicare for a specific number of months. For example, now if you qualify for Medicare based on ESRD and have a kidney transplant, your Medicare coverage will end 36 months after the month of your transplant.

The BENES Act of 2020 change will allow kidney transplant beneficiaries to continue their Medicare Part B coverage past 36 months if they have no other health insurance source. The purpose of this is so these beneficiaries will continue to have coverage for immunosuppressive drugs.

According to the Social Security Administration (SSA), Part B’s premium under these circumstances would be less than the base premium and not subject to late penalties.

When Does the BENES Act Take Effect?

The BENES Act will take effect on January 1, 2023, but like many laws, different aspects will be implemented over time to give all the institutions and organizations time to comply.

The two changes I think most important are General Election Period (GEP) and Initial Enrollment Period (IEP).  Those will be implemented on the start date–January 1, 2023.  The outreach program and kidney transplant patients will take about two years to enact the changes fully.

The number of people enrolling in Medicare is monster.  I think all the Baby Boomers enrolling in Medicare have forced politicians and bureaucrats to streamline the Medicare system.  Upcoming changes to Medicare enrollment in 2022 and 2023 are going to make life easier.  Late enrollment penalties and complaints should decline significantly with the more efficient and user-friendly rules.  The most vulnerable, like kidney transplant patients, will have better options.

omaha Nebraska medicare insurance agent

Christopher Grimmond

Medicare and Medicare insurance, however, is still complicated.  When you need help understanding the new BENES rules and all the others, give us a call at 402-614-3389 and speak with a licensed and experienced insurance professional.

55648_051622_MK

Medicare Initial Enrollment PeriodAs much information as there is about Medicare, I’m surprised people still do not remember important Medicare dates.  The surplus of commercials, mailers, emails, and advertisements probably do more to obscure and confuse people about Medicare enrollment dates.  The first Medicare enrollment date to remember is the most important one.

Medicare Initial Enrollment Period

You are first eligible for Medicare at age 65.  You can enroll in Medicare three months before your 65th birthday, the month of your birthday, and three months after your birthday. If you do not enroll, a penalty is permanently added to your Medicare Part B premium if you do not enroll.

The penalty is 10% of your current Part B premium added to your Part B premium for the rest of your life.  Yes, it never stops.  The 10% penalty is for not being enrolled in Medicare each full year when you were eligible.  I have client who cannot verify he had employer health coverage for 4 year.  Yes, he has a permanent 40% penalty tacked on to his Medicare Part B premium.

There is also a separate permanent penalty for not having a Medicare Part D plan as well.

The exception is if you have an employer health plan that is as good as Medicare.  If you do, then you may defer going on Medicare indefinitely without penalty as long as you remain on a qualifying employer health plan.  This is the part that many salespeople leave off in the rush to sell you a supplement or Medicare plan.

The Big Medicare Enrollment Date Is Annual Election Period (AEP)Medicare Annual Election Period

Once you are on Medicare, you have an opportunity to change your Medicare Part D or Medicare Part C/Medicare Advantage plan during Annual Election Period (AEP).  AEP that is from October 15th–December 7th each year.

You need this period because Medicare plans change, and your health needs change. You can switch to a plan that better serves your needs during this time.  AEP is particularly important for a person on expensive medications.

Part D and Part C plans can drop prescription drugs, move them to higher tiers, or increase their copays significantly.  The Annual Election Period allows people to switch to a plan that covers their medications at a lower cost.

Those on Part C/Medicare Advantage plans may be interested in other Medicare Advantage plans that have lower copays and better benefits.  The Annual Election Period (AEP) is an opportunity to shift to a better plan.

For those who want to move to a Medicare Supplement from an Advantage plan or go from an Advantage plan to a Medicare Supplement, this is the time for that switch.

Medicare Advantage Open Enrollment Period (OEP)

A couple of years ago, CMS (Center for Medicare & Medicaid Services) decided to create Medicare Advantage Open Enrollment Period (OEP).  OEP is from January 1 — March 31 each year; if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a Medicare Part D prescription drug plan) once during this time.

CMS observed that Medicare beneficiaries change Medicare Advantage plans during Annual Election Period AEP (Oct 15th–Dec 7th), but mistakes happen.  The biggest mistake is the plan they switched to did not have their doctors in the network.

Other mistakes happened as well.  OEP was an opportunity to rectify the situation.  It was a free get-out-of-jail pass.  You can make one change to another Part C/Medicare Advantage plan.

Or you could ultimately get out of your Medicare Advantage plan and go back to Original Medicare (Part A & Part B) and purchase a Part D plan.

Medicare Open Enrollment The Lesser-Known Medicare Enrollment Date Is General Election Period

Another Medicare enrollment date to remember is January 1-March 31 each year for those who missed their initial enrollment period. This is called the General Enrollment Period. Your coverage, however, does not start until the following July 1. You might pay a monthly late enrollment penalty if you don’t qualify for a Special Enrollment Period.Medicare Enrollment Dates to Remember

At this time, you may have an open enrollment period for a Medicare Supplement starting in July.  You may also enroll in a Part D plan, but you will need to wait until Annual Election Period in October to enroll in a Medicare Advantage plan.

Medicare Late Enrollment PenaltySpecial Enrollment Periods

There is a myriad of Special Enrollment Periods.  One of the most common is when someone is past 65 and 4 months and losses their employer’s health plan.  At this time, CMS will allow you to enroll in Medicare Part A and Part B without delay or penalty if you can verify employer health coverage.

Some additional forms need to be completed and submitted to the Social Security Administration. Still, you will be enrolled on the date of your choosing and not need to wait for General Election Period.

Rules & Penalties

Medicare has lots of rules, regulations, norms, and penalties.  Some of them are pretty obscure, but there is little to no forgiveness for mistakes or ignorance of the law.  If you have questions about Medicare, please call us at 402-614-3389 or check out our blogs and videos on OmahaInsuranceSolutions.com.  You can also call Medicare at 800-633-4227 or look on Medicare.gov for information about Medicare enrollment dates to remember.Center for Medicare and Medicaid Services

 

Open Enrollment PeriodMedicare Open Enrollment Is Also Known As Medicare Annual Election Period 

Medicare Open Enrollment is when people may make changes to their Medicare plan.  Medicare Open Enrollment is also called Annual Election Period or AEP. That is the new official name Medicare Open Enrollment.  Annual Election Period (AEP) is when you can change your Medicare Part D prescription drug plan or your Medicare Part C Medicare Advantage plan.  AEP is from October 15th–December 7th.  A lot of people blow this opportunity.  They don’t check to see if they have the best plan for their needs and situation for the coming year.  BIG MISTAKE.  For some people with serious health issues and medication needs, HUGE MISTAKE!

There are a thousand complaints the day after Medicare Open Enrollment (Annual Election Period), December 8th. People offer a myriad of  excuses–It’s the agent’s fault,’ ‘I was too busy to deal with it,’  ‘The dog ate my Medicare card.’  The number of phone calls I get on December 8th is amazing–mostly non-clients.  They are hoping to find a Medicare-fairy-godmother to save them from their negligence.  Sorry, there is no Medicare-fairy-godmother!

When January 1st arrives and the new plan year begins, people may find out their plan does not cover one or more medications, or the price of one of their drugs went through the roof. Now they have a deductible on their plan they didn’t have before, a medication moved to a higher tier, or their doctor is no longer in-network.  Their Medicare situation is a disaster because they didn’t double-check during the Medicare Open Enrollment / Annual Election Period (AEP).

What are the most significant problems created by not reviewing your Medicare plan during Medicare Open Enrollment / Annual Election Period (AEP)?

Medicare Open EnrollmentFormulary Check During Medicare Open Enrollment 

During Medicare Open Enrollment /Annual Election Period (AEP), insurance companies determine the medications on their approved list of drugs in the formularies that service their Medicare Part D prescription drug plans and the Part C Medicare Advantage plans.

Some years, they drop certain medications altogether.  In other years, they might shift the medications from a lower to a higher tier.

The result is you may end up paying more for your prescription drugs.  In some cases, a lot more.  Checking the formulary and comparing it to the other plans in the area is a straightforward but essential process.

During Medicare Open Enrollment / Annual Election Period (AEP), reviewing medications is a big part of what we do.  I sometimes have to arm-twist clients to send me their current list ofMedicare Open Enrollment Period medications.  Some will tell me that they don’t need to do anything because their medications have not changed, but I try to remind them it doesn’t matter.  The insurance companies change their formularies.

Over the years, I have had clients neglect their reviews and end up with substantial prescription drug bills as a consequence.  Your agent should thoroughly check your medications with dosages each AEP. 

Medicare Open Enrollment Double Check Physician Directories

The Medicare Advantage plan manages your care.  That means that an insurance company under the supervision of Medicare is making determinations about your care.  As part of that program, they have doctors contracted with the plan.  Some doctors and hospitals are not contracted.  DoctorsAnnual Election Period may change their credentialing.

It is important to double-check to ensure your doctor is still in-network during Medicare Annual Election Period (AEP) / Medicare Open Enrollment.

We have three medical networks in the Omaha, Lincoln, and Council Bluffs area.  The vast majority of medical professionals are part of one or more of these networks.  The networks work with the local Medicare Advantage plans. Doctor access is not an issue.

I have clients, however, throughout the U.S., and the other plans are not as generous in the number of in-network medical professionals.  Checking the directory to make sure your physicians are still in-network every year is critical during Annual Election Period (AEP) / Medicare Open Enrolment.

Medicare Open Enrollment Review CoPays

With Medicare Advantage plans, copays may change from year to year.  This AEP saw very little change among the plans around here.  I suspect that was because the plans determined prices in the Spring of the preceding year.

The inflation we are experiencing right now was not a factor in the 2022 planning.  I think 2023 will be a different ball game.Annual Election Period

Copays can change each year, so you need to review those changes.  For example, the cost of MRIs may jump on your plan to the extent you want to change to another plan.  Sometimes plans will drop benefits that Medicare does not require, like dental.

I’ve seen plans in the past drop benefits like dental.  Beneficiaries don’t imagine their plan could ever change.  The lack of coverage and the price tag associated with that shocks clients.

Re-Explain The Donut Hole

AEPThe dreaded Donut Hole or Gap!  The Donut Hole is still there.  I’ve seen the burden of drug costs lighten for some of my clients, but it is still expensive when people fall into the Donut Hole.

If you are on expensive medications that drive you into the Gap, checking your medications for the level of Gap coverage is essential.  While no plan eliminates the cost, some plans are structured, so you pay less than other plans.  Some plans delay going into the Gap longer, or other plans even out the cost because of a zero deductible.

If drug costs are an issue for you, look at the various Part D, and Part C plans side-by-side to determine which payment schedule would benefit your wallet during Medicare Open Enrollment.

Have A Conversation About Your Travel Plans

Annual Election Period AEPMany clients on Medicare like to travel.  Their grandkids are scattered throughout the country.  Friends moved to warmer clients, or getting out of town is just great.  Other clients have semi-permanent homes in Arizona, Florida, and Texas.  Medicare is a federal program.  It exists from sea to shining sea in the U.S.  The Medigap policies that company them work anywhere in the U.S. too.  (Medicare. however, does not leave the borders of the U.S.)

Medicare Advantage plans, however, are set up for a particular area or region.  The HMO (Health Maintenance Organization) plans onlyOpen Enrollment Period include doctors and hospitals in that area.  Emergencies are a different matter.  Emergency visits are covered anywhere in the country.  Some insurance companies with HMO plans also have national networks, so you can still get in-network services and prices outside of your geographic region for ordinary services.

For those who travel a lot and especially those who stay for long periods away from home, I highly recommend the PPO (Preferred Provider Organization) plans.  You may go to doctors and hospitals outside the network as long as they take Medicare.  Out-of-network copays may be more, but you have the convenience and security of going anywhere that accepts Medicare.

You can change your Medicare Advantage plan during Medicare Open Enrollment even if you are out of the area.  There is email, U.S. mail, text, and even voice signatures.

Changing Circumstances Makes Medicare Open Enrollment Critical

Over the years, I have had client reevaluate their situation during Medicare Open Enrollment or AEP.  Those paying enormous amounts in monthly Medigap premium look to switch to a Medicare Advantage plan.

The amount of money they pay in premium very quickly covers any copays.  Others anticipate more medical costs as they age, switching to Medigap plans.  Medicare Open Enrollment or AEP is the time to review your ever-changing circumstances and adjust accordingly.

Save Money On Medigap Quote Anytime, Not Just During Medicare Open Enrollment

While Medicare supplements are not geared toward Medicare Open Enrollment or AEP exclusively, it is still an excellent time to look at your pricing.  Running Medigap quotes only takes a few moments. I can tell you in a minute if you have the lowest price for Plan G or Plan N in your area.  We can then make adjustments accordingly.

omaha Nebraska medicare insurance agent

Christopher Grimmond

Medicare planning is not a one-and-done deal.  As you change, Medicare changes and the Medicare plans change.  You need to make the adjustments that best fit your needs and circumstances at that time.

Ignore Medicare Annual Election Period (AEP) October 5th–December 7th at your peril or not.

 

Medicare TaxIRMAA Tax Definition

Many of you may see the letters IRMAA when learning about Medicare.  The government loves acronyms.  IRMAA stands for Income-Related Monthly Adjustment Amounts.  It is based on a person’s modified adjusted gross income (MAGI).  The IRS uses a tiered scale.  Your Medicare Part B and Part D premium will cost more based upon the income thresholds you cross for that year.  How you file your taxes also determines where you fall in the IRMAA brackets and thus the amount you pay.  Be conscious of your tax filing status.  Married filing separately can have a devastating effect.

I was helping a new client prepare for Medicare a few years ago.  His income alone was over $120,000 not counting his wife’s income.  She was five years younger and had health insurance through her employer.  Her income was quite a bit smaller.  The IRMAA brackets were much lower than the IRMAA 2022 brackets now.  My client had only crossed the first rung of the IRMAA threshold.  His Part B premium was going to be just a little over the Part B premium most people were paying at the time.

He called me a month before his Medicare started.  He was almost hysterical because his IRMAA premium was over $400 per month.  I said it was a mistake and had him call Social Security.

It turned out not to be a mistake.  As the story unfolded, I discovered that he was estranged from his wife.  They were still legally married.  As a matter of fact, they had been divorced, and he remarried her again. Part D IRMAA They lived in the same residence–he lived upstairs and she lived downstairs–but they filed separate tax returns.  She absolutely refused to file jointly, and he would not divorce her because of the financial consequences.

My client fell into the bizarre category of “Married Filing Separately.”  You can see on the IRMAA Chart for 2022 what that does to the premium.  Even the lowest income earner on the IRMAA chart pays the same premium as the highest earners!

After decades in the insurance industry and thousands of clients, you eventually see everything!

He canceled his Medicare and stayed on his employer’s health plan that was terrible coverage rather than pay the IRMAA Medicare tax.

IRMAA rules are the same if you are on Original Medicare with a supplement and Part D plan or a Medicare Advantage plan.  The Medicare tax is imposed on all Medicare benefits whose income is above the tiered IRMAA limits.  IRMAA affects 5% of Medicare beneficiaries.  IRMAA 2022 rates went up significantly from IRMAA 2021.

IRMAA Brackets for 2022

your yearly income in 2020 (for what you pay in 2022) was You pay each month (in 2022)
File individual tax return File joint tax return File married & separate tax return
$91,000 or less $182,000 or less $91,000 or less $170.10
above $91,000 up to $114,000 above $182,000 up to $228,000 Not applicable $238.10
above $114,000 up to $142,000 above $228,000 up to $284,000 Not applicable $340.20
above $142,000 up to $170,000 above $284,000 up to $340,000 Not applicable $442.30
above $170,000 and less than $500,000 above $340,000 and less than $750,000 above $91,000 and less than $409,000 $544.30
$500,000 or above $750,000 and above $409,000 and above $578.30

What Is IRMAA Part D?

The IRMAA Part D prescription drug element of Medicare has a separate charge for the higher income brackets from the Medicare Part B health insurance.  The IRMAA for Part D affects 8 percent of people on Medicare prescription drug plans.  Medicare IRMAA Part D is on top of the cost of the prescription drug plan itself.  Each Part D plan has its own monthly premium the insurance companies collect.

The IRMAA Medicare Part D can be deducted from your Social Security or bank account.  Below are the new rates for Medicare Part D IRMAA 2022.

File individual tax return File joint tax return You pay each month (in 2022)
$91,000 or less $182,000 or less $0.00
above $91,000 up to $114,000 above $182,000 up to $228,000 $12.40
above $114,000 up to $142,000 above $228,000 up to $284,000 $32.10
above $142,000 up to $170,000 above $284,000 up to $340,000 $51.70
above $170,000 and less than $500,000 above $340,000 and less than $750,000

$71.30

$500,000 or above $750,000 and above

$77.90

How Does IRMAA Work?

The Social Security Administration (SSA) will notify you within which IRMAA 2022 brackets you fall.  The notification is an initial determination.  In the notice, your rights will be spelled out and an appeal form included.

I suggest you verify that your tax information is correct and your income falls within the IRMAA limits Social Security specifies.  Double-check you are looking at the IRMAA 2022 brackets.  The official numbers come out each year by the first of the year and are found on the Medicare.gov website.

IRMAA Medicare TaxThe IRS provides SSA with your tax information.  In the initial determination and before the tax is applied, check the accuracy of the IRS’s information.  Make sure SSA has your correct income,  filing status, and year.  If your income decreased significantly because of a life-changing event (LCE) consider a Medicare IRMAA appeal to SSA.

SSA’s determination can change from year to year based upon the rise or fall of your income.  Income is not only earned income but also qualified money from retirement accounts, sales of property and stock, and other investment income.  Consult with your tax advisor for the relevant and current information for your situation.  The IRMAA tax is based upon your income going back two years.  The IRMAA limits can change each tax year.

I warn clients about the IRMAA tax, but inevitably I get the hesitant phone call. ‘What is this bill from Social security about?’ I remind them of the past conversations, and for those prospective high-income earning clients, the discussion around IRMAA might determine whether they stay on their employer health plan or go on Medicare.

Sometimes, it makes financial sense–if you plan on working anyway–to stay on the employer health plan, and not enroll in Medicare Part B.  The cost of Medicare and the IRMAA tax may be substantially more than what you pay in premiums for your health plan at work.  As much as I prefer to acquire clients than not, I have recommended several individuals over the years to stay on their employer health plan.

I spoke IRMAA appealwith a surgeon the other day.  He is now 70.  We have talked each year for the past five.  He works as a research consultant at a much-reduced salary.  He is effectively part-time.  His employer provides health coverage for him and his wife that is as good as Medicare for a much lower price than what he would pay because of IRMAA.  He and his wife only have Medicare Part A.  As his income decreases, they may eventually transition to full Medicare, but with the IRMAA brackets where they are, staying off Part B and not paying IRMAA tax is better.

IRMAA Appeal

Here are the IRMAA chart 2022 exceptions broadly considered.  There are more reasons for an IRMAA appeal than can be easily listed.  This list is not exhaustive.

Situation

Description

Tax return inaccurate or out of date

  • A beneficiary filed an amended tax return for the year SSA is using to make an IRMAA decision
  • There was an error in the IRS data
  • The IRS provided SSA with older data and the beneficiary wants to use newer information
  • You had a major life-changing event that significantly reduced your income

A Life-Changing Event (LCE) that affects the beneficiary’s modified adjusted gross income

There are 7 qualifying life-changing events:

  • Death of spouse
  • Marriage
  • Divorce or annulment
  • Work reduction
  • Work stoppage
  • Loss of income from income-producing property
  • Loss or reduction of certain kinds of pension income

The most common exception that has occurred among my clients over the years is a large IRA withdrawal.  When people go to retire, some make a one-time large withdrawal from their IRA.  The purposes vary.  The most common one is to pay off a home mortgage upon retirement.

Of course, you pay the deferred taxes on the qualified money withdrawn from the IRA, but in terms of Medicare, the money is considered income even though it is retirement assets.  You did not take the IRA contributions as income when you deferred them into your retirement account, so the government wants the taxes when you realize it as income.  But, it is then counted as income for purposes of Medicare IRMAA.

More importantly, the result of an IRA withdrawal is to raise your income that year a considerable amount over your normal income.  The IRMAA tax may apply, even though it is not your normal income.  I have found those who go through the appeal process frequently receive a favorable decision in this kind of instance.  I can help you with the form.  The IRMAA appeal form is on the Social Security website.

IRMAA Medicare TaxThe Mechanics of IRMAA

CMS (Center for Medicare & Medicaid Services) calculates IRMAA and publishes it yearly in the Federal Register.  Once the IRMAA is calculated, CMS informs Social Security.  Social Security has access to your income and tax information through the Internal Revenue Service (IRS).  They communicate  IRMAA determination.  Social Security, which administers Medicare, notifies you of whether you need to pay more than the standard premium. The standard premium for Part B in 2021 was $148.50.  Part B 2022 premium increased to $170.10 at the first of the year.  Part D premium varies upon the prescription drug coverage.

IRMAA Medicare is based upon your modified adjusted gross income (MAGI) that the Internal Revenue Service (IRS) will report. Social Security considers years prior.  They go back two years to determine the IRMAA surcharge.  The IRMAA will adjust each year based upon that year’s MAGI.  The surcharge is applied to the Part B premium and the Part D premium.

IRMAA Part D payments are paid separately to Medicare, and you must pay them even if your employer or another third party (such as a retirement system) pays your Part D plan premiums. You will receive a Medicare Premium Bill each month for your Part D IRMAA and you can pay it in the same way you pay your Part B premiums. You do not pay Medicare IRMAA Part D to your prescription drug plan.

Keep in mind that Medicare treats IRMAA payments the same as other premium bills, which means that you could lose your health insurance coverage if you do not make your payments on time each month.

How to Appeal Social Security IRMAA?
IRMAA Medicare Tax

The Office of Medicare Hearing and Appeals handles all appeals for IRMAA tax.  There are two categories of Medicare IRMAA appeals.

  • The calculation is incorrect.
  • A life-changing event.

The specific life-changing events are marriage, divorce, death of a spouse, reduction in work hours and/or termination, loss of income-producing property, or loss of pension.  You submit the Medicare IRMAA appeal form to the Office Medicare Hearing and Appeals where Social Security determines if the tax will be reduced.

As I am writing this article, I can no longer find the appeal form on the Medicare.gov or CMS.gov websites where is generally where you could find this form without much difficulty.  After an hour’s search, I gave up.  Hopefully, they will put the form back upon the website soon.

If you fall in the IRMAA tax category, it is something to seriously consider as you go on to Medicare.  The tax may be temporary as your income declines in retirement, but for those whose income remains in the higher tiers, you may wish to consider other alternatives.

omaha Nebraska medicare insurance agentAs always, if you need help navigating the archine world of Medicare and Medicare insurance, please give us a call at 402-614-3389.

What Our Clients Are Saying About Omaha Insurance Solutions

Doug & Vicki K.

Chris does an excellent job of listening to your needs. He uses that information to help you choose the best plan out of many options. Very happy for all his help.

Tony A.

My wife Maria and I would like to thank you and Angie for helping us with all our different options with medicare supplemental policies. We appreciated how you spelled everything out. With your help, we feel we have chosen the right policy for all our needs moving forward. We will recommend your company to others. Thank you again.

Tom & Suzi F.

My wife and I were so very impressed with Chris and his ability to explain Medicare and the various options available patiently. Chris is very knowledgeable, and experienced, plus he is an absolute pleasure to work with. With his assistance, we now feel confident about our coverage decisions. We would highly recommend visiting with Chris as a critical first step in moving to Medicare.