Telemedicine is booming during the coronavirus pandemic. People are afraid to venture out of their homes to seek care at doctors’ offices, urgent care facilities and hospitals for fear of exposure to the virus. But sometimes consulting with a physician is necessary to make sure you stay healthy during these stressful times. Putting off or ignoring physical symptoms can worsen a condition that might otherwise be easily treated with the right care.
The best place to start when considering telemedicine is your insurance plan. Many plans already have this benefit in place or have expanded its use during this crisis. The Centers for Medicare and Medicaid have implemented new guidelines to expand access to virtual medical visits. If your insurance doesn’t offer telemedicine, you can use one of the many telehealth companies like Teledoc, LiveHealth or Doctor On Demand. Some require insurance and most will have a copay or set fee per virtual visit.
As at a regular doctor’s office, you will be required to disclose your medical history, including the medications you currently take. Prepare yourself before the visit by making a list of your symptoms, writing down any questions you may have, and have your pharmacy information on hand should the doctor need to call in a prescription for you. Not everything can be checked at a virtual visit, and the doctor may require to see you in person, or if your symptoms are severe, he or she may have you go to the nearest emergency room for treatment.
If you have recently lost group employee health insurance coverage and are 65 or over and need to sign up for Medicare, you can submit your applications by FAX to help speed up the process. You must fill out an Application for Enrollment in Medicare Part B and also the Request for Employment Information forms.
The application can be downloaded at https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-E.pdf and the request for employment information form can be downloaded at https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS-L564E.pdf.
Be sure and indicate in the “Remarks” section of the application your desired effective date which will always be the first of the month, i.e., if you are applying in May, request an effective date of June 1. Also, if you cannot obtain your employer’s signature, the following alternatives will suffice.
When completing the CMS L564
- State on the form “I want Part B coverage to begin (MM/YY)”
- If possible, your employer should complete Section B.
- If your employer is unable to complete Section B, please complete that portion on behalf of your employer without your employers signature and submit one of the following forms of secondary evidence:
- income tax form that shows health insurance premiums paid;
- W-2s reflecting pre-tax medical contributions;
- pay stubs that reflect health insurance premium deductions;
- health insurance cards with a policy effective date;
- explanations of benefits paid by the GHP or LGHP; or
- statements or receipts that reflect payment of health insurance premiums.
Once completed, the forms can be faxed to Social Security at 1-833-914-2016.
Balance Billing is a common problem when you go to out-of-network doctors not covered or partially covered by your health insurance. The consumer is charged for these costs in bills that could come weeks or months after the initial visit or procedure.
There are steps you can take, however, to mitigate these surprise medical bills. First, be sure to check your Explanation of Benefits (EOB) which usually comes with the bill. Check the dates to make sure the service you are being billed for is accurate and which services were actually performed by out-of-network providers. Be prepared. Get an itemized copy of your bill and know what the “usual” charge is for the procedure. Sites like FAIR Health can help you determine what costs are common for medical procedures in your area. Call the provider and ask to speak to someone in billing who can assist you with the bill. You can also write to your insurer and request that they cover a portion or all of the balance billing.
Ultimately, one of the best ways to avoid balance billing is to make sure you go to network providers. Call your insurer in advance, if possible, to make certain all your care is being handled by in-network doctors, from the surgeon to the anesthesiologist. Make sure all lab work and tests needed in preparation for the surgery is covered as well.
IRMAA stands for Income-Related Monthly Adjustment Amount, and what it means is that you are being charged more on your Medicare Part B premium and your Medicare Part D Drug Plan premium based on your income. If your Modified Adjusted Gross Income, or MAGI, is over $87,000 as a single person or over $174,000 as a couple, you will have this surcharge added to your monthly premiums. It goes up incrementally as your income rises to an additional $347.00 on Part B and $76.40 for Part D if you are in the highest brackets (above $500,000 for individuals or $750,000 for couples). The amount is added to the standard premium which is $144.60 for 2020. The good news is that it doesn’t affect what you pay for a supplemental or advantage plan.
Only about 5% of people on Medicare pay the extra charge which was implemented on Part B in 2003 and on Part D in 2011 as a way to save the federal government money on the burgeoning cost of the Medicare program. What can be even more frustrating is that Medicare looks at income tax records from two years prior. That means if you sign up for Medicare in 2020, your IRMAA will be based on your 2018 tax records. Most people are making less money once they retire and go on Medicare, so what can you do if you are in this situation? You can appeal the extra charges to Medicare directly. By filing form SSA-44, Medicare may adjust the amount you owe to reflect your current income levels. If you don’t appeal, your income is re-evaluated yearly, so you won’t be paying the higher premiums forever if your income does decrease.
If you’re approaching Medicare eligibility, it is important to know the various times to sign up for this important milestone. Below are the enrollment periods that will help you determine what your eligibility is or whether you need to sign up for Medicare at all:
Annual Enrollment Period – Period every year between October 15 and December 7 when you can change your Medicare Advantage Plan or Prescription Drug Plan.
Open Enrollment Period – Additional period of time from January 1 through March 31 when you can change your Medicare Advantage Plan. You can also return to Original Medicare with or without a drug plan.
Retirement/Loss of Group Health Insurance – Period of time once you retire or lose creditable group coverage to sign up for Medicare and a Supplemental, Advantage Plan and/or Part D Drug plan.
Supplemental Plan Birthday Rule – Period that allows you to change your Supplemental plan that begins 30 days before your birthday up to 60 days after your birthday.
Special Enrollment Period – Period of time to change your Medicare Advantage plan or Part D drug plan because of a life event, i.e., moving out of service area, qualifying for Low Income Subsidy. If you are still actively working and have a creditable (as good as Medicare) group employee health insurance plan, you may be able to keep the plan until you retire and delay signing up for Medicare without incurring penalties. Check with your benefit’s administrator to see if this is a viable option for you.
While most peoples’ health insurance costs go down when they sign up for Medicare, many are surprised that Medicare doesn’t pay 100% of their medical expenses. There are deductibles, copays, and coinsurance which can add up to hundreds, if not thousands, of dollars per year of out-of-pocket costs if you have Medicare alone.
How can you bridge the gaps and keep more money in your pocket? There are basically two ways you can go. Below is an explanation of each:
Medicare Supplemental Plans – You remain in Original Medicare and can go to any doctor who takes Medicare throughout the United States. Your plan travels with you, and you do not have to get a new plan if you move out of state. You don’t need to get referrals to see a specialist. If you want prescription drug coverage, you would have to purchase a stand-alone Part D plan to go with your Supplemental Plan since none of these plans cover prescription drugs.
Medicare Advantage Plans – You opt out of Original Medicare and go with a private company that combines Parts A, B and D into one plan (which is also called Medicare Part C). Most plans require you to see network doctors and get referrals to see a specialist. Some plans exclude Part D if you have other drug coverage such as VA benefits. Advantage Plans include Special Needs Plans for people with certain chronic conditions and Medi-Medi plans for those who qualify for both Medicare and MediCal.