If you are over 65 and leaving group insurance through an employer, there is a good chance that you will be going onto Medicare. Allen Heffler, President of MyMedicareAdvisor, helps people in the Philadelphia area with their Medicare decisions. If you are leaving employer-sponsored health insurance, either through your active employment or your spouse’s, active employment, you have a short window to apply for Medicare Part B (you will probably already be enrolled in Medicare Part A). If you have creditable health coverage based on active employment, you are eligible for Medicare Special Enrollment Period. During this time period, you can enroll in Medicare Part B without penalty. This time period lasts for eight months after you leave active employment. After eight months, you are no longer eligible for a Special Enrollment Period to apply for Medicare Part B. To emphasize, this is based on you or a spouse current employment, not COBRA. If you delay more than eight months, you will then have to wait for Medicare’s General Enrollment Period to apply and enroll, which will mean delays and you will also be accessed penalties. To enroll in Medicare based on this Special Enrollment Period, you will need two forms from Social Security. Form CMS 40B-Application for Enrollment in Medicare. The second form is CMS L564 Request for Employment Information. Your employer will need to sign this last form, verifying your group insurance. Let’s face it- the entire Medicare process is really confusing and going it alone might seem like an impossible task. Medicare rules are fairly unforgiving. If you mess up and miss your Special Enrollment Period, it will not be a good situation. Allen Heffler and MyMedicareAdvisor can help. We can walk you through the entire Medicare maze. Just call us at (215) 658-1776. MyMedicareAdvisor- we make your Medicare decision easy.
Presenting your Provider with the Wrong ID Card
The other case -of-the-presenting-the wrong-ID card relates to prescriptions. If you have a Medicare prescription plan, you receive your drug coverage through a Part D plan. Sometimes mistake can be made when a person presents their Medicare care or their Medigap card at the drug store for prescriptions. Or vice vesa, presenting their Medicare Part D ID card for items other than prescriptions.
Think of your Part D drug plan as a pharmacy card. You only use it at the pharmacy. So unless you are picking up a retail prescription, you generally won’t be presenting your Part D card for payment.
Two scenarios: Number 1. You have Medicare, a Medigap Plan and a seperate Part D (prescription) plan. Use your Part D card (NOT your Medigap card) for your prescriptions. Scenerio number 2: You have a Medicare Advantage Plan with Part D/prescriptions BUILT-IN. In this case, you will show your Medicare Advantage card that indicates Rx/Part D on that card.
Another question that often arises is which card to present for items such as test strips for diabetes or replacement parts for insulin pumps or CPAP machines. This is covered under Medicare Part B. You will present your Medicare and Medigap cards if you have Original Medicare/Medigap. If you have a Medicare Advantage plan, you will then present your Medicare Advantage card. While mistakes do happen, it is important to try to avoid them! Since even the most prepared person might encounter issues, it’s in your best interest to work with an independent Medicare broker who knows what they are doing when it comes to Medicare. We are here to help you every step of the way! Wouldn’t it be nice to have someone on your side with Medicare? Just call Allen Heffler – MyMedicareAdvisor at (215) 658-1776.
Presenting your Provider with the Wrong ID Card – Part 1
Let’s make sure we present the correct insurance card to the health care provider or facility. If you have decided to have Medicare as your primary coverage and a Medgap plan, you must show both of those cards (your red white and blue Medicare card and your Medigap card) to the doctor or facility at the time of service. Only showing one of those card will not do! However, what card do you show if you have a Medicare Advantage Plan? You ONLY show your ONE Medicare Advantage card. Remember, your Medicare Advantage plan essentially takes over all your health care needs. If you have a Medicare Advantage plan and show only your red white and blue Medicare card by mistake, all claims very well could be denied- since those claims must be processed by your Medicare Advantage Plan. Furthermore, if you have a Medicare Advantage Plan, you do not even need to carry your Medicare card-you can put it away in a safe place. So, depending on the coveerage you have, always remember which card or cards to present. Your spouse should be aware as well, in case of an emergency. While mistakes do happen, it is important to try to avoid them! Since even the most prepared person might encounter issues, it’s in your best interest to work with an independent Medicare broker who knows what they are doing when it comes to Medicare. We are here to help you every step of the way! Wouldn’t it be nice to have someone on your side with Medicare? Just call Allen Heffler – MyMedicareAdvisor at (215) 658-1776.
Not Notifying Medicare That You’ve Left Employer Coverage
Does Medicare still think you you have Employer Sponsored coverage? One phone call to Medicare/Social Securty to notify them of the change of coverage- that you no longer have employer health insurance- could very well prevent future denials and big issues.
In a perfect world, if everythng ran perfectly smoothly, Medicare would automatically be aware that you are no longer working for your former employer and that you have left that coverage. If this were the case, Medicare would then know that it is now your primary insurance (instead of being your secondary which was probably the case when you worked), and it would begin to pay as primary.
This is how it is supposed to work and this is how it works for most of the time. However, in many cases, Medicare is not notified that you left work and that employer coverage has stopped. If this were the situation, when you present your Medicare card to the doctor or facility, Medicare might deny those claims because they believe the bills should have gone to your employer insurance first. A world of headache.
Let’s be proactive and avoid this mistake! Make a simple phone call the Medicare at (800) Medicare. Inform then that you have left your employer and that you no longer have health coverage through your job. You will confirm with Medicare that Medicare is now your primary coverage. An ounce of prevention… While mistkae do happen, it is important to try to avoid them! Since even the most prepared person might encounter issues, it’s in your best interest to work with an independent Medicare broker who knows what they are doing when it comes to Medicare. We are here to help you every step of the way! Wouldn’t it be nice to have someone on your side with Medicare? Just call Allen Heffler – MyMedicareAdvisor at (215) 658-1776.
Please click on the ALLEN HEFFLER to read next Article “Seven Medicare Mistakes to Avoid- Mistake # 5”