Basic Medicare
What is Part D's late penalty?
1% of the national average for every month you were eligible but did not sign up. (2016=$34.10) You pay in addition to the premium and any IRMAA for as long as you have Part D.
What are the 4 types of Medicare Savings Programs (MSP)?
1. QMB (Qual. Med. Bene. Program) 2. SLMB (Spec. Low-Income Med Program) 3. QI (Qual. Individual Program) 4. Qual. Disabled & Working Ind. Program
Once employment ends or EGHP ends, what do you need to know?
1. You have a Special enrollment period: You have 8 months to sign up for Part B without penalty. If you don't enroll during this time, you must wait until General Enrollment and will have a penalty. 2. You may be able to et COBRA (for up to 18 months) which extends your EGHP but it will be a higher cost. 3. When you sign up for Part B, your Medigap Open Enrollment period starts.
What is an EOB?
An explanaion of Benefits is a summary each month you fill a prescription with your Medicare PDP. It summarizes your drug claims/costs.
Question
Answer
When can you leave a MA plan?
During Annual Disenrollment (January 1-February 14.) Also during Annual Enrollment (October 15-Dec 7).
When is Medicare Initial Enrollment?
During the 7 month period that begins 3 months before themonth you turn 65, includes the month you turn 65, and ends 3 months after themonth you turn 65.
Who pays first: if under 65, have a disability and have a EGHP and the employer has 100+ employees?
EGHP pays first.
Who pays first: if you're 65 or older, have EGHP based on current employment, and there are 20+ employees?
EGHP pays first.
What is a drug formulary?
Each PDP has a different formulary, which is a list of drugs covered by the plan. It covers both generic and brand name drugs. This list must meet Medicare's minimum requirements, but it doe not have to include all prescription drugs.
How do I know if I may a IRMAA for Part B?
Each year Social Security will tell you if you have to pay more than the standard premium. The amount you pay can change each year depending on your income. If you disagree, you can submit an IRMAA adjustment form. (There is a fact sheet under Medicare Premiums: Rules . . . .)
You can join a MA plan even if you have pre-existing conditions, except for what condition?
End-Stage Renal Disease
Can a drug company change its formulary at any time?
Generally, plans can't discontinue or reduce drug coverage you are taking during the year. The plan must let you know at least 60 days before the change takes place.
What is the QMB program?
Helps pay Part A & B prem., deduct, copays
What is the SLMB program?
Helps pay Part B premiums only
What is the QI program?
Helps pay Part B premiums only (apply each year, first come)
What does Extra Help (LIS) do?
Helps pay for Medicare pres. drug coverage.
When does your coverage start if you enroll during the first 3 months?
In most cases, your coverage begins the first day of your birthday month. If your birthday is on the first day of the month, your coverage will start the first day of the prior month.
When does your Medigap Open Enrollment period begin?
It begins as soon as you sign up for Part B.
What is a MSN?
It's not a bill, but a notice you get if you have Original Medicare. Mailed every 3 months, it shows all your services/supplies from providers/suppliers billed to Medicare, what was paid, and the maximum you may owe the provider during this 3 month period. KEEP RECEIPTS AND COMPARE THEM.
When is Medicare General Enrollment Period?
January 1-March 31 each year. Your coverage doesn't start until July 1 and you may pay a higher Part A and/or B premium for late enrollment.
Are both Medicare Part A & B considered minimum essential coverage?
Medicare Part A is considered minimum essential coverage, but if you only have Medicare Part B, you aren't considered to have minimum essential coverage.
Who pays first: above senerio but with under 100 employees?
Medicare pays first.
Who pays first: above senerio but with under 20 employees?
Medicare pays first.
Who pays first: if you have retiree insurance?
Medicare pays first.
What is the Part A penalty?
Monthly premium may go up 10% for every 12 months you didn't have coverage. You'll have to pay the higher premium for twice the number of years you could have had Part A, but didn't.
What happens if you have been on a Markeplace plan and you become eligible for Medicare?
Once your medicare Part A coverage starts, you'll no longer be eligible for additional premium tax credits or other savings for a Marketplace plan based on your income. You'll have to pay full price for the Marketplace plan.
When can you join a MA plan?
Only at certain times: At IEP; if you have Part A and you get Part B for the first time during GEP; during Annual Enrollment between October 15-December 7; during SEPs.
What are Medicare Saving Programs (MSP)?
Programs where you can get help from the State to pay for various Medicare costs.
What if you have other coverage when enrolling in a MA?
Talk to BA of company before joining MA--could cause you to lose coverage. If you drop your employer or union coverage, you may not be able to get it back.
If your coverage through your (current or former) EGHP or union ends, how long is your SEP to enroll in a MA or Part D plan?
The SEP ends 2 months after the month your group plan ends.
If you are eligible for full Medi-Cal benefits, how long is your SEP to enroll or change a MA or Part D plan?
The SEP is on-going--you can change on a monthly basis.
If I buy Part A premiums, do I have to buy Part B?
Yes, in most cases.
If you qualify for QMB, SLMB, or QI, what else do you qualify for?
You automatically qualify for Extra Help.
If you lose your eligibility for full Medi-Cal benefits, how long is your SEP to change MA or Part D plans?
You have a 3-month SEP to change starting with the month you are notified of the loss of elegibility.
What happens if you are on a MA plan and you move to a new location?
You have an SEP to change plans or return to OM if you have different options in your new location.
If you are in an MA plan, and the plan leaves or you leave the service area, how long of a SEP do you have to get a new plan?
You have as early as 60 days prior to enroll in a Medigap, but you only have 63 days after you move.
If you live in an area with a 5 star MA or Part D plan, how long do you have a SEP to join the plan? When can you join?
You have basically a year to join the plan, from December 8 through November 30 (each year). You can only enroll in a 5 star plan once during this timeframe. Effective date is the first day of the following month (that you enrolled).
What do you need to know to join a MA plan?
You must have Part A & B. You must live in the plan's service area. You can't have ESRD (unless you were already in the plan when diagnosed.)
What if doctor prescribes a drug not on the list?
You or your doctor can request an exception with your plan. If the plan denies the request, you can appeal.
How long is your ICEP (initial coverage election period) to join an MA plan?
Your ICEP for a MA plan may be 3 months or 7 months. 7 months=IEP; 3 months=if delay part B, you have 3 months before both Parts A and B are effective.
What is Part B's late penalty?
Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B but didn't sign up.