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This is not correct. I hope the people you spoke with didn't tell you this.
The issue is with the Part B deductible - not the excess charge. The govt believes coverage of this deductible encourages people to run to the doctor unnecessarily because it doesn't "cost" them anything. With the Part B deductible rising each year, it is the govt's hope that many people will think twice before incurring that cost. 2016 deductible is $166. It won't be long that deductible will be over $200.
Excess charge coverage is not going away and will remain in the Plan G. Excess charges cover nonparticipating providers such as Mayo Clinic and their ilk who are allowed to charge 15% more than 95% of the Medicare-approved charge - effectively about 10% more than if they accepted assignment under Medicare.
Ariadne.....Sorry, you are correct. She did mention the excess charges but that was because the N plan doesn't cover those either. Never quite understood why they don't want you to do preventative stuff. Without a covered B deductible people will wait until they are sicker to go to the doc which costs more in the end. I just keep seeing the costs adding up and up and up. Scary thought for 2 people with only SS and savings. Never lucky enough to have jobs with a pension, sad for 2 people with college educations.
Preexisting conditions are not considered for Medigaps if you enroll within six months of when Part B becomes effective during the Medigap initial open enrollment period. Once enrolled, however, you may not be able to switch because of health underwriting unless you are in a guaranteed issue state - those are (with varying rules) NY, CT, CA, OR, MO.
Advantage plans don't require health underwriting (other than ESRD) and can be switched annually during Annual Open Enrollment beginning in October each year.
What state are you in and where and when are you planning to move?
Now, in Oklahoma, and likely moving to Utah probably about my birthday(?). I called about the ACA plan I have, and was told when to contact who and when so I don't end up with it and Medicare. The condition in quesiton is an ileostomy, and so far as I know some types of policies must cover them, which means mostly the supplies unless you have problems. I'm assuming the other expensive stuff needed like quality tape (so it doesn't irritate the skin) is still up to you and only strictly 'medical' costs in supplies count.
If the Advantage plans open in October, and birthday is in May and I may move somewhere in that time, it sounds like a complicated mess. How can I find out if medicare covers the basic needed supplies itself? That is likely the main and so far the only need I have.
Last edited by nightbird47; 10-01-2016 at 09:24 PM..
Now, in Oklahoma, and likely moving to Utah probably about my birthday(?).
If the Advantage plans open in October, and birthday is in May and I may move somewhere in that time, it sounds like a complicated mess.
October Open Enrollment is only for those already on an Advantage or other Medicare health plan and/or Part D who want to switch coverage.
When you become Medicare eligible, you enroll in an Advantage plan in the state in which you live.
If the timing is such you enroll in an Advantage plan in Oklahoma, you will need a new plan when you move to Utah because you will be moving out of the Oklahoma plan's service area. Once in Utah, you can then either enroll in an Advantage plan or a Medigap. Read this, carefully:
October Open Enrollment is only for those already on an Advantage or other Medicare health plan and/or Part D who want to switch coverage.
When you become Medicare eligible, you enroll in an Advantage plan in the state in which you live.
If the timing is such you enroll in an Advantage plan in Oklahoma, you will need a new plan when you move to Utah because you will be moving out of the Oklahoma plan's service area. Once in Utah, you can then either enroll in an Advantage plan or a Medigap. Read this, carefully:
I have no idea. Suggest you talk your local providers on their experiences with Medicare.
I'll do that. That's why I haven't spent any money on the ASA plan. They pay for the supplies, but not anything to stick them better. This is stuff like spray adhesives and special tape which can cost even more. But if there is stickum on it, your problem.
And thanks for the help. I very much appreciate it.
Just a heads up for those that are going to no longer be eligible for the ACA due to Medicare (mine will kick in 12/1 due to disability) - I couldn't make heads or tails of trying to do this online - called today and was told that it was a good thing I called today and not tomorrow as I would have been charged for an additional month (Dec.) because it would have been less than 15 days.... The site unfortunately is not terribly user-friendly but if you find yourself in a similar situation (I'd love to at least keep my current plan for the next month to end the yr., it's not allowed if you are Medicare-eligible) - I think/hope!!! that my plan is current through the end of Nov. as I recently had a surgery ..... such lengths we have to go through - call and document if possible (be prepared for long holds) if you need to make any such change.
Hubby and I have been on Medicare for a few years now. We both opted for an Advantage Plan which includes drugs and medical, at zero $$. But next year, we are switching to a Supplimental Plan F and D through UHC/AARP for a monthly fee.
We both happen to be getting the same plan, but each individual should assess a plan according to their particular needs. We will be paying about $150.@ for the two plans but will no longer pay copays and deductibles. We will just about break even on expenses, based on an average of the past few years, but if one of us has a serious illness or accident it will save serious money. Peace of mind is worth it.
One thing we found out is that, someone with a chronic medical condition has only a 6 month window, once you apply for Medicare, in which the supplemental plans have to accept you. They, unlike the Advantage plans, can turn you down after that. For example, my neighbor has a chronic mental illness which requires her to take very expensive drugs, and have lots of lab work and visits to a specialist. She and her husband, who is a physical wreck, signed up for the supplementals immediately, or they would have been turned down, for sure.
There is no need to go to any office and wait in any lines to sign up for Medicare. Info is readily available online, and all the insurance companies have hotlines to answer any questions. Sign up for Medicare 3 months before your 65th birthday, and the coverage starts on the first of the month your birthday falls on.
Another point I will mention, is that I found the Advantage Plan to be very controlling. It was a PPO, but still, on several occasions the company made me jump through hoops before agreeing to a procedure my doctor ordered. I believe (we'll see) that the new plan won't be this way.
I discovered something yesterday that I hope doesn't really screw us up. As stated in this thread hubby and I are on an ACA plan which is subsidized due to income. His birthday is in late October and we planned it so that he would apply for Medicare in November so it starts 1/1/17. I was concerned that if I cancelled him from our plan that somehow I would also get cancelled. Well I thought so far, so good. I got this.
Unfortunately when his Medicare card came, yes the Part B was starting 1/1/17, BUT the Part A was made to start retroactively to 10/1/16, his birth month!!! I did not know that they were going to start at different times, thought they would both start on 1/1/17. Heck this is even before he applied!! This means that for 3 months he had his subsidized ACA plan as well as Part A Medicare, which as I understand isn't allowed. I am so afraid that we will lose his subsidy for those 3 months and end up owing a TON of money back to the government. Why would they do that?? Why would they start them at different times with one being retroactive for 2.5 months????
The really bad thing is that hubby expressed this concern about this exact thing and I told him that from what I found out this wouldn't be a problem. He will be absolutely livid with me if this happens.
Unfortunately when his Medicare card came, yes the Part B was starting 1/1/17, BUT the Part A was made to start retroactively to 10/1/16, his birth month!!! I did not know that they were going to start at different times, thought they would both start on 1/1/17.
Heck this is even before he applied!! This means that for 3 months he had his subsidized ACA plan as well as Part A Medicare, which as I understand isn't allowed. I am so afraid that we will lose his subsidy for those 3 months and end up owing a TON of money back to the government.
Why would they do that?? Why would they start them at different times with one being retroactive for 2.5 months????
They did that because someone misunderstood you. Did you specifically state you didn't want Medicare Parts A&B until January b/c of the ACA subsidies?
Or, someone wasn't thinking and automatically made Part A enrollment retroactive to his birth month.
You can disenroll. Call SS or go to an office and have this changed. This happened to me at age 65, automatically put on Part A, went to an office, and they took me off.
Per Medicare - he can CHOOSE his enrollment date for Part A:
Quote:
When you're first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.
Example For example, if you're eligible for Medicare when you turn 65, you can sign up during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
Note You can sign up for free Part A (if you’re eligible) any time during or after your Initial Enrollment Period starts. Your coverage start date will depend on when you sign up.
If you can't get this handled over the phone, I would make an immediate visit w/no appointment to a Social Security office. Tell them b/c of ACA insurance hubby CANNOT be enrolled in Part A until Jan. 2017. Fwiw, I've never done anything w/SS over the phone - always went to a office - there are three w/in five miles of my house, including a big one downtown.
I discovered something yesterday that I hope doesn't really screw us up. As stated in this thread hubby and I are on an ACA plan which is subsidized due to income. His birthday is in late October and we planned it so that he would apply for Medicare in November so it starts 1/1/17. I was concerned that if I cancelled him from our plan that somehow I would also get cancelled. Well I thought so far, so good. I got this.
Unfortunately when his Medicare card came, yes the Part B was starting 1/1/17, BUT the Part A was made to start retroactively to 10/1/16, his birth month!!! I did not know that they were going to start at different times, thought they would both start on 1/1/17. Heck this is even before he applied!! This means that for 3 months he had his subsidized ACA plan as well as Part A Medicare, which as I understand isn't allowed. I am so afraid that we will lose his subsidy for those 3 months and end up owing a TON of money back to the government. Why would they do that?? Why would they start them at different times with one being retroactive for 2.5 months????
You can sign up for Part A anytime but the coverage effective date is restricted. "Your coverage start date will depend on when you sign up."
Quote:
Part A coverage begins the month the individual turns age 65, provided he or she files an application for Part A within 6 months of the month in which he or she becomes age 65. If the application is filed more than 6 months after turning age 65, Part A coverage will be retroactive for 6 months.
A person is no longer eligible for ACA exchange Premium Tax Credits (PTC) when they become eligible for Medicare Part A. It is based on eligibility for Part A, not when you want Part A to become effective.
Quote:
Instructions for IRS Form 8962:
Minimum essential coverage. Under the health care law, certain health coverage is called minimum essential coverage. Even if you have coverage purchased through a Marketplace, you cannot take the PTC for any individual in your tax family for any month when that individual is eligible for minimum essential coverage, other than coverage in the individual market. Types of minimum essential coverage include: Government-sponsored programs (including most Medicaid coverage, Medicare parts A or C, the Children’s Health Insurance Program (CHIP), and Tricare).
Form 8962, Line 10:
Example 2. Starting on August 1, Mike is eligible for Medicare and does not notify the Marketplace. Because Mike is eligible for other minimum essential coverage, their coverage family changed starting in August. As a result, Mike and Susan must update the premium for the applicable SLCSP (which changes PTC) reported in column B for the months of August through December (Form 1095-A, lines 28 through 32, column B). Since there will be a change for some months in column B, Mike and Susan must complete lines 12 through 23.
Nowhere does healthcare.gov say "access." That word comes from an unofficial site, which is why I said "fwiw." Also, that site may be talking about people over 65 without any insurance at all attempting to obtain insurance, not someone already insured under a Marketplace plan.
Healthcare.gov says, instead:Nowhere on healthcare.gov are people told they could lose their Marketplace plan if they have "access" to Medicare.
What I am questioning is the inconsistency in the statement on healthcare.gov on "you can keep your Marketplace plan until Medicare coverage starts" and the possibility you've suggested that OP might have an ACA policy which cancels at age 65 and/or loses subsidies.
If this is true, then, healthcare.gov should explain, at the very least, that age 65 (access to Medicare) - whether enrolled in Medicare or not - could trigger the loss of the ACA insurance, or, at the very least, the subsidies.
Certainly policies outside the Marketplace may have the age-65-and-out caveat - but if Marketplace policies also allow this, healthcare.gov is omitting an important Catch22.
They clearly state that you are REQUIRED to report any life events to them (healthcare.gov) and that includes turning 65. They will tell you whether or not your ACA plan will allow you to continue on that plan beyond 65 and whether you'll be eligible for subsidy (probably not). That much I am sure of.
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