A red flag went up as the couple talked about their Medicare insurance. Each had a Medicare Advantage plan that covered only medical expenses because, she said, they were in good health and didn’t need prescription drug insurance.
They were speaking with a Senior Health Insurance Benefits Assistance (SHIBA) volunteer counselor. Both wife and husband had been Medicare beneficiaries for years and, he acknowledged, at some point might encounter health conditions requiring drug insurance.
The insurance decision they made years ago – to forego drug insurance – could be a costly one, albeit one that they thought reasonable at the time. It’s also evidence of the value of learning as much as possible about Medicare’s mechanics, benefits and penalties.
In this instance, if they elected to enroll in Medicare drug insurance they would each face a lifetime late enrollment penalty for failing to have had the insurance. The SHIBA counselor suggested that the late enrollment penalty for each of them might be $25 or more a month, and said they could obtain a better estimate from Social Security.
But this story of an expensive mistake may have a happier outcome. If the couple met requirements for limited income and assets, they would qualify for a benefit called Medicare Extra Help (also known as Low Income Subsidy). With that benefit they could escape the late enrollment penalty. They said they believed they would qualify, and planned to round up their income and assets data.
If you would like to make an appointment with a Senior Health Insurance Benefits Assistance (SHIBA) volunteer counselor, or to ask a question to be answered here, please see the end of this column.
I’m 66, plan to retire in the spring, and will make a SHIBA appointment to learn what I can about Medicare and insurance. Do I need to do anything to prepare for a SHIBA meeting?
You don’t have to prepare, but you will find the SHIBA encounter more valuable if you do. Here are three things you might do.
- Have available a list of any prescription drugs you take including dosage and frequency. This is essential.
- It would be helpful to ask your doctor’s office two insurance-related questions. First, what Medicare Advantage insurance plans does the doctor accept? Second, in case you consider Medicare supplement (Medigap) insurance, will your doctor bill Medicare? Knowing answers to these questions will be really helpful in knowing what insurance types would work for you.
- If you have your Medicare card, have it available in case you decide to enroll in insurance while meeting with the SHIBA counselor. (The SHIBA counselor will have no need for your Medicare number, however, unless you are enrolling in Medicare insurance.)
You have written about times when insurance companies are required to sell a Medigap policy. But I’m more interested in Medicare Advantage insurance. When can I be assured of being able to get this insurance, and when can they refuse me?
True, companies offering Medicare supplement (Medigap) insurance may refuse to sell a policy (or may charge a higher premium) if a person falls outside of times when policy issuance is guaranteed. Guaranteed issue for Medigap occurs most often during the first six months that a Medicare beneficiary has Medicare Part B (also when a person receiving SSDI benefits turns 65).
By contrast, Medicare Advantage plans accept any Medicare beneficiary. The premium is the same for everyone regardless of age or health status. Before enrolling, though, it’s important to check whether the plan covers your prescription drugs and whether your doctor(s) accept the plan.
Jim Sellers of Salem is a certified Medicare counselor with the Senior Health Insurance Benefits Assistance (SHIBA) program. To ask a question to be answered in this column, e-mail [email protected]. To schedule a free SHIBA phone, Zoom or in-person appointment with a volunteer Medicare counselor, call 800-722-4134.
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