When individuals are enrolled in Medicare Part A & B, they are very protected. Original Medicare and the insurance products that accompany it, can work very well together and can be very comprehensive. Once enrolled in Medicare there are very few pre-existing limitations situations we need to worry about.
Your potential medical cost liability is dependent on the additional products you added onto Medicare. Original Medicare and a Medicare Supplement Plan cover almost all your costs. Original Medicare is a comprehensive national insurance product that allows you to go to the doctor when and where you like. The Medicare Supplement Plans pick up all or most of those deductible and co-pays depending on the plan you enroll in.
Some individuals who have Original Medicare and chose to enroll in a Medicare Advantage Plan. In this situation you also have useful coverage. The Medicare Advantage Plans have co-pays and deductibles that you are responsible for. Each plan has a Maximum Out of Pocket expenses you will pay, as long as you use participating providers for the plan. In 2021 the Maximum out of Pocket is; for HMOs $7,550, for PPOs as much as $11,300. This annual amount, is a LOT of money, but when you think of how many hundreds of thousands of dollars some procedures can cost, it is a pretty low cost share.
You don’t want to spend that much year after year of course. But it is important to remember that you can CHANGE your insurance, especially if what you have doesn’t fit your situation any more.
The opportunities to change your insurance are called Annual Enrollment Periods (AEP) and Special Enrollment Periods (SEPs). January, February and March is the Medicare Advantage AEP, so right now you can switch your insurance if you wish and your new coverage would begin 4-1-21.
The SEPs are special circumstances or situations that allow you to change your mind and enroll in a different insurance product. There are 19 different SEPs when enrolled in Medicare. Medicare enrollees have access to some great insurance coverage options.
These SEP’s may give you the freedom to make a new choice when and if that becomes necessary. I cannot guarantee everyone can always change their insurance coverage immediately. But I can say you could have some opportunities to change your choice now and at the very least once annually, during October 15th to December 7th. Even in situations where I have worked with an individual who may not have the perfect plan right now, we can breathe easy knowing there could be SEPs to use or AEP each year to find a better more appropriate plan for next year.
The list of 19 SEPs are for pretty specific situations, but one of these could allow you to change your insurance plan. The most commonly used SEPs are having EPIC (the New York State Pharmacy Assistance Product), or leaving a group plan (like an employer group plan or retiree group plan), or going into or out of a Skilled Nursing Facility (like for rehab after a stroke, knee replacement or hip fracture), or moving to a new location, (different county or state).
If your situation has changed because of illness, or other circumstances and you want to know what can be done to improve your situation, please call and ask for help! If you are not sick, it’s important to know that you can change your coverage in the future if you need to. Your insurance can be adjusted to find a better fit for what you need.
When you have Medicare you have great insurance, place your worries in a jar and put it on the shelf! Life is a wonderful thing. We need to celebrate what we have! We need to celebrate today because we have it!