The Medicare Q&A
Mutual of Omaha understands that things can get confusing when it comes to Medicare. To help you get the information you need, we’ve launched The Medicare Q&A, a recurring feature where we answer some of the most common Medicare questions.
Q: What kind of out-of-pocket expenses does Medicare supplement insurance help cover?
A: Medicare provides essential health care coverage for millions of Americans, but it’s designed to only cover 80 percent of medical expenses. Medicare supplement insurance — also known as “Medigap” — is designed to help cover the remaining 20 percent.
Medicare supplement insurance primarily helps cover your out-of-pocket costs. It helps pay for:
If your circumstances require you to visit the doctor frequently or you need routine medical services as part of a treatment regimen, out-of-pocket costs can be substantial. Medicare supplement insurance can go a long way toward helping to make those shared costs more manageable.
When shopping for Medicare supplement insurance, it’s important to note that the plans are standardized. There are 10 plans, and by law, the coverage provided under each plan is the same from company to company, though the prices offered by each company can be different.
(Please note that if you live in Wisconsin, Massachusetts or Minnesota, Medicare supplement insurance policies may differ. Visit medicare.gov to learn more.)
What the different plans do have in common is a focus on helping cover copays and deductibles that aren’t covered under Original Medicare. Medicare supplement insurance plans are specifically designed to work with Original Medicare, and you must have Original Medicare to sign up for a Medicare supplement policy. You do not need a Medicare supplement insurance policy if you are enrolled in a Medicare Advantage plan.
Q: Does Medicare cover vision care?
A: Medicare is designed to help cover services that are deemed medically necessary. For the most part, that does not include vision care or dental coverage.
When it comes to vision care, Original Medicare does not offer comprehensive coverage. Routine vision care — eye exams, prescription glasses or contact lenses — is 100 percent out of pocket. (An exception is if you have a medical condition that requires custom eyeglasses or contact lenses.) Medicare may pay to cover diseases of the eye — things like glaucoma, diabetic retinopathy, cataracts and macular degeneration — especially if there is an underlying health reason for the vision impairment (diabetes, for example).
Medicare supplement insurance plans do not cover standard vision care or glasses; however, some plans do offer vision discounts on services and eyewear.
There are other Medicare plans that can help cover standard vision care. Some Medicare Advantage plans (available through private insurance carriers) offer coverage for standard vision testing, as well as glasses or contacts. The specific vision benefits that are covered depend on where you live and on the specifics of your plan.
Q: Are all Medicare supplement plans the same?
A: Medicare doesn’t cover everything. While it does cover 80 percent of health care costs, the remaining 20 percent of costs can add up, especially if you’re in the position of using medical services more than other folks (that’s why Medicare supplement insurance is also called “Medigap”).
Medicare supplement insurance helps cover things that Original Medicare doesn’t, like copays, deductibles and coinsurance. It does all this with a monthly bill you can plan for, rather than pay out of pocket for a bill you hadn’t budgeted for. Medicare supplement insurance helps give you more flexibility and peace of mind than stand-alone Original Medicare.
Medicare supplement policies are not a part of the federal government’s Medicare program, but are instead sold by private insurance companies. By law, the benefits provided under each Medicare supplement plan are standardized for all companies, though the costs of the policies may be different with each provider. For example, Plan A will give you the same benefits no matter which company you choose, but the costs can vary depending on your choice.
Despite that standardization, not every insurance company offers the same menu of plans. Each company can decide which Medicare supplement insurance plans it offers, though in some states, there are laws that stipulate insurers have to offer basic benefits.
Q: Can I get a Medicare Part D late-enrollment penalty removed?
A: First, let’s make clear how the Medicare Part D late-enrollment penalty works. According to Medicare.gov1: The late-enrollment penalty is an amount added to your Medicare Part D monthly premium. You may owe a late-enrollment penalty if, for any continuous period of 63 days or more after your initial enrollment period is over, you go without one of these:
- A Medicare prescription drug plan (Part D)
- A Medicare Advantage plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage
- Creditable prescription drug coverage (prescription drug plans — for example, from an employer or union — are considered “creditable” when they meet or exceed the Centers for Medicare and Medicaid Services (CMS) Standard Medicare Part D Prescription Drug plan)
Your initial Medicare enrollment period occurs when you are eligible to sign up for Medicare for the first time. This seven-month period includes the three months before your 65th birthday, the month that you turn 65, and the three months after your 65th birthday month.
There is a process for reviewing late-enrollment penalties — it’s called “reconsideration.” Start by requesting information from your Part D drug plan sponsor on how to initiate a reconsideration.
Your Part D drug plan sponsor will send you a form to fill out and return. The form lists the reasons a person can ask for and get a review of their case. You must submit the form within 60 days of the date on the letter from your provider notifying you that you owe a late-enrollment penalty. Also, you’ll need to send proof that supports your case, such as a copy of your notice of creditable prescription drug coverage from an employer or union plan.
If Medicare determines there was an error with all or part of the late-enrollment penalty, they will remove or reduce your penalty. Your Part D plan sponsor will send you a letter that shows the correct premium amount and explains if you’re entitled to a refund. If Medicare decides that your late-enrollment penalty is correct, Medicare will send you a letter explaining this decision, and you will be obligated to pay the penalty.
Q: When is the Medicare open enrollment period?
A: Medicare’s open enrollment period for 2021 coverage is October 15 to December 7, 2020. During this time, anyone already enrolled with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs.
You should review the information about your Medicare health plan (Original Medicare, Medicare Supplement or Medicare Advantage) or Part D prescription drug plan to see if there will be changes in the upcoming year and if the plan still meets your needs. If you’re satisfied with your current plan and don’t want to change to another plan, you don’t need to do anything — your current plan will stay in effect.
Remember, the open enrollment period is the only time you can change Medicare Advantage and Part D prescription drug plans. If you have a Medicare Supplement plan, you can switch at any time, but may have to answer health questions (known as underwriting) to qualify for a new plan.
Information for next year’s plans will be available beginning in October at Medicare.gov.
Q: How much does the average Medicare recipient pay out of pocket for medical expenses?
A: According to a Kaiser Family Foundation report (Medicare Current Beneficiary Survey, 2016), the average Medicare beneficiary paid $5,460 out of pocket for medical expenses in 2016, including premiums as well as out-of-pocket costs. Medicare beneficiaries who had no supplemental coverage paid $7,473 out of pocket for medical expenses. People who had Medigap coverage (a Medicare Supplement or Medicare Advantage plan) paid an average of $6,621 out of pocket, while beneficiaries with Medicare and Medicaid spent the least out of pocket, paying an average of $2,665 in 2016.