Parallelograms and Health Insurance
My kids always talk about how they didn’t learn practical stuff in school — such as how to file their taxes. This summer, I saw the perfect sign in a store: “Good thing I learned about parallelograms in school instead of how to do my taxes. That really comes in handy during parallelogram season!” I modified the sign a bit in the photo to the left.
I can’t stress enough how important it is to take some time to learn about how your health insurance works and how Medicare works!
I wish there was a required class to learn about health insurance and Medicare! It sure would make open enrollment season a lot easier for health care consumers!
Some of the calls/emails I’ve received in the past few weeks:
1. “I just found out my dad was talked into switching to a Medicare Advantage plan last year. How can we get his old Medicare supplemental insurance back ASAP?”
2. “I thought my new doctor was in-network but I didn’t confirm that and he’s out-of-network and now I have a huge bill. Can you help?”
3. “Medicare pays for long-term care, right?”
2. Try to negotiate a lower amount but only see an in-network doctor from now on.
3. That’s a hard no.
I can’t stress enough how important it is to take some time to learn about how your health insurance works and how Medicare works! A few tips about using your health insurance:
#1 STAY IN-NETWORK. That’s pretty clear. Know your network. Choose doctors and hospitals that are in the network. Don’t rely on the online provider directory from your health insurer’s website — those are notoriously out-of-date and filled with errors. Call your provider to confirm and call the health insurer to confirm. Take notes about who you spoke with and ask for a reference number for the call to the insurance company.
#2 Look over the plan documents and understand what’s covered, what isn’t, and what your costs are in different situations — e.g., going to immediate care vs. the emergency department.
#3. Generics can save you money on prescriptions.
#4. Make sure you understand the rules for pre-authorization. Err on the side of caution: call your health insurance company to confirm even if your provider tells you you don’t need pre-authorization or they took care of it for you.
#5. When a test or procedure is recommended, ask questions. Why do I need this? What will it cost? What information will it give you that you don’t already have? Imaging tests (e.g., MRIs, CT scans) are generally most expensive in the hospital versus an outpatient facility.
#6. For elective tests and procedures, be strategic about when you get them — before or after the new year depending on whether you have met your deductible or not.
Specific to Medicare:
#1. DO NOT switch plans — or switch from Original Medicare to Medicare Advantage — without having someone you trust look over the information. While you can switch between Original Medicare and Medicare Advantage each fall during open enrollment, you may not have “guaranteed issues rights” to get a supplemental policy at that time or at a later date. Tell everyone you know who is on Medicare not to switch plans without careful consideration and a second opinion from a family member or friend (or patient advocate!)
#2. Medicare does not pay for long-term care. Period. It will pay for UP TO 100 days in skilled nursing/rehab in specific situations. After that, you’re on your own.
#3. Medicare’s annual fall open enrollment season starts October 15th. The commercials, mailings, etc from insurance companies/agents are about to ramp up exponentially. Remember: if something sounds too good to be true, it usually is. Please do not make any changes to your Medicare without reviewing your options with someone you trust — some changes have lifetime ramifications!
There’s so much to know about Medicare. I have a great presentation which helps people to understand their Medicare coverage. Contact me at Gayle@InTuneHealthAdvocates.com to schedule this presentation (in-person or on Zoom) for your organization or even for a group of your friends.
Bottom line: We aren’t taught about health insurance in school or anywhere else. It’s up to us to learn how the system works. But you still need to understand parallelograms to pass geometry.