Stay On Top of Your Coverage: Tips For 2021
While working with clients who are newly enrolled in Medicare or accessing health insurance via the Open Market and/or from employers, we identified common themes in the advice we offer. I share those themes below, in the hope that it will get your new plan year off to a smooth start!
Make Sure You Know How To Pay Your Premiums.
This may seem like common sense, but please be sure to pay your premiums! Just as every insurance product is different, so are the processes by which premiums can be paid.
For some, a monthly paper bill is received and must be paid by a certain date. For others, coupon books are sent, and it’s up to you to remember. For still others, some form of electronic payment is possible*.
[*If you sign up for a form of automatic payment — it will take time for bank deductions to begin. During this time, you may be required to continue making payments, so be sure to understand and follow the insurance company’s requirements.]
Whatever the specifics, make sure to create a plan for payment and follow it. See below for more detail on how payment works…
Premium Payment Options for Medicare:
Unfortunately, there are several entities involved, each of which requires separate payment:
Medicare Part B premiums and Medicare IRMAAs (Income Related monthly Adjustment Amounts) for Part B and Part D
Premiums can be deducted from your Social Security benefit, if you are receiving one.
Premiums can be paid after receiving a paper bill. (These can be very confusing initially, as they are processed by different systems and do not arrive together.)
Premiums can be paid via your “My Medicare” portal.
Premiums can be deducted automatically from a checking or bank account via Medicare Easy Pay.
Regardless of which method you use, we highly recommend that everyone on Medicare enroll in a “My Medicare” account for viewing bills online and making quick electronic payments.
Paying Premiums for Medicare Part D Prescription Drug Plans or Medicare Advantage Plans:
Premiums can be deducted from your Social Security benefit, if you are receiving one.Premiums can be paid after receiving a paper bill or coupon book.
Premiums can be deducted automatically from a checking or bank account, or set up as a recurring payment from a credit card. (Note that electronic payment requires enrolling in the Part D plan’s member portal, which can be valuable in any case for reviewing claims and medication costs.)
How to Pay Premiums for Medicare Medigap/Supplement Plans:
Premiums cannot be deducted from your Social Security benefit. Premiums can be paid after receiving a paper bill or coupon book.
Premiums can be deducted automatically from a checking or bank account, or set up as a recurring payment from a credit card. (Note that electronic payment requires enrolling in the Medicare Medigap/Supplement plan’s member portal, which can be valuable in any case for reviewing claims and benefits.)
Premium Payments For Open Market Plan Policies:
On most plans, you are not given much of a grace period before you may be disenrolled from the plan for non-payment. Reinstatement can be tedious, sometimes even impossible, which could leave you without insurance until January 1 of next year!
As we have mentioned in (many!) previous newsletters, setting up a member portal on your plan’s website is valuable for payment, for reviewing claims and benefits, and for asking questions.
Paying Employer-Sponsored Health Insurance Plan Premiums:
Typically, your contributions to premiums are made via payroll deduction. Even so, be sure the amounts deducted are accurate and reflect the choices you made during Open Enrollment season.
Make The Call To Medicare Coordination of Benefits.
If you are newly enrolled in Medicare and all of its associated products, you should contact the Medicare Coordination of Benefits (855-798-2627) the week Medicare and the associated products become effective/primary for you. You want to make certain the Medicare system shows Medicare as your primary insurance and your Medicare Supplement as secondary.
Follow the prompts and provide the information requested. The system will then provide a response — the response you want to hear is “Medicare is primary” for Part A and Part B. If you hear anything else, follow the directions to get to a live person and explain that Medicare should be primary as of a specific date.
If you do not take this extra step, in addition to notifying your healthcare providers that Medicare has become primary for you, bills could be inadvertently sent to your previous insurer, be denied, and cause administrative hassles that you will need to troubleshoot later on.
What If You Made a Change to Your Health Insurance...
Three things: First, be sure that your previous insurance company is notified that your plan was discontinued as of midnight the day before your new coverage begins.
Second, be sure you receive your new plan’s identification card and share it with your healthcare providers and pharmacy, so they know to bill the appropriate health insurance company.
Third, remember to put copies of your new insurance cards in your Grab-n-Go Kit!
Understanding Benefit Levels.
Every January, we receive lots of calls from clients who are surprised by how large the out-of-pocket costs are for their prescription refills. Most often, it’s because the deductible — which resets to zero on January 1 — has not yet been met. Many generic medications are not subject to a deductible, but for those that are, the out-of-pocket costs can be significant.
Make sure as well to pay special attention to plans that require staying within a network of providers and/or require prior authorization, have quantity limits, or employ step-therapy protocols for prescription drugs. Understanding how these requirements work can prevent confusion and aggravation as you begin to use your plan.
I understand, it’s a lot to manage. But as we write often, it’s important to stay informed and be proactive about your health insurance benefits. Doing so will ensure that your year is off to a strong start, providing you with the coverage you need and with limited surprises!