Frequently Asked Questions

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LOTS OF PEOPLE HAVE LOTS OF QUESTIONS ABOUT HEALTH INSURANCE. HERE ARE SOME OF THE MORE COMMON QUESTIONS, IN NO PARTICULAR ORDER, AND ANSWERS THAT I HOPE WILL CLEAR THINGS UP FOR YOU:

The House of Representatives has passed a bill to “repeal and replace” Obamacare.  What can we expect will happen to the Individual Health Insurance Market?

Well, nothing, right now.  The House Bill has been sent to the Senate and at least some Senators have said that they want to come up with a bill of their own.  The usual course of things like this is that, once the Senate has passed their plan, a Conference Committee, made up of representatives from both Houses of Congress and both political parties, will examine both bills and come up with a compromise bill.  That bill may or may not be voted on by both Houses of Congress and, if so and if passed, will be sent to the President to be signed into law.

With the Summer Recess upon us and all of the other delays built into our political system, that process will likely take until the end of 2017, if not longer. Until then, Obamacare is still the Law of the Land.  And Anthem Blue Cross as well as Aetna, two of the biggest marketers of individual health insurance and the last major insurance companies still in that market, have already publicly stated that they are not likely to remain for 2018.  Obamacare is collapsing of its own weight.

Unfortunately, none of our elected officials have had the good sense to consult with any of us who are actually in the trenches on a daily basis and understand this topic better than anyone else.

There is a Free Market solution to this whole mess.  All health insurance companies who wish to do so should be allowed to sell health insurance to all comers regardless of a person’s health history…no exclusion for pre-existing conditions.  Those who wait until a health problem develops before they buy a plan should be required to pay more for their insurance than those who bought it before any health problems occurred.  That would require health questions be asked on the applications; not to deny coverage but to determine if extra premium needs to be charged.  If they buy a plan, collect the benefits and then drop the plan, they should be charged an even higher premium should they ever re-enroll.  There has to be a measure of personal responsibility built into this law.

All policies should have a $5,000,000 annual limit to their benefits but the insurance company’s liability should be capped at $1,000,000 per calendar year.  There are re-insurance companies that will sell coverage to the primary insurance company that will indemnify the primary insurance company for the remaining $4,000,000 but that should be the limit of their liability.  Then, if a person’s medical expenses exceed $5,000,000 in any given year, that’s when the government (Federal, State or a combination of the two) can step in and pay the rest of that person’s medical bills for the remainder of that calendar year.  Then, on January 1st of every year, the entire process starts all over again.

What about “The Poor”?  That’s a little tougher problem to solve but it’s not impossible.  First of all, no one should be denied emergency care simply because of their inability to pay for it.  An “emergency”, in the insurance language, means a threat to life or limb.  Medicaid can be reconfigured to provide funding for such indigent emergency care but only to citizens or legal aliens with Social Security numbers.  Medicaid should then be able to access IRS records to confirm that the individual in question is actually indigent.  If they qualify, Medicaid should provide the benefits for the indigent individual.  If not, then the individual should be held liable for their expenses.  Again, there has to be a measure of personal responsibility in this law.  If you have the resources to pay and have not obtained health insurance prior to your need for emergency care, you should be required to accept responsibility for your own expenses.  Those who would commit fraud should be prosecuted to the fullest extent of the law.

In short, the government should be the insurer of last resort and, even then, only after all other private insurance benefits have been exhausted.  It’s not a difficult concept to understand.

But, under no circumstances should anyone be forced under penalty of fines to buy health insurance or any other commodity.  There should be policies available that have very, very high deductibles for those people who are willing to “take their chances”.  But much smaller deductibles should be available to those who are smart enough to have insurance in place before something catastrophic happens.

Another option which is circulating is to start to phase Medicare in, slowly, for ever younger ages.  Drop the age requirement by 2 or 3 years every year until, eventually, every one is eligible.  Adding a maternity benefit and a complications of pregnancy benefit for the appropriate ages would be the only benefit additions necessary.

The trouble with this option is that it requires what the Republicans like to call a “Single Payer System” and they are opposed to that.  I’m not sure why because Medicare is a single payer system for our Senior population and it seems to be working fairly well.  Of course, the other problem with this option is that Medicare has always been under funded and opening it up to the entire country would only exacerbate that situation.  So, if this option were pursued, our government would have to stop wasting all of our money on social engineering and devote billions, maybe trillions more dollars to the healthcare of our citizenry.  Healthcare of our citizenry has, however, never been their goal.  Many people believe that control of the populace is their only goal.

What insurance will be available for people under the age of 65 in 2017?

Great question!  I wish I had a great answer.  United HealthCare, Humana and Aetna have already announced that they are leaving the under age 65 individual  market entirely in all states at the end of 2016.

That leaves just one major carrier and one regional carrier left, Blue Cross Blue Shield of Texas and FirstCare.  Both of them are offering only HMO policies.  Last year, I checked and found that, of the 1100 medical care providers in the Panhandle of Texas, there were only 59 in Blue Cross’s HMO Network.  This year there are 200; an improvement, to be sure, but the rate at which the medical care providers in the Texas Panhandle are joining Blue Cross’s HMO Network (and most of the ones who have joined are in the outlying communities, not in Amarillo proper) is so slow, it is doubtful that you will be able to find a Physician that will take you as a patient if the insurance you have is a Blue Cross HMO.

I know that the vast majority of Doctors do NOT like HMO plans.  Those plans impose too many restrictions on the Physicians and they don’t pay as well as PPO plans always did.  But PPO Major Medical plans are a thing of the past.  They are gone and I cannot foresee a time when they will ever come back.  What I fear for the Doctors is that many of them will find themselves standing in their waiting rooms with their arms folded and their foot tapping wondering where all their patients have gone if they don’t join Blue Cross’s HMO Network.

FirstCare is a great deal more popular with many of the Physicians in Amarillo but their trade territory is the Texas Panhandle, the South Plains and a few counties outside of the South Plains.  That limits you to the Physicians in those areas.  Having said that, we are very fortunate to have some of the finest medical care facilities and Providers in the entire country right here in the Texas Panhandle and the South Plains.

I wish I could have a meeting with some of the more influential Physicians in Amarillo and advise them of what the future portends.  Maybe they could come up with some ideas.

 

I signed up for Medicare and I got a Medicare Supplement policy to pay what Medicare does not pay.  Lately, I’ve had some pretty big medical expenses and, all of a sudden, I’m getting inundated with all of these bills.  Now, what do I do?

It’s hard to understand, when you first start having a bunch of medical expenses, why the bills come to you.  Let me explain it to you.  All Medicare Approved medical care providers are required by the Medicare Modernization Act, which became law in 1990, to file their claims with Medicare.  Medicare then cross files your claim with your insurance company if you have one.  While it may seem to you that all of that claims stuff should be handled by Medicare and your insurance company without involving you at all, keep in mind that every medical bill you incur is ultimately a matter between you and the medical care provider.  Their billing system, usually computerized, will continue to bill you until the bill is paid.  Medicare usually pays the provider and so do most insurance companies.  In almost every case, these bills will be taken care of but it takes a little time.  And, until a bill is taken care of, you will continue to be billed by your medical care provider’s computer.

What does the future of Medicare Part D, the prescription drug plan benefit of Medicare, look like to you?

I get asked this question a lot during the Annual Election Period (AEP), October 15th thru December 7th, because it’s on the minds of many Seniors and they’re not stupid.  They know their plans are not getting any better.  In fact, they are getting demonstrably worse…and more expensive!  What follows is the answer I give everybody that asks.

By 2020, two things are going to happen, one of which is completely unavoidable. The number of people enrolled in Medicare will be double the number that were enrolled in 2010 because the Baby Boom Generation will have, by then, all aged into Medicare. The Medicare program is already under enormous financial pressure because it has never been properly funded.  Double the load and there’s no telling what will happen.

The other thing is that the Centers for Medicare and Medicaid Services (CMS), the Federal Agency that oversees Medicare, has said that, by 2020, they will reduce the “Donut Hole” (CMS calls it the “Coverage Gap”) to a 75%/25% arrangement where the insurance companies will pay 75% of the cost of your medications while you’re in the “Donut Hole” and you will only pay 25%.

Really?

When this Medicare Part D program started, just 10 years ago, there were some 86 plans being offered by 45 different entities, mostly insurance companies. For 2016 in Texas, there only 26 plans to choose from being offered by only 13 insurance companies. This has been such a money loser for the insurance companies that they are dropping out in droves. In Florida,the last time I looked, there are only 19 plans available. The difference? Florida has a larger per capita Senior Population than Texas and the insurance companies are backing away from that high cost population.

Medicare, in an effort to keep as many of them in the program as they can, is allowing all of these insurance companies to charge Brand Name copays for many generic medications.  The insurance companies, themselves, have almost all changed their Tier 3 and/or Tier 4 (Brand Name Medications) cost share from a fixed copay to a percentage of the actual retail cost of those medications, some as high as 50%. Sadly, most of the people affected by this won’t even know it until next year when they have to start paying those larger amounts at the drug counter.  And, by then, there won’t be a thing they can do about it because the Annual Election Period ends on December 7th.  These people will be stuck in their plan until the next year.

If the insurance companies are already backing away from this coverage and structuring their plan benefits so that, in many (if not most) cases, the patients pay more for the medications than the insurance company does (is this how it was supposed to work when this Program came into being?), how can any sensible person believe that they will simply lay down and let the government dictate to them a requirement that they, the insurance companies, pay 75% of the cost of your medications while in the “Donut Hole”?  We’re down to just 13 insurance companies available in Texas now.  What’s it going to look like in 2020?

If they all eventually back out, Medicare will have to take this program over in full.  We are already $20 Trillion in debt in this country. How will our government EVER pay for this?

Can I ever disenroll from Medicare Part B and, if I do, can I get back in?

Yes and yes. But it’s a little more involved than that. Medicare part B is completely voluntary. You must pay a premium to Social Security in order to have that coverage. The minimum monthly premium is $134.00 currently. If you enroll when you first become eligible for Medicare Part B (usually on the first day of the month in which you turn 65) and then later decide to disenroll, you can do that and you must contact the Social Security Administration (National Number 1-800-772-1213) for instructions on how to do that.

Now, if you disenroll because you are going to be actively employed and covered by an Employer Sponsored Group Health Insurance Plan (ESGHIP), and then later lose that coverage, you may re-enroll in Medicare Part B, without penalty, during the month in which you lose your ESGHIP and for 8 months thereafter. Being covered by COBRA doesn’t count. Being covered by a Retiree Plan offered by your former Employer also does not count.  You must be actively employed and covered by, or about to be covered by, your Employer’s Group Health Insurance Plan.

However, if you disenroll and will no longer be actively employed and enrolled in an ESGHIP, and then later want to re-enroll in Medicare Part B, you will only be able to re-enroll during the General Enrollment Period (January 1st through March 31st of each calendar year), your coverage will not be in effect until July 1st of that same year and you will pay a 10% penalty (extra Medicare Part B premium) for each full 12 month period during which you had opted out of Medicare part B. And that is a lifetime penalty. You never lose it.

I’m confused about when I can make a changes to my insurance coverage.

This is a question that comes up almost every day. We get inundated with TV and Radio ads during the Annual Election Period (AEP), which is between October 15th and December 7th of each year, and those ads make it sound like you can’t make any changes to your insurance at any other time of the year.

That is not correct.

True, you can only make changes with regard to your Medicare Advantage plan, if you have one, or your Prescription Drug Plan, or you can change from a Medicare Supplement to a Medicare Advantage plan during the AEP, but you can change your Medicare Supplement from one plan to another, either within the company you are already with or to a new company, any time of the year if you can qualify health-wise.

If it is more than six months since you became eligible for Medicare Part B (the part of Medicare that covers Doctors Bills, Hospital Out-Patient Bills, and Rental of Durable Medical Equipment, aka DME) then you must qualify for the new policy by answering health questions on the new company’s application. But, if you can qualify, you can change your policy any time you want to. You do not have to wait until the AEP.

One quick note: If you enrolled in a Medicare Advantage plan during the AEP and you change your mind and want to get out of it, there is period of time during which you can do that… January 1st through February 14th of the year right after the year you enrolled in the Medicare Advantage plan. No questions asked. You will be returned to Original Medicare and, if the Medicare Advantage plan you opted out of contained a Prescription Drug benefit (such plans are referred to as MAPD plans), then you can qualify for a Special Enrollment Period (SEP) which will allow you to sign up for a stand-alone Prescription Drug Plan.  No penalties incurred or applied.

And, this part is important, if you dropped a Medicare Supplement in favor of the Medicare Advantage plan, and you disenroll during the disenrollment period (remember, that is between January 1st and February 14th), your old Medicare Supplement company MUST accept you back so long as they still offer the plan you left. They do, in fact, have dibs on you. However, if you don’t want to go back to either that plan or that company, and you can legitimately answer “No” to all of the health questions on another company’s application, you can change to any plan you can qualify for with any company you choose. You must exercise that option fairly quickly, though, so don’t spend too awful much time trying to make your decision. Remember, in this instance, He Who Hesitates Is Lost!

I’m about to turn 65 and qualify for Medicare. When will my Medicare coverage actually start?

In most cases, if you are aging into Medicare, your Medicare Eligibility Date will be the first day of the month in which you turn 65, not your actual birth date in that month. An exception to this is if your birthday is the first day of the month. In that event, your Medicare Eligibility Date will be the first day of the month prior to your actual birthday.

For example, if your 65th birthday is March 15th, your Medicare Eligibility Date will be March 1st. If, however, your 65th birthday is March 1st, your Medicare Eligibility Date will be February 1st. Why is it done this way?

I haven’t a clue. It’s one of the great mysteries of Medicare.

I’m not taking any prescriptions at all. Why should I buy a Medicare Part D Prescription Drug Plan (PDP)?

Although the Medicare Part D program is voluntary…you don’t HAVE to take it out…if you don’t take it out when you first become eligible for it, you’re setting yourself up for some big problems.

First, you will incur a 1% penalty (1% of the average monthly premium for all plans available nationally and, since the premiums change each year, the average of those premiums will also change) for each month you were eligible but did not take out a plan.  And the months will add up until you do take out a plan. This is called the Late Enrollment Penalty or LEP. And, keep in mind, it is a lifetime penalty. You never get rid of it. Actually, that penalty doesn’t begin until the fourth month after you became eligible for a PDP because part of your Initial Election Period (IEP) continued until the end of the third month after you qualified for Medicare.

Second, if you fail to take out a plan when you are first eligible, during what’s called your Initial Election Period, or IEP, you won’t be able to even apply for one until the next Annual Election Period, or AEP, (October 15th through December 7th of each year), and it won’t become effective for you until January 1st of the next year.  That’ll present a real hardship to you if, all of a sudden, you need some very expensive drugs.

Actually, there are some Special Election Periods (SEP’s) that you might qualify for that would reduce or eliminate that LEP. Moving out of an area covered by your plan, for example moving out of Oklahoma into Texas would be one. Going into a Nursing Home would be another. So would qualifying for Low Income Subsidy or LIS.

Barring an SEP, if you fail to enroll in the AEP immediately following your IEP, you must wait until the next AEP and, by so doing, you add another 12 percentage points to your lifetime penalty. In fact, you add another 12% for every year that you fail to take out a plan. It can get very, very expensive when you wait and wait and wait.

That penalty is not paid to the insurance company from which you eventually buy your plan. It is paid to Social Security. And, to make sure you pay it, they deduct it from your Social Security check before they deposit it in your bank account.

But, more importantly than that, what happens if you don’t take a plan out when you’re eligible and then, before the next AEP, you come down with an ailment that requires that you take some pretty expensive medication? What happens is, you pay for it yourself until January 1st of the next year, assuming that you do enroll in a plan during the next available AEP.

My advice? Think twice before you choose not to enroll when you first become eligible.  There is one plan, Humana’s Walmart Plan, that costs only $17/month in 2017.

But what if I stay on my Employer’s insurance past age 65? Will I be penalized when I leave that group and get my own Prescription Drug Plan?

No, as long as the prescription drug coverage you had with your Employer Sponsored Group Health Insurance Plan (ESGHIP) provided coverage that was at least as good as the Medicare Standard Plan, (that is called Creditable Coverage and your Human Resources or Personnel Department can tell you if it is, indeed, considered Creditable Coverage) you can join a stand alone PDP when you come off of that group coverage and the Late Enrollment Penalty will be waived. You’ll get a letter from the new plan telling you that you may be penalized if you cannot demonstrate that you had Creditable Coverage. The agent who sold your plan to you should be able to fix that for you. I do it for my clients all the time.

I have been covered by Medicare Part B for more than 6 months so I no longer qualify for Open Enrollment but my health is poor.  Is there any insurance company out there that will issue me a Medicare Supplement?

Actually, in most cases, there is.  United HealthCare, through membership in AARP, will accept some risks most other insurance companies will not.  There are still some qualifiers, however.  In Texas, in order to determine if you are insurable with them, you must be able to legitimately answer Questions 5a and 5b on AARP’s application “No”.

If you have end stage renal disease (total kidney failure) or if you are currently receiving dialysis or if you have been diagnosed with kidney disease that may require dialysis or if you have been admitted to a hospital as an inpatient within the 90 days prior to your application date, you will have to answer Question 5a “Yes” and that will disqualify you for their coverage.

Here’s Question 5A:

5A. Do any of these apply to you?
• have end stage renal (kidney) disease
• currently receiving dialysis
• diagnosed with kidney disease that may require dialysis
• admitted to a hospital as an inpatient within the past 90 days

If, however, you can legitimately answer that question “No”, then you must answer Question 5b.  If, within the two years prior to your application date, a medical professional has recommended or discussed with you as a treatment option, hospital admittance as an inpatient that has not been completed, organ transplant that has not been completed, back or spine surgery that has not been completed, joint replacement that has not been completed, surgery for cancer that has not been completed, heart surgery that has not been completed or vascular surgery that has not been completed, you must answer that question “Yes” and that will disqualify you for their coverage.

Here’s Question 5B:

5B. Within the past two years, has a medical professional
recommended or discussed as a treatment option, any
of the following that has NOT been completed:
• hospital admittance as an inpatient
• organ transplant
• back or spine surgery
• joint replacement
• surgery for cancer
• heart surgery
• vascular surgery

If you can legitimately  answer both of those questions “No”, then you will not be turned down for their coverage.  The rest of the health questions are there to help them determine what your premium will be.  Obviously, they will charge more for a person who has had any of the health problems mentioned in the health questions than they will for someone who has not had any of those problems, but they will, at the very least, insure you.

The questions in your mind then become, “How much does it cost?” and “Can I afford it?”  You can call me with no obligation whatsoever on your part for a free, no pressure quote.  You can then decide for yourself what you want to do.  That choice is always yours.

Keep a few things in mind.  First, Medicare Supplements are not subject to Obamacare so you must answer health questions (unless you’re in an Open Enrollment or Guaranteed Issue period) and you must qualify for the coverage.  And, second, unless you are coming off of another Medicare Supplement that you have had for at least six months, the AARP policy will impose a 90 day waiting period for preexisting conditions.  The good news is that the only thing they count as a preexisting condition is any health problems you have had in the 6 months prior to taking their policy out.

And, finally, you must be a member of AARP (the dues are $16 per year for a single person or a couple) to get their insurance but you do not have to maintain that membership to keep the insurance.  In fact, Medicare forbids insurance companies from cancelling a Medicare Supplement policy for any reason other than fraud or non-payment of premium.  Once your first year’s dues have run out, you can cancel that membership with no fear of losing the insurance policy.

Does Medicare cover a Chiropractor?

Yes, actually, they do.  However, Medicare will only pay for a Chiropractor to perform his or her art.  That is to say that Medicare will cover a sublaxation, what most of us call an adjustment. Medicare will not pay for X-Rays which are read by a Chiropractor.  Medicare believes that only a Radiologist can properly read an X-Ray.  There isn’t a Chiropractor I know of who isn’t already aware of this fact so virtually all of them farm their X-Rays out to a Radiologist or a Radiology Department.  Other services and supplies such as vitamins or vitamin injections are also not covered by Medicare but Medicare, for the most part, doesn’t cover those expenses anywhere else, either.

What happens to my insurance coverage if I move to another State?

In most instances, your Medicare Supplement policy will remain in force, as long as you continue to pay your premium, but the premium may change. Premiums for Medicare Supplement policies are Zip Code driven meaning that your premium is determined by, among other things, where you live. It could go up or it could go down. You can find out what changes will occur in your premium by calling the Customer Service Number on the back of your ID card and giving them your proposed new Zip Code.

The story changes, however, when we’re talking about a Medicare Advantage Plan or a Medicare Part D Prescription Drug Plan. Not all plans are available in all Zip Codes. If you move from one area of the country or, in some instances, even within the same State, you may have to cancel your existing plan and change to a plan that is available in your new residence. Such a move on your part constitutes a Special Enrollment Period, or SEP, so you will not have to pay any penalty. Your premium will likely change, too and, again, it could be higher or lower. The Customer Service people at the toll-free number shown on the back side of your ID card can tell you what it will be and, when the time comes, get you enrolled in your new plan.

What effect will ObamaCare have on Medicare Aged people?

Obamacare is for people who are under age 65 and not on Medicare. In fact, it is illegal for someone to sell you an Obamacare policy if you have Medicare.  So, Obamacare does not have any direct effect on you if you have Medicare. However, there are some indirect effects that will create problems for nearly everybody on Medicare.

The Obama Administration has taken $716 Billion out of Medicare’s funding to help fund Obamacare over the first 10 years that Obamacare is effective. By the year 2020 ,the number of people on Medicare will double because the Baby Boom Generation is aging into Medicare and the non-partisan Congressional Budget Office (CBO) has already publicly announced that Medicare will RUN OUT OF MONEY by the year 2020. Something is going to have to give.

Medicare has already announced that they are going to be reducing reimbursements to Physicians who see Medicare Advantage Patients which is causing more and more Physicians to re-evaluate whether they even want to accept Medicare Advantage Patients into their practices. Additionally, Medicare is tightening up on their coverage of ambulance bills. There is separate, stand alone ambulance coverage available and it is very reasonably priced. You can explore that coverage in the Get A Quote section of this website.

Medicare Supplement coverage will, in my opinion, serve you far and away better than a Medicare Advantage plan.

What’s the difference between an Unapproved Charge and a Non-Covered Charge under Medicare?

Those two terms sound synonymous but they are not. If a Doctor is a Medicare Approved Physician, meaning that Medicare will accept billings from that Physician, Medicare will determine the Approved Amount of any of his or her charges. (It’s the Golden Rule…They have the gold…they’re makin’ the rules!)

For example, let’s say Dr. Quackenbush charged $100 for a service he provided to one of his patients. Let’s further say that Medicare only approved $60 of that charge. That means that, if Dr. Quackenbush accepts assignment from Medicare (that is to say Dr. Quackenbush allows Medicare to pay him rather than you) he must write off the Unapproved Amount of his charge or, in this case, $40. And the patient is not responsible for that $40 Unapproved Amount of the Doctor’s charge.

If Dr. Quackenbush does not accept assignment from Medicare, he is allowed to charge you 15% above the amount that Medicare approves and you will have to pay it unless you have a Medicare Supplement (the F Plan or the G Plan) that will cover it for you. In this way, Dr. Quackenbush can recoup some of the charges he otherwise would have to eat.

A Non-Covered charge is wholly different. Non-Covered means that Medicare does not cover a charge, no matter how much or how little the Doctor charges for it. This is often seen in the case of some Radiology charges. Sometimes, Medicare does not see the medical necessity for some X-Rays because they don’t feel the patient’s diagnosis warrants that particular X-Ray. Knowing this, some Radiologists require that you sign a waiver that says you understand that Medicare may not cover one or more of the charges by that Radiologist and you agree to pay for them yourself if Medicare does not cover them.

Of course, when you’re in front of the insurance clerk at the Radiologist’s Office and she hands you some papers and says, “Sign here, here and here.” most folks just sign there, there and there, trusting that the Physician will always do what’s in your best interest. And that is almost always the case. Just because Medicare doesn’t think you need a particular X-Ray, doesn’t mean you don’t actually need that X-Ray. If your Doctor ordered it, he or she had a good reason to do so based on years of training and experience. Medicare seldom takes that into full consideration.

Think of a Non-Covered Charge like this: If your house burns to the ground, Medicare won’t pay you a dime! That’s because they don’t cover that sort of thing. That is a very good, if somewhat extreme, example of a Non-Covered Charge.

If Medicare doesn’t cover a particular charge, will my Medicare Supplement pay it?

In most cases, no. Keep in mind that a Medicare Supplement supplements Medicare. If Medicare never starts on a bill, your Medicare Supplement insurance policy won’t start on it, either.

One example of a charge that Medicare will not cover, but your policy will, is medical care rendered to you outside of the borders of the United States for an emergency. You can’t go to Cabo San Lucas to see a Specialist there for your Lumbago and expect your Medicare Supplement policy to help you pay for it. That’s not an emergency.

The C Plan, the D Plan, the F Plan, the G Plan, the M Plan and the N Plan all have a Foreign Travel Emergency Benefit. That benefit has a $250 deductible and will thereafter pay 80% of the rest of your medical expenses for an emergency occurring in a foreign country where you may be visiting, for example, up to $50,000 US. The purpose of this benefit is to get you stabilized so you can be transferred to a Stateside hospital where Medicare’s regular benefits are available to you.

What’s the difference between Non-Cancellable and Guaranteed Renewable?

The difference between these two terms is largely about the premium. A Non-Cancellable policy is one where, once the policy is issued, nothing, not even the premium, can be changed. There aren’t very many of those policies around anymore for obvious reasons.

A Guaranteed Renewable policy is one where the insurance company has to keep the policy in force as long as you pay the premium. They can make changes, including the premium (with approval from The Texas Department of Insurance) and you might decide that you don’t want to keep the policy for one reason or another but at least that will be your decision to make.

What’s the difference between Medicare and Medicaid?

Medicare is insurance, Medicaid is welfare. It’s pretty much that simple. Because of Obamacare, many more people have been added to Medicaid’s rolls, And, because Medicaid’s reimbursement rates to Physicians are so low, fewer and fewer Doctors are accepting Medicaid Patients.  This may get ugly.

What does the letter mean at the end of my Medicare Number?

If the letter at the end of your Medicare Number is an A, it simply means that your Social Security benefits are based on your earnings over your working lifetime and your Medicare Number is, actually, your Social Security Number with the addition of the letter. If the letter is a B, it means that your Social Security benefits are based on someone else’s (usually a spouse’s) earnings.

You may also notice that, if your Medicare Number ends in a B, the number, itself, isn’t your Social Security Number, but your spouse’s. If your Medicare Number ends in a D, that means that the spouse, from whose earnings your benefits are derived, has passed away.

If your Medicare Number ends in a T, that means that, while you do have Medicare coverage, you do not presently get a Social Security benefit so there is nothing from which Social Security can deduct your Medicare Part B premium. So you have to pay Social Security for Medicare Part B out of your personal funds.

Once you begin to receive your Social Security benefit, Social Security will deduct the cost of your Medicare Part B coverage from your Social Security Benefit before depositing that money in your bank account each month.

You will get a new Medicare Card and the letter at the end of your Social Security Number will have changed to an A. There are other letters that Medicare uses but these are the four most common.

I just got on Medicare but I don’t get a Social Security benefit yet. And now I’ve just gotten a bill in the mail from Social Security for over $300. What’s the deal?

The bill you got was for $365.40. That’s for the first three months of your Medicare Part B Premium. While Medicare Part A, for the overwhelming majority of us, costs nothing, Medicare Part B costs you a minimum of $121.80 per month. Once you pay this bill and the three months have past, Social Security will bill you monthly until you start receiving a Social Security benefit and then they will deduct that premium from your Social Security benefit prior to depositing that money in your bank account.

You may have to pay more than $121.80 per month depending on how large your income is, For more details on that, go to “What is Medicare Part B and How Does It Work?” at the top of the Home Page and look for the discussion on IRMAA (Income Related Monthly Adjusted Amount).  Also, check the chart on “What Is Medicare Part D and How Does It Work”.

When I sign up for a Medicare Part D (Prescription Drug Plan), will I get a new Medicare Card that shows the effective dates of Medicare Part A, Part B and Part D?

No, your Medicare Part D coverage is sold to you by private insurance companies and they will issue you an ID card for the plan you purchased from them and it will have its own ID Number, separate and apart from your Medicare Number.

And, remember this: During your Initial Enrollment Period, or IEP, whatever Prescription Drug Plan you sign up for, you are stuck with it until the next Annual Election Period, or AEP (between October 15th and December 7th of each year).

During the AEP you can sign up for as many different PDP’s as you want to but only the last one you sign up for will be the plan you keep for the upcoming calendar year.

What’s the difference between an F Plan Medicare Supplement and a G Plan Medicare Supplement?

The F Plan covers the Medicare Part B (Doctors, Hospital Out-Patient and Rental of Durable Medical Equipment or DME) deductible (in calendar year 2016, $166), the G Plan does not. The premium for the G Plan is often so much cheaper than the F Plan that it saves you more in premium than you lose by having to pay the deductible out of your pocket with the G Plan. In other words, it doesn’t make much sense to pay $400 or more to cover $166! Otherwise, the plans are identical.

Which Obamacare policy is better for me, a plan that provides copays for prescriptions and office visits or a high deductible that has no copays?

A lot depends on your own personal circumstance. If you have small children, you may want a policy that provides for copays for Doctors office visits and prescriptions but just be aware that this kind of insurance is very expensive. In most cases you will spend $200 to $300 per month more for that kind of insurance than you would spend on a plan that does not have copays.

If you would be spending that amount on office visits and prescriptions each month, and I mean each month, it would probably make sense to have that kind of policy. If not, then it might make more sense to have true catastrophic coverage, (which is a lot less expensive), put the premium savings in the bank and use it to cover your deductible as you incur it.  That’s the way HSA (Health Savings Account) policies work for people under the age of 65 and not qualified for Medicare.

If I buy a Medicare Supplement and pay an annual premium, can I quit that policy in favor of another one before that year is up? And, will any of that annual premium be refunded to me?

You can quit any policy any time you want to but, if you quit a policy in its first policy year and you have paid any advance premium, no premium refund will be available to you. It is my understanding that this is because of premium taxes the insurance company has to pay to the State of Texas in the first policy year. Those taxes, once paid, are not refundable to the insurance company by the State of Texas so the rule is, the insurance company doesn’t have to refund any premium money you paid them in the first policy year.

But, once the policy is a year old, if you have paid for another advanced period and you cancel the policy before that period is up, a refund of the unused portion of your premium, called unearned premium, is available. However, it must be requested. It is not customarily done unless you ask for it and any such request should be made in writing.  The Customer Service address is usually found on the back side of your ID card from that insurance company.