Caroline Mayer, Author at �鶹Ů�� Health News

Turning 65? 9 Tips For Signing Up For Medicare

Caroline Mayer — Tue, 07 Oct 2014 07:41:05 +0000

This KHN story also ran in . It can be republished for free. (details)

“Welcome to America’s hottest talk line. Ladies, to talk to interesting and exciting guys free, press 1 now. Guys, hot ladies are waiting to talk to you . . . .”

Wait! I thought I was calling Social Security to ask a question about enrolling in Medicare.

It’s the first hour of my mission to sign up for Medicare and already I’m making mistakes. In this case, it’s minor (and amusing), misdialing the toll-free number by one digit. But it serves as a warning: There are many missteps I can make, some of them serious, if I’m not careful.

Even for me, a consumer reporter who has written about health-insurance issues, enrolling in Medicare is a daunting task. The terminology is confusing and the options are seemingly infinite, based on the amount of promotional material that’s begun arriving in my mailbox. The letters from various insurance carriers began appearing exactly six months before my 65th birthday and after three months they weighed 1.5 pounds. More packets arrive daily. Medicare experts tell me I can thank the data brokers for the onslaught: Names and birth dates are for sale to anyone.

Enrolling is a task I’d like to put off, but I can’t. I no longer have job-based insurance, and my current health insurer has notified me that my policy will soon expire, on the first of the month in which I turn 65.

I know that the decisions I make may differ from those made by friends, relatives and even my husband. Yet we share many of the same frustrations in the sign-up process. For anyone in a similar situation, here are some of the lessons I’ve learned since I embarked on my Medicare sign-up mission.

Just do it!

Yes, Medicare is complicated, but turning 65 is the time to deal with this. The government will not automatically enroll you, unless you are already drawing Social Security benefits.

You may be like many people who have chosen to delay receiving Social Security payments until at least age 66 to ensure the full monthly payout. But you’ll be sorry if you do the same for Medicare, because there’s a very strict enrollment period that runs from three months before your birthday to three months after you turn 65. If you miss that, you will be penalized, unless you have health insurance through your job or your spouse’s job.

First stop: Medicare, with its helpful Medicare.gov website and its “” booklet, available through the mail or online. Medicare is also easy to reach by phone (as long as you dial correctly) at 800-MEDICARE. If there’s a long wait to talk to a representative, you can leave your number and someone will call you back. Really. It worked for me.

More information — and even one-on-one guidance — is available from your (SHIP), a federally funded, free counseling service.

Get to know the lingo.

Unless you understand how Medicare is structured, you may not be able to make good decisions about what you’re buying. These are some of the terms you might see:

— of traditional Medicare covers inpatient hospital services, skilled nursing home care and hospice, among other things.

— of traditional Medicare helps cover preventive care and physician and outpatient services, among other things.

— plans are private insurance plans covering prescription drug costs.

— is an alternative to traditional Medicare. In this program, private insurance plans are paid by the federal government to provide coverage that is equivalent to original Medicare.

— Private supplement traditional Medicare and help pay some out-of-pocket costs, such as co-payments and deductibles and sometimes emergency medical expenses overseas. These policies are optional, but if you want one, you’re best buying it when you sign up for traditional Medicare. Otherwise, you won’t be guaranteed coverage and may be subject to medical underwriting, through which you could be denied coverage or charged a higher rate for preexisting conditions.

Failing to sign up can be costly.

You may be in for a surprise if you’re among the many baby boomers I’ve encountered who believe Medicare is free. It’s not. Not only is there an annual deductible ($147 for Part B in 2014), but there are also monthly premiums, ranging from $104.90 to $335.70 for individuals. (The exact premium is pegged to your income, generally based on the tax return you filed two years earlier.)

If you don’t sign up in your initial enrollment period or when your job-based coverage ends, you will pay a penalty that will raise your premiums for Medicare Part B and Part D for the rest of your life. Every year you delay signing up for Part B, your monthly premium rises by 10 percent — and missing the deadline by just one month is considered a one-year delay. There is also a waiting period for the coverage to kick in, so you could be without any insurance for several months, perhaps even a year, if you miss the deadline. For Part D, the penalty is 1 percent for every month’s delay. So a year’s delay would add 12 percent to the monthly drug premium base, currently set at $32.42.

Don’t make assumptions.

Perhaps the biggest mistake you can make is assuming that your health insurance will stay the same when you turn 65. Retiree plans can end, and even coverage from some workplace plans ends, especially if you or your spouse is employed by a . You also need to apply for Medicare at 65 if you are on COBRA, the program that allows you to purchase health coverage offered by your employer if you’ve been laid off. You also need to apply even if you are entitled to the military’s Tricare coverage for life.

Don’t rely solely on advice from your spouse or close friends. “You need to look at your own medical needs: doctors, hospitals, drugs,” advises Jennifer Whittaker, operations supervisor for Allsup Medicare Advisor of Belleville, Ill., a company that provides enrollment advice for a fee.

‘Open enrollment’ may be a misnomer.

Once you’ve signed up for Medicare, you should be notified each fall about an open season that allows you to switch plans. But the open enrollment period allows easy switching only for certain plans, not all of them — and that may affect what you do when you turn 65.

Open enrollment does not give you a free pass to move from one Medigap plan to another, for instance. Although some plans (and some states, like New York) do guarantee the ability to make a change, Medicare allows plans to evaluate your health if you try to switch. So if you’ve developed an illness, you may be rejected or face a sharp rate increase. (If you stay with your existing plan, your rates can always rise — but only if they are rising for the plan or group as a whole.)

“If you didn’t pick a benefit you wanted initially, you may not be able to get it in the future,” says Diane Omdahl, co-founder of 65 Incorporated, another for-fee consulting firm based outside Milwaukee.

That’s also the situation you could face if you want to change from a Medicare Advantage plan to traditional Medicare with a Medigap plan. One of Omdahl’s clients who was on a Medicare Advantage plan recently developed diabetes, and he concluded that switching to traditional Medicare with Medigap would work better financially. But his diabetes kept him from finding an affordable Medigap plan. If he had signed up for traditional Medicare with a Medigap plan, he would not have been charged extra when he subsequently developed diabetes.

So what does open enrollment really mean? If you’re on a Medicare Advantage plan, you can switch to another plan. You can also switch Part D drug plans annually. And since both Medicare Advantage and the drug plans change premiums, benefits and providers regularly, it’s important to review your plans yearly.

Consider your health over the long term, not just how you feel now.

Since it may not be easy to switch Medigap plans in the future, many Medicare advisers suggest that if you are choosing a Medigap policy, buy the best coverage you can afford when you sign up.

The cheapest price is not necessarily better.

Consider more than the cost of the premium when you sign up for a Medicare Advantage or Medigap plan. Look at co-payments and deductibles, too. The cheapest premium might not provide you with the cheapest overall plan. Also, review a company’s complaint records as well as its financial stability to hopefully ensure that it will be around as long as you plan to be.

For Medicare Advantage plans and drug plans, the Centers for Medicare & Medicare Services (the agency that runs Medicare) provides a helpful five-star rating system based, in part, on member satisfaction surveys.

Customer satisfaction ratings for Medigap plans are harder to find, but one valuable site for me was for Medigap issuers. (Many of the companies on this list operate nationwide.)

Several companies rate the financial strength of insurance carriers, although you may have to pay to get information. Two of the most frequently cited rating firms are and , neither of which charges for basic information.

Make calls and ask questions; you’d be surprised by what you learn.

Once you pick a plan, call and confirm its different points, such as the premium and out-of-pocket limits,” Omdahl advises. “It’s rare, but sometimes the information online isn’t accurate.”

You may also discover added discounts. After I narrowed my search to two Medigap companies, I learned that if I went with the plan that my husband used, we’d both get a 5 percent discount on premiums. None of my research mentioned a “household discount.”

Don’t be afraid to seek help.

In addition to advice from Medicare and your state’s health-insurance assistance program, tools that helped me included the National Council on Aging’s , AARP’s and the fact sheets. Consumer Reports “” article also is a valuable primer.

You might also consider seeking advice from an independent insurance agent. But remember, these agents typically talk only about the plans they offer – and they usually receive a commission on the policies they sell.

There’s also a growing list of firms that will help you for a fee. These include:

— , with a fee of $299 for an initial enrollment consultation, $499 for a couple.

— , charging $500 to $850 for a complete initial assessment.

— , with a $585 initial consultation, $195 more for each additional hour.

— , with consultation fees ranging from $750 to $1,250.

This article was produced by Kaiser Health News with support from .

�鶹Ů�� Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at �鶹Ů��—an independent source of health policy research, polling, and journalism. Learn more about .

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Turning To The Web To Help Pay Medical Bills

Caroline Mayer — Tue, 02 Jul 2013 06:00:00 +0000

This story was produced in collaboration with

Even with Stage IV lung cancer, there are moments when 32-year-old Chip Kennett feels blessed. Over the course of two weeks in April, those moments were many, as 325 friends and family members contributed $56,800 over the Internet to help defray his out-of-pocket medical costs.

The Kennett family shows the “Team Kennett” wristbands a family friend made for them and their friends to show support for the family (Photo by Alison Hathaway of Red Shoes Photography/For KHN).

Kennett’s wife, Sheila, says she was overwhelmed by the generosity. We “kept saying how lucky we were!” she wrote in her blog Team Kennett. “Now just how messed up is that?”

The Kennett family of Alexandria is one of thousands turning to the Internet to raise money for medical bills. The sites that host these campaigns operate much like online business fundraising sites such as . It takes only a few keystrokes for a family to set up a Web page, where they tell their story and state a fundraising goal; later, they can spread the word on social media sites such as Facebook. Donations can be made with credit cards or via PayPal.

The contributions, which can be given by name or anonymously, typically range from the very small (as little as $5) to the extremely generous ($1,000 and up). In the Kennetts’ case, donations ranged from $10 to $2,000. Most sites are for-profit and charge a fee, between 3 and 12 percent of the money donated, to cover the processing costs and the expenses of running the Web site. , the site the Kennetts used, charges 7 percent.

The Kennetts acknowledge they are lucky to have good health insurance. (Sheila has a federal employee policy through her job at the Senate.) Even so, the Kennetts have paid thousands of dollars in out-of-pocket expenses, including the insurance plan’s co-pay requirements and its $5,000 annual deductible ($7,000 for out-of-network doctors) for both 2012 and 2013. They also face large bills for their share of medication costs, including $485 a month for a blood-thinning injection that Chip, who works for a defense firm, needs daily and $480 a month for a bone-strengthening injection.

There are also the travel expenses for Chip’s overnight trips to Philadelphia, often weekly, where he is enrolled in a clinical trial. Since Sheila accompanies him, there’s the extra cost of child care for their children, Joe, 3, and Crosby, who was born six months ago.

The Internet fundraiser has helped alleviate some of those concerns. But perhaps more significant, it has boosted the family’s morale.

“I could be having a bad day and be really down,” says, Chip, who was caught off guard by his diagnosis since he had not been a smoker. “I’d go check the Web site. It was inspiring to check the dollar figure and the notes from friends. I’d find new notes from friends I hadn’t talked to forever. It provided emotional comfort that was extremely uplifting.”

Getting Lots Of ‘Hugbacks’

The Kennett family walks in Old Town Alexandria, Va. (Photo by Alison Hathaway of Red Shoes Photography/For KHN).

Medical fundraising sites are growing in number and profitability. In the first 12 months after it launched in 2008, GiveForward raised $225,000 for 359 campaigns; this year, it raised more than $20 million for more than 15,000. Company officials said GiveForward had more than $1.4 million in revenue in 2012 and has raised more than $47 million for families since it began.

Other sites have sprung up over the past five years, including , , and . Unlike GiveForward, these sites also raise money to help pay for tuition, travel, disaster relief, pet medical care and funeral costs.

Some medical institutions and associations are joining in. The nonprofit Rare Genomics Institute, for example, was created two years ago to help families raise money to sequence genes of patients with rare genetic diseases, a process that generally costs about $10,000 and is rarely covered by insurance.

When it launched, GiveForward also raised money for other causes — “scholarships, art projects, whatever,” says co-founder Ethan Austin. But the “hugbacks” — calls or messages from users — from medical fundraisers were so appreciative, “we decided, ‘Why do anything else?'”

Austin says he is not surprised at the rapid growth of crowd-funding for medical costs, citing a 2011 National Bureau of Economic Research study that found that half of American adults say they would not be able to come up with $2,000 in the event of a medical emergency. This, taken along with another recent study showing that the average cancer patient incurs as much as $8,500 a year in expenses not covered by insurance, further explains why so many ailing Americans are seeking outside help to pay their expenses, according to Austin.

Far easier than a bake sale

Crowd-funding for medical costs, supporters say, is fast and efficient, far easier than holding a bake sale or silent auction. Still, it may not be a solution for every patient.

“People think the money magically flows in, but it doesn’t happen like that,” says , president of the . The institute has raised more than $300,000 for 30 projects, with four more campaigns in progress. “There is a lot of work involved. Putting up a page is just the beginning. Families need photos and personalized stories to help people connect, they need to think about how to leverage the people they know to raise funds, and they need to use social media to stimulate support.”

“It’s not intuitive,” Austin says. “You can’t just send out a mass e-mail and be done with it.” To be successful, there’s a sophisticated strategy, he explains, including asking close friends and relatives to contribute first. They are more likely to make a larger donation, say $50 to $100, prompting others who follow to make similarly sized contributions.

“It’s the law of ‘monkey see, monkey do,'” Austin says. Persistence is also required. “If you stop asking, you won’t keep getting donations.”

Fundraisers looking for a quick influx of funds may also be surprised. Although some Web sites pass on the money, minus the fees, as soon as a donation is made, several hold on to all donations until the fundraiser is over. (An end date is usually set when the campaign is launched.) In some instances, no money is turned over if the goal stated at the outset is not met. In that case, contributions are credited back to the donors.

There are also privacy issues. An Illinois freelance writer says she became concerned after friends created a fundraiser to help cover the costs of her chronic illness. Prospective employers, she worried, might stumble on the site while searching for her name on the Internet. She believes this is the reason she didn’t get a job she applied for.

“I don’t mind if they know I’m sick, but I don’t want them to think I’m so sick they can’t hire me,” says the writer, who declined to be named for this article. “I found the whole process humiliating and would have preferred for people to donate privately, through checks.”

For people on Medicaid or other programs that serve only people who are low on assets and income, there may be financial consequences. Donated funds could affect a person’s eligibility for assistance, so it would be wise to check with the appropriate officials before raising money. For donors, too, there are also drawbacks to donating via crowd-funding sites. For one thing, most such contributions are not tax-deductible since virtually all the campaigns are being staged by people, not nonprofit organizations.

Perhaps more important, there’s the issue of accountability on the use of funds since donors have no control over how the money is spent, notes , founder of the , an Austin firm that is partnering with GiveForward and provides patient advocacy and bill-mediation service to help resolve medical billing issues.

“I would hate to think people are giving up their hard-earned money to help a friend, family member or even a stranger and then discover that the patient hadn’t done the necessary homework to make sure he or she was paying a fair price” for medical services, Dale says. And that often takes a lot of work, given the increasing complexities of medical bills.

Additionally, because crowd-funding Web sites do not verify the legitimacy of every fundraiser, there is ample room for fraud. Crowd-funding executives say that’s rare, adding that their sites are similar to eBay and Craigslist, which rely on users to police the sites and report suspicious activity. That’s why most sites caution donors to give only to people they know, or to friends of friends. Even then, donors can’t be assured that the money will be used as described by the fundraisers.

The Kennetts are well aware of that concern, as Sheila joked in her blog: “We wonder if anyone would notice if Chip was suddenly driving a new car. . . . But we clearly jest. . . . Please, please know we respect your generosity so very much that we promise to use the funds exactly as intended and will do our best to make it stretch as far and long as possible.” The Kennetts say they were buoyed by all the support they received during the fundraiser – from grade-school friends, parents and teachers from their son’s day care center, people they worked with 10 years ago (as well as more current ones), even the nurse in the maternity ward where their daughter was born.

“Not only was it therapeutic to rid our minds of this financial stress we were starting to come under, but it also was just downright fun watching names pop up,” Sheila wrote in her blog. “It was a trip down memory lane for us both. Some gave a little and some gave a lot, but the dollar amount didn’t matter. What mattered was that the reach was just so far and wide, you were most likely also saying a prayer, sending positive energy, feeling good vibes or at least thinking of us. Wow. That is so incredibly humbling and invigorating.”

Updated at 10:40 p.m. to clarify that the Karis Group is partnering with GiveForward.

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