Most Commonly Asked Questions After Enrolling in Medicare
In this article, we will explore the most commonly asked questions after enrolling in Medicare and provide answers to help you navigate this complex system.
Can I Change My Medicare Plan?
Yes, you can change your Medicare plan during certain enrollment periods. The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year and allows you to make changes to your Part C and Part D plans. The Medicare Advantage Open Enrollment Period (OEP) runs from January 1 to March 31 and allows you to switch from one Medicare Advantage plan to another or switch from a Medicare Advantage plan to Original Medicare.
Why am I getting a letter suggesting that I owe a penalty even though I was covered by my employer plan?
If you receive a letter stating that you “did not have creditable coverage” for prescriptions and may be assessed a penalty, please do not panic. This is very common for individuals enrolling in a Medicare plan after age 65.
Although the employer coverage forms verified your medical coverage, Medicare often requires plans to verify prescription coverage independently after the enrollment has been completed.
If you do receive a letter indicating a potential penalty, please give the number on the letter a call and inform the agent that you’ve been covered by an employer plan. You will then just need to provide verbal confirmation that you did in fact have creditable coverage.
Please make note of the agent you spoke with as well as the time of the call. Your verbal confirmation should be sufficient to address this issue in most cases.
Why is my doctor/pharmacy saying that Medicare is secondary when I don’t have other insurance?
Another less common yet no less frustrating issue we’ve seen is after receiving medical services and submitting a claim. Sometimes the claim may get denied because Medicare isn’t showing up as your primary form of insurance. This is known as a Medicare Crossover issue where the Medicare system hasn’t been updated to reflect your active enrollment. Instead, your employer group plan is still showing up as your primary form of insurance. 95% of the time this can be resolved by calling the Medicare Recovery Resource Center at 1-855-798-2627. You will be prompted to answer some personal verification questions and then you’ll be transferred to a representative. Once you are transferred the script to use is this: “I recently received medical treatment and the claim was denied due to Medicare not being my primary insurance. This is not correct. I have been on Medicare since _______(part B effective date) and am no longer covered under my employer group plan and I would like my records to be updated to reflect this.” They can then look into your records and help resolve the issue for you. Once they confirm that Medicare will now show up as your primary form of insurance all you have to do is contact the facility where you received treatment and ask them to resubmit the claim to Medicare.
How do I pay my Medicare Part B? Is it automatically deducted from my social security check?
Medicare Part B is billed by Medicare directly and not by any of the insurance companies.
If you are collecting social security (either your own, on a spouse’s record, or via disability):
You will not receive a bill for Medicare Part B. Your Part B premiums will be automatically deducted from your social security check each month.
If you’re not collecting social security:
You will receive a separate bill from Medicare in addition to any bills from your Supplement/prescription or Advantage plan. Billing statements are typically quarterly. You can set up monthly payments through your Medicare.gov account.
What happens if I was assessed an income surcharge and my income has now been reduced due to retirement?
If your income is over a certain threshold, you will be assessed an income surcharge for both your Part B and Part D (There are 2 income surcharges). Your surcharge is based on your level of income on your tax returns 2 years prior. To see where your surcharge falls (if any). Please refer to the income surcharge table here (insert link).If your income after enrolling in Medicare has dropped below your income levels 2 years prior, we recommend that you file for an income appeals form (SSA44). You will have to pay the surcharges when your appeal is being processed but you will be refunded any excess amounts that you have paid. Our office is happy to assist you in this process.
How to file an SSA44 income appeals form?
(PDF link for SSA-44)https://www.ssa.gov/forms/ssa-44.pdf
If you are subject to a high-income surcharge and think your income will decrease due to a life-changing event (e.g., retirement), you can submit the SSA-44 form to have that surcharge adjusted.
To complete, fill in your personal information on page 1.
In Step 1 on page 2, select the type of life-changing event and the date it occurred.
In Step 2, project what you think your income will be in the year that your life-changing event occurred. If you think your income will decrease again the following year, you can also project that income
In Step 3. Be sure to sign and fill in your personal information at the bottom of page 3.
You will also need to submit proof of your life-changing event with your completed form. If you are retiring, you can obtain a letter from your employer on company letterhead indicating your retirement date to satisfy this requirement.