Diary of a Seasoned Life – The Most Frequently Asked Medicare Questions

Did you know that nearly 10,000 people in the United States turn 65 each day? The total number should reach 83.7 million by 2018. This trend is expected to continue until 2030.

Since many seasoned life people are on Medicare or will be signing up within the next decade, I thought I would share some information from someone who knows much about the subject. Guadalupe “Lupe” Gonzales, a licensed independent insurance agent specializing in Life and Health insurance with clients in Rockwall, Dallas, Tarrant and Collin counties, is considered by many companies who serve seniors in Northeast Texas to be the local expert. Lupe and his wife Diane reside in Rockwall, Texas. He is also bilingual, an active member of his church and his community, several veteran’s organizations and a retired veteran of the United States Marine Corps.

Many people have the misconception that you are automatically enrolled once you turn 65. That is not correct. I asked Lupe when is the best time to start checking into enrolling in Medicare and any supplemental policies for the first time?

Answer:  “That is a vast question with many possible considerations. In a word, as early as a year is certainly not too soon.”

In researching for a little more information, I found that 3 months before your 65th birthday is the most recommended time. It allows for the time it takes for the enrollment to take effect with the most minimal time one may go without coverage. Some people who are still working at age 65 and receive other health insurance and are not taking social security payments, will want to look into holding off enrolling until beyond 65. It all depends on the insurance company and your group plan. Check with your agent or human resources manager.

Lupe said the most frequently asked question he receives concerning Medicare is, “WHY DOES IT HAVE TO BE SO COMPLICATED?”

Answer:  “Knowing where to look and what questions to ask will focus your inquiry and may reduce the stress and make your life much easier. That being said, everyone at every stage of Medicare beneficiary status, to include those of us who care for loved ones, should consider their individual statuses and needs.  I believe these 7 tips that I included may be the most immediate concerning Medicare.”

Lupe’s 7 Tips for Simplifying Medicare
  1. Review your Medicare insurance plan yearly.
    1. Has your situation or that of your loved one’s living conditions recently changed?
    2. Has your financial situation or medical condition changed in the past year?
    3. Does your current plan meet your needs?
    4. Has my plan changed? If so, how?
    5. Is your doctor or that of your loved one going to continue accepting your current insurance plan?
  1. Review your prescription drug plan’s formulary, at least
    1. Even if you’re happy with your Medicare insurance plan, your prescription drug coverage may have changed. It is not uncommon for drug plans to add, modify or discontinue co-pays and coverage of some prescription drugs.
  1. Read all mailings from Medicare and your insurance plan.
    1. If you’re in a Medicare plan, your plan will send you a “Plan Annual Notice of Change” (ANOC) each fall. The ANOC includes any changes in coverage, costs, or service area that will be effective in January.
  1. The Annual Enrollment Period (a.k.a. “Open Enrollment Period”) is October 15th through December 7th.
    1. This is the annual period for enrollment, making changes to your Medicare Advantage Plan (Part C) and/or your Prescription Drug Plan (Part D).
    2. Medicare beneficiaries who have maintained (only) their Original Medicare
    3. (Parts A and/or B only) and have enrolled in an individual Part D, Prescription Drug Plan are also affected by this enrollment period. (See attached weblinks)
  1. If you are a Veteran you be eligible for additional healthcare options.
    1. Having both Medicare and the V.A. greatly broadens the veteran’s medical coverage and will give you broader coverage when it comes to the doctors, hospitals, and providers you can use.
    2. Veterans are entitled to use both VA and enrollment in a Medicare Advantage or stand-alone Prescription Drug plan. If you ever need to use a non-VA hospital or pharmacy, you’ll have more options available.
  1. If you are a caring for a loved one, get organized and be proactive.
    1. Is your loved one now receiving Low Income Subsidy (Extra Help)?
    2. Could they now qualify for Medicaid?
    3. Become familiar with basic Medicare terms, definitions and resources (see below web links)
    4. Locate your loved one’s insurance card, Social Security cards, medical documentation and have them readily available.
    5. Go online or contact a trusted insurance agent and setup an insurance review of any changes that may affect them. Most are happy to help.
  2. Helpful websites, links & phone numbers:

https://www.medicare.gov/Pubs/pdf/11034.pdf

http://eldercare.gov/Eldercare.NET/Public/Index.aspx

https://www.medicare.gov

https://www.medicaid.gov

http://benefits.va.gov/benefits/

https://explore.va.gov/health-care

http://www.mpmoaa.org/documents/TFL_Handbook_rev_08.pdf

http://www.aarp.org/health/medicare-qa-tool/does-medicare-work-with-veterans-coverage/

I hope this is helpful information. If you have more questions or need an insurance review, please reach out to Lupe. He can be contacted directly via email (GonzalesInsurance71@gmail.com) or by phone (972) 514-2160.

He also asked me to add the following disclaimer:

I am a licensed and commission-paid insurance agent that represents the various carriers with whom I am contracted to represent. As a professional insurance agent, I do my best to answer all questions regarding Medicare plans however, I do not represent Medicare nor any of its affiliates. Furthermore, For the most up to date information I urge readers to refer to the attached links.”

Author: Kim Lawrence

After owning a successful distribution business for 18 years, Kim’s life was turned upside down when her mother suffered a major stroke. She had to suddenly take over not only the care decisions for her mother, but also manage her mother’s business affairs, home, finances, and estate. This was all in addition to managing her own business and personal situation. This blog is to help tell the story in the hope that what she learned, and is still learning, will help guide others if they are or suddenly find themselves in a similar situation.

2 thoughts on “Diary of a Seasoned Life – The Most Frequently Asked Medicare Questions”

  1. Kim, the service that you provide in the form of information, cannot be measured simply by “likes” of social media and the like. Caregivers and Medicare beneficiaries alike will benefit greatly by reading your blog. I will be a consistent reader. Good work!

    1. Thank you, Lupe! That is so nice to hear. There are many people I have met in the last few months that are quite passionate about helping and educating seasoned life people and their loved ones with aging and its transitions. You are one of those people. I look forward to working with you.

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