New to Medicare? Here’s what to expect

You made it, now what?

Maybe you turned 65 and enrolled into Medicare Part A and B. Or, maybe you left your employer’s group health insurance plan and joined Medicare. 

Regardless, you learned what you needed to do to get both Parts A and B in place with the government. You worked with us to determine what path you then wanted to take to provide the balance of your coverage. Remember that Medicare (the government piece) doesn’t cover 100% of costs so it’s wise to look towards a Medigap policy to supplement those costs OR to receive your Medicare health insurance coverage through a Medicare Advantage Plan. 

You’re all approved, your Medigap policy or Medicare Advantage plan is in place, soooo?   

We’re going to provide you with our top tips to make your Medicare experience as good as it can be. Here we go: 

After you receive your ID cards from your new carrier(s), and have received all of the plan documents, organize yourself. Use our annual guidebook to write things down if you’d like and keep things in a physical folder labeled, of course, Medicare. 

Register your accounts online

Whether you’re a technology fan or not (you know we are!), it’s wise to create an online account with the carrier(s) that you’ll be interacting with. So many carriers have excellent online portals where you can set up your payments, change your automatic drafting information, get replacement ID cards, check on claims processing and more. Warning - not all carriers are created equal in this department, so don’t be bummed out if your carrier is not stellar in this area. 

Be sure that you’ve set up an account on Medicare.gov. This is a really nice system that can tell you all sorts of things. See our YouTube clip to see what you’ll be able to access and why you may want to get this set up. Here you’ll be able to see that your insurances are set up properly (it’ll let you see your current carrier information), you’ll see when you satisfy your Part B deductible, you’ll be able to print a new Medicare ID card and more. Really a great tool to get used to check into.

After your new policy or plan is in place, it’s really wise to call the Medicare Benefits Coordination line. And here’s why you’ll want to do this. If you have left employer insurance, you’ll want to be sure that your insurance carrier from that time has “disconnected” themselves from your Medicare account. 

What happens with Medicare is that there an order of billing and it depends on what insurance is in the “first position”. If you worked for an employer with over 20 employees, for example, your prior group insurance would be in the first position. 

If you left the employer coverage and moved to Medicare, you’ll want to be sure that either Original Medicare (Parts A and B) OR your Medicare Advantage plan is now listed in that “primary” position. If you see your employer insurance carrier still listed, know that bills will be sent to that insurance company. They will be rejected. And, you’ll call us saying “this doesn’t work”. Well, it does. But the billing order has to be correct. 

Ensure things are accurate "out there" 

Most of the time, things are smooth but, just in case, it’s always worth a double checking phone call. So, here is their phone number and here is exactly what to request and ensure. 

Call the Medicare Benefits Recovery Center at 1-855-798-2627 and advise them that you are no longer enrolled in the employer group health plan.

Know your insurance plan

If you enrolled into a Medicare Advantage plan, dive into the benefits that the plan offers and use them! You may have quarterly perks of over the counter benefits where you can buy cough syrup, bandaids, etc. You have the benefit; use it. Many carriers are adding perks but you have to be paying attention and using them. 

Understand your specific plan and the billing system

If you bought a Medigap policy, your bills will go to Medicare (the government) first and then electronically over to the Medigap policy carrier. You’ll get an explanation of benefits (EOB) each quarter so that you can follow along. 

If you enrolled into a Medicare Advantage plan, you’ll have specific co-pays and such that you will be billed from the insurance carrier whose Medicare Advantage plan you enrolled into. Original Medicare will not be receiving and paying your bills. Yes, even though you are paying Medicare (the government) a monthly amount, they will not be actively paying your claims. Your Medicare Advantage plan insurance carrier will be solely responsible.

Coverage - try and learn what types of things are covered

This can be difficult but you’ll eventually learn!  Use the Medicare.gov website and there is a search bar for “what is covered”. There’s also a good app that you can add to your smartphone. It’s the Medicare.gov app and you can then search on your phone for things like “flu shot”, or “acupuncture”, or “physical therapy”, etc. There is really a lot of great information from the Medicare system itself. 

If you enrolled into a Medicare Advantage plans, things will work differently yet again. They will typically pay for an annual physical whereas Medicare does not. Know what things are covered. Look at the summary of benefits of your plan each and every year to see what has changed. Keep updated as these plans change. 

If you have Medigap policy, know your “letter type” and know what it covers. For example, if you bought a Plan G, it will follow Medicare. Once Medicare pays their 80%, the bill will go to your Plan G carrier and they will pay the 20% after you have exceeded your $226.00 Part B deductible (2023 figure). 

A Big One

Here’s a hard one. Understand how your drug plans work. You may have a stand alone prescription drug plan (PDP) or you have your prescription coverage through your Medicare Advantage plan. 

If you take expensive prescriptions, you should understand how the feared “donut hole” works. You won’t like the outcome (higher costs) but at least you’ll understand how it works. 

Check mail order pricing on all plans, understand why you should use a preferred pharmacy and learn why you should be checking your stand alone prescription drug plan annually. 

If you have a Medicare Advantage plan, be cognizant of networks. Always check to see if a doctor, hospital, surgical center, rehab facility and more is in your network. This is extremely important for best pricing. You have to follow the “rules” of the Medicare Advantage plan to be obtaining preferred pricing. 

You’ll receive an Annual Notice of Change (ANOC) each year from your prescription insurance carrier and it’s imperative that you pay attention to the changes they have made so that you have time to change something as needed. The annual window is your opportunity each year to fine tune your plan (Medicare Advantage or Part D) is between October 15 and December. It's also referred to as the Annual Election Period. (and it's called incorrectly, the Open Enrollment time....)

Speaking of the Annual Election Period, remember that the soliciting mailers in the mailbox, the phone calls that come from call centers and the like, are all designed to confuse you and gain your business. If something looks extremely appealing on TV (maybe Joe Namath suggesting that you can eat over the top healthcare for FREE), slow down, make some notes and give us a call. 

We’ll talk you off the ledge. 

Try and recall why you bought what you bought. Understand that the Medicare market is enormous and there are millions of 65+ that can get tricked each year. 

Our goal for you: 

• Make a great buying decision up front;
• Tweak what you need during the Annual Election Period each year;
• Don’t panic. 

And, stay smart related to Medicare. Keep tuned in with us, read our emails, check in for a webinar here and there to stay up to date, email your agent and yell when you need us. 

So, Happy Transition to Medicare. It’s generally smooth, but yell when you need us.