Medicare FAQ

I gathered the top medicare questions asked by patrons and gathered them in this FAQ section. If you don’t see a question you’d like answered, please feel free to email me at kathi@medicarenewmexico.com

Getting Started

How should I apply for Medicare?

The process depends on whether you are receiving Social Security benefits or not. 

Receiving Social Security benefits? Your Medicare card should be automatically mailed to you three months before you turn 65. It should show that you have Medicare coverage for both Hospital (Part A) and Medical (Part B).  Part A has no cost, while Part B has a premium, which will be $134.00 per month for most people whose Medicare starts in 2018. If your income is high, your premium could be higher than the $134.00 average. You will receive a notice showing the Part B premium amount.  

NOT receiving Social Security benefits? If you are not receiving Social Security benefits, there are three ways to get signed up. You can phone Social Security at 1(800)772-1213, or visit your local Social Security office, or you can sign up online at SSA.gov 

When will may coverage start?

For most people, Medicare will start on the first day of the month in which they turn 65. 

For example, someone turning 65 on July 27th will have their Medicare start on July 1st. We coordinate your Colorado Medicare supplements and prescription drug coverage to start on the same day as your Medicare. 

Did you know: If your birthday happens to fall on the first day of the month, your Medicare will start a month earlier.

How should I apply for a Medicare Supplement (Medigap) policy?

I can help you enroll! It is best to wait until you have your Medicare card, or your Medicare ID and Part A & Part B start dates when enrolling online, or an award letter from Social Security confirming your Medicare coverage. I can do your application in person or over the phone or, send you a link to do an online application if that is offered by the provider. 

When you meet with me or any agent be sure to bring with you….   

  1. Medicare card (red, white & blue) 
  1. Checkbook 
  1. A list of your medications and doctors 
  1. Insurance card of your current health insurance carrier.  

How long will it take to get approved?

For Medicare Part A & B: It generally takes three weeks to get your Medicare card after submitting your application. If you enroll online you will receive an system generated ID number available to you via your account on SSA.gov 

For a Medicare Supplement: It depends on the time of year. Most of the year it takes one to two weeks, but if you apply in the last three months of the year, it could take twice as long, or longer, due to how many applications are coming in all at once. 

How do I know you are getting me the best price possible on my Medicare Supplement policy?

The price or “premium,” as it is called, is approved and fixed by the New Mexico Division of Insurance. Whether you buy from us, another agent, over the Internet, or directly from the insurance company, the premium will be identical—so long as the quote is for the same plan. 

While buying through us won’t cost you a penny more, it will make the application process go more smoothly. If there are any problems that come up, I will deal with the hassles so you don’t have to! Plus, I’ll be there for you in the future whenever you have a question or need help in resolving a problem. 

What if I have a pre-existing health condition?

Original Medicare automatically covers all pre-existing conditions. 

In addition, all Medicare Supplement policies in New Mexico will cover pre-existing conditions if you apply: 

** during your initial six-month open enrollment period when you first qualify for Medicare at age 65, 

**or a Guarantee Issue period if you delayed signing up for Medicare Part B 

You can reach me at 505.350.5859 or email me at kathi@medicarenewmexico.com to discuss how to proceed properly if you have delayed your Part B coverage – as this can get tricky. A mis-step here can leave you without medical coverage for a period of time. Those who qualify for Open Enrollment or Guarantee Issue do not have to answer any medical questions.  

If you apply for a Medicare Supplement policy outside of your initial Open Enrollment period or Guarantee Issue period, you will need to answer medical questions and may or may not be approved, depending on your medical history. If you are approved, your pre-existing conditions will be covered immediately if you have had prior qualifying medical coverage in six months before the effective date of your Medigap policy. 

However, if you have not had qualifying coverage in the prior six months, then Medigap plans are allowed to exclude coverage for pre-existing conditions for the first six months of your policy after which pre-existing conditions will be covered. 

Can I save money by buying directly from the insurance company?

No. The New Mexico Division of Insurance controls the rates, so your premiums will be identical regardless of whether you buy from us, buy online, or buy directly from the insurance company. 

By working with me you’ll get better service because you’ll be getting my local help and advice should you ever have a problem with the insurance company. Also, if the company you choose to enroll with gets too expensive down the road, as an independent broker, I can simply move you to another insurance company. 

So, how do you get paid?

Whether your case is simple or complicated there will never, ever, be a charge to you! Here is how get compensated: insurance companies pay me a commission for providing them with a new client. Please note that this commission does not increase your premium in any way! 

Insurance premiums are determined and approved by the New Mexico Division, this means your premium will be identical regardless of who you buy your insurance from. By choosing to work with me you benefit from my knowledge and support.  I will always me here to advise you if there are personal changes or market changes that could affect your coverage.  

Claims Benefits and Coverage Related Items:

Can I see any doctor I want?

It depends on the type of plan you have.   Original Medicare and Medicare Supplement plans in New Mexico have no networks, so you can see any doctor or provider anywhere in the U.S., as long as they participate with Medicare. 

On the other hand, if you have a Medicare Advantage plan, you will, normally, have to see a network doctor. 

I recently submitted a claim that was denied. I strongly disagree with this decision. What’s the best way to appeal this claim denial?

My service to my clients does not end when you buy a policy.   I can help review with you the reason for the claim denial. If it appears a mistake was made, I can show you how to file an appeal. An example of a common reason for a claim denial occurs when the doctor’s office sends in the wrong procedure code for your service. This is easily fixed by having the doctor send in a corrected billing form. 

It saddens us to hear from a client a year or two after a claim problem occurred and to learn that they are upset with their coverage.  If only they had called me sooner, I could have helped them, gotten their claim paid and everyone would have been happy. On the other hand, if the denial is legitimate, I can explain why so you know what to expect.  

Does Medicare cover all medical expenses?

Well, not quite. No policy in the world covers “all” medical expenses. Every policy has a list of exclusions. That being said, Medicare’s coverage is comprehensive and excellent. Most people find that the combination of Medicare and a Medigap plan gives them better coverage than what they had before! 

How much of a premium increase will I get after I buy a policy and how is that determined?

Future increases in your premium are determined by two main factors. 

Age increase: The chances of people having medical expenses increases each year, as we get older. Insurance companies know this and consequently increase their premiums a little each year to account for this ever-growing actuarial risk. This yearly age increase is disclosed to the New Mexico Division of Insurance (your consumer watchdog). You will be notified yearly by your insurance company of an increase, if one occurs.  

Note: Medicare Advantage plans do not increase with age. 

Medical Inflation increase: Insurance companies also look at how much they paid out in claims and how much they expect to pay out in the following 12 months. This is called a “medical trend factor.” If the premiums that are coming in are not sufficient to cover the increase in the medical trend factor, the insurance company will increase premiums to cover the expected increase in medical claims. This part of the rate increase equation cannot be accurately predicted. 

It is important to note that the insurance companies do not look at your personal claims in setting rates, but rather at the entire block of business in your geographic region. This means that you will not be singled out for a rate increase just because you had a big claim. 

I’m still working. Can I still contribute to my HSA after I’m 65?

Once you qualify for either Part A or B of Medicare, you are no longer allowed to contribute new money to your HSA account beginning with the first day of the month in which you qualified for either Part A or B of Medicare. 

I delayed taking Medicare because I was still working and was insured by my employer’s group plan. Should I take COBRA first for 18 months and then go on Medicare?

Medicare rules are extremely tricky in this area and we have seen several people get trapped by Medicare’s rules. Make one tiny mis-step and you could find yourself with absolutely NO INSURANCE of any kind for many months. 

Based on my personal experience and reading about how others have been left without insurance, we highly recommend not taking COBRA if you are over 65. 

 

Can I save money by buying directly from the insurance company?

No. The New Mexico Division of Insurance controls the rates, so your premiums will be identical regardless of whether you buy from us, buy online, or buy directly from the insurance company. 

By working with me you’ll get better service because you’ll be getting my local help and advice should you ever have a problem with the insurance company. Also, if the company you choose to enroll with gets too expensive down the road, as an independent broker, I can simply move you to another insurance company. 

So, how do you get paid?

Whether your case is simple or complicated there will never, ever, be a charge to you! Here is how get compensated: insurance companies pay me a commission for providing them with a new client. Please note that this commission does not increase your premium in any way! 

Insurance premiums are determined and approved by the New Mexico Division, this means your premium will be identical regardless of who you buy your insurance from. By choosing to work with me you benefit from my knowledge and support.  I will always me here to advise you if there are personal changes or market changes that could affect your coverage.  

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