Can I keep my COBRA coverage when I enroll in Medicare

It depends on when you got your COBRA coverage.

COBRA is a federal law that gives you the right, to continue your health insurance once it ends because of job loss, divorce, death or other reasons. You must pay the full premium yourself.

If you already have COBRA coverage when you enroll in Medicare: Your COBRA will probably end. Contact your COBRA benefits manager to find out.
Caution: If you have COBRA and become Medicare-eligible, you should enroll in Part B immediately because you are not entitled to a Special Enrollment Period (SEP) when COBRA ends. Your spouse and dependents may keep COBRA for up to 36 months, regardless of whether you enroll in Medicare during that time.

If you become eligible for COBRA coverage after you are already enrolled in Medicare:
You must be allowed to take the COBRA coverage. It will always be secondary to Medicare (unless you have ESRD). You may wish to take COBRA if you have very high medical expenses and your COBRA plan offers you generous extra benefits, like prescription drug coverage.

If you have drug coverage through COBRA and you want to keep it, you should find out if that coverage is as good as or better than Medicare's drug coverage (creditable). You should have received a letter from the company providing your COBRA coverage letting you know whether your drug coverage is as good as Medicare's. If it is creditable, you may want to keep your COBRA coverage and delay enrolling in Medicare drug coverage. Many COBRA plans will not allow you to drop your drug coverage and keep your other medical coverage. Also, if you enroll in Medicare drug coverage later you will not have to pay a higher premium (premium penalty) as long as you join within 63 days of losing your creditable COBRA drug coverage. When COBRA coverage ends, you will have a Special Enrollment Period to enroll in a Medicare drug plan outside of the standard enrollment periods.

If your COBRA drug coverage is not creditable, you can switch to a Medicare private drug plan at any time. However you will have to pay a premium penalty if you did not enroll in the Medicare drug benefit when you were first eligible and have been without creditable coverage for more than 63 days. You will not have to pay a penalty if you can show you received inadequate information about whether your drug coverage was creditable.

What can I do if my Medicare private health plan refuses to pay for care I already received?

If your plan is refusing to pay for care you already received, you have the right to appeal. There are several stages to the process and deadlines you must meet.

Note: If your plan will not approve care that you need and have not yet gotten, you are entitled to a faster appeal.

Below are the steps you must take to file a “standard” appeal if your plan will not pay for care you already received. Make sure to keep any notices you receive from the plan and write down the names of any representatives you speak to and when you spoke to them.

1. Get a Denial Notice
The plan must send you a written denial notice before you can start the appeal.
The notice will tell you what information you need to send to the plan to start an appeal.
2. Request a Reconsideration
You have 60 days from the date on your denial notice to appeal to the plan (request a reconsideration).
In most cases, you will need to send a letter to the plan explaining why you needed the service. Ideally, you should also include a supporting statement from your doctor explaining why you needed the care (medical necessity).
3. Get the Plan’s Decision
Once you appeal, the Medicare private health plan must make a decision within 60 days. If you do not hear back, call the plan.
If your plan still does not change its decision, it must forward your request to the next level of appeal—the Independent Review Entity (IRE) —automatically. The IRE is an independent group of doctors and other professionals that contracts with Medicare to ensure that you receive quality care.
The IRE must decide your case within 60 days.
Continue to Additional Levels of Appeals
If the IRE says the plan does not have to pay for the care you received (upholds the plan's denial), you must take active steps to continue the appeal.
You can appeal to an Administrative Law Judge (ALJ) (if the cost for the service in dispute is at least $130 in 2011). You must appeal to the ALJ within 60 days of the date on the IRE’s decision.
If you are turned down at the ALJ level, you can appeal to the Medicare Appeals Council (MAC) and then to Federal Court.
If you plan to appeal at the ALJ level or higher, you may want to find an advocate or lawyer to help you.
4. Get an Independent Review

What insurance can I buy to fill gaps in Original Medicare?

You may be able to buy a supplemental coverage policy that is designed to fill gaps in Original Medicare. Such a policy is called a “Medigap.” Medigaps can help cover Original Medicare deductibles, coinsurances and some additional benefits. If you do not have other supplemental coverage, such as a retiree plan, you might want to consider purchasing a Medigap policy.

There are different standardized Medigap plans, labeled by letters. Not all plans are available in all areas.  

The plans that were available before June 1, 2010, are labeled by letters A-L.

Starting June 1, 2010, there will be two new Medigap plans (M and N), and four plans (E, H, I and J) will no longer be sold.

• If you bought a plan before June 1, 2010, you can usually keep it as long as you like. The benefits will not change. 
• In general, if you are happy with your current plan, there is no reason to switch. If you decide to switch, you should get unbiased advice to make sure that the plan you pick fits your needs.
• Remember that plans are not required to sell you a policy if you are not within a time that you have the right to purchase a Medigap.

Note: Massachusetts, Minnesota and Wisconsin have different standardized Medigap plans that you can buy.

Each Medigap plan pays for a particular set of benefits. Plan A offers the fewest benefits and is usually the least expensive. Plans that offer more benefits, like Plan F, are generally more expensive.

The most popular Medigap plans are C and F, because they cover major benefits and are less expensive than many other plans.

Prior to June 1, 2010 all Medigap plans were required to include the following basic benefits:

• Hospital coinsurance coverage
• 365 additional days of full hospital coverage
• Full or partial coverage for the 20 percent coinsurance for doctor charges and other Part B services
• Full or partial coverage for the first 3 pints of blood you need each year

All Medigap plans sold starting June 1, 2010 (including new plans M and N) must offer these basic benefits and also pay all or part of the hospice coinsurance for drugs and respite care.

Depending on which Medigap plan you choose, you can get coverage for additional expenses Medicare doesn't cover, including:

• Hospital deductible
• Skilled nursing facility coinsurance*
• Part B deductible
• Emergency care outside the U.S.
• At-home recovery**
• Preventive care that Medicare does not cover**
• Excess doctor charges. “Excess charges” refer to the amount above the Medicare-approved amount “non-participating doctors” can charge

eligible for Medicare if I am under 65?

There are three ways you can get Medicare coverage if you are under 65 years of age.

You are eligible for Medicare if you are a U.S. citizen or have your resident visa, have lived in the U.S. for five years in a row; and

1. You have a disability and have been receiving Social Security Disability Insurance (SSDI) for more than 24 months. Your eligibility begins during the month you receive your 25th SSDI check. You do not need to contact anyone. Social Security should automatically mail you your Medicare card three months before you become eligible.

Note: If you are receiving railroad disability annuity checks, whether you are eligible for Medicare and when you get it depend on how your disability has been classified by the Railroad Retirement Board.

Or

2. You have been diagnosed with End-Stage Renal Disease (ESRD) and you
• are getting dialysis treatments or have had a kidney transplant;
• apply for Medicare benefits (up to 12 months retroactively);and
• you
• are eligible to receive SSDI;
• are eligible to receive railroad retirement benefits; or
• are otherwise considered to be “fully” or “currently” insured by Social Security, as defined by the length of time you have worked and the amount of money you have made (you need a certain amount of Social Security “work credits” depending on how long you have worked).
• Note: Because Social Security and Medicare eligibility rules are complex, you should call Social Security at 800-772-1213 to get the most accurate information regarding your particular situation.
  Note: If you are a railroad worker with ESRD, you must contact Social Security, not the Railroad Retirement Board, to find out if you are eligible for Medicare because you have been diagnosed with ESRD.
  When your Medicare benefits begin depends on the circumstance.
  • If you are getting dialysis, Medicare begins after a three-month waiting period. For example, if you start dialysis in May, Medicare begins August 1st.
  • If you are getting dialysis and start a self-dialysis training program during the waiting period, Medicare begins the same month as the program. You must be expected to finish the training program and continue to do self-dialysis after it is over.
  • If you are getting a kidney transplant, Medicare begins the month you go into a Medicare-approved hospital for either the transplant or the health care services you need before getting the transplant, as long as you get the transplant within three months. For example, if you go into the hospital in August and want your Medicare to start in August, you must get the transplant by the end of October. If the transplant is delayed more than two months after you go into the hospital, your Medicare coverage is also delayed—Medicare begins two months before the transplant actually happens. So, if you go into the hospital in August but don’t get the transplant until March, Medicare begins in January.
  Or
  3. You have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), commonly known as Lou Gehrig’s Disease. You will automatically be enrolled in Medicare the first month you receive SSDI or, if you are a railroad worker, the first month you receive a railroad disability annuity check.

When can I enroll in Medicare?

If you are eligible for Medicare, but not currently receiving Social Security retirement benefits or railroad retirement benefits, there are three different time periods during which you can enroll in Medicare Parts A and B.

"Home care" and when does Medicare cover it?

Home care is a phrase commonly used to refer to a wide range of health and social services. These services are delivered at home to recovering, chronically or terminally ill persons or people with disabilities in need of medical, nursing, social or therapeutic treatment, and/or assistance with the essential activities of daily living.

Medicare covers various types of home health services under both its home health care benefit and its hospice benefit. Each benefit has very specific eligibility criteria.

Can I keep my COBRA coverage when I enroll in Medicare

It depends on when you got your COBRA coverage.

COBRA is a federal law that gives you the right, to continue your health insurance once it ends because of job loss, divorce, death or other reasons. You must pay the full premium yourself.

If you already have COBRA coverage when you enroll in Medicare: Your COBRA will probably end. Contact your COBRA benefits manager to find out.
Caution: If you have COBRA and become Medicare-eligible, you should enroll in Part B immediately because you are not entitled to a Special Enrollment Period (SEP) when COBRA ends. Your spouse and dependents may keep COBRA for up to 36 months, regardless of whether you enroll in Medicare during that time.

If you become eligible for COBRA coverage after you are already enrolled in Medicare:
You must be allowed to take the COBRA coverage. It will always be secondary to Medicare (unless you have ESRD). You may wish to take COBRA if you have very high medical expenses and your COBRA plan offers you generous extra benefits, like prescription drug coverage.

If you have drug coverage through COBRA and you want to keep it, you should find out if that coverage is as good as or better than Medicare's drug coverage (creditable). You should have received a letter from the company providing your COBRA coverage letting you know whether your drug coverage is as good as Medicare's. If it is creditable, you may want to keep your COBRA coverage and delay enrolling in Medicare drug coverage. Many COBRA plans will not allow you to drop your drug coverage and keep your other medical coverage. Also, if you enroll in Medicare drug coverage later you will not have to pay a higher premium (premium penalty) as long as you join within 63 days of losing your creditable COBRA drug coverage. When COBRA coverage ends, you will have a Special Enrollment Period to enroll in a Medicare drug plan outside of the standard enrollment periods.

If your COBRA drug coverage is not creditable, you can switch to a Medicare private drug plan at any time. However you will have to pay a premium penalty if you did not enroll in the Medicare drug benefit when you were first eligible and have been without creditable coverage for more than 63 days. You will not have to pay a penalty if you can show you received inadequate information about whether your drug coverage was creditable

Medicare Insurance Plan Options for Seniors: Understanding my Medicare health coverage options?

Medicare Insurance Plan Options for Seniors: Understanding my Medicare health coverage options?

Understanding my Medicare health coverage options?

There are different ways to get your Medicare benefits. It is important to understand your Medicare options because the way you choose to get your Medicare benefits will affect the care you get. For example, depending on how you get your Medicare benefits, you may only be able to see certain doctors and you may have to get permission before you can access certain health services.

• If you know more about how Original Medicare and Medicare private health plans can work, you will be better equipped to choose the option that works the best for you.
• If you understand how different plans work, you will be more likely to get your care covered. Plan rules for when and where you can get care can greatly affect how much you pay for services. When exploring your coverage options, it is especially important to check whether you will be covered to go to your preferred hospitals, doctors and pharmacies and whether you need to get official permission from the plan (“prior authorization”) before services will be covered.
• Understanding your Medicare options can save you money. Knowing your options may make it easier for you to find a plan that meets your health needs and is affordable for you.
• If you understand your coverage options and choose well, you will have better coverage over the course of the year. In most cases, you can only change how you get Medicare benefits at certain times of the year. Because of this, it is especially important to make careful coverage choices