Your Money
MEDICARE MADE EASY
My husband died last year, and I’m still receiving bills for his hospital stay and medical services. How do I determine what Medicare has already paid now that his Medicare.gov account has been deactivated?
Medicare will process claims for your husband to cover services up until his death. Doctors and care providers have one year to submit claims to Medicare. To identify what Medicare has paid, and what may still be owed, you’ll need copies of your husband’s Medicare Summary Notices (MSNs). Since your husband’s Medicare.gov account is no longer active, you’ll need to fill out CMS Form 10106, also known as Authorization to Disclose Personal Health Information. You can get this form online. Or call Medicare at 800-633-4227.
Will my employer-based prescription drug plan still be “creditable” given changes to the Medicare prescription drug benefit?
Creditable coverage means that your current prescription drug plan through your employer, union or another group is just as good as the standard Medicare prescription drug plan. It is especially important to check this year’s notice because some drug plans that were previously considered as good as Medicare’s plan no longer meet that standard. Each year, by Oct. 15, your health plan must let you know whether your coverage is still considered as good as Medicare’s standard coverage. If you find out that your prescription drug plan is no longer creditable, you will need to sign up for a Medicare prescription drug plan to avoid a late enrollment penalty. If your plan is no longer creditable, you get a special enrollment period (SEP) that starts in the month you lose that coverage and lasts for the next two months. Enrolling in Medicare Part D during this time means you won’t face a late enrollment penalty.
My doctor informed me that she will be retiring next year, and the practice will be closing. Will I be eligible for a special enrollment period to switch out of my Medicare Advantage plan?
When a doctor or health care provider leaves a Medicare Advantage (MA) plan, patients are not routinely given a special enrollment period. Doctors and health care providers in MA plans can decide to leave the network at any time. If your primary care doctor or behavioral health provider decides to leave a plan, you should receive a written notice at least 45 days before they go. If a specialist is leaving, you should receive a written notice at least 30 days in advance. The notice will include information on how to select a new provider, how to request ongoing care with the departing provider and/or how to request a special enrollment period to change plans. The Centers for Medicare & Medicaid Services (CMS) may decide that the provider’s departure impacts a plan network so much that all affected plan members will be given a special enrollment period to switch to a different Medicare Advantage plan or go back to original Medicare. If this happens, you will receive a notice from the plan explaining the timing and reason for the SEP.
Ann Kayrish has worked as a Medicare counselor with the State Health Insurance Assistance Program and as the Medicare expert at the National Center for Benefits Outreach and Enrollment at the National Council on Aging. Send your questions about Medicare to medicare@aarp.org.
MEDICARE HOTLINE:
800-Medicare (800-633-4227)
MEDICARE ONLINE:
medicare.gov