7 Original Medicare Coverage Gaps & Limitations to Consider for 2014

Healthcare Symbol with Gaps7 Original Medicare Coverage Gaps & Limitations to Consider for 2014

Each year, tens of millions of elderly and disabled Americans rely on original Medicare coverage to offset their health care costs. However, while the federally-funded program is vital — especially as average life expectancy and health care costs increase — it can be a minefield for those who aren’t up-to-date on the latest changes.

To help you avoid unwelcome surprises – or abrupt shocks – when you
enroll in various plans or file a claim, here are 7 original Medicare coverage gaps and limitations to consider for 2014:

1. Original Medicare Doesn’t Cover Non-Preventative Follow-Up Fees

Under Medicare Part B, you’re entitled to a free “Welcome to Medicare” doctor’s check-up. However, if your doctor recommends a follow-up test or procedure that isn’t covered because it’s not defined as “preventative”, then you may be required to pay 20%.

2. Original Medicare Doesn’t Cover Many Out-of-Pocket Costs – and there’s No Limit

Like many people, you may assume that out-of-pocket expenses are an element of your overall health care costs, and therefore, applicable for Medicare coverage. However, the truth is that many out-of-pocket costs aren’t covered. What’s more, there’s no annual limit to how high these out-of-pocket costs can go, which means that this assumption could be financially devastating unless you have supplemental insurance.

3. There’s an Optimal Window to Sign up for Medigap Coverage

If you’re thinking about supplementing your Medicare insurance with Medigap coverage, then don’t think about it for too long. That’s because there’s a one-time Medigap open enrollment period, during which a potential insurer cannot base their premium on your medical history. This open enrollment period begins 6 months after you’ve enrolled in Medicare Part B or turn 65 and have both A & B. If you miss the open enrollment period, then your medical history is fair game and you may face much higher premiums or even be denied coverage.

4. There’s a Optimal Window to Sign-Up for Medicare Part B

If you’re planning on signing up for Medicare Part B, then the best time to do so is within a 7-month window that starts 3 months before your 65th birthday, and ends 4 months after. You can still enroll later, but you’ll be subject to a late enrollment penalty that amounts to a 10% premium hike each year. The exception is if you’re still working after age 65 and covered by your employer’s coverage. In that case, you can sign up for Medicare Part B within 8 months of the plan ending (note: COBRA coverage and retiree health plans don’t qualify for this exception).

5. There’s an Optimal Window to Sign-up for Medicare Part D

As with Medicare Part B and Medigap, if you’re thinking of signing-up for Medicare Part D then you don’t want to delay – because late enrollment penalties kick in if you don’t sign-up when you first become eligible, and if you go 63 or more days in a row without prescription drug coverage. However, even if you sign-up for Medicare Part D, keep in mind that some plans will oblige you to seek authorization before filling certain types of prescriptions, and/or may require that you try a lower-cost drug before approving a similar, higher-cost drug.

6. There’s a Gap in Medicare Part D Regarding Prescription Drug Costs

Still with Medicare Part D: there is significant coverage gap that you want to know about before enrolling and submitting a claim – not after. The gap pertains to prescription drug costs incurred between a range of $2,850 and $6,691. Within this range (after which catastrophic coverage takes over) only 52.5% of the costs for brand name drugs and 28% of the costs for generic drugs are covered. The good news is that this gap is slated to be eliminated by 2020. The bad news is that 2020 is still 6 years away, and plenty of retirees and disabled people are going to get dinged in the meantime.

7. Original Medicare Only Covers the a Portion of the First 100 Days in a Nursing Home

At some point, and especially after a hospital stay, you may find yourself obliged to stay in a nursing home. However, Medicare will only cover a portion of the costs for your first 100 days. Days 1-20 Medicare will pick up 100%, days 21-100 you will have to pay $152 a day and then Medicare will pick up the rest.

Helping You Make the Right Decisions

At Medigap Providers, our goal is to help you make decisions that are right for you and your future. And that includes making sure that you have the supplemental insurance you need to avoid being surprised – or shocked – by Medicare changes in 2014 and beyond.

To learn more, contact our experienced, caring and licensed advisers at (855) 321-3210, or email us at info@medigapproviders.com. We’re here to help!


Leave a Reply

Your email address will not be published. Required fields are marked *

Carriers Offered

AetnaAflacAmerican ContinentalAmerican Retirement LifeBlue Cross Blue ShieldCentral States IndemnityCignaCombined InsuranceContinental LifeEquitable LifeFamily LifeForeThoughtGerber LifeGovernment Personnel MutualHeartland NationalHumanaLoyal AmericanManhattan LifeMedicoMutual of OmahaNew EraOmaha InsuranceOxford LifePhiladelphia AmericanSentinel LifeSterling InvestorsSterling LifeStonebridge LifeUnited AmericanUnitedHealthcareUnited of OmahaUnited World

Medigap Plans

Medicare Supplement Plan AMedicare Supplement Plan BMedicare Supplement Plan CMedicare Supplement Plan DMedicare Supplement Plan F • Medicare Supplement Plan F High Deductible • Medicare Supplement Plan G • Medicare Supplement Plan K • Medicare Supplement Plan L • Medicare Supplement Plan M • Medicare Supplement Plan N

Contact Us

  • Please enter a value between 5 and 5.
  • This field is for validation purposes and should be left unchanged.