HARRISBURG, Pa., Aug. 15, 2016 /PRNewswire-USNewswire/ -- Insurance Commissioner Teresa Miller today issued a consumer alert advising consumers of factors that should be considered before they make a decision on which part they will enroll in when they become eligible for Medicare.
"As some Pennsylvanians stay in the workforce beyond 65 or choose a retiree health plan over Medicare, it is important to understand how your health coverage works after you're Medicare-eligible," Commissioner Miller said. "Not doing so could create unexpected out-of-pocket expenses on your health care."
Medicare, which is administered by the federal Department of Health and Human Services, provides coverage through private health insurance companies at four different levels and consumers can choose which of these four Parts make sense for them:
- Medicare Part A (Hospital Coverage)
- Medicare Part B (Medical Coverage)
- Medicare Part C, or Medicare Advantage (Parts A and B together)
- Medicare Part D (Prescription Drug Coverage)
If a consumer continues working after becoming Medicare-eligible or has a retiree health plan through their employer, they may choose not to enroll in a Medicare plan. However, some employer-sponsored health care plans take an offset for Medicare regardless of whether the member is actually enrolled in Medicare. Taking an offset means the employer-sponsored health plan pays a smaller percentage of costs incurred for services, because the member is eligible to have some of these costs covered by Medicare. If the eligible individual enrolls in Medicare, then the employer sponsored plan and Medicare work together to deliver benefits on a primary or secondary basis. Thus, enrolling in Medicare Parts A and B may help cover potential gaps in coverage.
Commissioner Miller recommended that consumers who could face this issue talk to their human resources departments or their plan administrator during a pre-retirement meeting or near when they become Medicare-eligible, and be sure to review the language within their health insurance policy. Specific details such as coordination of benefit terms and conditions can change from year to year, so consumers need to be sure that they are making decisions based on the most up-to-date information.
"All Medicare beneficiaries have access to a free, local, personalized counseling and assistance program through Pennsylvania's APPRISE program," said Secretary of Aging Teresa Osborne. "Our program is designed to help Pennsylvania's Medicare beneficiaries navigate a process that can, at times, be complex and challenging. Specially trained counselors are available to answer your Medicare questions, including your health benefits, premiums, and co-insurance, along with helping beneficiaries to decide whether to leave or join a Medicare Advantage Plan, and any other Medicare health plan or Medicare Prescription Drug Plan. The Wolf Administration is committed to ensuring that Pennsylvanians have access to information that will enable them to made good health care decisions, and our collaborative efforts with the Insurance Department is evidence of a government that works. If you need help with your Medicare benefit, including filing an appeal, please call the toll-free APPRISE Helpline is 1-800-783-7067. All services are free and confidential."
If a consumer decides that enrolling in Medicare is the best choice to ensure proper coverage, it may be better to enroll when the consumer first becomes eligible. Electing to enroll in Medicare after initial eligibility may result in a higher premium due to the late enrollment. Medicare eligibility begins three months before you turn 65 and ends three months after (Initial Enrollment Period), and the General Enrollment Period for Medicare takes place from January 1-March 31 each year with coverage beginning on July 1. There are also select situations which may qualify one for a Special Enrollment Period.
"My department has heard complaints from consumers who received bills from their health insurance provider because they opted not to enroll in a Medicare Part B plan and their health plan is paying only a small portion of the charge," said Commissioner Miller. "While my department does not regulate Medicare plans, I want to be sure that Pennsylvanians understand their options before they reach their Medicare enrollment period.
Commissioner Miller also advised consumers who are disabled and Medicare-eligible to check how the eligibility will affect their coverage.
MEDIA CONTACT: Ron Ruman, Insurance, 717-787-3289
Drew Wilburne, Aging, 717-705-3702
SOURCE Pennsylvania Department of Insurance