Avoiding the Medicare Penalty Box

by Marc Manor

Relative to most individual healthcare plans, many people find Medicare a significantly less expensive alternative with more coverage and lower deductibles.  After all, if you have been employed throughout your life, you have been paying into the Medicare system and have earned the Medicare Benefit!  If you have been employed for 10 years or more, it is likely your Medicare Part A will have no cost and your Medicare Part B will be only $135.50 per month* for most people (*Part B premiums are higher for higher income earners).   Medicare costs can be found here:  

https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance#collapse-4809

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To take full advantage of the value of your Medicare benefits, it is best to avoid late enrollment penalties.  There are late enrollment penalties for Medicare Part B and Part D and with so many low-cost options available, there are few reasons that would justify putting yourself in the Medicare “Penalty Box.”  Sometimes people seem surprised and are frustrated by the penalties.  They claim they just aren’t fair.  I understand how someone must feel but Medicare justifies these penalties because they base their rates and calculate their risk based on eligible beneficiaries in the pool of enrollees.  But you won’t care about why they penalize you for being late. So, let’s talk about the penalties and some ways you can stay within the rules and avoid them!

Be Prepared for Long-Term Care with Clear Communication

By Marc Manor

Most of us are horrified as the prospect of being in a position of no longer being able to care for ourselves.  We are horrified for two reasons:  First, we don’t like the idea of not being able to carry out our own “Activities of Daily Living” (commonly known as ADLs) which are those activities required for one to adequately take care of themselves (bathing, bathroom, mobility, dressing, self-feeding etc.); and secondly, we really don’t like the idea of our spouse or children changing our diaper!  

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It is hard to imagine ourselves getting to the point where we cannot function on our own, but assisted living and nursing homes are full of people who probably felt the same way just a few short years ago.  The reality is we are all just one accident or illness away from that horrible reality.  Some of us think about how we will handle the possibility of requiring long-term care, yet others don’t seem to think of this as a priority.  As someone who has dealt with this situation for both of my parents, I highly recommend discussing the possibility with those you love and trust and have a plan in case long-term care becomes a reality.  Some of the most well thought out financial and estate plans have been derailed because of long-term care requirements.  Here are some things to consider:

Help For Medicare Beneficiaries With Special Needs

By Marc Manor

Many of our seniors and other Medicare beneficiaries are living on fixed incomes with very little wiggle room for unexpected medical expenses. Fortunately, there are a number of state and federal programs available that can bring much needed relief to those who need “extra help” with paying for medical expenses. One of the most prevalent sources of assistance for medical expenses is Medicaid.

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Those Medicare Beneficiaries who get their assistance via Medicaid are referred to as “Dual Eligible” because they qualify for both Medicare and Medicaid. There are a number of Medicare Part C (or Medicare Advantage) Plans that are specifically designed with Dual Eligible beneficiaries in mind. These types of plans are known as “Dual Special Needs Plans” or D-SNP. If you are getting Medicaid and qualify for Medicare, I highly recommend speaking to an agent about what plan choices are available in your area. The agent can assist you with sifting through the D-SNP options in your area to be sure any specific requirements you may have are met with the plan you choose.

Not sure if you qualify for Medicaid?