Q: My Husband died five months ago and I continue to receive many medical bills. He had Medicare coverage. Why am I getting all these bills?
A. Medicare pays 80% of the eligible amount. You will be balance billed 20% of the eligible amount if your doctor accepts assignment, and the difference between the eligible amount and the actual charge in addition to the 20% if the doctor does not accept assignment. If your husband had a Medicare supplement, it would pick up and pay these balances. This is why having a Medicare supplement is so important; Medicare by itself is not enough. If he did not have a Medicare supplement, get out the check book and start writing!
Q: I am over 65 and still working. My group health insurance is primary. A friend said I will not be able to buy a Medicare supplement when I retire. Is this true?
A: The answer to this question is multi-faceted. If you do not have Part B Medicare now (medical expense coverage) you will be able to purchase any Medicare supplement upon your retirement, providing you apply for Medicare Part B when you retire. There will not be a waiting period for pre-existing conditions and there will be no penalty in having to pay a higher premium. If you already have Part B Medicare, you will not be able to purchase a Medicare supplement which offers prescription benefits if you are already taking prescription drugs. You will be able to purchase Medicare supplements A-G.
Q: Will my health insurance pay for a mammogram?
A: If this mammogram is for diagnostic purposes, meaning you have a problem that must be diagnosed, your insurance will pay for the mammogram in accordance with the terms of your insurance contract. If this is a routine mammogram, it will be covered, depending on your age. Most plans will cover a routine mammogram starting at age 40. Be sure to check your insurance benefits booklet to see what the criteria are for your plan. Some plans will cover one mammogram between the ages of 35 and 39 and then one every two years starting at age 40. At age 50 most plans will cover a mammogram annually. Of course, at any age, if there is a problem and the mammogram is diagnostic, it will be covered by your coverage. There is a big difference between a routine mammogram and a diagnostic mammogram. October is breast cancer awareness month, so please let this question serve as a reminder to you that it is extremely important to your well being to have a routine mammogram if you over age 35. Likewise, if you suspect a problem, do not wait.
Q. I have a Medicare supplement policy and the claim was not automatically forwarded to my Medicare supplement carrier. Why?
A: Most likely, the information about your Medicare supplement insurance was not stated on the claim form that was submitted to Medicare. Be sure to always give your insurance information to each new doctor you go to! If the providers give Medicare all of your secondary insurance information, the claim should be automatically forwarded. Keep in mind that when computers talk to each other across the miles, glitches can occur. You should always read your Medicare Summary notice (MSN). There should be a statement on the MSN that tells you your claim was automatically forwarded to your secondary insurer. If you do not see this statement on your MSN, it will be necessary for you to make a copy of the Medicare explanation, and submit the claim yourself according to procedure for your specific Medicare supplement carrier.
Q: I paid my insurance premium late, and the next day received a notice that the insurance company had terminated me! Can they do that?
A: Once again, YES! You must pay your premium on time each month in order to keep your health insurance in force. You do have a 30 day grace period but I do not recommend making a habit of paying your premium during the grace period. Be on time! Most premium checks go directly to lock boxes in banks. It often takes up to 2 weeks for your check to post to your account from when it was received. If you know you are late with the premium, call your agent, or the company directly for further instructions to expedite it. You may be able to do a payment over the phone, or mail it directly to a person’s attention to keep the policy from accidentally lapsing.
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