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I Just Signed Up For a Plan. Now What?

The last section PAYING FOR MEDICARE covered a big part of the “Now What?” Clients are usually most concerned with who needs to be paid and how they go about paying them. If you didn’t get a chance to read the last section on Paying for Medicare and you are wondering who you need to pay, then as they say in board games: Go Back One Space.

It is one thing to pay for something — but in an ideal world we also want to get the most value out of what we paid for. Of course, with our Medicare plan we probably don’t want to get the maximum value by having lots of operations and or even constant visits to the doctor. Ideally we don’t want to be boasting, “I got three surgeries out of the deal this year.”

But we do want to get the most out of promoting the best health we can for ourselves. The best way to accomplish this is by knowing about — and taking advantage of — all of our plan’s perks. Here are some important items to know about:

1) Approval Process: After we, as your agent, take your enrollment it will be submitted electronically to the plan’s carrier such as Humana or Aetna. The carrier will then submit it to CMS (Center for Medicare Services) for final approval. This process takes around three days. CMS is not approving you but only confirming that your Medicare card is legitimate and you are entitled to benefits. Problems with the approval process are very rare. Unless of course you are 17 years old and pretending to be 65.

2) Welcome Kit and Membership Card: You’ll receive a welcome kit along with your card in the mail within a couple of weeks of your enrollment. If you signed up for Medicare Advantage you will receive one welcome kit and card which you will use for both your medical needs and for prescriptions. If you signed up for a Medigap supplement and a stand-alone Prescription Drug Plan you’ll get two separate kits with cards, even if both plans are with the same carrier. Your kit is going to provide you with lots of information about your plan including where to look for further resources.

3) Using Your Cards: If you have Original Medicare, you’ll have a Medicare card from Medicare itself, a card for your Medigap supplement, a Prescription Drug Plan card and quite possible a dental plan card as well. I know, it’s a lot of cards and maybe you’ll need a new wallet just to hold all those cards. But you will need them all. A medical provider will want both your Medicare card and your Medigap plan card. You’ll need your Prescription Drug plan at the pharmacy. The good news is that once they have them on file they shouldn’t need to see them again. But keep them handy, because the next place will.

For a Medicare Advantage plan you will only need two cards: your Medicare card and your plan card.

4) Your Start Date: This will usually be on the first day of the month your Medicare Part B starts or on the first day of a future month you selected as your plan start date. Plans always begin on the first day of a month at midnight. Your old plan will expire at the last day of the month at midnight.

5) Disenrolling from Your Current Coverage: 

It’s important to let your current plan know at least a week in advance that you’re no longer going to be with them. Doing so will let them know not to bill you or take money from your account once you start your Medicare plan. Your Group Insurance Plan is required to allow you to disenroll from their plan as soon as you start Medicare.

CRITICAL TO KNOW: You must resign from your Group Health Coverage (if you’re on it) to coincide with when you start your Medicare plan, either with Medicare Advantage or Original Medicare. The reason why this is so vital is that if you keep your Group Health coverage active, then by Medicare rules your Group Health coverage will remain as your primary coverage. This will mean that your Medicare plan benefits will be negated.  Think of it this way: You don’t want your sleep mask still on when you’re ready to start the day.      

6) Member Portal: We live in a world where more and more like it or not our entire lives it seems are happening online. The other day I even attended a birthday party online, though they still haven’t figured out how to serve cake and ice cream through the World Wide Web.

Your Medicare plan will invite you to sign up for a personal portal. Your portal is a site where you’ll be able to “See It All” and “Do It All”. Think of it as being on the Amazon website: everything is there.

A summary of the things you can do in your portal: See all your claims; pay your bill if you have one; order from the over-the-counter products catalog, download or fill in forms you need such as reimbursement forms; read wellness articles and information.

Exploring your portal may not be as good as a trip to the Grand Canyon but it is well worth taking an hour and seeing what there is to see and know about.

7) Customer Service: Yes, you will still be able to talk to a real live person and not a telephone robot voice. There will be customer service numbers in your welcome kit and on the back of your plan’s membership card. Customer service agents with your carrier are trained to deal with a wide variety of customer issues including helping you find a specialist, looking up the formulation of a drug, figuring out what is covered or not, and helping you submit a reimbursement, as a few examples.

8) Your Wellness Exam: No, it’s not mandatory like an army physical is. Even so, scheduling your one-time “Welcome to Medicare Wellness Exam” is a really good idea. And, there is no deductible for this Wellness exam (and the lab tests which go with it) regardless of whether you’re on Original Medicare or Medicare Advantage. Many doctors schedule Wellness exams months in advance so it is a good idea to book your exam as soon as possible in anticipation of starting your plan.

Every year thereafter you also get a Wellness visit, generally without any copay. The purpose if this annual exam is to update your health situation and set a treatment plan for any conditions that you have. This exam is less thorough than your initial wellness visits and if further tests are needed then with Medicare Advantage there could be a copay.

9) Silver Sneakers: You will be eligible to join Silver Sneakers if your plan has that benefit, or the equivalent if your plan uses Silver and Fit or Renew Active (AARP United) as soon as your plan begins. To join, or to see gyms that are free to join and use in your location, go to:

Silver Sneakers: www.silversneakers.com

Renew Active: www.renewactive.com

Silver and Fit: www.silverandfit.com

10) Over the Counter Products: Hey it’s free stuff! If you have a Medicare Advantage plan then chances are you’ll get an allowance for free over-the-counter products (medicines, vitamins, medical doodads, even toothbrushes and paste). It’s like walking down the aisles of a CVS minus the funny greeting card section. Learn how to access the online catalog, download it and make a point to use it. With most Medicare Advantage plans you get an allowance such as $40-$75 each quarter. If you don’t use it that quarter you lose it. This is almost the same as throwing several $20 bills in the trash.

11) Your Plan Automatically Rolls Over: We will discuss this more in the next section on changing plans but let’s assume for now that you are satisfied with your plan, as most people are, and you do not want to change plans.

When Annual Enrollment Period rolls around each year and once again your mailbox fills up with what a lot of my clients describe with a word that rhymes with “frap” you can toss out all that frap and not do a thing. By doing nothing your current plan, be it a Medicare Advantage plan or an Original Medicare Medigap supplement and Prescription Drug Plan, will automatically continue. You do not need to reenroll each year as long as you want to keep your same plan.

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