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Reading the Fine Print of Your insurance Policy

If you have heard this once, you have heard it more times than you can count — “Read the fine print.” This is actually really good advice because there is things in an insurance policy you need to know and you will not find out about them until you need to use your health insurance and then find out that what you needed to use it for is not covered.

Your health insurance policy tells you a variety of things not the least of which is what it covers, but also, what it does not cover. If you do not read the entire policy, you could be in for a surprise later. However, insurance policies tend to be dense and complex. If you find that you have questions or concerns about your insurance policy, talk to your insurance agent.

Insurance agents are there to answer all of your questions. No one wants to be in a situation where they were sure their health insurance policy covered all they needed and wanted, but because they did not read the entire policy, it turned out to not be the case. To avoid a situation where you are faced with mounting medical bills, discuss your policy with informed insurance agents.

To read more about the benefits of health insurance or to get a free quote, visit EZ.Insure today!

Posted on Tuesday, October 22nd, 2019. Filed under Health Insurance.

Foreign Travel With Medicare May Be Problematic

Do you travel a lot? If so, make sure you check whether or not Medicare is in force when you are abroad.

Read over your insurance policy and find out what it does and does not cover. If, at any point you do not understand what the document encompasses, talk to a qualified insurance agent and have them walk you through your policy before you start to travel with Medicare.

You may not know that Medicare Advantage Plans and Original Medicare do cover urgent or emergency medical services anywhere in the United States and its territories. So if you have a Medicare Advantage Plan, you are getting urgently or emergency medical care that:

  • Limits on how much the plan bills you by being out of network
  • Must cover follow-up care in relation to the emergency if delaying it puts your health in danger
  • Your plan cannot demand you see an in-network provider
  • You can appeal if your plan denies care costs
  • You do not need a referral
  • That if the condition was not an emergency but looked/felt like it was, Original Medicare/ Medicare Advantage must cover care

What happens if you are denied coverage of an urgent or emergency medical assistance because you went to an out-of-network provider without an OK or a referral? Appeal the denial and get the physician to provide the appropriate documentation that the medical services rendered were urgently needed or in response to an emergency. Your State Health Insurance Assistance Program can help you in putting together an appeal.

Medicare does not cover medical costs while you are travelling outside of the United States. However, the plans must cover care in certain circumstances, including: paying for care received on a cruise ship while that vessel is in U.S. territorial waters; paying for E.R. services in Canada while traveling a direct route between Alaska and another state and the nearest treating medical facility is in Canada; and in certain limited cases, Medicare may also pay for non-emergency inpatient care in a foreign hospital.

There are a few Medigap policies that offer coverage for travelers’ abroad and they include Medigap plans C through G, M and N and offer 80 percent of the cost of emergency care.

If you do not know what your plan does and does not cover, check your policy for specific rules, and if that is not clear, contact the insurance agent and ask them to discuss the relevant sections and what they mean when you are travelling outside the United States.

Posted on Friday, May 31st, 2019. Filed under Medicare.

Does Medicare Provide Coverage Anywhere in the United States?

Increasingly Americans travel to other states to visit relatives, take vacations and take care of family. As people move between states it is important to keep track of Medicare coverage. For instance what happens if your home state is South Dakota and you take up residence in Florida to care for a family member? Do you need to get a Medigap plan in Florida or one in South Dakota? Would there be any out-of-network expenses involved here? These are some of the questions many people ask.

Original Medicare offers coverage anywhere in the United States provided medical professionals accept Medicare and nearly all do. When you have Original Medicare, you should also consider Medigap plans which offer additional coverage for copayments, deductibles and coinsurance. For anyone traveling inside the country it is important to note that once you have a plan, you may retain that plan regardless of your location in the United States.

If you decide to move out of your home state, you can keep your current Medigap policy as long as you have Original Medicare. If you want to switch to a new Medigap policy, however, you will have to check with both your current and new insurance company to see the Medigap policy options they offer. There are 10 standardized Medigap plans, this means that you may be able to reaming with your plan. Therefore, you may get a Medigap policy in South Dakota or in Florida.

What if you decide to switch to a Medigap issuer in Florida? You can certainly do that once you have established residence there, but it is not required that you do so. If you do make the decision to switch, you might be charged more in Florida because you do not have “guaranteed first rights.” “Guaranteed first rights” are rights that you have in certain situations when insurance companies are required to offer certain Medigap policies.

Your situation may look different if you are enrolled in a Medicare Advantage plan or in Medicare Part D when you decide to move out of state. If your current Advantage plan is not available in the area you are moving to, your plan is required by Medicare to disenroll you. If this happens outside of the special election period (SEP) you will be returned to Original Medicare. However, if you notify your plan provider before you move, you SEP will be changed. The SEP will begin one month before the move and last three months. If you forget to notify your provider about your move, you can still do so the month of the move. In such a situation, you will also receive a three month SEP, which begins the same month of the move.

Always check with an experienced insurance agent if you have any questions about how changes in your situation may affect your Medicare coverage.

Posted on Friday, December 1st, 2017. Filed under Medicare.
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