Case Stories
Ways other seniors have used their Medicare coverage.
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© Silver Health Advisors – All Rights Reserved
© Silver Health Advisors – all rights reserved
Case Studies
These are examples of the ways in which other people have used their Medicare coverage. The right plan for each individual varies, we can help!
Pre-Existing Conditions
Do they matter when it comes to Medicare?
Margaret was in great health when she enrolled in Medicare at age 65. She decided on a Medicare Advantage plan based on her good health and desire to keep her premiums low. At the time, it seemed like the right choice, until Margaret went to her doctor and discovered she had cancer.
With a family history of cancer, she wasn’t surprised by the diagnosis and, given her good health, her prognosis was good. What wasn’t good was the high cost of her cancer treatments under the plan she had chosen.
When we looked into alternatives with higher premiums but -in her case- better coverage, we discovered that Margaret no longer could qualify for a Medigap Program because of her preexisting condition.
In this case, Margaret’s practical useable benefits did not fit her healthcare needs. When you look at coverage options, think about your family history of disease, and weigh the likelihood of your need for more coverage in the coming years because, with certain coverage, after the initial enrollment period and or after a diagnosis, carriers will not grant you a policy.
To understand what options are available to you and what the right coverage is for your unique circumstances…
Working Past 65
What do you do when it’s time to retire but you’re over 65?
When Gilbert turned 65, he was still working. At that time, he was advised not to enroll in Medicare Part B during his seven-month Initial Enrollment Period (IEP) since he was still covered by his work insurance. That was 5 years ago and, after the COVID downturn and the layoffs in his industry, Gil has decided to retire.
With the end of his employment, he is now ready to enroll in Medicare Part B but realizes he’ll be doing so late. Gilbert is worried that he’ll have coverage gaps and might have to pay penalties.
The good news is that his circumstances qualify him for a Special Enrollment Period. For 8 months after anyone comes off the employer-sponsored health insurance, they can enroll in Medicare Part B without any penalties or gaps in coverage. Coverage always begins 1 month after enrollment, so in Gilbert’s case, he’ll want to enroll before he actually steps down from his position to ensure seamless coverage.
This simple example highlights the need to know when your enrollment periods are, and what you can expect from enrollment in terms of timing and coverage gaps.
To understand how your situation is best served…
An Active Lifestyle and an Accident
When rehab takes longer than expected, what is covered?
Being active and fit has always been important to Charlotte. For years she’s been hiking the trails behind the retirement community where she and her sister live.
When she had a fall and broke her leg, 6 ribs, and punctured a lung she spent 2 days in the hospital and then 66 days in a skilled nursing facility fending off pneumonia and rehabilitating her leg to where she can walk again.
After just a week out of the facility, she fell again and this time broke her hip.
As she heads for another rehab facility she is worried that her traditional Medicare won’t cover the stay past 34 days (when she will reach her 100-day limit).
Charlotte is right to be concerned but there are options. Medicare will not cover any days over 100 in a facility. Her Medicare Part A coverage will pay for the first 20 days in full and days 21 – 100 at a daily rate of $185.50 per day. Because Charlotte was not out of the skilled nursing rehab facility for 60 days in a row she is still within the same benefit period, even though she is being treated for a different injury.
If Charlotte cannot afford to pay out-of-pocket she may qualify for home health care instead. The doctor will have to decide if she qualifies as homebound. Since she was in the hospital for her injury, her Part A coverage would cover the home health care.
There are additional coverage options that can help offset the cost of unexpected health care needs like Charlotte’s. Please reach out to us with questions.
Life in the Arts
A life outside the traditional corporate sphere and a divorce complicate eligibility
Kevin just turned 65 and is hoping to enroll in Medicare. He is an artist and has never worked for a corporation, relying on his husband’s health insurance all these years. Since their divorce, Kevin is worried that he will not qualify for Medicare since he has heard that people who have fewer than 10 years of work history may either not qualify or owe a premium for Medicare Part A. Kevin’s husband Robert is 61 and has worked in corporate America for over 25 years. Neither of them is remarried.
The good news is, despite the divorce, Kevin is eligible to enroll in Medicare using Robert’s work history. Now that Kevin is 65, he can enroll anytime, in fact he could have enrolled three months before his birthday month when his initial enrollment period began.
Because Kevin never worked for a company that provided Medicare deductible insurance he would not qualify for premium-free Part A Medicare coverage without Robert’s work history. But, even though they are divorced now, he can still use Robert’s work history to qualify – he just has to wait until Robert turns 62 and is eligible for Social Security benefits.
The best choice for Kevin is to enroll in Medicare Parts A & B during his initial enrollment period and pay the premium until Robert turns 62 (only a few months away but after the enrollment period). After Robert is eligible for Social Security, Kevin’s premiums will drop off because he will qualify for the premium-free plan A coverage under Robert’s work history.
Robert does not have to collect Social Security, he just has the qualify. these kind of complex situations are our specialty, reach out to us today for more information on the right plan for you.