You might feel confused by all the different health insurance options and choices you have to make when you turn 65. No matter whether you choose Original Medicare or a Medicare Advantage Plan, you are guaranteed certain rights:
You are guaranteed to be treated with dignity and respect. Some unscrupulous agents may think just because you’re older, you’re easy prey, but you should never let anyone intimidate you when you’re researching and signing up for your Medicare benefits and Medicare supplement insurance (also known as Medigap). If someone treats you wrongly, report him or her to your state insurance department.
Your questions about your Medicare coverage must be answered. You may be able to find the answers to common questions at the Medicare website. You also can call the Medicare help line at 1-800-633-4227, 24 hours a day, including weekends. Your state insurance department also may be able to answer your general questions about health insurance plans.
Your questions must be answered in a way that you understand, whether the answers come from Medicare, the people at your health insurance plans or, under certain circumstances, contractors.
You must be accepted in a Medicare supplemental plan if you apply when you enroll in Medicare. You can’t be turned down for health reasons, says Lucas Burton of Golden Age Providers in Largo, Fla. If you want to switch Medigap insurance plans, you might be refused, but not when you first enroll, he says.
Your Medigap insurance policies must be renewed as long as you pay your premiums. You can’t be dropped for making claims. Don’t let anyone tell you that if you make too many claims on your Medigap health plan, you may lose it.
You can make changes to your health and prescription drug coverage. In most cases, you can make these changes during the open enrollment period, which is Oct. 15 to Dec. 7. Any changes made during that time take effect on Jan. 1, 2020. There’s also a more limited open enrollment from Jan. 1 to March 31 when you can only switch Medicare Advantage plans or change from Medicare Advantage to Original Medicare.
There are special circumstances that allow you to change your Medicare health or prescription drug coverage at other times of the year, Burton says. The circumstances may depend on the state in which you live, but may include the death of a spouse or moving.
You can appeal decisions about coverage for services or prescriptions drugs. You can file an appeal if your plan denies coverage or stops paying for items or services you believe you need. If you have Original Medicare, you must fill out a Medicare Summary Notice within 120 days of obtaining it. You should receive a decision within 60 days. If you have a Medicare Advantage plan, you must file the instructions from your plan. If you need help with your appeal, you can contact your State Health Insurance Assistance Program.
Medicare can be confusing, but make sure you understand your rights so you can get the right plan for you.