Medicare FAQ's

How should I apply for Medicare in Colorado?

The process depends on whether you are receiving Social Security benefits or not.

Receiving Social Security benefits? Your Medicare card should be automatically mailed to you three months before you turn 65. It should show that you have Medicare coverage for both Hospital (Part A) and Medical (Part B).

Part A can be No Cost, while Part B has a premium, which will be $170.10 per month for most people whose Medicare starts in 2022. If your income is high, your premium could be higher than the $170.10 average. Much higher! Click here to see a detailed chart showing the different premiums.

NOT receiving Social Security benefits? If you are not receiving Social Security benefits, there are three ways to get signed up. Click here for a detailed discussion.

When will my coverage start?

For most people, Medicare will start on the first day of the month in which they turn 65.

For example, someone turning 65 on July 27th will have their Medicare start on July 1st. We coordinate your Colorado Medicare supplements and prescription drug coverage to start on the same day as your Medicare.

Special bonus: If your birthday happens to fall on the first day of the month, your Medicare will start a month earlier! Now, how great is that?

How should I apply for a Medicare Supplement (Medigap) policy?

Through us of course! It is best to wait until you have your Medicare card or an award letter from Social Security confirming your Medicare coverage. We can do your application in person or over the phone or, send you a link to do an online application if that is offered by the provider.

In order to speed up the process, please bring the following:

1. Medicare card (red, white & blue)
   
2. Checkbook
   
3. This Medicare Fact Finder Form or your own list of doctors & medications
   
4. Scope of Appointment Form (“permission slip” allowing us to speak to you about Medicare plans.)
   
5. Insurance card for your current health insurance carrier

How long will it take to get approved?

For Medicare Part A & B: It generally takes three weeks to get your Medicare card after submitting your application. If you need proof of Medicare coverage sooner, call us at (970) 224-5500 to learn how to get an expedited letter of approval.

For a Medicare Supplement: It depends on the time of year. Most of the year it takes one to two weeks, but if you apply in the last three months of the year, it could take twice as long, or longer, due to how many applications are coming in all at once.

How do I know you are getting me the best price possible on my Colorado Medicare Supplement policy?

The price or "premium," as it is called, is approved and fixed by the Colorado Division of Insurance. Whether you buy from us, another agent, over the Internet, or directly from the insurance company, the premium will be identical— so long as the quote is for the same plan.

While buying through us won’t cost you a penny more, it will make the application process much smoother. If there are any problems that come up, we’ll deal with the hassles so you don’t have to! Plus, we’ll be there for you in the future whenever you have a question or need help in resolving a problem.

What if I have a pre-existing health condition?

Original Medicare automatically covers all pre-existing conditions.

In addition, all Medicare Supplement policies in Colorado will cover pre-existing conditions if you apply:

• during your initial six month open enrollment period when you first qualify for Medicare at age 65,
• or a Guarantee Issue period if you delayed signing up for Medicare Part B.
  

Call us at (970) 224-5500 to discuss how to proceed properly if you have delayed your Part B coverage - as this can get tricky. A mis-step here can leave you high and dry without medical coverage for a period of time. Those who qualify for Open Enrollment or Guarantee Issue do not have to answer any medical questions.

If you apply for a Medicare Supplement policy outside of your initial Open Enrollment period or Guarantee Issue period, you will need to answer medical questions and may or may not be approved, depending on your medical history. If you are approved, your pre-existing conditions will be covered immediately if you have had prior qualifying medical coverage in six months before the effective date of your Medigap policy.

However, if you have not had qualifying coverage in the prior six months, then Medigap plans are allowed to exclude coverage for pre-existing conditions for the first six months of your policy after which pre-existing conditions will be covered.

Can I save money by buying directly from the insurance company?

No. The Colorado Division of Insurance controls the rates, so your premiums will be identical regardless of whether you buy from us, buy online, or buy directly from the insurance company.

By going through us you'll get better service because you'll be getting our local help and advice should you ever have a problem with the insurance company. Also, if the company we place you with gets too expensive down the road, as an independent brokers, we can simply move you to another insurance company.

Hey, I know no one works for free, so how do you get paid for your services?

Whether your case is simple, or full of complications, there will never, ever, be a charge to you! Here is how we get compensated: insurance companies pay us a commission for providing them with a new client. Please note that this commission does not increase your premium in any way!

Insurance premiums are determined and approved by the Colorado Division of Insurance and cannot be changed by any distribution channel. This means your premium will be identical regardless of who you buy your insurance from. Even if you buy directly from the insurance company, your premium won’t be any lower than if you buy from a broker.

Can I see any doctor I want?

It depends on the type of plan you have. Original Medicare and Medicare Supplement plans in Colorado have no networks, so you can see any doctor or provider anywhere in the U.S., as long as they participate with Medicare.

On the other hand, if you have a Colorado Medicare Advantage plan, you will, normally, have to see a network doctor.

I recently submitted a claim that was denied. I strongly disagree with this decision. What’s the best way to appeal this claim denial?

We tell our clients to call us! Our service to our clients does not end when you buy a policy from us. We will review with you the reason for the claim denial. If it appears a mistake was made, we will show you how to file an appeal. An example of a common reason for a claim denial occurs when the doctor's office sends in the wrong procedure code for your service. This is easily fixed by having the doctor send in a corrected billing form.

It saddens us to hear from a client a year or two after a claim problem occurred and to learn that they are upset with one of our providers. If only they had called us sooner, we could have helped them, gotten their claim paid and everyone would have been happy. On the other hand, if the denial is legitimate, we will tell you straight up, so you’re not left wondering.

Does Medicare cover all medical expenses?

Well, not quite. No policy in the world covers "all" medical expenses. Every policy has a list of exclusions. That being said, Medicare’s coverage is comprehensive and excellent. Most people find that the combination of Medicare and a Medigap plan gives them better coverage than what they had before!

Where can I find an explanation of technical terms, such as copay, coinsurance, etc.?

Go to our web page entitled Basics of Medicare for a thorough explanation.

How much of a premium increase will I get after I buy a policy and how is that determined?

Future increases in your premium are determined by two main factors only one of which can we predict very accurately.

Age increase: The chances of people having medical expenses increases each year, as we get older. Insurance companies know this and consequently increase their premiums a little each year to account for this ever-growing actuarial risk. This yearly age increase is disclosed to the Colorado Division of Insurance (your consumer watchdog). We are subscribers to these updates and keep you informed accordingly.

Note: Medicare Advantage plans do not increase with age.

Medical Inflation increase: Insurance companies also look at how much they paid out in claims and how much they expect to pay out in the following 12 months. This is called a “medical trend factor.” If the premiums that are coming in are not sufficient to cover the increase in the medical trend factor, the insurance company will increase premiums to cover the expected increase in medical claims. This part of the rate increase equation cannot be accurately predicted.

It is important to note that the insurance companies do not look at your personal claims in setting rates, but rather at the entire block of business in your geographic region. This means that you will not be singled out for a rate increase just because you had a big claim.

I’m still working. Can I still contribute to my HSA after I’m 65?

Once you qualify for either Part A or B of Medicare, you are no longer allowed to contribute new money to your HSA account beginning with the first day of the month in which you qualified for either Part A or B of Medicare.

Example: Bill turns 65 on July 30th so his Medicare will begin on July 1st. He can contribute new money to his HSA for January through June, but no new contributions are allowed beginning July 1st.

Be sure to read the next Q&A on using HSA funds to pay for a Medigap policy.

Can I use money in my HSA account to pay the premiums for my Medigap or Medicare Supplement policy?

No, you cannot pay Medigap or Medicare Supplement premiums from your HSA.

Also, while the general rule is that HSA funds cannot be used to pay for insurance premiums, there are a few exceptions, especially for those over 65! You CAN pay for the following insurance premiums with HSA funds penalty-free and totally tax-free, if you are over 65.

Premiums Reimbursable with HSA funds:

• Medicare Part B premium. If Social Security automatically reduces your check to pay for Medicare, simply write yourself a check from your HSA account to reimburse yourself. Just be sure to keep records of what you are doing in case the IRS were to audit you.
• Medicare Part D drug plans.
  
• Employee portion of premiums for employer-sponsored group health insurance.
  
• Long-Term Care insurance. You do not have to be 65 for this one. However, the amount you can deduct is dictated by your age.
  
• Health insurance premiums while you are receiving unemployment compensation under federal or state law. You do not have to be 65 for this one.
  

Of course, you can still continue to use any money that remains in your HSA account to reimburse yourself for medical expenses, such as deductibles, copays, and coinsurance costs for doctor visits, prescription drugs, dental and vision expenses.

Did you know? While over the counter medications are normally not eligible for HSA reimbursement, you can be reimbursed for them if you first get a doctor’s prescription for those over the counter medications!

In addition, note that once you are 65 or older, you can take money out of your HSA account for non-qualified uses, such as a vacation, and pay no tax penalty. You will just have to pay taxes at your regular tax rate.

I delayed taking Medicare because I was still working and was insured by my employer’s group plan. Should I take COBRA first for 18 months and then go on Medicare?

Medicare rules are extremely tricky in this area and we have seen several people get trapped by Medicare’s rules. Make one tiny mis-step and you could find yourself with absolutely NO INSURANCE of any kind for many months.

Based on our personal experience and reading about how others have been left without insurance, we highly recommend not taking COBRA if you are over 65.

 
This is all very overwhelming. What can I do to simplify dealing with Medicare?

To say Medicare is complicated in an understatement...

...and in many respects Medicare is a moving target as laws change. We like to say, “In changing times, experience matters.” This has been our area of expertise since 1986 so we have invested the time to understand all the rules, analyze the plans, and be familiar with the all the processes.

Our job at Trozan Insurance Agency is to explain the rules and “demystify” Medicare so it actually will make sense to you! We promise! Once we’ve “demystified” Medicare for you, we’ll help you find the best Medicare plan to meet your needs.

But we don’t just sell you a policy and say “thank you for your business.” We provide you with periodic tips and updates through our own in-house newsletter. We also provide on-going service to support you when any questions or problems arise.

Finally, we’re here to review your initial choices and make sure that the policy you initially chose is still the best for your needs. If not, we’ll recommend a better alternative for your changed situation.

I’m confused about “plans” and “parts”. Is it Medicare Part F or Medicare Plan F? Is it Medicare Part G or Medicare Plan G ?

Yes, there is a lot of alphabet soup and the terminology makes things a bit confusing.
Here’s the skinny on how to sort it all out…

Parts: Medicare is written under 4 parts of the legislation.
This is where you need to know your A, B, C’s and D’s.
Medicare law under Part A & Part B covers the rules for Original Medicare.
Medicare law under Part C covers the rules for Medicare Advantage plans.
Medicare law under Part D covers the rules for the prescription drug plans.

Plans: The Government has also alphabetized the private Medicare supplement plans

• Plan A
  
• Plan B
  
• Plan C
  
• Plan D
  
• Plan F
  
• Plan G
  
• Plan K
  
• Plan L
  
• Plan M
  
• Plan N