Sandy D’Elia, senior director of Medicare Sales for Blue Shield of California, explains how Medicare is changing — and isn’t.
Sandy D’Elia, senior director of Medicare Sales for Blue Shield of California explains some of the pitfalls in Medicare, how coverage has changed during the pandemic and how the new administration and Congress has shifted the program.
What will happen if members forget to sign up when first eligible for Medicare?
Medicare Part A is automatically provided Aging into Medicare. However, Medicare beneficiaries are notified to enroll in Part B as they age into Medicare. The notification states it is “voluntary”; However, if a beneficiary decline to enroll and does not have creditable coverage, they will get financially penalized.
What is the timeframe and/or how often they can sign up?
A Medicare beneficiary is automatically enrolled and will receive their red, white and blue card 3 months before their 65th birthday or 25th month disability benefits. There is no premium for Part A. If the Medicare beneficiary chooses not to keep Part B and decide they want it at a later date, they may have to pay a penalty for as long as they have Part B. (penalty is 10% increase in Part B premium for each 12 month-period they could have had Part B but didn’t sign up.
If you don’t sign up is there any penalties?
Yes there is a Part B premium penalty if not enrolled when age in to Medicare.
The new administration has pushed through new public policy, has any of this affected Medicare and whom might be eligible?
Eligibility into Medicare has not changed at this time.
Many people used telehealth services during the pandemic, does Medicare cover these? Will it do so in the future?
Medicare covers telehealth services provided by a doctor or other health care provider who is located elsewhere using interactive 2-way real-time audio and video technology.
Medicare is a government program, why is Blue Shield involved?
lue Shield of California has a contract with the Federal Government – Centers of Medicare/Medicaid Services, to provide health care coverage and administer the Medicare benefits through Medicare Advantage Plans. Blue Shield of California offers different Medicare options including MediGap programs/policies. MediGap policies offer different types of coverage and do not require the policyholder to work within a provider network.
Some media reports say Medicare is becoming top heavy with Baby Boomers retiring into the program, does this have an impact on the program?
The Medicare program is managed by the Federal Government and has programs and policies to protect the integrity of the system. Due to beneficiaries living longer, this has naturally put a strain on the overall system. Therefore, health care management on behalf of patients and providers is essential to mitigate systemic challenges.
Other reports suggest Medicare scams are on the rise. What should members do? What is Blue Shield doing?
Members and carriers responsibility on fraud, waste and abuse are critical to the wellbeing of the system. There are federal policies in place that allow for reporting of these behaviors. Blue Shield of California provides extensive training, policies and procedures for it’s employees and business partners to help protect and mitigate any issues.