Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

 Question: My spouse just passed away, and I am so overwhelmed with all that needs to be done. Now I found out his retiree health insurance will no longer cover me. Now what do I do?

Answer:

I am so sorry for your loss. This is an especially difficult and stressful period of time for you. Now with the loss of your insurance, you have one more task to take to take care of. So, let’s talk about solutions.

Usually when you lose coverage in this situation, you will lose coverage at the end of the month. It is February, so you have until March 1st to pick a replacement for that retiree coverage without a gap in coverage.

There are also times during which you can make certain changes to Medicare without penalties called Special Enrollment Periods (SEP). SEPs are made available by law for many different reasons, mostly when someone loses coverage in their area. Because your current plan is ending due to the death of your spouse, this is counted as an acceptable loss of coverage, so you are allowed to research and sign up for any Medicare products you wish. In your circumstance, your SEP lasts for 60 days after your coverage ends, so that would be all of March and April, but we really don’t want to wait – again your retiree coverage through your spouse will still terminate at the end of the February, so you would still have a coverage gap if you wait longer, but the SEP gives you flexibility and avoids penalties.

In general, changes in Medicare coverage go into effect no sooner than the 1st of the upcoming month. So, if you sign up for a for a product in February, it would begin March 1st, if you sign up in March it begins April 1, and so on. I would strongly encourage you to do something in February, so that when your coverage ends, you would go directly onto your new policy, with no gap in coverage at all.

In order to qualify for that retiree plan, you needed Part A & B of Medicare, and now you’ll need those same parts to pick additional coverage. To pick new coverage, we need to review all the alternatives. In Western New York, we have more than 60 different insurance options to add onto your Medicare A & B. Remember that in order to avoid penalties, you must also have Prescription Drug Coverage, which is not part of A&B, but you can pick up during this month and the rest of your SEP.

Last week we talked about resources available to you. To check available plans, you could first check www.medicare.gov. The site is designed to help you learn about, research, and enroll into everything Medicare. If you have used this website in the past, you can log back in and update your information. If you have not used the website, I would encourage you to try it out. If you are uncomfortable using the website, you can also call 1-800-MEDICARE to work with the customer service staff to help you through the options and alternatives. I really like the website because it allows us to ‘see’ the alternatives in screen, and I personally tend to learn easier if I can read it, so I often print out articles or pages I want to study.

The website collects the relevant data, your zip code, your pharmacy, your medications, and then sorts which plans work the best for your medications. But remember medications are only part of the answer. You need to be sure that the plan you choose works with your physicians, and your budget.

You can of course reach out to others for help with these alternatives as well. This could be just a family member who is more tech savvy than you who could help you with this website. It could be an agency who helps with Medicare, like Office for the Aging, or Southwestern Independent Living Center. Or it could even be an Insurance Broker who works with Medicare products locally.

At this point, you really have pathways: the first is add coverage to you Part A &B called Medicare Supplement Plan and a standalone Prescription Drug Plan. This pathway tends to be more expensive when it comes to monthly premiums, but it also works anywhere and it’s very comprehensive. Note this option is not “bundled,” so you would end up with 3 separate insurance cards, you Medicare ID card, one card for your Supplemental plan, one for your Prescription Drug Plan.

The second pathway is enrolling in a Medicare Advantage Plan. These include Preferred Provider Organizations (PPO), Health Maintenance Organization (HMO) and more. This alternative tends to be much lower with regard to premiums, but may be restrictive in where you are allowed to use it. Using this pathway, you would have one insurance card and you show it wherever you go.

Whatever you choose, it’s important that you do not put this off, and ideally should make your choice in February, so your new coverage can begin March 1st.

I hope this is helpful information and please reach out for help during this difficult time.

If you have questions or need assistance navigating your options, don’t hesitate to reach out to the Lawley Medicare Solutions Team. You can contact Medicare Service Team Lead Gabrielle Connor at 716.849.8223, or submit an inquiry through our contact form below. We’re here to help you find the right coverage for your needs!

At Lawley Medicare Solutions, our Medicare and Individual Health Consultants are dedicated to helping you make the most informed decisions about your healthcare needs. We offer personalized service and expert advice tailored to your unique situation. Contact us today by phone or email to schedule a consultation and ensure you’re getting the best coverage for your needs.

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Our licensed Medicare & Individual Health Insurance team can help clients understand the details of Medicare insurance plans, assist with choosing the right benefits and coverage, and provide guidance when life events that affect health coverage occur. For questions, concerns, or to reach Lawley Medicare Solutions, call 716.849.8223.