This is in relation to the penalties for failing to sign up within the time frames for Medicare Part B or Part D. Missing these dates can significantly cost seniors throughout their remaining lives. It can also affect the choices that you may make on your Medicare Advantage plans. Check with your agent about the timelines and penalties for missing out on signing up.
Original Medicare lets you see any doctor nationwide and works well for people who travel or want flexibility. It usually costs more monthly, especially if you add drug (Part D) and Medigap coverage, but you’ll have fewer restrictions.
Medicare Advantage is a lower-cost, all-in-one option from private insurers that includes extras like dental and vision. It often has network limits and copays, but can save you money if you’re okay with those trade-offs.
When a American Citizen whom comes off of C.O.B.R.A. there is no guarantee issue right into a Medigap Insurance plan. C.O.B.R.A. can last 18 months or 36 months. Medigap Insurance means the same as Medicare Supplement Insurance. Therefore, their application for Medigap Insurance may be denied.
If you are not “officially” admitted to a hospital, you are what is known as being “under observation”, making you responsible for the days & nights that you are there. Though at this time, this is rare, all you need to do is to ask your nurse or doctor if it’s official? If their answer is in the affirmative, then you definitely can believe them.
One Medicare rule that is outdated and unfair is when someone is first eligible for Medicare and are allowed to enroll in just part A and they continue to work and contribute to an HSA account, once they enroll in Part A they are no longer allowed to contribute pre-tax dollars to their HSA account. They may also be subject to a penalty if they did not stop contributing to the HSA account 6 months prior to retirement. This is outdated and unfair to seniors who continue to work because most people these days do not plan their retirement 6 months in advance.
One outdated and potentially unfair Medicare regulation is the "Improvement Standard" that some argue inappropriately limits coverage for skilled nursing home care when no improvement is expected. This standard suggests that Medicare may not cover care for conditions where no improvement is possible, even if the care is essential for maintaining or preventing deterioration. Here's why this is a problem:
Focus on "improvement" over maintenance: The standard focuses on whether a patient can improve, rather than whether they require skilled care to prevent or slow decline, according to the Center for Medicare Advocacy.
Limited access to necessary care: This can deny individuals the care they need to manage chronic conditions and maintain their quality of life, notes the Center for Medicare Advocacy.
Disproportionate impact: This can disproportionately affect individuals with progressive illnesses or those who are near the end of life, notes the Center for Medicare Advocacy.
While the Medicare program acknowledges the need for skilled care for maintenance purposes, some argue that the "Improvement Standard" interpretation by some providers or insurers may not fully reflect this principle.
That would be the "Donut Hole" as most people refer to it. I was on Medicare for 17 years, and I would ultimately hit it every year around August, but I noticed that it started to get earlier and earlier every year. However, starting in 2025, it was eliminated, and there isn't a "Donut Hole" anymore.
One rule I think is pretty outdated—and honestly not fair to seniors—is the 3-day hospital stay requirement for Medicare to cover rehab or skilled nursing care. A lot of folks don’t realize that if you’re in the hospital under “observation” instead of being officially admitted for three full days, Medicare won’t help with the nursing home costs after. Even if you’re lying in a hospital bed for days, it might not count. It’s confusing, and it ends up costing seniors way more than it should.
Medicare is updated every year. For example, next year's Medicare Advantage plans will not provide food allowance. This is going to upset many seniors. However, if an individual has a chronic conditions, like diabetes, Cardiovascular....they will. I believe that people with Medicaid and Medicare will have a food allowance.
Medicare raises costs for seniors who miss their Part B or Part D signup deadline, even if they didn’t know about it. Government Required Disclaimer: Agents may not offer every plan available in your area.
The 3-day hospital stay to have skilled nursing covered by Medicare and your Medicare Supplement. If you have Medicare Advantage, there's no 3-day rule thankfully.
The silly marketing rules for agents...like the Scope of Appointment and call recorded line. Both are childish and don't stop the bad agents. They only make it harder and less efficient for the good agents and Medicare beneficiaries.
I would say the three-night hospital stay required for nursing home benefits. It states that an individual must stay in the hospital for 3 consecutive nights to be eligable for Medicare coverage at a skilled nursing facility.
I wouldn't call it a rule or regulation that is outdated. I would call it one that does not exist. Medicare needs to REQUIRE the insurance companies and doctors/facilities to sign network contracts with a January 1 effective date. This way the beneficiary would be certain that they will not lose their doctor part way through the year. It is not fair to seniors to pick a plan in the Fall, have plan start on January 1, only to be told part way through the year that their doctors or local hospital will no longer be in network. This does not open a special election period to change plans and forces the patient to find care from a different in-network provider.
