Many readers have questions about Medicare, which has strict coverage rules and payment provisions that can be confusing.
■ I am a federal retiree. I pay almost $400 a month for coverage through the Federal Employees Health Benefits program. It would save money if we bought a Medigap plan instead to supplement Medicare. Please tell me the pros and cons.
Like retirees from some private companies, many federal retirees can keep their health care coverage to supplement Medicare once they become eligible for Medicare at age 65.
If you sign up for Medicare Part A (hospitalization) and Part B (outpatient care), that Medicare coverage becomes your primary insurance, and your federal retiree plan acts as secondary coverage for services or costs not picked up by Medicare.
Your current FEHB plan may provide more coverage than you need; retiree plans are the same as for current workers. Once you are on Medicare, some federal health plans waive deductibles, coinsurance, and copayments.
You can change your FEHB plan 30 days before you are eligible for Medicare, and during the annual open season (Nov. 12-Dec. 10 this year).
If you opt for the private market, Medigap supplemental plans fill in some of the gaps in Medicare benefits and cover some of beneficiaries’ out-of-pocket costs, such as the Part A and B deductibles, coinsurance, and copayments. It’s important to factor in your health care needs and carefully evaluate services provided by different plans. For example, in some cases, “a retiree’s FEHB plan doesn’t cover the same length of stay at a skilled nursing facility’’ as some Medigap plans, says Casey Schwarz, at the Medicare Rights Center.
If you’re considering a Medigap plan, make sure you understand the rules in your state. Some states allow people to sign up only during specified periods or impose a waiting period before the plans cover care related to a preexisting condition.
■ I am an American retiree in Spain. My visa requires Spanish health insurance. However, Medicare won’t accept foreign coverage in lieu of Part B coverage. If I eventually return to the United States and want Part B, I will be penalized for each year I haven’t paid for it. That doesn’t seem fair.
There is no easy solution. If you get Social Security, you were probably automatically enrolled in Medicare parts A and B at 65. If you paid Medicare taxes while working you probably don’t owe anything for Part A. This coverage doesn’t benefit you since Medicare doesn’t generally cover care overseas, but it doesn’t cost you anything. The same can’t be said for Part B. Most Medicare beneficiaries pay $99.90 per month for this. You can refuse it, but for each 12-month period that you delay enrolling you incur a 10 percent penalty, based on the premium. That prevents people from waiting to sign up for Part B until they become sick.
If it’s unlikely you’ll return to the States, it may make sense to delay enrollment.