This is essentially part II of a previous blog explaining how employer retiree benefits work compared to Medicare benefit options.  See blog: https://www.cdi-cares.com/blog/employer-retiree-plans-and-medicarewhat-you-should-know.  In this blog, we are going to dive deeper into Federal Retirees specifically.  Federal Retirees include people who worked for and retired from government/legislative offices, military bases, post offices, etc. These individuals have access to a special benefits program that includes medical, prescription drug, dental, vision and hearing benefit plans.  Some have access to plans as early retirees before turning 65, and others have special plans for over the age of 65 and retired.  However, there are cost and coverage restrictions to be aware of.  In some cases, it may be beneficial to combine these benefits with Medicare or not use the Federal Retiree offering at all.  Let’s explore…..

Each year as we head toward the last quarter of the year, the Center for Medicare/Medicaid Services or ‘CMS’ announces changes to Medicare for the coming year.  However, with the changes in 2025 having such a widespread impact, everyone has already been talking about it.  We have already had seminars, webinars, in person conferences and analysts have put out videos earlier this year.  Why does 2025 seem to have such a shock appeal?  This is because Medicare will have the biggest change to Part D since its inception in 2006.  So, what is coming up for 2025, and how could it affect you?  Here is a sneak peak at the good and the potentially bad.

Having worked in the Senior Healthcare market in one form or another for over 20 years, I am surprised that I can still get confused at the difference between Medicare and Medicaid.  It is not easy for everyone to grasp.  I recently cultivated a wonderful networking relationship with a Medicaid Specialist who works for a reputable elder law firm.  During our discussions, we realized there are a lot of myths and mysteries related to Medicare and Medicaid.  Now, is this a riveting topic?  No, but it is important to a lot of people!  So, let’s do a brief review of the basics to help distinguish between these two important services.

I frequently get calls from clients about why something that seems so basic is not covered by their Medicare plan.  It happens whether you are on Original Medicare with a stand-alone prescription drug plan or on an all-inclusive Advantage Plan.  This is true of prescription drugs, medical procedures, lab tests, alternative medicine and dental procedures.  The basis for the decision to not cover something boils down to whether that drug or service is considered medically necessary, has an effective alternative, or could be considered cosmetic.  Based on questions from you, here are some common non-covered items or services that might surprise you.  It is very likely that one of these things will come up for you too, so read on.

In a previous blog, I shared some information and tips about how Medicare covers (or doesn’t cover) preventive care.  It was a good generalization related to Original Medicare as a whole.  To take it a step further, let’s dive into preventive care and how it pertains to Advantage Plans or Part C.  As a rule, if Original Medicare covers a medical service, then the Advantage Plan is required to cover it as well.  There are, however, differences in cost share, authorization processes and how the covered service is billed and paid.  In addition, one could argue that Advantage Plans go beyond Original Medicare in covering preventive services.  Let’s look at how that plays out.     

On more than one occasion, I have received a call from a client fairly new to Medicare concerned about a bill.  In one case, a client went for an annual physical at his Family Doctor’s office and was shocked to find his visit was not covered by Medicare.  In addition, he stated his doctor recommended a Tetanus booster shot since he hadn’t had one in over ten years.  He later got a bill for over $300.  So how can this be and what, if any, preventive care does Medicare cover?  Here is a look at what is covered and what to look for if you get an unexpected bill!

I wrote and posted a previous blog on what Late Enrollment Penalties are and how to avoid them.  [https://www.cdi-cares.com/blog/what-are-medicare-penalties-and-how-do-i-avoid-them] But let’s go a bit further to help Medicare beneficiaries who already have Late Enrollment Penalties (LEP).  I have found that some clients come to me after the fact and don’t even realize they have a Late Enrollment Penalty (LEP).  Also, once you are notified that you have a penalty, how do you pay it?  Is there anything you can do about it after the fact?  Let’s get into it!