The other day I met with a new client who is turning 65 in November, just over two months from now. One of the first questions I asked him was, “Do you have your Medicare card?”.  His answer was, “no”.  With this bit of information I knew that he is not yet collecting Social Security – and this means he has to take some action to get enrolled in Medicare.

Most people I meet, who are turning 65, are already collecting Social Security, although the full age for collecting is 66. About 75% of people decide to start collecting as early as they can, which is when they turn 62. They get a smaller check if they decide to start receiving Social Security payments at 62 rather than 66, but lots of people have “retired” early, or lost their job, and they need the money sooner rather than later.

How you enroll in Medicare Part B depends on your current situation related to Social Security.

1) If you are receiving Social Security payments, you will automatically be enrolled in Medicare A and B. Part B has a monthly premium, which will be deducted from your Social Security check at the start of the month in which you turn 65.  Your Medicare card will be sent to you three months before your birthday month.

2) If you are not drawing Social Security payments, you will need to contact Social Security to tell them you want Part B. Part A has no premium, so you get this automatically.

You can enroll in Medicare on-line by going to SSA.gov. Or, you can call Social Security at 800-772-1213.  You will also need to make arrangements to pay your Part B premium, which is $99.90 per month. You have to pay 3 months at a time when you first start your Medicare coverage, but you can set up automatic bank withdrawals to pay the premium each month.

You can sign up for Medicare Part B three months before you turn 65.  If you wait to enroll in Part B until the month you turn 65, you will have to wait one month or more to get Part B.

If you are still working and have employer health insurance, you might not need to enroll in Medicare. If your employer has fewer than 20 employees, you must enroll in Medicare A and B (and pay the Part B premium).

Once you’ve enrolled in Part B, you will get your Medicare card.  Your Medicare card has important information that is required when you go to sign up for a Medicare supplement, Part D plan, or a Medicare Advantage plan (with Part D included). Your Medicare claim number is usually your Social Security number with a letter after it.  People who don’t use Medicare when they turn 65 will have different start dates for Part A and Part B.

Once you’ve got your Medicare card you need to choose your Medicare coverage.  Will you have only Medicare? (A financially risky choice)  Will you get a Medicare supplement and a stand-alone Part D plan?  Will you enroll in a Medicare Advantage plan that includes Part D drug coverage?  To get a brief overview of your Medicare choices, check out this video: Intro to Your Medicare Choices.

I have been contacted by several clients who received phone calls from their Medicare Advantage plan saying the plan would like to send a doctor to their home to give them a physical exam.  My clients called me to ask if this was legitimate. Or was it a scam?

Mindy called to say her Advantage plan is “bugging” her about letting their doctor come to her house.  “My plan is really pissing me off about this”,  she told me. She said they call her once a month to ask the same question, and each time she gives them the same answer: “No thanks”.

Mindy said a friend of hers, who is 90 years old, agreed to a visit by her Advantage plan’s doctor. The visit went just fine. The doctor was accompanied by a nurse, and they took her blood pressure and asked lots of questions.  Then they checked this lady’s home to see if there were rugs or other items that might put her at risk of tripping and falling.

Soon after the visit, this lady’s Advantage plan gave her a list of tests they think she should get. The lady took the list to her primary care doctor who poo-pooed it and said the Advantage plan should butt out of this lady’s business.  I guess doctors don’t like insurance companies getting in between them and their patients, even if the insurance company is trying to be of help.

It’s about money.

The reason Medicare Advantage (MA) plans are sending doctors and nurses to people’s homes has to do with getting more money from Medicare.  Medicare pays Arizona Advantage plans around $800 per month for each person enrolled with them. However, MA plans get more money for sicker members.  This is called “risk adjustment”, and it is very important since MA plans are now being paid a lower base rate than they were a few years ago. MA plans can get more money up front if they are able to identify members with serious health issues like diabetes and heart conditions, and this is the reason for the house calls.

It’s about stars.

The house calls are also about the Medicare star rating system.  The ratings go from one to five stars and are based on more than 30 criteria such as:  surveys of members and their satisfaction with the plan; telephone customer service; managing chronic illnesses of members; how many members get preventive screening tests and flu shots.

Most of the Medicare Advantage plans in Arizona get 3 to 3.5 stars, meaning they are average. The more stars a plan gets, the more bonus money it receives from Medicare. One plan in Tucson got four stars this year. In Phoenix, Cigna gets 4.5 stars. The plans have until 2014 to get to 4 stars and keep getting bonus money from Medicare.

Is it political?

Some people are calling the star rating bonus program “Obama’s Medicare slush fund“, and I wrote about it recently.

Over 45% of Medicare beneficiaries in Tucson, Phoenix, and Pinal County are enrolled in Medicare Advantage plans.  But they are not accustomed to their plan reaching out to them and asking to come over for a visit. This outreach is confusing for some. It is a bit scary for others. And in Mindy’s case, she is  pissed off by her plan.  I’m sure there are many people who think the doctor visits are a good idea. I just haven’t heard from them.