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How does a doctor’s participation in Medicare affect reimbursement?
Medicare reimbursement refers to the payments that hospitals and physicians receive in return for services rendered to Medicare beneficiaries. The reimbursement rates for these services are set by Medicare, and are typically less than the amount billed or the amount that a private insurance company would pay.
How do I change my Medicare coverage?
Thousands of Medicare beneficiaries change their coverage each year during several enrollment windows. Find out how and when you can switch plans.
Important Medicare enrollment dates
Enrollment dates for Medicare are critical. Missing an enrollment date could cost you higher premiums down the line — or it could cost you coverage entirely.
Q: Will my Medicare coverage follow me if I move out of the state?
A: If you’re enrolled in Original Medicare, then yes. But Medicare Advantage, Part D prescription drug coverage, and some Medigap plans can be state-specific.
Check with your insurance provider before moving to make sure your insurance is transferable and will be accepted by doctors and hospitals in your new state of residence. When moving, you’ll have access to a special enrollment period or guaranteed issue right you can use to select new coverage.Original Medicare has participating providers across the country. If you have Original Medicare plus a Medigap plan, your Medigap insurer must allow you keep your coverage. What you pay for your Medigap plan may change though, because states differ in their rules for determining Medigap premiums.
You can’t keep your current coverage if you’re moving to Massachusetts, Minnesota, or Wisconsin, where Medigap plans operate differently. If this is the case, you’ll have an opportunity to apply for new coverage. Contact your state insurance department for more information.
Medicare Advantage and Part D plans have defined service areas. If you are moving out of your plan’s service area, you have two months before and after the move to select new Advantage or Part D coverage. You can do this by calling 1-800-MEDICARE.
Moving can also be an opportunity to switch to Original Medicare if you’re unhappy with Medicare Advantage. While most Advantage enrollees who transition to Original Medicare face barriers to purchasing Medigap outside of their open enrollment period and must go through medical underwriting, Advantage enrollees leaving their plan’s service area have a guaranteed issue right to purchase any Medigap Plan A, B, C, F, K, or L.
People who first qualified for Medicare on or after January 1, 2020 are not eligible to enroll in Medigap Plans C or F, but can use their guarantee issue right to purchase Plan D or G instead. The guaranteed issue right starts two months before and lasts for 63 days after your Medigap coverage ends.
If your Medigap coverage is with a Medicare SELECT plan, it has a localized provider network that you’re required to use, and thus will no longer be suitable if you’re moving out of state. As long as you’ve had the SELECT plan for at least 6-months, you can purchase a regular Medigap plan from your current insurer with the same or fewer benefits than your current SELECT plan. You can also use your guaranteed issue right to purchase any Medigap Plan A, B, C, F, K, or L, regardless of how long ago you enrolled in Medicare SELECT. (As mentioned above, people who qualified for Medicare on or after January 1, 2020 can’t enroll in Plan C or F, but can select Plan D or G instead.)
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients with extensive Medicare claims and appeals. In addition to advocacy work, Josh worked for the health insurance exchange technology firm hCentive. He also has held consulting roles, including at Sachs Policy Group, where he worked with insurer, hospital and technology clients.