Medicare

It is common knowlege that when you turn 65 you qualify for Medicare.  Unfortunately not everyone understands what that means, what they have as options and what to look for to choose what is best for them.  When you first become eligible you will be given an Initial Enrollment Period (IEP) to make your choices.  Deductibles, copayments, and coinsurance are costs you should consider. Once on Medicare you can make changes to your coverage during the Annual Enrollment Period (AEP) which is from October 15th to December 7th annually.  If you move to another state or retire after 65 and lose your employer coverage, or if under 65 and become eligible for Medicare, you would be given a Special Enrollment Period (SEP). 

When you retire or leave your employer's coverage after age 65 (or your spouse is over 65 and on your employer's coverage),please be aware that if you choose to go on COBRA, COBRA and retiree health plans aren't considered coverage based on current employment. You're not eligible for a Special Enrollment Period when that coverage ends. Also, find out what happens to your retiree coverage when you're eligible for Medicare. For example, retiree coverage might not pay your medical costs during any period in which you were eligible for Medicare but didn't sign up for it. When you become eligible for Medicare, you may need to enroll in both Medicare Part A and Part B to get full benefits from your retiree coverage.This Special Enrollment Period also doesn't apply to people with End Stage Renal Disease.

 It is best to begin your research 3-4 months before your 65th birthday or before an expected enrollment period so that you can complete your choices within the allotted time. So let's look first at the basics:

Medicare is a federal health insurance program for people age 65 and older and for younger people with disabilities and people with End Stage Renal Disease (ESRD).  Original Medicare is comprised of Parts A and B. 

Medicare Part A (Hospital Insurance) is provided premium free for most people because they paid Medicare taxes while working.  If not you could pay up to $413 each month.  In 2017, the deductibles you would pay are:

Hospital Stay

  • $1,316 deductible per benefit period
  • $0 for the first 60 days of each benefit period
  • $329 per day for days 61-90 of each benefit period
  • $658 per "lifetime reserve day" after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)

Skilled Nursing Facility Stay

  • $0 for the first 20 days of each benefit period
  • $164.50 per day for days 21-100 of each benefit period
  • All costs for each day after day 100 of the benefit period

Medicare Part B (Medical Insurance)is a voluntary program that requires a monthly premium. It covers 80% of Medicare aproved costs for physician services, outpatient therapy, and durable medical equipment after the Part B Deductible has been met. In 2017, the Part B Deductible is $183 per year.  (In 2017 there may be limits on physical therapy, occupational therapy and speech language pathology services. Exceptions may be granted.)  Most people pay the standard premium amount that changes annually.  In 2017 the standard premium average is $109 ($134 per month if you are new to Medicare in 2017). However, if your modified adjusted gross income as reported on your IRS tax return from 2015 is more than $85,000 for an individual or $170,000 for a joint return, you may pay more.  These amounts may be higher if you pay a late enrollment penalty.  Social Security will tell you the exact amount you will need to pay in 2017.

Medicare Part C is also known as Medicare Advantage. It is offered by private insurance companies approved and contracted by the Centers for Medicare and Medicaid Services.  It combines the coverages of Part A and Part B into one policy.  It may also include Part D, Prescription Drug Plan. These plans can also include additional benefits such as vision, dental and hearing coverages, all in one plan.  You must be enrolled in both Part A and Part B to join a Medicare Advantage plan.  You will remain enrolled in Medicare Parts A and B, but you will receive your benefits through your Medicare Advantage insurance company instead of the government.  These plans can be Health Maintenance Organization (HMO), Point of Service (POS), Preferred Provider Organization (PPO), Special Needs (SNP), Private Fee for Service (PFFS) or Medical Savings Account (MSA) plans.

Medicare Part D is also known as the Prescription Drug Plan (PDP).   It helps pay for the prescription drugs that your doctor prescribes.  Part D can be purchased as a standalone Medicare PDP with Part A and Part B or as part of a Medicare Advantage Plan or with a Medicare Supplement plan. Part D plans should be purchased when you first become eligible even if you are currently not taking prescription drugs so that you can avoid Medicare's late enrollment penalty.  If you are currently taking medications it is important to check the plans formularies for the cost of your prescriptions and that your pharmacy accepts the plan. 

Medicare Supplement Insurance is also know as Medigap Insurance.  It can only be used in combination with Original Medicare Part A & B.  It helps pay for the out of pocket costs that are not covered in Part A and B.  You cannot have both a Medicare Advantage and a Medicare Supplement policy.  The plans are standardized plans usually identified by the letters A though N, meaning each company must offer the same basic benefits no matter which insurance company sells it. So in other words if you choose a "G" plan for example the only differences are the insurance company's prices and added services. Medicare Supplement Insurance does not help with the cost of Long Term Care such as nursing home care.  Many people who choose a Medicare Supplement policy often also add a standalone Prescription Drug Plan.

TIPS FOR CONSIDERING WHAT PLAN IS RIGHT FOR YOU

Call your doctor to see what plan(s) they accept

Compare out of pocket costs such as monthly premiums, copays, coinsurance, and deductibles

Review your prescription drugs costs against the plan's formulary

Check to see what coverage is available out of the area if you travel and may need coverage in other areas

If you are offered coverage from a former employer make sure your choices won't void your retiree coverage

CONFUSED BY THE OPTIONS?

We are here to help.  We represent many of the major carriers for MEDICARE ADVANTAGE, PRESCRIPTION DRUG PLANS AND MEDICARE SUPPLEMENT POLICIES to give you options and help you make the right decisions for you. 

Finding appropriate medical and prescription drug coverage is a necessity for anyone who becomes eligible for Medicare.  Some clients prefer to pay a monthly premium knowing they will have no copayments and deductibles when coverage is needed.  Others prefer no monthly premiums but are willing to pay copayments and deductibles when coverage is needed.  Still others prefer something in between. 

By representing multiple carriers we are able to offer you multiple options to choose from for your needs and budget.  We'll do the work at no cost to you other than the cost of the insurance you choose.  There is no obligation to purchase.