planning for the future.

Medicare & You.

Understanding Medicare:
What you need to know.

Medicare is a health insurance program for:
– People age 65 or older,
– People under age 65 with certain disabilities, and
– People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Medicare is made up of a few parts:

Part A (Hospital Insurance) – Most people don’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Part B (Medical Insurance) – Most people pay a monthly premium for Part B. Medicare Part B helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. If you delay applying for your Part B premium when you are first eligible, then there may be a penalty and a gap in your coverage.

Part D (Prescription Drug Coverage) – Most people will pay a monthly premium for this coverage. In January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. This coverage is to help you lower prescription drug costs and help protect against higher costs in the future. Beneficiaries choose a prescription drug plan and pay a monthly premium. Like Part B, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

Medicare only covers 80% of our medical bills and so we as individuals are responsible for the other 20%. Under Part A, we are responsible for a sizable co-pay for hospitalizations and this resets every 60 days, so we can be responsible for that up to 5 times per year. Under Part B, it is an 80/20 split, with no maximum out of pocket limit on our 20%. Since Medicare only covers 80% of our medical costs, there are 2 paths people take to fill those gaps. You cannot have both, you must pick 1 of them to meet your healthcare needs. To join either of these paths, you must still pay your Part B premiums.

This information comes from www.cms.gov

By contacting the phone number on this website you will be directed to a licensed agent.

Medicare Supplements / MediGap

If you choose a Medicare Supplement plan, this plan literally “supplements” Original Medicare. That means it will cover only what Original Medicare covers. Original Medicare does not cover prescription drugs, dental, vision or hearing services.

The federal government requires that Medicare Supplement plans be standardized. A Medicare Supplement Plan G will look the same whether it is offered by AARP, Aetna, Humana, Mutual of Omaha or any other carrier. The ONLY difference is the monthly premium. These plans will cover all, most, or some of what Original Medicare does not cover.

There is a monthly premium you will pay in addition to your Part B premium. For a Plan G, the average premium paid by a 65-year-old is $100/month. You should still get a Prescription Drug Plan because it is not included with the Medicare Supplement plan or Original Medicare.

You will need to carry multiple cards with you to provide proof of coverage. You will have your Medicare card (red, white, & blue card), your supplement card, a prescription card, a dental card, etc. Medicare Supplement plans allow you to have predictable and low out of pocket costs because you are pre-paying for your health expenses.

Medicare Advantage / Part C

If you choose a Medicare Advantage Prescription Drug plan (MAPD), you will get all your healthcare coverage through this plan. This plan will include everything Original Medicare covers and some extra benefits such as prescription drug coverage, dental, vision, hearing, & some over-the-counter benefits.

These are not standardized plans and insurance companies offer a variety of additional benefits to help people depending on their healthcare needs and concerns.

These plans do change every fall in September. You can change or update your plan every year during the Annual Enrollment Period, from October 15 – December 7. It is important to review your plans to make sure that you are still in the best plan, and your doctors and drugs are still in-network at the best cost for you.

These are typically low cost or no cost plans, with most plans ranging from zero premium to $40/month. You will only have to carry 1 card. The same card will be used at the hospital, the doctor’s office, the pharmacy, dentist, optometrist and audiologist.

Questions & Answers.

important things you should know.

Can I have both a Medicare Supplement & a Medicare Advantage Plan?

You cannot have both plans, you must choose one. People often want a supplement since it covers the 20% that Medicare does not cover and then add the no cost Medicare Advantage Plan to get the drug coverage, dental, vision & hearing. But you must pick either a supplement and get a standalone Prescription Drug Plan or get a Medicare Advantage Plan.

Do I need anything else If I have Medicare & Medicaid?

For the most part, if you have Medicare & Medicaid then your healthcare needs are taken care of. However, in most cases, you can add a no cost Medicare Advantage Plan that will offer you additional benefits such as extra dental, vision & hearing. Most of these plans will come with a healthy groceries benefit, transportation to and from medical appointments, as well as some over-the-counter benefits. It is important to make sure you’re getting all the benefits you are eligible for and entitled to. These plans are designed to add additional benefits for a largely underserved demographic.

Do I still need to Pay for Part B if I can get a no cost plan?

Regardless of which path you choose, supplement or Medicare Advantage plan, you must continue to pay for your Part B premium.

It seems like there are 100s of plans, how do I sort through them?

When you watch TV commercials or sort through all the mail that comes to your home, it seems like there are 100’s of Medicare Plans and it can be very overwhelming to figure out which to choose.

All of these plans actually fall into 2 categories, the plan is either a Medicare Supplement plan (also called MediGap) or it is a Medicare Advantage Plan. You can sort through the noise by separating them into 2 piles.

Medicare Supplements are like paying for a buffet, you pay monthly and will have little out of pocket to pay throughout the year. Medicare Supplement plans do not come with drug coverage, dental, vision, or hearing coverage so you’ll need to add plans if you want to include them in your healthcare. Medicare Advantage Plans can range from zero-premium plans to plans with a low monthly cost. Much like the health insurance you had when working, there will be some co-pays required to see specialists, to cover some diagnostic tests, and/or if you are hospitalized. These plans do come with prescription drug coverage, dental, vision, hearing, and some over-the-counter benefits.

Why are Medicare Advantage Plans no cost or low cost?

Medicare Advantage Plans are low cost or no cost because the federal government actually pays the insurance companies to administer your Medicare services. Medicare Advantage plans have networks of care providers to manage healthcare needs. These plans offer preventative care through dental, vision, hearing, no-cost gym memberships, and over-the-counter benefits to keep you healthier. Healthier patients will typically have lower healthcare costs and less expensive hospitalizations. The catch is, much like your previous work health insurance, there are co-pays, co-insurances and deductibles. This can make sense for people who either cannot afford a supplement or do not want to pay the annually increasing costs to have a supplement and a prescription drug plan.

I don't take prescription drugs, do I need a prescription drug plan?

Once you are age 65 you should be enrolled in a Prescription Drug Plan (PDP). If you have “creditable coverage” through your work or your spouse’s work then you can delay drug coverage. People often ask if they can wait to get a PDP until they start taking medications, unfortunately, there is a penalty if you delay drug coverage after the age of 65. Please consult with a licensed agent to see when you need to enroll to avoid a lifetime penalty.

I am a Veteran and have VA benefits or Tricare, do I need anything else?

Veterans who have served, have access to VA benefits. If an individual retires after serving as a career Veteran with the military, they have access to TRICARE benefits. Both groups can benefit from a no cost Medicare Advantage plan. There are specific plans that are tailor-made to complement VA benefits. These plans commonly have a Part B giveback which returns part of the Part B premium payment back to the Veteran! This type of Medicare Advantage plan typically comes with dental, vision, hearing, and over-the-counter benefits. If you do not have TRICARE but still have VA benefits these plans can also give you options to go outside of the VA, putting more of your healthcare decisions in your hands.

What are the different types of supplements?

Supplements, (also known as MediGap plans), are regulated by the federal government and are the same in every state where they are offered. They are the same regardless of which insurance company offers the plan. The only difference is the premium charged by the insurance carriers. Supplements cover all, most, or some of the 20% that Original Medicare does not cover.

The most common supplements are: Plan F, G, and N. Think of Plan F for “full.” You pay the Plan F monthly premium to have no additional medical out of pocket costs for the year. Individuals would have to age into Medicare before January 1, 2020, to qualify for this plan.

The most popular plan now is Plan G. Think of G for “Great Value.” This plan will cover most of the 20% of what Original Medicare does not cover, except for your annual Part B deductible.

Plan N will cover all 20% except the Part B deductible. In addition, you will likely have some co-pays to see the doctor of $20 or $40 for urgent care. If you see a doctor that does not accept Medicare assignment, you could be subject to paying Part B excess charges. These are doctors who don’t agree to take the Medicare-approved amount as full payment.

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