1. Turning 65 and what that means for you
Turning 65 is a critical time in your life where you decide if you’re going to stay with your company sponsored health plan or join a Medicare Advantage plan, or purchase a Medicare Supplement plan. Many of the choices you make regarding your health benefits will determine your experiences regarding your health treatments. Many people often fall under three categories in regards to their Medicare choices.
- Seniors who are under a company sponsored or government plans such as Tri-Care or certain union plans, often decide to stick with their group plans for the benefits that are associated with these plans. These people often purchase vision and dental plans independently.
- Seniors who are on a tighter budget and don’t have access to a company or government sponsored plan often choose a Medicare Advantage plan so that they can receive their Part A and B and prescription Drug plan bundled together. With these plans customers will still see co-pays and deductibles that they have to pay out of their pocket.
- There are also people who are interested in the freedom to travel within the united states and see any Medicare participating doctors they like. These seniors often choose to stay with traditional Medicare and purchase a Supplement plan. These plans afford the customer more freedom with their providers. It also greatly reduces the co-pays and deductibles. In some cases these plans will pay 100% of their co-pays and deductibles.
2. What does Medicare Cover
|Part A||Part B|
|Hospital Stays, Skilled Nursing Facility.||Ambulance Services.|
|Limited Home Health Services||Clinical Research (if your apart of research study.|
|Hospice Care.||Mental Health (in and outpatient)|
|Part A Pays 80%. you are responsible for 20%||Preventative services, Medically necessary services.|
|Getting a Second Opinion Before Surgery|
|Durable Medical Equipment (DME)|
|Limited Outpatient Prescription Drugs|
|Part B Pays 80% You are responsible for 20%|
3. What are Medicare Advantage plans?
You can get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan (like an HMO or PPO). If you have Original Medicare, the government pays for Medicare benefits when you get them. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare
benefits. If you join a Medicare Advantage Plan, the plan will provide all of your Medicare
Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage. The most common types of Medicare Advantage Plan are:
Health Maintenance Organizations (HMOs)
Preferred Provider Organizations (PPOs)
Private Fee-For-Service (PFFS)
All Medicare Advantage Plans must include a limit on your out-of-pocket expenses for Part A and B services (for example, the out-of-pocket maximum for HMO plans in 2017 is $6,700). These limits tend to be high. Plans can’t include cost-sharing (copays or coinsurances) that are higher than they would be under Original Medicare for certain services, like chemotherapy and dialysis, but they can have higher cost sharing for other services. Medicare Advantage Plans can also provide additional benefits that Original Medicare does not cover, such as routine vision or dental care.
Medicare Advantage Plans often charge a premium in addition to the Medicare Part B premium. They also generally charge a fixed amount, called a copayment, that you are responsible for whenever you receive a service. Some plans charge a percentage of the cost of the service, called a coinsurance, for some or all services.
You can join a Medicare Advantage Plan if:
You have Medicare Parts A and B;
You live in the plan’s service area; and
You do not have End-Stage Renal Disease (ESRD).
Note: If you have ESRD that requires dialysis or a kidney transplant, you can enroll in a Medicare Advantage Plan if you join a Special Needs Plan (SNP) that specifically accepts people with ESRD or if other special circumstances apply.
If you want Medicare coverage through a Medicare Advantage Plan and also want drug coverage (Part D), you must generally choose a plan that offers Part D drug coverage as part of its benefits package. If you join an MSA, a PFFS without drug coverage, or a Cost Plan, you can join a stand-alone Part D drug plan.
4. What are Medicare Supplement Plans?
Also known as Medigap, Medicare Supplement plans are offered by private insurance companies and can take care of certain health care costs not covered by Original Medicare, like deductibles, premiums, and copayments. Plans are categorized by letter—A, B, C, D, F, G, K, L, M, and N—and plans of the same letter offer the same benefits. However, insurance companies can offer plans at different prices; therefore, you may have different out-of-pocket costs, even if the standardized plan benefits are the same. These plans do not provide prescription drug coverage. This means that you will have to enroll in a stand-alone Medicare Prescription Drug Plan for medication coverage.
While Medicare Supplement plans help with deductibles and other expenses not paid by Original Medicare, they do not cover services if Original Medicare does not cover them. For example, they do not cover long-term care, dental care, or vision coverage.
5. How can I get a Free Consultation
To speak with a licensed agent for a free consultation please fill out the Get a Free Quote form at the bottom of our site or contact a live agent at 888-566-9556.
6. What is Medicare Part D
Medicare Part D, also known as a PDP, first came on the scene in December 8, 2003 with the passing of the Medicare Prescription Drug Improvement and Modernization Act. This law implemented an elective drug benefit for Medicare beneficiaries and established the Medicare Part D program as we know it today.
Anyone on Part A or Part B Medicare is entitled to prescription drug coverage. You can’t be denied for health issues and there are no physical exams required. As soon as you become eligible for Medicare, you can volunteer to join Medicare Part D which is drug coverage. If you have switched from Medicaid to Medicare, you are required to enroll in Part D to get your prescriptions.
Every plan has a list of drugs that they cover and certain medications may not be on the list. There are six classes of drugs and the plan must cover at least two of the drugs within each class. The six classes are: anticancer drugs, antiretrovirals, antidepressants, anticonvulsants, antipsychotics and immunosuppressants. There are drugs that are excluded from Medicare Part D coverage by law. These include: weight medications, cosmetic, fertility, anti-anxiety, erectile dysfunction, cosmetic use and over-the-counter medications.
If you don’t enroll in Medicare Part D, make sure you have other creditable prescription drug coverage, which is insurance that is as good as the standard Medicare prescription drug benefit. If you don’t enroll in Medicare Part D when you’re first eligible and go without creditable prescription drug coverage for 63 days in a row or more, you could face a late-enrollment penalty if you sign up for Part D later on. This penalty comes in the form of an extra cost that is added to your monthly Medicare Part D premium; you may have to pay this higher premium permanently.
7. Compare the difference between Medicare Advantage and Medigap Policies.
- Most plans patient has to stay within coverage area and are unable to travel with the plan.
- Part A and B Prescription Drug Plan D are often bundled under one plan with private insurance company.
- Customer often pays co-pays and deductibles for medical treatment.
- Customer can travel anywhere within the united states and use the plan with a Medicare participating doctor.
- No doctor referral is needed.
- Customer will have purchase separate prescription drug plan Part D with separate company.
- Many Supplement plans will pay 100% of co-pays and deductibles that Part A and B will not cover, leaving customers sometimes with zero out of pocket expense.
8. What are the Medicare enrollment Periods
|Open Enrollment October 15- December 7||Medicare health and drug plans can make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks. October 15 to December 7 is when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs.|
|Initial Enrollment Period||Medicare Part A and/or Part B during the Initial Enrollment Period (IEP) that begins three months before you turn 65 and lasts for seven months. Initial enrollment in Original Medicare, Part A and/or Part B, occurs automatically if you are turning 65 and already getting Social Security or Railroad Retirement Benefits (RRB) benefits or will start collecting retirement at age 65. You will need to sign up for Medicare Part B at the time that you apply for retirement benefits, and Medicare Part A enrollment occurs automatically if you are eligible for Social Security retirement. A Medicare card will be mailed out about three months before your 65th birthday.|
|Special Enrollment Period||There are cases where an individual may enroll in Medicare outside of regular enrollment periods due to extenuating circumstances. This is known as the Medicare Special Enrollment Period (SEP). If you qualify for the Medicare Special Enrollment Period, you can enroll in Medicare outside of your Initial Enrollment Period (IEP) and the General Enrollment Period (GEP).|
|General Enrollment Period January 1- March 31st||This period is specifically for people who missed signing up for Medicare Part B at the required time — either during their initial enrollment period or during a special enrollment period for Part B. If you need to sign up for Part B during this period, be aware that your coverage will not begin until July 1, and you may be required to pay a late penalty based on how many years you have delayed.|
|Disenrollment Period January 1- February 14th||This period is specifically for people enrolled in a Medicare Advantage health plan who want to change to traditional Medicare. It doesn’t matter how long you’ve been in the Medicare Advantage plan. Even if you’ve just signed up with a plan (during a recent annual open enrollment) and your coverage began only on Jan. 1, you can still use this period to change your mind and switch to the traditional Medicare program. You also can enroll in a stand-alone Part D prescription drug plan at this time. In both cases, your new coverage begins the first day of the month after you make the change.|
9. What are Medicare Part B excess charges?
If you are enrolled in Original Medicare (Part A and Part B) then you may be familiar with Medicare’s Excess Charges. This relates to Medicare Part B, which covers medical and doctors’ services.
Some doctors who accept Medicare patients accept the “assigned” Medicare rate for their work. Others charge a higher rate, but they cannot charge more than 15 percent above the assigned rate and still be reimbursed by Medicare.
For example, Medicare might determine that the fair and reasonable “assigned” rate for a certain procedure should be $600. A doctor who accepts the Medicare assignment would bill at or below that rate.
However, your medical provider may decide that $600 is not a sufficient reimbursement. Providers are allowed to charge up to an additional 15% over and above what Medicare has approved. Therefore, in this case, your provider could charge you $690 and you would be responsible for paying the additional $90 “excess” charge out-of-pocket ($600 X 15% = $90 excess charge) in addition to any applicable deductible and co-pay.
Depending on the doctors you choose and the number of visits and procedures that you use on a yearly basis, your Medicare Part B excess charges could add up to a substantial amount.
How to Protect Yourself from Medicare Excess Charges
There are several ways to avoid being exposed to Part B excess charges:
Choose only doctors who bill the assigned Medicare rate. There is a database maintained at Medicare.gov that attempts to keep track of all doctors who accept Medicare and tells if they accept the assigned rate. It’s wise, however, to also just ask your doctor’s office if they accept the Medicare assignment or if they charge excess charges.
Buy a Medicare Supplement policy that pays for excess Part B charges. Medicare Supplement Plan F and Plan G both provide coverage for excess charges.
If you live in Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island or Vermont, your doctors who participate in Medicare are prohibited by law from charging more than the assigned Medicare rate.
10. The difference between Plan F and Plan G
The only difference between Medicare supplement plan G and F is the Part B deductible. Plan F will pay the deductible and Plan G will not. It’s that simple.
Plans F and G are the only Medicare Supplement insurance plans that cover costs known as Medicare Part B excess charges. An excess charge is the difference between what a doctor or provider charges and the amount Medicare will pay. These plans will help protect you from additional out-of-pocket expenses should you need treatment that exceeds what Medicare will approve. Plans F and G cover 100% of the Medicare Part B excess charges.
Basic Medicare benefits for plan G and F includes:
Hospitalization: pays Part A coinsurance plus coverage for 365 additional days after Medicare benefits end
Medical Expenses: pays Part B coinsurance — generally 20% of Medicare-approved expenses — or copayments for hospital outpatient services
Blood: pays for the first three pints of blood each year
Hospice care: pays Part A coinsurance
In addition to the basic benefits, Plan F and G also provide coverage for:
Skilled nursing facility care
Medicare Part A deductible for hospitalization
Medicare Part B excess charges (this is the difference between what a doctor or provider charges and the amount Medicare will pay up to Medicare’s limiting amount)
Travel-abroad medical emergency help
*Plan F also has a high-deductible option. If you choose the high-deductible option on Medicare Supplement Plan F, you have to pay a deductible of $2,200 for 2017 before the plan pays anything. This amount can go up each year. High-deductible policies have lower premiums, but if you become sick, you’ll have higher out-of-pocket costs. Depending on where you live, you may be eligible for Medicare Select Plan F.