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Medicare

Simplifying the Medicare Puzzle

Turning 65 is a milestone that brings change. A major change could be how you obtain your medical insurance. Whether you currently have group insurance or individual insurance, you will need to make decisions involving your Medicare options. My expertise in Medicare is your resource to simplifying the Medicare puzzle.

Original Medicare

You have Choices:

Part A (Hospitalization) AND Part B (Medical)

Part A helps cover services such as inpatient hospitalization, skilled nursing facility care, hospice and home health care
Part B helps cover doctors’ services, outpatient medical & surgical services, clinical lab tests, Durable Medical Equipment and Preventive services.

Cost:

Part A is premium free for most but don’t assume.
Did you or your spouse pay FICA taxes for at least 10 years? Part A could be free
Did you apply for Medicare when first eligible? If not, you may pay a penalty
In addition, there is a deductible and copay for services.
Part B has a premium based on income.
Your premium is based on your yearly income from two years before your 65th birthday. An Income-Related Monthly Adjustment Amount (IRMAA) is determined annually, if applicable
In addition, there is a deductible and 20% coinsurance for most services.
There are programs available to help pay these costs for those with limited income and resources.

Part D

Optional Medicare Prescription Drug Coverage offered by insurance companies approved by Medicare.
It is important to know that you may owe a late enrollment penalty if at any time your Initial Enrollment Period is over, there is a 63 or more days in a row when you do not have Part D or other creditable prescription drug coverage. If you have creditable coverage you can stay with that plan in lieu of Part D but you must make sure the coverage is credible; otherwise, you could pay a penalty when you decide to take Part D coverage.
Part D has a premium based on income and you must have Part A and/or Part B.
Your premium is based on your yearly income from two years before your 65th birthday. An Income-Related Monthly Adjustment Amount (IRMAA) is determined annually, if applicable.
In addition, there is a deductible, copayments and coinsurance for coverage.
There is Extra Help to pay Part D costs if you have limited income and resources.

Part C (Medicare Advantage)

Offered by private insurance companies. They are approved by the Centers for Medicare & Medicaid Services (CMS). Some Medicare Advantage plans don't include Part D coverage. These plans are called MA (without Prescription Drug coverage) or MAPD (with Prescription Drug coverage) Plans.
In addition to any Part A and Part B premium, you usually pay a monthly premium for MA and MAPD Plans. Each plan has different premiums and costs for services. It is important to compare plans in your area and understand costs and benefits before you join a plan. Benefits change from year to year.
Medicare Supplement Insurance Policies or Medigap Policies
Original Medicare pays for many, but not all, health care services and supplies. A Medigap policy is private insurance that helps supplement Original Medicare. This could include copayments, coinsurance, and deductibles. You must have Medicare Parts A and B to be able to buy a Medigap policy. Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share.
In addition to any Part A and Part B premium, you pay a monthly premium to the private insurance company that sells you the policy. Even though the plans are standard, rates vary by insurance companies.
If you want prescription drug coverage, you must get a stand-alone Medicare Prescription drug plan that works with Original Medicare.

Medicare Supplement Insurance Policies or Medigap Policies

Original Medicare pays for many, but not all, health care services and supplies. A Medigap policy is private insurance that helps supplement Original Medicare. This could include copayments, coinsurance, and deductibles. You must have Medicare Parts A and B to be able to buy a Medigap policy. Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share.
In addition to any Part A and Part B premium, you pay a monthly premium to the private insurance company that sells you the policy. Even though the plans are standard, rates vary by insurance companies.
If you want prescription drug coverage, you must get a stand-alone Medicare Prescription drug plan that works with Original Medicare.