You are at or nearing the age of Retirement (65) and you may still be covered by your own Health Insurance or by your Employer or through the VA. You have heard about Medicare for years but you also know Medicare has Part A, Part B, Part C and Part D. Family members and friends have mentioned Medicare Supplement Plans and Medigap Plans, Medicare Advantage Plans and probably Prescription Drug Plans. What does it all mean, how and which plan should I choose. Is one better than the other? Are there hidden fees or additional out of pocket expenses for Co-Pays and Deductibles?
These are all great questions and it is important to ask about anything and everything so that you have all of your questions answered honestly and ethically and all of your concerns addressed so you have a clear understanding of your rights and your choices when it comes to Medicare. The process of learning about your Medicare choices should not be stressful or difficult and you should never be made to feel pressure to make a decision and you should never allow anyone rush you into making a decision until you have had a chance to work with a qualified, licensed Medicare Agent or Broker. I have made a lot of information available to you and I encourage you and to review all of the information, write down all of your questions and I will always be available to help you free of charge.
Your Initial enrollment period (IEP) for Medicare is the first 3 months prior to your birth month when you turn 65 and continues for the 3 months after your birth month. This 7 Month Period is your Initial Enrollment Period (IEP). During your Initial Enrollment Period you have a guaranteed Issue for either Medicare Insurance (Medicare Part C) either in the form of a Medicare Supplement/Medi-Gap Insurance Plan (MS) or with a Medicare Advantage (MA) Plan. You may also choose a Prescription Drug Plan (Medicare Part D) (PDP) if one does is not included in your Medicare Insurance Plan. During this initial plan as long as you do not have ESRD or ALS you are guaranteed acceptance into the plan of your choice without any underwriting. This is very important it is the only time you will have "Guaranteed Issue" for your Medicare Insurance, regardless of your health status. But, remember that if you ever change your plan, you are not guaranteed acceptance into a new Medigap/Medicare Supplement Plan and you may be subject to Underwriting.
Most of you have worked hard your entire life and part of your Social Security Deductions have given you instant enrollment into Medicare PART A A which covers Hospitalization. The other part of Medicare is PART B which covers Doctors Appointments, Lab Tests, Office Visits , and Lab work. You need to be enrolled in Medicare PART A and PART B prior to choosing a Medicare Plan.
Medicare consists of 4 Parts. The 1st part of Original Medicare is PART A is your Hospitalization, this is covered and a benefit you have earned for paying into the Social Security system over your working career. Generally, as long as you have been an employee and have 10 or more years as a Full -Time employee you have earned your Premium Free Medicare PART A Hospitalization to be completely paid for from the Medicare Taxes you paid while working. If you worked less than 10 their may be a Monthly Premium for your Medicare PART A Hospitalization.
The charge for Medicare PART B depends on your Individual or combined income which the SSA verifies with the IRS. The 2nd part of Medicare is Medicare PART B, which covers Outpatient Services, Doctors Appointments, Lab Tests, X-Rays, Office Visits , and Blood Work and has an Annual Deductible which is a set dollar amount ($185.00 for 2019) if you are choosing a Medicare Supplement Plan or a Medigap Plan and it is a 20% Co-Pay for each visit and each test if you choose a Medicare Advantage Plan.
The 3rd Part of Medicare is PART C, this refers to either Medicare Supplemental Insurance or Medicare Advantage Insurance. Medicare PART A & PART B are part of Original Medicare which is administered by the government. PART C are plans offered by Insurance Companies and must cover the same level of care and services as Original Medicare, and in most cases have "Value Added" items that are not available with Original Medicare. if you are choosing a Medicare Supplement Plan or a Medigap Plan your PART B annual deductible is a set dollar amount ($185.00 for the entire year for 2019) If you choose a Medicare Advantage Plan you will always be responsible for 20% of the bill from services you receive. this means that the Government pays the Insurance Companies to manage your care and your benefits. About 80% of Clients choose Medicare Supplemental Insurance or Medigap and 20% choose a Medicare Advantage Plan.
The last part of Medicare is Medicare PART D. Medicare PART D refers to Prescription Drug Plans which are not part of Original Medicare (Medicare PARTS A and B). There is a cost for enrolling in Medicare PART D, and there is also a Penalty that can add up quickly if you do not enroll in Medicare PART D as soon as you are eligible. There is an exception if you are currently the beneficiary of a separate "Qualifying" Prescription Drug Plan. The cost of PART D can vary based on whether it is included in a Medicare Advantage Plan (MAPDP) or if it is a stand alone PDP. If you are currently on any medications I recommend that you make a list of all of your medications, whether it is a generic or name brand, what the dosage is and how many you order at a time so we can compare them with all of the Prescription Drug Plans that are offered. Each Insurance company has their own Formulary List of prescription medications that they use so it is extremely important to make sure your medications are on their list. Choosing the right plan can save you hundreds of dollars each year.
Medicare Supplement or Medigap Plans are the most flexible with access to any Doctor Nationwide who accepts Medicare patients. There are no referrals needed to see a specialist either. There are almost 900,000 Doctors who accept Medicare thats 91% of all physicians! All of these doctors will accept any Medigap Policy that you enroll in, regardless of the Insurance Company you choose to partner with. All of the Medicare Supplement Plans are identified by a Alphabetic Letter such as Plan A, B, C, D, F, G, N, S, T. These plans have the same coverage for all insurance companies for each plan, although the pricing is different from one company to another.
Medicare Advantage Plans on the other hand, have far fewer doctors. This is because they operate local networks of providers near where you live. Plans can range from local HMO Medicare Plans, which require you to choose a PCP (Primary Care Provider) to local and sometimes regional PPO Plans and there are some PPO Plans that you can see any physician anywhere but, you will have to agree to pay their fees if they are out of your local network. which allow you to pick any Doctor in any state without needing a referral. Most Medicare Advantage Plans require office visit Co-Pays, annual deductibles with a maximum annual out of pocket (OOP) of around $6,700. and some plans have no Co-Pays and No Deductibles Co-Pays are 20% of any covered procedure. If you believe a Medicare Advantage Plan is the best option for you, we would recommend you write down a list of all of your doctors and any specialists that you may see so we can check to see if they are on the Medicare Advantage Plan network.
If you are travelers or seasonal residents in another state for part of the year the only plans you should consider are a Medicare Supplement/Medigap Plan or a Medicare Advantage PPO Plan that allows you to see Doctors in any state.
All Medicare Insurance must cover the same items as Original Medicare Parts A & B and most offer more than Original Medicare. It is important that you take the time to review your list of doctors and any medications you may be taking. This is critical to ensuring that you pick a plan that covers your Doctors, Medications and any Medical Supply Company that you may use.
You can change Medicare Supplement/Medigap Plans anytime but you need to remember that after your IEP (Initial Enrollment Period) there is no guarantee that you will be accepted by an Insurance Company and you may be subject to Underwriting depending on your current state of health.
You are limited to when you can change your Medicare Advantage Plan. The Annual Enrollment Period (AEP) Period is in the Fall from October - December. There are other times you may make a change such as moving out of a coverage area or to another state.
We are always available to answer your calls and to give you the best, straightforward answers to all of your healthcare questions. If you would like to engage us to represent you and your interests please know that we get paid by the various Insurance companies and that we would never charge our clients for any services.
The best form of knowing that we helped you is by you referring us to family and friends who need help understanding the fundamentals of Medicare and you have our promise that we will treat them with the same level of care and respect that we have given to you and to each of our nearly 800 Clients.