If you are nearing age 65 and are getting ready to enroll in Medicare, you may feel buried and confused by all the mail and phone calls you are receiving. We can help unbury you by improving your understanding and reducing the confusion by separating Medicare into four main points and giving you a brief overview of each.
1. Understand Medicare Parts A, B, and D — Medicare has 3 parts, Parts A, B and D, and here’s the main points of each. Parts A and B, called Original Medicare, are provided by the Centers for Medicare and Medicaid Services (CMS). When you apply for Medicare through Social Security, Parts A and B come together. Part A is for inpatient hospital and skilled nursing care. Part B is for doctor visits, outpatient procedures, tests, lab work, etc. Part D is an insurance plan to decrease the costs of prescription medicines. Eligibility for Part A, B and D start the first day of the month you turn 65, or at a sooner date in the event that you have been receiving Social Security Disability Benefits for 24 months.
2. Understand your Premiums for Each Part — For a great many people, Part A is no cost as long as you or your spouse has 10 years of work history. Part B has a premium and it is based on your income. The lowest premium for 2019 of $135.50 every month and most people pay this amount. Those with higher earnings pay a higher monthly premium. Your earnings used for calculating a higher Part B premium come from your last filed tax return. So, on the off chance that you have experienced an earnings decrease, get in touch with Social Security and request a recalculation. Part B premiums are withheld from your month to month Social Security check, except if you delayed receipt of your Social Security benefits. If you have delayed, then you are billed quarterly for Part B premium. You can setup automatic bank draft if you like. Part D’s prescription medicine insurance is provided by private insurance carriers, and the monthly premium differs by state and carrier. Part D premiums are paid by you to the carrier rather than to CMS, but you can have the premium taken out of your Social Security check. The possible higher premium for Part B, discussed above, also applies to Part D premiums.
3. Understand Your Cost Share When Services are Used — Medicare is quite comprehensive, but it does not cover 100% (except Medicare does cover 100% of certain preventive services) of all medical services. Original Medicare, Parts A & B, have cost share responsibilities for you in deductibles, co-pays, and co-insurance. Part A has a deductible of $1,364 for 2019 and it covers your first 60 days in the hospital. Days 61 and more have daily co-pays as your cost share. Part B pays 80% of your outpatient costs after a one-time deductible every year, $185 for 2019. So for Part B, your cost share is the deductible and the remaining 20% of all medical services. It is very important to know that there is no annual limit to the cost share you are responsible for Parts A and B. This unknown cost exposure can be quite scary (See your Medicare Options next for alternatives to this problem.) Your Part D cost share varies by plan but includes the deductible then co-pays or coinsurance for each medicine you take.
4. Understand your Medicare Options — There are two options to pick from:
Option 1: Add a Medicare Supplement (Medigap) plan to help you pay your cost share within Part A and B. There is a premium for a Medigap plan, but the plan can completely pay your Medicare Part A & B cost share mentioned above or most of it, your choice. A Medigap plan, offered by private insurance companies, lets you see any doctor or hospital that accepts Medicare so there is good flexibility and peace of mind with this option and this is great for snowbirds. You will keep your stand-alone Part D plan with this option.
Option 2: Replace Original Medicare with a Medicare Advantage plan while still paying your Part B premium. Medicare Advantage plans are called Part C plans. The main advantages of a Part C plan over just Original Medicare is the annual limit in the amount of cost share you must pay and there can be no additional premium over the Part B premium you are already paying.
Medicare Advantage plans are offered by private insurance companies and can be either an HMO or PPO; HMO- you must go to doctor or hospital who accepts the plan, PPO- you must go to doctor or hospital that accepts plan to get lower cost. Part C plans can have a deductible and always have co-pays or co-insurance as your cost share as you use the services. Your prescription costs will be part of your Medicare Advantage plan with this
In the event that you need help understanding Medicare and eliminating the confusion, we are here to be YOUR expert from YOUR local insurance agency. This was a brief overview and we can add the required specific details based on YOUR particular needs, so call Safeguard Assurance today. There is no cost to you for our Medicare assistance, and that’s only one of the reasons you will be happy you called Safeguard Assurance.
Dawn Cook Medicare Supplements | Ellenton FL Medicare Advantage | PDP Plans