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What is Medicare?
Someone who’s attained the age of 65 (or is older now).
Someone who is younger than 65 and collecting disability social security for at least two years.
Someone suffering from ESRD (End-Stage Renal Disease/Illness). ESRD is a condition where the kidneys fail to function permanently, and the patient requires recurring dialysis or a full transplant.
Different parts of Medicare cover different services. Not having credible coverage for all of the parts can cause you to incur a late enrollment penalty when you do enroll.
You can understand Part A as hospital insurance. It includes inpatient stays at hospitals, nursing facilities following a hospitalization for rehabilitative care, and PROFESSIONAL home health care if you are determined to be home bound. This does not include custodial care (living in a nursing home) or help with Activites of Daily Living (food preparation, laundry, companion services, bathing, etc.).
Part B basically covers medical services recieved when you are not admitted into the hospital, including: doctor visits, preventive and diagnostic testing, medical supplies, vaccines, urgent and emergency services, medication administered in a doctors office (think steroid shots and intensive medication treatments such as radiation and chemotherapy), and more.
Part D covers prescription drugs. These are drugs you get through a pharmacy. Be sure to know your plans preferred pharmacies and mail order pricing to help lower your costs. Plans are not required to cover vitamins or prescriptions for cosmetic conditions (such as hair loss). But some plans do offer coverage for certain vitamins and ED medications.
If you don't qualify for premium-free Part A, you can still buy it with monthly payments. If you paid Medicare taxes for a period less than 30 quarters, your premium may be around $499. If taxes were paid for over 30 quarters, but less than 40 quarters, the premium is about $274.
The general rate for Part B Premiums (Medical Insurance) is $170.10 in 2022. This may differ depending on your income. If you are a high income earner, you may be charged an additional Income Related Monthly Adjustment Amount (IRMAA) for your part B and part D premium. Talk with me to see if you qualify for an exception to this IRMAA charge. Conversely, there are also programs offered to cover your part B Premium and help with your part D premium if your income falls within a specified range. I can help to assess your eligibility.
The initial enrollment phase for a standard Medicare plan starts three months prior to turning 65 (your birthday month), and three months after.
There is a Special Enrollment Period for those coming off of Employer Group Coverage starting 3 months prior to the month you are leaving coverage and extending 3 months beyond.
For Part A and Part B, there is a general enrollment period that lasts from the 1st of January till the 31st of March every year.
You can shift to different plans from an existing Medicare plan between the 15th of October and the 7th of December.
Part A and B of Medicare cover general hospital and medical insurance. Together, they’re called Original Medicare. Although they pay for a lot of your medical needs, they leave you to pay large deductibles and a 20% coinsurance on part B services without a limit on what that number could add up to. This leaves you financially vulnerable for medical costs.
Original Medicare also does not offer prescription drug coverage, but is mandated by Medicare. So if you don’t enroll into one of these plans, you may face a penalty down the road. Not to mention paying the full cost of prescriptions.
Other considerations include how to cover the cost of your dental, vision, and hearing needs. These services (unless medically necessary) are not covered in Original Medicare.
Medicare Supplement vs. Medicare Advantage
There are basically 2 options in covering the gaps in Original Medicare.
Medicare Supplement: You pay a monthly premium to have this type of plan. When you recieve services, Original Medicare pays first and then the supplement picks up its portion of deductibles and coinsurance that is left after Medicare pays. A supplement generally does not cover what Medicare does not cover (Rx, dental, vision, etc.), so you would need to combine this plan with a prescription drug plan and possibly a dental and vision plan as well.
Medicare Advantage Plan: $0 or low monthly premium. This style of coverage combines the benefits offered in Original Medicare with additional benefits such as prescription drugs, dental, vision, hearing, over the counter products, and other useful benefits. In an advantage plan, you are paying copays and coinsurances as you use the services and you are protected by a Maximum Out Of Pocket amount. Coverage does depend on the usage of the chosen carriers network. There are a lot of variables within these plans and it is best to consult with a knowledgeable broker when deciding which plan and carrier will best serve you.
We can make an appointment to discuss the pros and cons of each alternative and see which one is better for you.
We do not offer every plan available in your area. We offer 10 carriers with 121 plans in Trumbull County Ohio. We offer additional carriers in various states as well. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options