Do yourself a favor and get familiar with Medicare’s alphabet because you’ll be referring to it frequently, especially as you become educated on the details of the different health plans.
- Plan A
Covers most inpatient hospital stays, treatment at skilled nursing facilities, and home health care. Inpatient care at skilled nursing facilities are also covered, however long term stays may not be. The plan also covers hospice care.
- Plan B
includes coverage for basic doctor office visits as well as ambulance services, medical outpatient & mental health services, second opinions on medical advice, medical devices, and limited selection of outpatient prescription drugs.
- Plan C
is a combination of parts A and B called Medicare Advantage.
Plan C plans are run by private insurance companies that contract with the federal government. Many times they’ll include basic dental & vision coverage.
- Last but not least, Plan D
contributes to the costs of prescription drugs. Individuals can join a standalone Part D Plan or Prescription Drug Plan (PDP) if enrolled in Original Medicare. Or, they can sign up for a Medicare Advantage Plan (Part C) in which Part D is included.
Medicare lingo tends to be somewhat redundant so let’s break it down to what usually demands the center of attention:
The premium is the monthly fee you pay to the insurer for coverage such as Medicare Part B, Medicare Advantage, Part D Prescription Drug Coverage and Medicare supplemental or Medigap plans. For Part A, if you have paid into the system for enough years with your Medicare taxes, there are no premiums. The government determines the premium for Part B while private companies set the monthly fee for Medicare Advantage, Part D and Medigap plans.
(FYI: Your premium doesn’t always offer the best gauge in determining the out-of-pocket-costs for the year. Make sure you check with your current doctor to see if you are in their plan’s network. If not, you’ll obviously end up burning a bigger hole in your wallet)
A DEDUCTIBLE is the amount you must pay PRIOR to insurance chiming in to cover any remaining costs. The government decides what flat fee you’ll be responsible for IF you are enrolled in Plan A. After you pay the deductible, Medicare will take the hit on the lion’s share of that bill. Part B, Medicare Advantage plans and Medigap plans all have annual deductibles. The federal government also determines the deductibles for part A and B but limits the Part D deductible. So far, so good? Let’s move on.
Familiar with the word CO-PAY?
This is the flat fee that you’re responsible for paying out of pocket. This includes any doctor visits, healthcare service, and prescription drugs. Price range varies depending on the healthcare plan you are enrolled in. Most Part C Medicare Advantage Plans don’t require a copayment. Any healthcare services are also covered, within certain service areas. Thus, any out-of-pocket costs stem from your premium. Also, Part C Medicare Advantage Plans perpetually offer extra benefits like dental and vision, and prescription drug coverage. There are plans that offer gym membership discounts and grocery delivery. How ‘bout that? For many people, Medicare Advantage offers the most healthcare coverage for the best price.
Here’s another term you’ll reference a lot:
This is a percentage of your Medicare bill that you are FULLY responsible for. Let’s say for example, you are enrolled in the original Medicare part B; You would be responsible for 20% for the cost of services received. If you are enrolled in a Medicare Advantage Plan, you might have co-pays, coinsurance, or a combination of both.
includes coverage for basic doctor office visits as well as ambulance services, medical outpatient & mental health services, second opinions on medical advice, and limited selection of prescriptions. This is sometimes referred to as “supplemental insurance” because it is insurance in addition to your Medicare plan. This is different from PLAN C, which is a combination of parts A and B called Medicare Advantage. You cannot have both Medigap and Medicare Advantage.
I’m sure like most people, you want to have a stable understanding around prescription drug medications.
Keep in mind that if you have Original Medicare, Part D plan can be added for an additional cost. Each insurance company will provide a list of approved prescription drugs covered under their specific plans. With that said, it can be very valuable to know what your current prescriptions are. That way, you can weigh out your options in regards to the Part D plans, ensuring that your Advantage plan covers everything you need.
Keep a mental note that the Part D portion of your Advantage plan only covers certain drugs. Obviously new drugs are researched, developed, and manufactured constantly. It can take a little time for new drugs to appear on your plan’s Part D list.
Prescription drugs are usually organized in tiers. If in need of a top-tier drug, (a newly-developed or very expensive medicine to manufacture), it’s likely that your premium will increase, or get charged for a larger co-pay than normal. All insurance carriers handle this situation in various ways. When gauging which Medicare Advantage plan suits you best, you may want to do some research on how the prescription coverage designs differ from plan to plan.
Do you have to enroll in Medicare at the
golden age of 65?
The answer is NO. In order to keep your Social Security benefits, you are only obligated to have Plan A benefits. You can opt-out of Part B which has a premium. You are automatically eligible for Medicare at age 65 if you or your spouse contributed payroll taxes for at least ten years during your lifetime. If you are already receiving Social Security benefits by the time you turn 65, you will be automatically enrolled in Parts A and B. Three months prior to your 65th birthday, your card is sent to you through the mail. If you decide to decline the Part B coverage, follow the instructions on the card.
(But, BE AWARE: If you decide to enroll in Plan B later down the road, you will spend the rest of your days paying monthly penalties!)
Now, if you are 65 without Social Security benefits, you will need to sign up for Medicare online through the Social Security Administration. Once enrolled in Medicare Part A and B, you can also choose a Medicare Advantage Plan.
If you want to go deeper into the linguistics of these health plans, Please visit..
So then, what’s NEW and IMPROVED for Medicare
Savings Programs in 2020 ?
A few things! Winding down 2019 means that there are even more updates and changes taking place for the new and upcoming year. With that being said, once you get the hang of what’s what, it’s never a bad idea to give yourself an annual refresher . . . Especially when renewal time rolls around.
With that being said, for the first time in over a
decade, Medicare has been granted a makeover, making it easier to access their very complex alphabet! For one, they’ve simplified comparisons between the original Medicare and Medicare Advantage plans and an updated guide has been created for reviewing Part D options. Also new in 2020, the monthly premiums for Medicare Advantage plans are expected to drop down to around $23. Premiums for Part D prescriptions are also expected to decrease to about $30 a month.
FYI: Premiums and out-of-pocket costs differ for MA and Part D plans depending on where you live and the coverage within your plan. CMS recently announced the premiums and deductibles for parts A and B.
For the 73% of you with chronic health issues, LISTEN UP . . .
CMS is expanding the resources for Medicare Advantage extra services, These benefits will range from getting meals delivered right at home to your transportation to doctor appointments to nutritional consultations and even improvements to make your space at home as safe as possible. AGAIN, not all MA plans are offering these benefits, so looking carefully at these coverage descriptions are crucial! We are here to HELP!
MORE good news for 2020 Medicare
Savings Programs? Yep.
MA plans are now capable of covering costs for any telehealth benefits nationwide. Check-ups with your doctors online and other healthcare providers will be available to all Medicare
Don’t get too ahead of yourself! Honing in and
exploring the many options to choose from is a really smart place to START. Deciding what Medicare Savings Program to commit to is a loaded project in & of itself. Staying up-to-date on changes made within those plans is another intense layer.
It is obvious that there is a lot to consider when it comes to enrolling in Medicare. Our hope is that this article has provided some valuable information, providing a stable footing to begin making your own Medicare decisions.
Before determining anything else, decide if Original Medicare or Medicare Advantage is the best option for you. Then ask yourself the following questions . . .
Number one, how much money do you want to pay out-of-pocket? Next, what is your doable budget for premiums and co-pays? Lastly, would it benefit you to have healthcare services accessible & available anywhere OR are you content with receiving care in a defined service area? As you consider your overall well-being take into account the lifestyle and budget you currently sustain.
As you are percolating over ALL of this, it’s normal to feel overwhelmed. Remember that you do NOT have to grind through this alone! We are here to guide you through a Step-by-step process, assisting you in the personalized coverage you need. This includes Medicare Advantage Plans, Prescription Drug Plans, and Medigap policies.
Again, there are significant factors to consider when choosing a Medicare Savings Program. If you want to ensure that the options you choose are going to benefit and cater to YOUR specific needs, we recommend that you get in touch with a licenced Medicare insurance agent.
They will walk you through each decision and this will allow the enrollment process to bring a sense of sureness. By the end, you will feel confident in what program you chose.
Keep in mind are the important rules and regulations that apply the Medicare enrollment process. At Insurance Professional of Arizona, our team of brokers are experts in Medicare insurance. We have years of experience and knowledge. We understand each and every aspect of the Medicare enrollment process.
We are more than happy to answer all questions you might have. Our goal Is to make sure you have the right amount of coverage AND we ensure that our clients have the best coverage at the most affordable and reasonable prices.
Something else to take into account …
Hiring a professional agent to guide you in choosing a customized plan will give you access to better options. As independent agents, we can shop many competing health insurance companies for the most competitive policies with all of the additional benefits that would benefit your specific needs.
If you have questions or need personalized help as you percolate on the new open enrollment options, we are More than happy to HELP you.
We advise you to create a strategy with a licensed Medicare insurance agent to determine your personal healthcare needs. Our agents will be able to assist you in understanding ALL of your options, step by step.
Note: The deadline for all changes you want to make to your Medicare plan is December 7th. We advise you to get in touch with one of our professionals today.
We’re here to help! Call us today.