NEWS!!! 2019 Medicare & You booklets are in. Download here!
READ ON FOR SOME BASICS OF MEDICARE?
Taking the mystery out of Medicare
Medicare can be very confusing, there’s no question about it. That’s what I’m here for. Medicare pays for 80% – We care how you pay for the rest!
We make it easy for you to understand, help you figure out your options, when to enroll, what will be covered and so much more! And the best part is, you don’t pay any more or less to have us as your advocate!
OPEN ENROLLMENT DATES TO KNOW:
MEDICARE: OCTOBER 15th – DECEMBER 7th: This is the time you can change
Part C and D Plans. Let me negotiate this often confusing process for YOU.
Know how to get the most out of the plans available, including prescription drugs.
TIP…you can always change Supplement (MediGap Plans) any time of the year.
However, you will have to answer insurable questions unless you have a ‘
special circumstance’ that will make you ‘guaranteed issue’.
SO, WHAT IS MEDICARE?
If you are nearing your 65th birthday, you’ve likely been hearing a lot about Medicare lately, probably have received a mountain of mail and no doubt you have questions. Medicare is the federal health insurance program for individuals who are 65 or older. Others who may be eligible? People under 65 with disabilities and those suffering from End Stage Renal Disease (ESRD) requiring a kidney transplant or dialysis.
What does Medicare Cover?
This is where things can start to get confusing! We take the mystery out of Medicare by breaking it down as follows:
All you have to do is remember 4 and 3!
4 PARTS & 3 OPTIONS
MEDICARE HAS 4 PARTS:
A – Hospital, Skilled Nursing, Hospice, etc.
B – Doctors, Outpatient, Ambulance, etc.
C – Medicare Advantage Plan
D – Prescription Drug Plan
MEDICARE HAS 3 OPTIONS:
1. Original Medicare (Part A & Part B)
2. Original Medicare (Part A & Part B) PLUS a Supplement Plan (Medigap) AND/OR Prescription Drug Plan (Part D).
3. Medicare Advantage Plan (Part C, like an HMO, PPO, MSA, PFFS, etc.). Most times, these plans include Part D and can include other services that Medicare doesn’t cover (dental, vision, transportation, acupuncture or chiropractic care). Deciding on a Medicare Advantage Plan? Check out this great ARTICLE on a few mistakes to avoid!
Once you’ve got that down, time to look at your personal situation. It comes down to ACCESS and BUDGET. Here are some questions to ask yourself:
- Do you want access to any provider that accepts Medicare or will you go to a provider suggested by your Primary Doctor
- Are you ok with paying more premium for more choice?
- Do you have a 2nd home in another part of the country?
- What are your medications (name, dosage, quantity per day)?
WARNINGS AND ‘GOTCHAS’
GOTCHA #1: What is the biggest negative about choosing Option 1 (Original Medicare) only?
In a nutshell – there is NO maximum out of pocket. Medicare pays for approximately 80% of your medical expenses, you’re on the hook for 20% including Part B drugs. Chemo and anti-rejection drugs are Part B drugs. Do the math and calculate what 20% of chemotherapy for one year would be and you’ll see very quickly why this is not a very good option.
GOTCHA #2: Affectionately knowns as ‘IRMAA’, higher Income = higher Part B & D premiums. TWO (2) years before you plan on electing Part B, consult with your financial and tax professionals on ways you can decrease your MAGI!
The figure used to determine your premium is based on your ‘MAGI’ (Modified Adjusted Gross Income). Basically, take your AGI (Adjusted Gross Income) and add back any UNTAXED Social Security and Tax Exempt Interest. Yes, it’s exempt from Federal & State taxes but not from the dreaded IRMAA! Many tax and financial pros are not aware of this little tidbit. They may have you convert your IRA to a Roth IRA or take stock options before you retire. Those will ALL increase your MAGI! Be very careful or consult us to help guide you.
TIP…If your income has decreased because of a life event (retirement, deceased spouse, divorce, etc.), you can request a ‘reconsideration’ from Social Security. Run (don’t walk) to your local Social Security office with proof and this reconsideration form (Form SSA-561-U2). Here are the current Income Related Monthly Adjustments for 2019:
PART B IRMAA:
Beneficiaries who file an individual tax return with income:
Beneficiaries who file a joint tax return with income:
Part B income-related monthly adjustment amount
Total monthly Part B premium amount
|Less than or equal to $85,000||Less than or equal to $170,000||$0.00||$135.50|
|Greater than $85,000 and less than or equal to $107,000||Greater than $170,000 and less than or equal to $214,000||$54.00||189.50|
|Greater than $107,000 and less than or equal to $133,500||Greater than $214,000 and less than or equal to $267,000||$135.40||$270.90|
|Greater than $133,500 and less than or equal to $160,000||Greater than $267,000 and less than or equal to $320,000||$216.70||$352.20|
|Greater than $160,000 and less than $500,000||Greater than $320,000 and less than $750,000||$297.90||$433.40|
|Greater than $500,000||Greater than $750,000||$325.00||$460.50|
PART D IRMAA:
|Less than or equal to $85,000||Less than or equal to $170,000||Your plan premium|
|Greater than $85,000 or less than or equal to $107,000||Greater than $170,000 or less than or equal to $214,000||$12.40 + your plan premium|
|Greater than $107,000 and less than or equal to $133,500||Greater than $214,000 and less than or equal to $267,000||$31.90 + your plan premium|
|Greater than $133,500 and less than or equal to $160,000||Greater than $267,000 and less than or equal to $320,000||$51.40 + your plan premium|
|Greater than $160,000 and less than or equal to $500,000||Greater than $320,000 and less than or equal to $750,000||$70.90 + your plan premium|
|Greater than $500,000||Greater than $750,000||$77.40 + your plan premium|
GOTCHA #3: Affectionately knowns as the ‘DONUT HOLE’
Unfortunately, we’re not talking about the treat you enjoy during your coffee break. This “Donut Hole” is a coverage gap in your Medicare Part D – Prescription Drug Plan. Once you enter the “coverage gap” you won’t pay a co-pay, you will only receive a discount on your medications. It’s based on the TOTAL cost of the drug (not what you pay). Every year, the amount changes. For 2017, when the TOTAL cost of your drugs =$3,700, you’re in it. Now it will cost you approximately 40% till you reach ‘catastrophic’ coverage (another confusing formula) which is $4,950. In the Donut Hole, you would be out of pocket approximately $3,000 – $3,600 of your own money! Then you’re in ‘catastrophic coverage’ and your out of pocket goes down dramatically. However, if you’re on a heavy duty, very expensive medication, even the catastrophic cost could be thousands of dollars.
The good news is the ‘donut hole’ will eventually be a lot smaller. As a part of OBAMACARE, each year, the percentage you’ll pay when you’re in the donut hole are adjusted until they will be approximately 25% in 2020.
So, what do you do in the meantime and how can you get extra help with prescription drug costs when you hit the donut hole? There are options and tips to minimize the ‘donut hole’, contact us for help!
GOTCHA #3: Will ALL of my medical needs be covered by Medicare?
Unfortunately, the answer is NO. Medicare Parts A & B DO NOT cover everything. You may end up paying out of pocket unless you have other insurance or Medicaid OR you’re in a Medicare health plan that covers these services.
Don’t forget… with a Medicare Advantage Plan or a Supplement (other than F) even when Medicare DOES cover the service you may still be responsible for deductibles, coinsurance and co-pays.
Here are some of the things that Medicare DOES NOT cover:
- Long term care (aka Custodial care)
- Holistic practitioners
- Routine dental or eye care
- Cosmetic Surgery
- Hearing Aids and exams for fitting them
WHAT IS A SUPPLEMENT OR MEDIGAP PLAN?
Supplemental policies are issued from a private insurance companies. They are mandated to be the same (F Plan with Company A is the same as an F Plan with Company Z). They will cover SOME or ALL of what Medicare doesn’t cover (has to be Medicare approved). There are two things that can be different with Supplements:
1) additional services (optional dental, vision, transportation, etc.)
2) how their premiums are calculated
We know all the ways the carriers price their premiums so we’re not just interested in saving you money the first year but subsequent years to come.
TIP: Premiums can increase TWICE per year. For your AGE and when they have a ‘community’ increase. To save money as you age, there is a window of time that you need to switch companies to maintain lower premiums as you age. Since we know these companies, how they calculate their premiums, how to minimize what you pay out of your pocket and we’ll remind you when that time comes!
IMPORTANT: If you are interested in supplementing your Medicare, you must consider a Supplement (Medigap), Medicare Advantage Plan and/or Part D drug coverage…NOT an ACA (ObamaCare) Plan. It’s actually illegal for you to receive an ObamaCare subsidy while eligible for Medicare!
Okay, so let’s break down Medicare Advantage Plans (Part C)!
Medicare Advantage Plans are offered by a private companies that contract with Medicare to provide you with all your Part A and Part B benefits. The insurance companies basically get paid a monthly fee from the government to manage the administration and medical care. Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans (PFFS), Special Needs Plans, and Medicare Medical Savings Account Plans (MSA). If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the PLAN and aren’t paid for under Original Medicare. Many Medicare Advantage Plans also offer prescription drug coverage and other benefits such as vision, hearing, dental, transportation, etc. There are pros and cons to all Plans and you must know what to watch out for. Before deciding on a Medicare Advantage Plan, this ARTICLE is a MUST read and will explain a lot!
We’ve only just scratched the service here of the wonderful world of Medicare health plans! There is so much more to know and we’re sure you have questions!
For more information please give us a call at: 323-455-4961 We’ll be happy to answer all of your questions and get you started at NO EXTRA CHARGE! We DO NOT charge broker fees, we accept what the insurance pay us and since we’re contracted with most of the carriers, it doesn’t matter to us which one you choose. We just want to make sure it’s the better Plan for YOUR specific needs.
- We will always do what’s best for you, not us, whether we are compensated or not
- We will keep up to date with valuable Medicare news, hints and tips
- We will research the new Plans for you each year
- We will always CARE, be kind and do the right thing for you!
We would be delighted to help you with this journey. Just call us and if you don’t mind sharing some info (see below), we will do a comprehensive, complimentary search for you. Hopefully, you’ll choose us as your advocate, but if you don’t, at least we know you will be armed with the best information possible!
- Medications (names, generic or brand), capsules or tablets, dosage, quantity per day)?
- What are your favorite pharmacies?
- Chosen Physicians and Hospitals?
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