Understanding Medicare is step one in planning for your healthcare in retirement. Whether you’re new to Medicare, preparing to turn 65, or preparing to retire, you have to make several crucial decisions about your well-being coverage. Medicare is a health coverage program provided for those who are 65 years old or older. Medicare part A and part B coverage can be extremely hard to navigate since there are a number of important choices and elaborate terms to sort through.
Original Medicare is healthcare provided for senior citizens by the US government. Signed into law to offer health and financial security for seniors in 1965, it is an important source of health insurance coverage for 45 million people. If you don’t choose otherwise, you’ll have Original Medicare. You might have heard about the various parts of Medicare. Medicare is broken into parts, while Medigap insurance is broken up into plans. So Medicare can have different kinds of costs associated with it. You do not have to register for Medicare every year, under normal circumstances, any plan you are in rolls over automatically.
Before you choose what type of Medicare plan or supplement you want you need to enroll in Medicare Part A and Part B. So where do you go to sign up for Medicare? Most people turning 65 will automatically be enrolled in Medicare a few months before their 65th birthday. For those not turning 65 and qualifying for Medicare (such as those on disability), visiting your local Social Security office will allow you to apply for your benefits. Check out this article for instructions on applying for Part A and B for those who are disabled or meet other requirements. A lot of people who have Original Medicare choose to have a Medigap policy.
As stated in the last paragraph, in most cases people aging into Medicare at 65 are automatically enrolled a few months prior. You will receive a letter in the mail with a form giving you the opportunity to opt out of Part B benefits.
If you are still enrolled in an employer health plan you may opt out of Part B for the time being. If you delayed Part B coverage this would be a situation where you may need to provide a little more information when signing up for Part B at a later time. Opting to keep employer-based coverage, you’re going to be qualified for a Medicare Special Enrollment period also referred to as a Medicare special election period once you finally throw in the towel. In this open enrollment period, you cannot be refused coverage for virtually any reason.
In order to receive your full Medicare benefits and avoid late enrollment penalties, you’ll want to provide Social Security with documents showing that you had creditable coverage from your 65th birthday to the present. This will typically allow you to enroll in Part B immediately after losing group or other creditable coverage.
You probably have heard of the Medicare donut hole or maybe you have friends or family that have dealt with the Donut Hole. The Coverage Gap, also called the Donut Hole, has caused plenty of confusion for a lot of people. Hitting the gap ($3,820 in drug cost for 2019) and seeing an increase in the price of your medications is never enjoyable. When you reach the coverage gap the co-pays go away. However, in 2019 name brand drugs are discounted by about 75% and you’ll pay about 37% of the cost for generic medications. The gap changes every year and after you’ve spent the maximum allowed amount in the gap (total part D cost of $5,100 for 2019) you will reach catastrophic level coverage. Once in catastrophic coverage, you’ll only spend about 5% of the cost of your medications for the rest of the year. Only a small number of beneficiaries get to the catastrophic coverage stage every year.
A Medicare Advantage plan (or Part C) combines the benefits of Medicare Parts A and B, as well as, in some cases, prescription drug coverage provided by Part D. They may also provide some additional benefits like dental, vision and gym membership. Many plans do not have medical deductibles for in-network services and instead of co-insurance they may have co-pays (like $5 for an office visit) for many services. Medicare Advantage plans can on occasion be your very best bet since they might cost less and provide more coverage. In fact, many areas have Advantage plans that have no monthly cost to the Medicare beneficiary.
Essentially, a Medicare Advantage plan is a fantastic option if you’re eager to sacrifice some flexibility for lower monthly expenses. As an example, Medicare Advantage plans are generally rooted in the local area, limiting you to a specific network of providers (though some networks can be quite large). Also, they are not allowed to do a lot of risk selection based upon health, so they may be a good choice for less healthy applicants. Try to remember, it’s still true that you have Medicare should you enroll in a Medicare Advantage Plan.
There are 11 distinct forms of Medicare Supplement plans and each is designated by means of a letter of the alphabet. So what is covered by each lettered plan is still the exact same no matter whom you buy your Medigap insurance from. Obviously, there are various Supplement plans, and that means you must obtain more than one Medicare Supplement quote to acquire the very best price possible. Because Medicare supplement plans are governed by the federal government, the advantages of a specific plan (like Plan C or Plan F) are precisely the same, whatever the insurance policy business you opt for. If you submit an application for a Medicare Supplement Plan after your Open Enrollment (Guaranteed Issue Right) there isn’t any guarantee an insurance policy business will sell you a policy in case you don’t meet the health underwriting requirements. It’s imperative that you get a program which can fit your budget without leaving you pinching pennies at the close of every month. Medigap plans are provided to supplement traditional Medicare, but they can be costly and many feel they cannot afford them. A Medigap plan covers just one person. All plans aren’t available in every state. Some plans also offer coverage for emergency travel insurance away from the USA.
A Medicare Supplement plan would typically do the job best for people that have family history of chronic illness, are currently unhealthy and visit the physician frequently, live in a number of areas of the nation that have few or no Medicare Advantage plans available, or those who wish to minimize unexpected medical bills. Finding the appropriate Medicare Supplement Plan might seem confusing in the beginning, but the more you research your alternatives and become acquainted with assorted plan-related provisions, the more you will have the ability to choose the very best coverage for your requirements. The best thing about Medicare and Medicare Supplements is you don’t have to worry about whether your doctor is in the network. The policy charges depend on your current age, so as you get older you may want to consider if the supplement program is still your best option.
Say you have a Medicare Advantage plan that charges a co-pay of $5 for primary doctor visits, $10 for labs and X-rays, $200 for hospital stays, $200 for outpatient surgery and $80 ER visits. You may be comfortable with the $5 office visits and $10 labs and x-rays, but don’t want to worry about paying the higher co-pays. You can purchase a senior indemnity that pays $200 on admission to the hospital, $200 for surgery and $80 for ER visits. Now for about $20-40 a month, you don’t have to worry about paying these larger co-pays out of your pocket. In other words, it acts as a supplemental plan to your existing primary insurance coverage.
This coverage will make sure you’re not dipping into your savings account or retirement income to pay for your medical care co-pays.
Ready to talk about your options? I meet one on one with my Medicare customers to help them design a plan that does what you need it to do, pay your medical bills with no surprises. I want you to see your options in “black & white” so you truly understand the coverage and how Medicare might work best for you. Set an appointment online or just call or message me with any questions at 317-296-8881. You can also leave me a voicemail and I’ll make sure to get back to you ASAP.
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All Medicare Advantage plans (AKA Part C) have a list of preferred pharmacies. These are pharmacies that have contracts with the insurance company and you will receive the better lower priced co-pay when buying your medication there. Click on each Medicare carriers link to see a list.
*These links are for individual Medicare plans and may not apply to your plan or the plan you are considering. Talk with your agent to confirm preferred pharmacies in your plans network.
If your income is too high to qualify for Medicaid, but you are having trouble paying for your medications, you may qualify for LIS. LIS or low income subsidy is a program through the federal government that can lower the cost you pay for prescriptions as well as Advantage Part C plans and Part D drug plans. To see if you might qualify click the link below and take the quick survey. If the results say you likely qualify, give us a call at 317-296-8881. We can help you apply and find the right plan for your individual situation.