Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
The different parts of Medicare help cover specific services:
Medicare Part A (Hospital Insurance): Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. The Part A deductible for 2023 is $1,600.00
Medicare Part B (Medical Insurance): Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. The Part B deductible for 2023 is $226.00
Medicare Part C (Medicare Advantage Plans): A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. 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. Most Medicare Advantage Plans offer prescription drug coverage. Would you like to compare different plans?
Medicare Part D (prescription drug coverage): Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans. The Part D deductible for 2023 is $505.00. Unlike Medicare Supplement plans (they are same from one Insurance company to another), Prescriptions plans should be selected on Your prescription needs.
What if you have not worked the minimum ten years (40 quarters) paying into Medicare and Social Security? You can buy into Medicare.
How much does Part B cost?
You pay a premium each month for Part B. If you get Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Part B premium will be automatically deducted from your benefit payment. If you don’t get these benefit payments, you’ll get a quarterly bill.
The standard Part B premium amount in 2023 is $164.90. Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium. If you recently retired and your income will not be what it was two years ago or you just don't agree with the income figure, you can appeal,
using Form SSA-44
What are your options?
A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like co-payments, coinsurance, and deductibles. There is a monthly premium, and you are also required to enroll in an approved Part D program. With the Part D plan, you enroll in the plan which will give you the maximized benefits for your current prescriptions and we would be happy to do the research and advise... We are only an email or phone call away!
Some Supplement policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Supplement policy, Medicare will pay its share of the Medicare approved amount for covered health care costs. Then your Supplement policy pays its share.
There are Eight (8) standardized Medicare Supplements, which means the coverage is the same from one Insurance Company to another, by law there can be no differences. Why should you pay more for the identical coverage! We will be happy to explain in more detail...We are only an email or phone call away.
With a Medicare Supplement you can go anywhere Medicare is accepted (unlike an Advantage Plan, Providers are contracted with Medicare not your insurance carrier).
Passed legislation in 2020 referred to as MACRA (Medicare Access and CHIP Re-authorization Act of 2015) will, among other things, affect the Medicare Supplement Plan C & Plan F will no longer be an option for individuals newly eligible (Medicare Part A effective date of 01/01/2020 or after) for Medicare starting January 1, 2020. However, in-force policyholders will be able to keep their current versions of Plan C or F and individuals eligible for Medicare prior to January 1, 2020, can purchase the current version of Plan F on or after January 1, 2020. Bottom line, it is the effective date of Part A what plans you can enroll in.
A Medicare Advantage Plan or MAPD Plan, has to offer at least the minimum benefits Original Medicare offers and most Advantage Plans offer additional benefits, however, most procedures will have some form of a co-pay and your total out of pocket in a calendar year can be higher. Most Advantage Plans are still premium free.
The Advantage Plan networks are regional (unlike Traditional Medicare with or without a Supplement) and if you select an HMO plan, you must stay in network to receive coverage.
Most Advantage plans include a prescription plan at no additional cost to you (depending on income).
Unlike a supplement, in most cases you can only enroll or switch plans during the Annual Election Period, which is October 15th thru December 7th with an effective date of January 1st.
The Medicare Advantage Open Enrollment Period starts January 1st through March 31st. During this time, you can switch to another Medicare Advantage program. You can dis-enroll from your Medicare Advantage plan and return to Original Medicare. If you choose to do so, you will be able to join a Medicare Prescription Plan. However, you cannot switch from Original Medicare and enroll in a Medicare Advantage plan. You cannot enroll in a Medicare Prescription plan if you currently are in Original Medicare.
Some additional benefits may be: The Silver Sneakers (or equivalent) program which will cover your gym membership fees, Dental cleaning w/x-rays, hearing and vision benefits, just to name a few.
Send us a list of your current Doctors and we would be happy to verify networks and recommend a plan which may fit your needs...We are only an email or phone call away!
Need to Enroll in Medicare?
Just like any type of health insurance, we will do our best to find the type of coverage which not only fits your needs, but also your budget.
Are you looking for a Medicare Provider?
Changes that Happened in 2020
MACRA (Medicare Access and CHIP Re-authorization Act) does many things, but most importantly, it establishes new ways to pay physicians for caring for Medicare beneficiaries and went into effect January 1st 2020.
But what else does it do…
MACRA makes changes to all Medicare Supplement (Medigap) polices that cover the Part B deductible for “newly eligible” Medicare Beneficiaries on or after January 1, 2020.
Starting in 2020, Medicare supplement plans C and F, will no longer be offered to individuals “newly eligible” for Medicare as of January 1, 2020, or later. To better clarify this, anyone turning 65 on or after January 1, 2020, will only be able to enroll in plan C or F if they have a Medicare Part A effective date prior to 1/1/2020.
However, if you are currently on Medicare, plans C & F will continue to be available for individuals eligible for Medicare prior to January 1, 2020. Therefore, anyone who turns 65 before January 1, 2020 may continue to enroll in or keep plans C or F.
If you are currently on an Advantage plan, the changes in the supplements of course does not affect your current plan.
We also see additional changes happening because of mergers with the Prescription programs and also some changes with the Advantage programs. The Medicare Supplement premiums will now be gender related here in Florida.
Have questions or concerns? ... We are only a phone call or email away!
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Medicare has neither reviewed nor endorsed this information.