Medicare info

MEDICARE

You can read the countless brochures, pamphlets and websites or you can read the information below to get a simple and easy understanding of Medicare. Remember that Medicare is Parts A & B and is often referred to as “Original Medicare”. It can be found together on the red, white and blue Medicare Card.

Part A (HOSPITAL INSURANCE)

To make it easy, Part A is for when you get admitted into a hospital. This coverage is for inpatient hospital, skilled nursing facility, home health care, and hospice care. For most people Part A is free when you turn 65 or Medicare eligible due to you or a spouse having paid Medicare taxes while working. Part A alone has a high deductible if you are admitted in the hospital and then only covers the first 60 days in a hospital and first 20 days in a skilled nursing facility. Obtaining a MEDICARE SUPPLEMENT will help cover what Medicare Part A approved will not pay.

Part B (MEDICAL INSURANCE)

To make it easy, this is for everything non-hospital expense related. This is for things like doctor and specialist office visits, blood tests, x-rays, MRI’s, durable medical equipment, outpatient hospital care, etc. For most people Part B will cost $134.00 a month. It will be deducted out of your Social Security check if you are drawing Social Security. If you are not drawing Social Security you will be billed quarterly. There is a small annual deductible for Part B which is only $183 for 2017.. Once the deductible has been met, Medicare will pay only 80%, you will be responsible for the other 20%. Medicare will typically pay 100% for preventative services such as yearly wellness visit, flu shots, mammogram screenings, prostate screenings, colonoscopy screening, etc. Obtaining a MEDICARE SUPPLEMENT will help cover what Medicare Part B approved will not pay.

Part C (PRIVATE INSURANCE)

To make it easy, this is referred to as a “Medicare Advantage Plan” and is instead of original Medicare. Some refer to it as a “Medicare Disadvantage Plan” because you can no longer use your original Medicare A&B card. The biggest misconception we have encountered is that those on these types of plans think they have a supplement. THIS IS NOT A SUPPLEMENT. These plans are offered by private insurance companies that are approved by Medicare to provide you hospital, medical and usually prescription coverage. You are put into an HMO or PPO network. You no longer have nationwide coverage and have to go to the doctors, specialists and hospitals that accept that particular private insurance. If you are traveling you could end up paying some very high out of pocket expenses. You will still be required to pay your Part B monthly premium of $134.00. Although the plans may be offered for free or a low monthly premium by the private insurance company, you will still be subject to co-pays, deductibles and high out of pocket expenses. BE AWARE. A lot of these plans have an annual spending limit that can reach as high as $6,700. VERY IMPORTANT. These types of plans depend on what the government gives them to provide coverage instead of original Medicare. The government has provisions in the Affordable Care Act to substantially cut the funding to these plans over the coming years. WHAT THIS MEANS TO YOU. Keeping original Medicare A&B and purchasing a federally regulated Medicare Supplement will give you the MOST COMPREHENSIVE and best coverage possible.

Part D (DRUG PRESCRIPTION INSURANCE)

To make it easy; D stands for DRUG PRESCRIPTION. Since original Medicare A&B does not include prescription drug coverage, you will have to purchase a separate stand alone plan. The monthly premiums are very reasonable and will typically cost $17.00 to $45.00 a month depending on your list of prescriptions. The monthly premium can be deducted out of your Social Security check. A very popular plan for 2017 is the Humana/Wal-Mart Rx plan for $17.00 a month. There are roughly about 30 approved prescription drug plans through Medicare’s database. This allows you to tailor which plan gives you the lowest out of pocket costs on what you are taking. WE CAN HELP YOU WITH THIS. The Part D drug plans change formularies and costs during each Annual Enrollment (October 15th- December 7th). During this time each year, you can change your Part D to whichever plan will provide you with the best coverage and lowest out of pocket costs for the next calendar year.

MEDICARE SUPPLEMENT PLANS ARE FEDERALLY REGULATED AND OFFER THE SAME BENEFITS AND COVERAGE NO MATTER WHAT COMPANY YOU GO WITH SINCE THEY ARE GUARANTEED TO COVER WHAT MEDICARE A&B APPROVED WILL NOT PAY. THE ONLY DIFFERENCE IS THE RATING OF THE COMPANY AND PRICING. THIS KEEPS YOU ON ORIGINAL MEDICARE A&B. THERE ARE ONLY 2 PLANS THAT PROVIDE FULL COVERAGE: PLAN F or PLAN G

Medicare (Medigap) Supplement PLAN F

The Plan F is the best coverage and most popular plan with original Medicare. You will have no co-pays, no bills, and no deductibles for anything Medicare A&B approved. It fills all the gaps of original Medicare. It is incredible but is also the most expensive plan and the most over utilized plan so cost historically tend to be higher as you get older. We recommend looking closely at the Plan G.

Medicare (Medigap) Supplement PLAN G

The Plan G offers the same coverage and benefits as the Plan F except for only thing and only one thing alone. The Plan G does not pay the small Part B $183 annual medical deductible. That is it! Once and if you have paid or met the $183 medical deductible you are done. It then fills all the gaps of original Medicare after the $183 annual deductible. The monthly premium tends to be about $30 less a month then the Plan F. (Example: If you are saving $30 a month that would be $360 a year-$183 deductible=$177 total annual savings. If you only use your Medicare and Supplement for preventative services, you may not have to even pay the Part B deductible that calendar year and now have saved the full $360 in this example.)

R. Insurance Group LLC