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Medicare Overview

Here to help you solve the Medicare puzzle

Getting older should mean a more simplified life of fun with friends and family. Many times, when Seniors become eligible for Medicare, an overwhelming feeling of anxiety sets in; from the daunting task of transitioning from a current health insurance provider to Medicare. At 64 ½ one diligently collects on the dining room table all the Medicare literature mailed—we watch the un-read pile get higher and higher as one nears their birthday.

Medicare Part A provides coverage on inpatient and some other services. You usually don’t pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes while working. This is sometimes called “premium-free Part A.” In general, Part A covers: Hospital care, Skilled nursing facility care, Nursing home care (as long as custodial care isn’t the only care you need), Hospice, Home health services.

Medicare Part B  provides coverage on many outpatient services. 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 bill. 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. In 2016, the standard Part B premium amount is $121.80. Part B covers things like: clinical research, ambulance services, Durable Medical Equipment (DME), mental health, getting a second opinion before surgery, limited outpatient prescription drugs

Medicare Supplement Insurance coordinates with “Original Medicare Insurance.” This insurance helps to pay the deductibles, copays and coinsurance of Medicare A and B. Medicare Supplement Insurance plans do not have any doctor networks- as long as your doctor accepts Medicare A and B, they will accept your Medicare Supplement insurance. When you enroll in Medicare Part-B, you are in the Open Enrollment Period—no medical questions. If you retire past age 65, you may be in a Guaranteed Issue Period—no medical questions. Your Medicare Supplement benefits remain the same each year (only federal government can change benefits). You can change your Medicare Supplement anytime –but may be subject to medical underwriting.

Medicare Part C (Medicare Advantage)  is an option instead of using “Original Medicare Insurance” and a Medicare Supplement. Medicare Advantage Plans are managed care plans that have participating doctor networks. Typical examples of Medicare Advantage plans are HMOs, PPOs and Private Fee For Service Plans. Medicare Part-C has a lock-in period, and can only be changed at your Annual Enrollment Period. Plans should be reviewed annually during the Annual Enrollment Period (Oct 15th-Dec 7th) as plan benefits change annually every January 1st.

Medicare Part D  Prescription Drug Plans that can help cover some of your Rx costs. Initially, choose a Rx plan that fits your medication list. You should enroll during your Open Enrollment Period or Special Election Period to avoid penalty. Plans should be reviewed annually during the Annual Enrollment Period (Oct 15th-Dec 7th), as plan benefits change every January 1st.

 

Knowing where to start, navigating your choices, and understanding your deadlines can be overwhelming. We are here to help!
First, it is prudent to talk to Social Security about Medicare Parts A and B to see if it is right for you to get enrolled at this time. Make sure to review your enrollment and deadline options so you do not receive any “late enrollment” penalties.

Below are two You Tube Videos relating to Medicare.  If you haven’t seen these, you should!  They are about 5-8 minutes long, when you have spare time, feel free to watch!

Medicare Eligibility Enrollment & Penalties:

Medicare Part A & B and Medicare Supplements Explained:

 

For more education on Medicare Planning, please call us at 610-430-6650
Or you can email Medicare@HTAFinancial.com