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Understanding Medicare and Medicare Terminology

May 1, 2017 by Garrett Ball Leave a Comment

*This is Part 1 in a 3-part series designed for people going on Medicare or turning 65. Please contact us if you have any questions about this information or fill out a quotes request if you want to get Medigap quotes.*

Understanding Medicare and basic Medicare terminology is crucial to someone who is coming up on a Medicare start date. If you are on Medicare, or going on Medicare, your health care should be very important to you. Because you are on Medicare through either disability or turning 65, it is important to understand how Medicare works, what it covers, and most importantly, to know what you have and don’t have when you have Medicare.

Medicare, if you don’t already know, is the Federal health insurance program for people over age 65 or disabled. There are several parts of Medicare. First of all, Part A covers hospital/inpatient charges. Everyone gets this when they become eligible for Medicare, as long as he or she has worked 10 years and paid into the Medicare system through payroll taxes for this length of time. There is no premium for Part A in almost all cases.

Part B is optional. If you are still working past age 65, you can decline to take it at age 65. It covers doctor visits, outpatient services, labwork etc. There is a premium associated with Part B. It is dependent, to an extent, on income and varies based on when you started with Medicare. But for most people the current Part B premium is $134/month (2017). This typically is paid as a deduction from your Social Security check. If you are turning 65 and already receiving Social Security, you will be automatically enrolled in Medicare Parts A & B. You’ll receive a card 2-3 months before your Medicare start date, which is the 1st day of the month you turn 65, stating that you will have Medicare Parts A & B. You would have to then notify Medicare if you did not want Part B to start then.

Part C is also an optional part of Medicare. It is also called Medicare Advantage. Medicare Advantage plans are private insurance plans, which replace (or take the place of) Medicare Parts A & B. There are sometimes premiums associated with these plans, and coverage is provided through the private insurance company instead of through Medicare itself. In recent years, there have been many changes to these plans, including reductions in coverage and doctor acceptance. As a result, we do not necessarily recommend them as an advantageous option in most situations. But this is largely dependent on where you live, your income/assets, and your individual health situation.

Part D is the part of Medicare that covers prescription drugs. This is also optional, although there is no prescription coverage in Parts A & B. Also there is a penalty to delay enrollment into Part D unless you have other credible coverage. So, most people enroll in Part D when they are first eligible.

Medigap plans (also called Medicare Supplements) are plans that fill in the gaps in Medicare Parts A & B. These plans are sold by private insurance companies and standardized by the Federal government. Premiums can vary widely on these plans – by state, age, gender, etc. When you go on Medicare, it is crucial to compare Medigap premiums to ensure that you get a good deal on the plan you choose since the premiums vary from company to company for the exact same coverage.

Tomorrow, we will look at more specifics about when you should sign up for the various parts of Medicare, how to do so, and what your other options are.

Medigap-Quote.com is one of the nation’s leading independent brokers of Medigap plans. We work with 30+ companies in 40+ states and work exclusively with this type of insurance. As a result, we can provide unbiased, experienced expertise to those going on Medicare and turning 65. Feel free to contact us or request Medigap quotes online.

Filed Under: Frequently Asked Questions, Medicare A & B Tagged With: how does medicare work, how to get medicare, how to sign up for medicare, medicare, medigap, part a, part b, part c, part d, plan, supplement, supplemental, terminology, what is medicare part d, when do i get medicare

Medicare Part D Help – The Most Confusing “Part” of Medicare

May 28, 2013 by Garrett Ball Leave a Comment

Medicare Part D, for most people, is the most complex and confusing “part” of Medicare. Whereas Parts A & B are pretty straight-forward, Medicare Part D has many intricacies that cause headaches and stress for even the most educated and patient Medicare consumers. This article is intended to be a compilation of important reminders about Part D that will allow you to make an informed decision when it’s time to choose a Part D plan. We’ll look specifically at the questions of when to enroll, what to compare, and which plan to choose.

First of all, the question the is foremost in your decision-making process is when to enroll in a Medicare Part D plan. The easiest answer is that, for most people, you should enroll when either one of two things happens – you turn age 65 (assuming you don’t have other, creditable coverage for prescriptions) or you lose your existing, creditable drug coverage. Medicare charges a “late enrollment penalty” if you neglect to enroll in a Part D plan when you are first eligible. This penalty is 1% of the Medicare standard Part D amount, per month that you don’t enroll after your initial enrollment penalty. This is added on to the premium when you do enroll – and this penalty stays with you as long as you are on Part D. So this a definite downside of not enrolling in at least a basic plan when first eligible, even if your medication needs are minimal.

After that initial enrollment period, you can enroll in, or change, your Part D election during the annual enrollment period, which currently runs from October 15 to December 7 each year.

The 2nd question regarding Medicare Part D is what to compare when looking at the different Part D options. When you are preparing to enroll in a Part D plan, there are several things you will want to do. First of all, it is essential to compare the plans based on any current medication needs. There are usually 25-40 plans in each county, and the coverage/co-pays on these different plans varies considerably. The most effective way to compare the plans is to use the Medicare plan finder which is on Medicare.gov. On this site, you can pull up plans for your county, enter your medications and compare based on the overall annual costs – co-pays, etc. On the comparison that the Medicare website generates, you can view an estimated annual costs, which includes your premium, any deductible, and co-pays for the medications that you have entered. This bottom-line number is what we would recommend that you use to choose a plan in most cases.

That brings us to the next question of which Part D plan to choose. As mentioned above, we would recommend comparing the plans based on current medications usage and choosing a plan that gives you the lowest cost for your medications overall. Other factors to consider when comparing the options are where you can use the plan – most plans have networks and/or preferred pharmacies – and “donut hole” coverage. The Medicare “donut hole”, or coverage gap, is a feature of Medicare prescription drug coverage. Different plans have different ways of handling the “donut hole”, which could be important to you if you are on multiple medications or medications with a high retail cost.

Choosing the right Medicare Part D plan can literally be the difference of thousands of dollars. Plans vary greatly. Medigap-Quote.com does not sell Part D plans, but we do provide the Part D comparison service through Medicare’s plan finder for our Medicare supplement clients on an annual basis (plans change each year). If you have questions or would like to compare your Medicare supplement or Part D plan, feel free to contact us online or call us at 877.506.3378.

Filed Under: Medicare Part D Tagged With: how to sign up for part d, medicare, medicare part d, medicare pdp, part, part b, part d, plan, prescription drug coverage, when to sign up for part d

Medigap Plans, Medicare Advantage, and Part D

May 18, 2013 by Garrett Ball Leave a Comment

*This is Part 3 in a 3-part series designed for people going on Medicare or turning 65. Please
contact us if you have any questions about this information or fill out a quotes request if you want to get Medigap quotes.*

Medigap plans, Medicare Advantage and Part D are additional coverages that you should be considering if you are going on Medicare. Each of these has their own unique designs and advantages/disadvantages. This article is intended to introduce you to each and give you more information to consider about what is right for you.

First of all, let’s take a look at Medigap plans. Medigap plans are sold through private insurance companies, but they are Federally-standardized. What this means is that each company has to offer one of the standardized plan designs. The chart that shows these standardized plans can be seen here. As you can see, Plan F is the most comprehensive plan – it pays what Medicare Parts A & B do not cover at the doctor and hospital, so you should not have any out of pocket expenses. It is, of course, the most expensive. Other common lower-premium, less-coverage options include Plan G and Plan N. Plan G, in particular, is often a better value than Plan F (Read more about Why Plan G is often better than Plan F).

In addition to the coverage being standardized with Medigap plans, the claim payments and doctor acceptance are also standardized. That is, if a doctor/hospital takes Medicare, he or she will take the standardized Medigap plan that you have, regardless of which company sells you the plan. Additionally, claim payments are processed through the Medicare “crossover” system, so the plans, essentially, “follow” Medicare as a supplement and claims are all handled electronically. For these reasons, it is important to compare the Medigap plans on the basis primarily of cost and company rating. These are the two variables that can differ from one company to the next. You can get a Medigap quotes comparison for you area sent to you by email.

Medicare Advantage is entirely different from Medigap. Many people mistakenly lump them in together or call Medicare Advantage plans “Medicare Supplements”. This is not accurate, as Medicare Advantage plans do not supplement Medicare, but rather take its place in paying claims. These plans have networks, and most are either PPOs or HMOs. Often, premiums are lower than the premiums of Medigap plans, but the coverage is typically also lower. They, in most cases, work more like traditional employer/group type plans. There are some distinct drawbacks to this type of plan, in our experience, and we do not recommend them in most instances. Some of the particular downsides are the network restrictions (which are often based on your county or state) and future plan change issues. If you take a Medicare Advantage plan when first eligible for Medicare, you do have to qualify medically to switch to a Medigap plan at a later time.

Medicare Part D is a part of Medicare, but it is sold through private insurance companies. Part D covers prescription drugs. There are typically 20-40 plans in each county, so it is crucial to compare the plans based on how well they cover your current medications. Co-pays and plan premiums can vary greatly. You can do this on Medicare’s website at: Compare Part D plans.

It is important to sign up for Part D when first eligible unless you have creditable coverage. Medicare imposes a 1% per month penalty if you do not sign up for a Part D plan when you are first eligible (you are exempt from this penalty if you have creditable coverage through an employer-type plan). Premiums for Part D typically range from $15/month to $100/month so it is vital to choose a plan that covers your medications and is the appropriate coverage level for your current medication usage. You can change Part D plans during the annual enrollment period which runs October 15-December 7 each year.

This article explains some of the other coverages that go with Medicare, such as Medigap, Medicare Advantage and Part D. If you still have questions or want to discuss further, please feel free to contact us.

Filed Under: Uncategorized Tagged With: advantage, medicare, medigap, medigap plans, part b, part c, part d, plan f, plan g, plan n, plans, quotes, supplement

When and How Should I Sign Up for Medicare?

May 17, 2013 by Garrett Ball Leave a Comment

*This is Part 2 in a 3-part series designed for people going on Medicare or turning 65. Please contact us if you have any questions about this information or fill out a quotes request if you want to get Medigap quotes.*

So, in yesterday’s article, we went over some of the basic terminology associated with Medicare, including the parts of Medicare which are very crucial to understanding what Medicare covers and how it works. Today, we will discuss actually signing up for Medicare – how to do it and when to do it.

First of all, when should you sign up for Medicare? Most people get Medicare due to turning 65 – the exception would be if you receive Medicare due to a disability. Part A (hospital/inpatient coverage) you receive automatically – for Part B, you have the option of taking it when first eligible or postponing it. If you are working and covered through an employer group plan, it is often to your advantage to postpone taking Part B. You should always confirm this with your insurance administrator/HR at your employer, but often, paying for Part B (which as we discussed yesterday is approximately $105/month) is a duplication of the coverage you are receiving through your employer. You can always add Part B later as long as you are covered by the employer coverage, such as when that coverage ends (i.e. retirement or loss of benefits).

If you are not covered by a group plan when you turn 65, you will want to take Parts A & B when first eligible. Medicare always starts on the 1st day of the month that you were born (unless you were born on the 1st of a month in which case it starts on the 1st of the preceding month).

The “how” of signing up for Medicare is pretty straight-forward. First of all, if you are already receiving Social Security at the time you turn 65, you will get Medicare automatically (both Part A & B). You should receive your card approximately 2-3 months in advance of your Medicare start date. If you have not received it by two months before your Medicare should start, I recommend contacting Medicare or going to a local Social Security office.

If you are NOT already receiving Social Security, you should plan to contact Social Security 2-3 months in advance of your eligibility date to sign up for Medicare. You can do this by following the previous link or visiting a local Social Security office. If still working, you can decide through consultation with your employer (if still working) if you are going to take Part B when you are eligible.

This article is intended to help with knowing when and how to sign up for Medicare. If you still have questions, feel free to contact us. Tomorrow, we will discuss additional coverages that you will be considering such as Medigap, Medicare Advantage and Part D.

Filed Under: Frequently Asked Questions, Medicare A & B Tagged With: eligibility, enrollment, how do i sign up for medicare, how should i sign up for medicare, insurance, medicare, medigap, part a, part b, part d, plan, supplement, supplemental, when shoudl i sign up for medicare

Three Part Series Explores Going on Medicare

May 15, 2013 by Garrett Ball Leave a Comment

Going on Medicare for the first time can be a overwhelming, even intimidating thing. There is a lot of information and certainly, a lot of demand for your attention regarding the decisions that you have to make about your health insurance coverage. For most people, these decisions occur in the 3-6 months preceding their 65th birthday. For others, those decisions occur prior to age 65, due to disability, or after age 65, due to working past age 65. Regardless of when they occur, it is certainly an important time with many crucial decisions.

This article introduces a three-part series regarding going on Medicare. The utmost goal is to explain Medicare in terms that anyone can understand – provide the information you can get elsewhere but in an easier to process, straightforward way.

The first post in this series will appear tomorrow, May 16, and subsequent posts will appear on the following two days. We hope you will mark the site and check back to see more information about turning 65 or going on Medicare.

Filed Under: Frequently Asked Questions, Medicare A & B, Medigap Plans Tagged With: comparison, how to get medigap quotes online, how to sign up for medicare, insurance, medicare, medigap, part a, part b, part d, quotes, supplement, supplemental

Are Medicare Part B Premiums Going Up to $247 in 2014?

July 12, 2012 by Garrett Ball 1 Comment

Are Medicare Part B Premiums Going Up to $247 in 2014? This is the question I receive on a weekly basis from my clients. The question stems from an email that has been, and continue to, go around saying, basically that – that premiums are going up to $247 for Part B in 2014. The email has been going around in some form or fashion since 2009. Here’s the text of the email that I have seen (there may be other variations):

MEDICARE PREMIUM INCREASE

For those of you who are on Medicare, read the article below. It’s a
short but important article that you probably haven’t heard about in
the mainstream news:

The per person Medicare insurance premium will increase from the
present monthly fee of

$ 96.40, rising to:

$104.20 in 2012;

$120.20 in 2013; And

$247.00 in 2014.

These are provisions incorporated in the Obamacare legislation,
purposely delayed so as not to ‘confuse’ the 2012 re-election
campaigns.

Send this to all seniors that you know, so they will know who’s
throwing them under the bus.

So, is this true? Enough people believe it and are sending it around, so it must be true – right?

Not so fast! First of all, the 2011 and 2012 numbers are incorrect. The 2011 official Part B premium was $115.40, and the 2012 Part B premium is $99.90 (unless you fall into the high-income category or receive extra help paying your Part B premium).

Secondly, and most importantly, Obamacare or PPACA, as it is formally called, did not make any changes to the way that Medicare Part B premiums are figured. These processes for determining the Part B premiums are the same as they have been. One of the important components of these processes is the “hold harmless” provision – this says that Medicare premiums cannot go up for existing beneficiaries if Social Security payments do not go up. This “hold harmless” provision kept some beneficiaries, in 2011, paying the 2009 rates ($96.40) because there was no cost of living increase to Social Security in 2010 or 2011.

You should understand how Medicare premiums are calculated. Medicare beneficiaries are required to contribute to their Part B premiums. Right now, these contributions are required to be at 25% of total costs. So every year, Medicare figures out what the total costs will be and “backs into” that 25% figure that beneficiaries are responsible for.

For the Medicare Part B premium to go up that much, the cost of living increase in Social Security would have to be about 250%. Now, if that happens, there’s going to be a lot of happy Medicare beneficiaries! (That’s not going to happen!)

With all that understood, you can easily see that there is no way that this “scare tactic” email is correct. Sure, there are some things that insurance agents, insurance companies and consumers alike should be concerned with regarding the PPACA legislation, but this is simply not one of them. So if you receive this email, instead of “sending it on to all seniors you know”, why don’t you take a stand for truth and hit the delete button instead.

For more information like this, visit our Medigap website and blog on a regular basis. Or give us a call at 877.506.3378 with any specific questions regarding Medicare, Medicare Supplements or Part D.

Filed Under: Frequently Asked Questions, Medicare A & B Tagged With: $247, $99.90, 2014, how much are part b premiums going up, medicare, medicare part b premiums, obama, obamacare, part b