Finally, Understand How Medicare Works!

When You Begin Your Medicare Journey You Will Be Dealing With Two Different Entities

Federal Government

This government funded program offers Major Medical coverage to those who qualify, including:

• Persons turning age 65
• Persons with a qualifying Disability and who have been receiving Social Security for 24 months
• Persons with end stage renal disease

Medicare is NOT all inclusive... For this reason it is important to have a private insurance plan, (that is regulated by medicare) so that you don't end up with costly medical debt

Private Insurance

Because coverage through original Medicare is NOT all inclusive and includes many gaps in coverage for which you could be responsible, private insurance companies help to bridge those gaps and lower your out of pocket expenses when you need health coverage.

They do that through the following:
• Part C Medicare Advantage
• Part D Prescription Drug plans
• Medicare Supplement or "Medigap" policies
• Various other products like Dental and vision insurance

Breaking it Down

Original Medicare consists of two parts, Part A and Part B

Medicare Part A

Hospital Insurance

Helps Cover Things Such As:

Inpatient Hospital stays
*Skilled Nursing
*Home Health Care
*Hospice Care

*Must meet certain conditions before Medicare will cover these items

Medicare Part B

Medical Insurance

Part B Helps Cover Outpatient Services, Such As:

• Doctors/Specialist office visits
• Ambulance rides
• Radiology and Labs
• E.R./Urgent care Visits

Costs For Part A

Premium:

Most people don't pay a premium for Part A. If you have worked, and payed taxes for 10 years, or have a spouse who has Part A will be no premium. You also have the option to buy Part A if you have not paid into the program.

Deductibles and Copays:

Hospital Stay-

In 2023, you pay:

$1,600 deductible per benefit period
$400 per day for days 61–90 of each benefit period
$800 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)

Skilled Nursing Facility Stay:

In 2023, you pay:

$0 for the first 20 days of each benefit period
$200 per day for days 21–100 of each benefit period
All costs for each day after day 100 of the benefit period

Costs For Part B

Premium:

Premium is based on income, but most people pay the standard rate for Part B, this is $164.90 in 2023.

Deductible and Copays:

For Medical services received and covered by Medicare Part B, you will have an annual deductible of $226 for 2023
After your Deductible has been met Medicare will pay 80% of the costs of all covered services.
- Remember, with original Medicare there is NO CAP to how much you could have to pay out of your own pocket. With Medical bills, 20% can add up rather quickly! This is why it is important to have some type of private insurance to cover some of that cost for you.

The two paths to covering your Medicare expenses

Medicare Supplements

Also called "medigap" or "Med-sups"

In this option you will maintain original Medicare Parts A and B as your primary insurance.
To help cover all, or a portion of your out of pocket costs, such as your 20% coinsurance, you will purchase a Medicare Supplement policy from a private insurance company. This can be considered your secondary insurance.
You can also join a separate Medicare drug plan to get Medicare drug coverage (Part D).
You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
Medicare Supplements tend to be more expensive in terms of premium as compared to Medicare Advantage

Medicare Advantage

Also Known as Medicare Part C

Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
In most cases, you’ll need to use doctors who are in the plan’s
network.
Plans may have lower out-of-pocket costs than Original Medicare.
Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.

Part D Prescription Drugs

A prescription drug plan will help to cover the cost of prescription drugs. You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.

Click below to start shopping for Medicare Advantage or Prescription Drug Plans

Find Plans

When Should I Apply For Medicare?

One of our most asked questions is "When can I apply for Medicare?"

As a general rule of thumb you have a 7 month window to apply for Medicare beginning 3 months before your 65th birthday and ending 3 months after.

You may also delay your enrollment into Medicare if you have "creditable coverage" which is coverage that is at least as good as original Medicare. If you have done this, then you may apply anytime prior to retiring or ending your creditable coverage up until 8 months after that coverage ends.

There are several other "special enrollment" opportunities that apply in unique situations. Read here to learn more about those options as well as to see special forms that you may need to fill out or have filled out by your employer. As always please call us and we will guide you through this process and print any forms you may need.

There are many factors to consider when deciding when the best time to apply for Medicare will be.

Are you currently working and receiving benefits through an employer?
- If so you will want to compare the price for Medicare to what you are currently paying- including not only your premium but deductibles and copays as well.
Does your spouse who is not eligible for Medicare rely on your employer sponsored plan for their health coverage?
- If this is the case, you may need to stick with the employer plan for now, if there will be a long gap before your spouse will be eligible and you are ready to retire, then call us and we can help you AND your spouse get coverage!
Do you have options through VA/Tricare or Indian Health services?
- Typically you should still apply for Medicare even if you have these, however you have some unique options if you fall in this category- call us and we will be glad to help you understand how it works!

*Watch the video to learn more about when you can enroll and how to avoid Late Enrollment Penalties

Will I Be Penalized For Not Enrolling In Medicare?

If you want to avoid Medicare late enrollment penalties, read this...

What a lot of people don't know is that if you choose not to enroll in Medicare when you are first eligible, and you don't have "creditable coverage" or coverage that is at least as good as original Medicare then you will have to pay a late enrollment penalty when you do decide to sign up.

This penalty is different for Medicare Part B and Part D- for a detailed breakdown on Medicare.gov click here. We have also provided a chart to help you understand how the penalties work.

Another important thing to note is that if you do have a penalty there may be a way to get it to go away. Typically these penalties last for as long as you have Medicare, (so a lifetime). However, if your income falls below certain thresholds you may qualify to have the penalty removed. Come and see us and we can help you know if that could be an option for you. We will also help you apply for the subsidies you need.

Now what?

Hopefully all of this helps you understand your options and how they work.
Being a very brief overview of Medicare there is a good chance you might still have questions or need some help navigating the many plan options that are available to you.
At Southwest Senior Advisors our passion is helping people understand their options so they can make a confident and informed decision where their health insurance is concerned.
We will also be with you every step of the way to assist you with any issues or questions that may come up.
Give our office a call or contact us today and let our licensed agents know how we can help you!