Medicare

Medicare Part A is automatically assigned at age 65, is usually free to the eligible individual (see Part A costs), and provides hospital coverage after a deductible for up to 60 days, and for a per day copay thereafter.

Medicare Part B provides generally 80% coverage for medically necessary doctor’s visits, preventive care, and outpatient services. To determine your Part B premium, see: Part B Costs. If you have medical coverage through an employer with less than 20 employees, you must elect Part B when eligible as Medicare will be the primary payor (see: Coordination of Benefits).

Medicare Part C “Advantage” Plans are private plans offered by Centers for Medicare and Medicaid (CMS) approved insurance companies that coordinate coverage with Parts A and B to provide coverage for copays (some plans also include prescription drug coverage). Advantage plans must be renewed every January as rates and benefits change; if you are enrolled in an Advantage plan you can change your plan/insurer each year during the Annual Election Period (AEP) which is 10/15-12/7.

Medicare Supplement (“Medigap”) Plans are private plans offered by CMS-approved insurance companies that pay for the deductibles and coinsurance not covered by Medicare Parts A and B.  These are standardized policies which offer the same basic benefits regardless of the insurer or state. Supplemental plans can be elected instead of Part C Advantage plans to pay for the gaps in coverage A and B don’t provide (see Choosing a Medigap Policy).  Benefits do not change each year with Supplemental plans. Plan F is the richest Supplemental plan as it covers all Part A and B medical balances at 100% (including Part B “excess” charges), does not require referrals, and has no insurer-network restrictions (providers nationwide only must accept Medicare). Plan F is only available however to those eligible for Medicare before 2020. Plan G is the same as F except that the plan does not cover the Part B deductible each year ($233 in 2022). If you elect Plan G, then you pay the B deductible annually vs. the policy paying it for you as it does on Plan F. The premium difference between F and G however is more than the B deductible, making G the better plan to elect. If Supplemental coverage is elected, we recommend adding a Prescription Drug Plan (PDP) under Part D.

Medicare Part D provides prescription drug coverage through private insurers CMS approves in each state. Each year between October 15 and December 7th (the “AEP”) you can change your Part D Prescription Drug Plan (PDP) (or your Advantage plan which includes your Part D coverage, if applicable) for the following year. It is important to reevaluate your PDP each year to ensure you have the best card for your needs, as your Rxs can change, drug formularies on the PDPs (or Advantage plans) change, premiums change, and new cards are introduced into the market. Complete our online PDP Analysis Request Form or pdf version: PDP Quote Request, or login to www.medicare.gov to find a PDP to fit your needs. Note: most people only pay the insurer’s PDP premium for Part D coverage; however, higher income beneficiaries are charged an income-related monthly adjustment amount (IRMAA) from Social Security in addition to the insurer premium, see here: Part D Costs.

Contact us to for more information or to receive a quote.