Have Medicare? Get answers.
In a world of election periods, late enrollment penalties, pre-existing conditions and lock-in times, navigating the Medicare market can be downright confusing. You want to make the right choice to save yourself hassle and money, while ensuring that you have the coverage you need.
But the number of choices can be overwhelming. Wouldn’t it be easier if you could just make a phone call and get answers that make sense?
Good news. You can!
We’ll find the best Medicare plan for you.
Your Benefit Concepts agent will listen carefully to your coverage needs. Then we’ll use a simple, straightforward approach to determine which Medicare plan would fit your expectations and budget.
Give us a call today at 1-800-433-0553, e-mail us, or stop in to our Middletown office for an in-person consultation. Let’s get you started!
In the meantime, you probably have a few questions. Let’s answer some of them.
What is Medicare and how does it work?
Medicare is a federal program that provides basic medical coverage to citizens and legal residents of the United States age 65 or older, or to US citizens and legal residents of all ages who have qualifying disabilities, End Stage Renal Disease, or ALS (“Lou Gehrig’s disease”).
Traditional Medicare has several “parts” that cover different health needs. Some, like Part D prescription coverage, require their own enrollment procedures. We’ll talk more about the various Medicare parts below.
Private Medicare supplement policies — also known as “Medigap” policies — are referred to as “plans.” They’re not administered by the federal or state governments, but by health insurance companies. They exist to cover what Traditional Medicare will not.
Some recipients get confused by “parts” vs. “plans.” We’ll help you sort everything out!
Medicare Part A
Medicare Part A is the portion of the Medicare program that covers hospitalization. It covers inpatient room and board, inpatient medications, nursing home stays (following qualifying hospitalization events and subject to length-of-stay limitations), blood transfusions, inpatient mental health care, and hospice care.
There is a deductible for Medicare Part A, which resets 60 days after you have been released from the hospital (as long as you have not been re-admitted in the meantime). In addition, Part A charges recipients a daily co-insurance payment when hospital or skilled nursing facility stays exceed a certain length.
These can leave you with significant out-of-pocket bills, unless you purchase a secondary Medigap plan.
Medicare Part B
Medicare Part B covers physicians’ fees, diagnostic testing, preventive care, home health care, medical equipment, prosthetic devices, surgeons’ fees, ambulance and emergency room services, and certain medications.
Unless you qualify for a low-income subsidy, you will pay a premium for your Medicare Part B. Your premium is determined based on your income, the length of time you’ve been on Medicare and change in your health needs over time.
Part B benefits are subject to an annual deductible, plus an “80 / 20” coinsurance. Once your yearly deductible has been met, Medicare B covers 80% of additional expenses.
In some states, doctors that do not accept Medicare Assignment are permitted to “balance bill” you up to 15% over the Medicare allowable amount.
Other states do not permit this. And in the states that do, if your doctor accepts Medicare Assignment, they are not permitted to balance bill you.
That means that anticipating what you will be billed and what you will owe after Part B pays its covered portion can be an intensely frustrating, tricky exercise.
Luckily, private Medicare supplement plans can cover some of those out-of-pocket charges and simplify things for you.
Medicare Part C
Medicare Part C is more popularly known as “Medicare Advantage.” Part C coverages are privatized policies which pay in place of Medicare, not after Medicare. In this way, they are different from Medigap plans.
The federal government devised Part C as a way to shift some of the costs of Medicare onto the free market, by allowing private insurers to administer the plans semi-directly and leverage their cost advantages of HMO and PPO plan structures.
Part C coverages are administered by private health insurance companies. Conveniently, they often include Part D prescription coverage (more on that below), as well as other bonuses like hearing aids, dentistry and vision coverage, which aren’t covered under Traditional Medicare.
Part C premiums are typically very low (be advised, though, that participants are still responsible for their Part B premiums!).
As a trade-off for low premiums, though, Part C coverages often require co-pays, co-insurance and other shared responsibility payments. And they sometimes feature narrower provider networks than Traditional Medicare.
For some patients, Part C coverages make a lot of sense. For others, not so much. Give us a call to find out what Part C coverages are available in your area and we can weigh the pros and cons for you!
Medicare Part D
Part D covers prescriptions (an easy way to remember is that “D” stands for “drug”). You must enroll in Part D separately from Parts A and B; if you fail to do so, your prescriptions aren’t covered.
There are 3 ways to get Medicare Part D coverage.
- You can enroll in it as a standalone plan, in addition to your Traditional Medicare A and B.
- If you’re a Part C privatized coverage participant, your policy may include Part D coverage. We’ll need to check with your Part C insurer to make sure you’re covered.
- You can purchase a supplemental Medigap plan that includes Part D coverage.
Formularies, drug tiers, co-pays, and pharmacy networks can vary greatly from one company to the next, so it’s important your Benefit Concepts agent know what drugs you are taking, how often you take them, what dosages you take, and where you get them filled.
If you share that information with us, we can work with you to find the best possible coverage. If you choose not to, you risk encountering unforeseen gaps in your prescription coverage down the road.
Why Part D enrollment is so important.
Following Medicare Part D’s rollout, Congress passed an incentive / penalty system to push Medicare patients to enroll in prescription coverage of some form. It made the price for failing to enroll in prescription coverage pretty high.
If you don’t enroll in a Part D coverage during your initial election period (contact us for more details on this) you will not only be locked out of prescription drug coverage until the next Annual Election Period comes around, but you will be assessed a permanent 1% penalty (1% of the national average premium), on top of whatever plan you choose when you do sign up!
It’s absolutely in your best interest better to get Part D early — both for long-term savings, and to ensure you don’t get caught without coverage when you need it most.