Please read the Medicare information below:
Original Medicare: Medicare generally pays 80% of the approved costs of covered services, and you pay the other 20%. Some services, like flu shots, may cost you nothing.
Part A: Hospital Coverage – When a person has worked and paid taxes for 40 quarters during their life, they may be entitled to premium-free Medicare Part A. Medicare Part A is part of the federal health insurance program for adults aged 65 and over, as well as younger adults with qualifying disabilities.
Part B: Medical Coverage – Most people pay a monthly premium for Medicare Part B. The standard premium is $170.10 for 2022. Based on your income, you may have to pay more than this amount. If you qualify for state-based help due to a lower income, you may be able to pay less than this amount. Please refer to the Modified Adjusted Gross Income form attached. There is an annual Part B deductible of $233 (for 2022) that applies to certain covered services.
Since 20% of Medicare-approved charges are out-of-pocket costs with no maximum limit, people opt to enroll in supplemental insurance. There are two options:
(1) Medicare Supplement (Medigap) with a separate Prescription Drug Plan
(2) Medicare Advantage with prescription drug coverage
Medicare Supplement policies cover the remaining 20% of Medicare-approved charges once the Part B deductible is met. This includes your part of coinsurance and co-payments. Medicare Supplement policies are accepted by any doctor in the U.S. who bills Original Medicare. Monthly premium amounts vary by plan and carrier. The most comprehensive policy is Plan G. Prescription drug coverage is not included in Medicare Supplement policies; this coverage is sold separately.
Prescription Drug Plans (Part D) are used to help cover the cost of prescription medications. There are five tier levels that every covered medication will fall under. Some medications are not covered by any plan. Since coverage varies by carrier and pharmacy (standard vs preferred), we look at your specific medications to help determine which plan will work best. Part D plans may undergo changes throughout the year; therefore, many people choose to review their plan every year during the Annual Enrollment Period (AEP).
Medicare Advantage Plans (Part C) are offered as HMO (Health Maintenance Organization), POS (Point of Service), or PPO (Preferred Provider Organization). These include a network of providers that, typically, you must use for care. PPO plans are the exception, as they offer out-of-network coverage at a higher cost. Medicare Advantage plans include monthly premiums, deductibles, co-pays, and a yearly maximum out-of-pocket cost. Most plans have prescription drug coverage embedded, which means you cannot enroll in a separate Prescription Drug Plan. Costs and coverage vary by carrier; therefore, we look at your medications, providers, and facilities to help determine which plan will work best.
Original Medicare (therefore a Medicare Supplement policy) does not cover regular eye, dental, or hearing exams. It does cover diseases of the mouth and the eyes. Some Medicare Advantage plans include eye, dental, and hearing coverage.
Please note, you must be enrolled in Part B of Original Medicare to be eligible to enroll in a Medicare Supplement or Medicare Advantage plan. If you are leaving employer coverage and enrolling in Medicare Part B after age 65, you will need to fill out a Special Enrollment form to verify that you have had qualified health coverage prior to joining Medicare.
Once you receive your Medicare enrollment letter or card, we will assist you in enrolling in a plan.
Please let us know if you have any further questions. We look forward to speaking with you soon. Schedule a telephone appointment with us to answer any questions and get you protected.