Looking For Help With More Than Costs
Original Medicare doesnt cover things like prescription drugs, dental services, vision and hearing. To get prescription drug coverage, you need to purchase a Medicare Part D plan. Part D plans are sold by private insurance companies. Theyre specifically designed to help pay the cost of prescription medications. Learn more about Medicare Part D here. An additional way to get drug coverage is to purchase another part of Medicare, called a Medicare Advantage plan. Medicare Advantage plans are sold by private insurance companies and are also known as Medicare Part C.
Medicare Advantage plans often include additional coverage, like dental, vision and hearing. There are some important similarities and differences between Medicare Supplement plans and Medicare Advantage plans.
While both are provided by private insurance companies, there are some key differences between Medicare Supplement plans and Medicare Advantage plans:
- Medicare Advantage plans often provide prescription drug coverage. Medicare Supplement plans dont.
- Medicare Supplement plans work together with Parts A and B. Medicare Advantage plans include all the benefits of Part A and B but you work with a private company, not the federal government.
When Will Your Benefits Start
If youre automatically enrolled, your benefits will start the first day of the month you turn 65. You can apply for benefits if youre at least 64 years and 9 months old, do not currently have any Medicare coverage, and arent receiving any Social security retirement, disability or survivors benefits.9
You can also sign up for Medicare by phone by calling 800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday. Or you can visit your local Social Security office.
If you must enroll for Medicare Part B, your coverage start date depends on when you sign up:
|If you sign up for Part B in this month:||Your coverage starts:|
|During first three months of initial enrollment period||The first day of the month you turn 65, or if your birthday is the first day of the month, benefits start on the first day of the prior month|
|The month you turn 65||1 month after you sign up|
|1 month after you turn 65||2 months after you sign up|
|2 months after you turn 65||3 months after you sign up|
|3 months after you turn 65||3 months after you sign up|
You dont have to enroll in Medicare annually, but each year youll have the chance to review your coverage and change plans if desired. You can make changes between October 15 and December 7.11 This is especially important if you know your medical needs may change, so put an annual reminder in your calendar in October to go over your options.
What Is Medicare Part B
Medicare Part B helps cover medical services like doctors’ services, outpatient care, and other medical services that Part A doesn’t cover. Part B is optional. Part B helps pay for covered medical services and items when they are medically necessary. Part B also covers some preventive services like exams, lab tests, and screening shots to help prevent, find, or manage a medical problem.
Cost: If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount. Social Security will contact some people who have to pay more depending on their income. If you don’t sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.
For more information about enrolling in Medicare, look in your copy of the “Medicare & You” handbook, call Social Security at 1-800-772-1213, or visit your local Social Security office. If you get benefits from the Railroad Retirement Board , call your local RRB office or 1-800-808-0772.Learn More:
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What Does Part A Cost
With Medicare Part A, you may have to pay copays and deductibles for hospital stays, but may not have to pay a monthly premium. Copays and deductibles apply to hospital benefit periods, which start when you enter a hospital or skilled nursing facility, and end 60 days after youve left the facility . Its important to note that:
- For each hospital benefit period, you pay a deductible.
- You pay a copay if youve stayed in a hospital for more than 60 days.
- Theres no deductible or copayment for home health care or hospice care.
For many people, Part A comes without a monthly premium. You may have no monthly premium if you paid a certain amount toward Medicare taxes while working. In this case, you are often automatically enrolled in premium-free Part A.
If you dont automatically get premium-free Part A, you may be able to buy it if you :
- Are age 65 or older and allowed to Part B to meet the citizenship and residency requirements.
- Are under age 65 and are disabled but no longer get premium-free Part A because you returned to work.
What Can I Do Next
Generally, youre first eligible to sign up for Part A and Part B starting 3 months before you turn 65 and ending 3 months after the month you turn 65.
Because the company has less than 20 employees, your job-based coverage might not pay for health services if you dont have both Part A and Part B.
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Medicare Supplement Plans And The Part B Premium
You need to keep your Original Medicare insurance and continue paying your Part B premium when you get a Medicare Supplement plan. Medicare Supplement insurance only applies to you, so if your spouse is also looking to receive Medicare Supplement, he or she will have to purchase a separate policy. If you are unsure whether Medicare Supplement is right for you, here are the top 10 reasons why many beneficiaries get Medicare Supplement Insurance.Its important to note that Medicare Supplement policies dont generally cover items or services such as routine vision and dental, long-term care, hearing aids, private nursing care, or eyeglasses. Some of these benefits are covered through Medicare Advantage plans.
There are many reasons you might want to take advantage of Medicare Supplement insurance. I can help you find a Medicare Supplement policy that may work for your needs, or discuss your other Medicare coverage options with you. To schedule a telephone call with me, or have me send you more information, you can click on one of the links below. Want to explore the options on your own? Just click the Compare Plans buttons on this page.
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Medicare Part B And Va Benefits
Medicare Part B can provide you with medical coverage and services outside of the VA health system. Therefore, it is recommended that you enroll in Medicare Part B in addition to your VA benefits. If you wait to enroll in Part B when you are first eligible, you will likely experience gaps in coverage and incur a penalty for each 12-month period you were without Medicare Part B coverage. Learn more about Medicare Part B.
Do I Have To Be Enrolled In Medicare Part B Before I Enroll In A Medicare Advantage Plan
Yes. The Medicare Advantage program provides the means for Medicare beneficiaries to receive Medicare Part A and Part B benefits from a Medicare Advantage plan rather than from the government-administered Medicare program. Medicare Advantage doesnt replace Original Medicare Part A and Part B coverage it simply delivers these benefits through an alternative channel: private insurance companies. Medicare Advantage plans are offered by private insurance companies that contract with Medicare. Medicare Advantage plans must offer at least the same benefits as provided under Medicare Part A and Part B . Many Medicare Advantage plans offer extra benefits not available from Original Medicare. Therefore, to enroll in a Medicare Advantage plan, you must be enrolled in both Medicare Part A and Part B. You must also reside in the plans service area.
The Initial Enrollment Period is the first chance you have to enroll in Original Medicare, Part A and/or Part B. Your Initial Enrollment Period starts three months before you first meet all the eligibility requirements for Medicare and lasts for seven months.
To enroll in a Medicare Advantage plan, however, you have to be entitled to Medicare Part A and enrolled in Medicare Part B. This can occur simultaneously with the Initial Enrollment Period. You are likely to hear this enrollment period referred to as the Initial Coverage Election Period. This is the first time Medicare beneficiaries may enroll in a Medicare Advantage plan.
What Is The Medicare Buy
According to the Centers for Medicare & Medicaid Services , the Medicare buy-in program enables states to help more than 10 million Americans pay their monthly Medicare Part B premiums and more than 700,000 people pay their Part A premiums.
All states offer buy-in for Part B, but fewer states offer Part A buy-in. This is because the Part A premium is free for most people. The qualifications for Part A and Part B buy-in are different.
If youre eligible for Medicare, you must enroll in Part A or Part B during set enrollment periods or else pay penalties. If you qualify for the buy-in program, however, these penalties and timeframes are waived.
The Medicare buy-in program is also connected to Medicaid eligibility for prescription drug assistance through a program known as Extra Help. Well discuss this additional program a bit later.
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You Need Part B To Be Eligible For Supplemental Coverage
Medigap plans do not replace Part B. They pay secondary to Part B.
Part B works together with your Medigap plan to provide you full coverage. This means you must be enrolled in Part B before you are even eligible to apply for a Medicare supplement. Your healthcare providers will bill Medicare, and Part B will then pay 80% of your outpatient expenses after your small deductible. Medicare then sends the remainder of that bill to your Medigap plan to pay the other 20%.
The same goes for Medicare Advantage plans. You are not eligible for a Medicare Advantage plan unless you are enrolled in both Medicare Parts A and B and live in the plans service area.
On the flip side, having ONLY Parts A and B with no secondary coverage is also very risky. It leaves you exposed to paying 20%, unending, or some very expensive items. For example, if you needed a knee replacement and had only Medicare, you would pay 20%. A surgery like that might cost in excess of $100,000. Dont be left holding a bill for 20% of that.
My advice: You should enroll in both Part B and either a Medigap plan or Medicare Advantage plan.
Reasons To Delay Medicare
If youre thinking about deferring Medicare, discuss the pros and cons with your current insurer, union representative, or employer. Its important to know how or if your current plan will work with Medicare, so you can choose the most comprehensive overage possible.
Some of the common reasons you may want to consider deferring Medicare include:
- You have a plan through an employer that you want to keep.
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- Most people dont have to pay a premium for Part A . So, you might want to sign up for Part A when you turn 65, even if the active duty service member is still working.
- Youll pay a monthly premium for Part B , so you might want to wait to sign up for Part B.
Avoid the penalty & gap in coverageIf you miss this 8-month Special Enrollment Period, youll have to wait to sign up and go months without coverage. You might also pay a monthly penalty for as long as you have Part B. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?
What Is My Medicare Part B And Coinsurance Amount
The annual deductible for Medicare Part B is $203 in 2021. You will also be responsible for a 20% coinsurance for many covered services. If your doctor or health care provider accepts assignment for a covered service, you would pay the Part B deductible along with 20% of the Medicare-approved amount for services rendered. Accepting assignment means that your doctor will not charge you more than the Medicare-approved amount for the covered service. You would still be responsible for cost-sharing.
Just by entering your zip code in the form on this page, you can start comparing Medicare plans in your area instantly. But youre also more than welcome to reach out to us .
*Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plans official plan documents to understand how that plan handles pre-existing conditions.
This information is not a complete description of benefits. Contact the plan for more information.
Limitations, copayments, and restrictions may apply.
Benefits may change on January 1 of each year.
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Can I Drop Other Coverage To Enroll In Part B
Once youre eligible for Part B, youre eligible.
If one of the exceptions applies that qualifies you for a Special Enrollment Period, you can drop other coverage and enroll in Part B at any time, assuming you have enrolled for Part A.
You may be automatically enrolled in Medicare Part A.
Your retiree health plan may require you to enroll in Medicare. Whether or not this is the case, many health plans coordinate benefits with Medicare.
Medicare is the usually the primary payer. You may find that adding part B coverage can help lower your overall out-of-pocket health care expenses. In any case, having other coverage doesnt typically block you from enrolling in Part B if you are eligible.
You should consult your human resources office or benefits administrator to see how your employee or retiree plan coordinates with Medicare.
Should I Enroll In Part B If I Have Fehb Coverage
Deciding whether to enroll in Part B is complicated. And unlike Medicare Part A, all enrollees pay a premium for Medicare Part B . While FEHB plans cover most of the same types of expenses that Medicare covers, FEHB plans coverage may be more limited than Medicare Part B when it comes to orthopedic and prosthetic devices, durable medical equipment, home healthcare, medical supplies, and chiropractic care. Conversely, FEHB plans cover emergency care received outside the United States, and this isnt covered by Original Medicare at all and is rarely covered by Medicare Advantage. FEHB plans may also pay for vision and dental care thats not covered by Original Medicare and is limited in Medicare Advantage.
If you are covered by an FEHB HMO plan, youre normally limited to seeing providers who are part of your plan. Having Part B means you can go outside the HMOs network and see other providers, as long as theyre part of Medicare.
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Is This Program About Medicare Eligibility Age
There can be confusion around what the term Medicare buy-in program means.
There are proposed rule changes to lower the eligibility age for Medicare to 50 to 64 years old, and some may refer to this as Medicare buy-in.
Here, though, were talking about the Part A and Part B buy-in program offered by states through Medicare savings programs .
Medicare Part B Costs
While some people may be eligible for premium-free Medicare Part A if theyve worked at least 10 years and paid Medicare taxes during that time, most beneficiaries must pay a monthly premium for Medicare Part B insurance unless they qualify for low-income assistance. This premium amount may change from year to year. Learn how much you may have to pay for your Medicare Part B premium here.
If your income falls above a certain threshold, you may have to pay a higher amount for Medicare Part B coverage. This is known as an Income Related Monthly Adjustment Amount , which is an extra amount youll pay on top of your monthly Part B premium. Social Security will contact you if this applies to you.
In addition, you may owe certain out-of-pocket expenses for Medicare Part B-covered services, including copayments, coinsurance, and the Part B annual deductible. Once youve met your yearly deductible, youll usually pay 20% of the Medicare-approved amount for most medical services and supplies. However, this may vary, depending on the specific service or equipment.
Do you have questions about what Medicare Part B covers? Or perhaps youre interested in finding additional benefits beyond Original Medicare, such as through a Medicare Advantage plan. If youd like to discuss your Medicare coverage options with a licensed insurance agent, call eHealth today to learn about Medicare plan options that may work for your situation.
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