You can read the countless brochures, pamphlets and websites available, or you can read the information below to get a simple and easy understanding of Medicare. Remember that Medicare is Parts A & B and is often referred to as “Original Medicare,” or Traditional Medicare. It can be found listed on the red, white and blue Medicare Card.
Part A (HOSPITAL INSURANCE)
To make it easy, Part A is for when you get admitted a hospital. This coverage is for inpatient hospital, skilled nursing facility, home health care, and hospice care. For most people Part A is free when you turn 65 and are Medicare eligible due to you or a spouse having paid Medicare taxes while working. Part A alone has a high deductible if you are admitted to a hospital and then only covers the first 60 days in a hospital and the first 20 days in a skilled nursing facility. Obtaining a MEDICARE SUPPLEMENT will help cover what Medicare Part A will not pay.
Part B (MEDICAL INSURANCE)
To make it easy, this is for everything non-hospital-expense related. This is for things like doctor and specialist office visits, blood tests, x-rays, MRI’s, the use of durable medical equipment, and outpatient hospital care, etc. For most people, Part B will cost $144.60 a month. It will be deductible out of your Social Security, check if you are drawing Social Security. If you are not drawing Social Security you will be billed quarterly. There is a small annual deducible for Part B which is only $198 for 2020.. Once the deducible has been met, Medicare will pay only 80%, and you will be responsible for the other 20%. Medicare will typically pay 100% for preventative services such as yearly wellness visits, flu shots, mammogram screenings, prostate screenings, and colonoscopy screenings, etc. Obtaining a MEDICARE SUPPLEMENT will help cover what Medicare Part B will not pay.
Part C (PRIVATE INSURANCE)
To make it easy, this is referred to as a “Medicare Advantage Plan” and is used instead of original Medicare. Some refer to it as a “Medicare Disadvantage Plan” because you can no longer use your original Medicare A&B card. The biggest misconception people have that we have encountered is that those on these types of plans think they have a supplement. THIS IS NOT A SUPPLEMENT. These plans are offered by private insurance companies that are approved by Medicare to provide you with hospital, medical and, usually, prescription coverage. You are put into an HMO or PPO network. You no longer have nationwide coverage and have to go to the doctors, specialists and hospitals that accept that particular private insurance. If you are traveling, you could end up paying some very high out-of-pocket expenses. You will still be required to pay your Part B monthly premium of $144.60 for 2020. Although the plans may be offered for free or a low monthly premium by the private insurance company, you will still be subject to co-pays, deductibles and high out-of-pocket expenses. BE AWARE! A lot of these plans have an annual spending limit that can reach as high as $11,500. VERY IMPORTANT! These types of plans depend on what the government gives them to provide coverage instead of original Medicare. The government has provisions in the Affordable Care Act to substantially cut the funding to these plans over the coming years. WHAT THIS MEANS TO YOU? Keeping original Medicare A&B and purchasing a federally regulated Medicare Supplement will give you the MOST COMPREHENSIVE and best coverage possible.
Part D (DRUG PRESCRIPTION INSURANCE)
To make it easy, D stands for DRUG PRESCRIPTION. Since original Medicare A&B does not include prescription drug coverage, you will have to purchase a separate stand-alone plan. The monthly premiums are very reasonable and will typically cost $17 to $87 a month depending on your list of prescriptions. The monthly premium can be deducted out of your Social Security check. There are roughly about 30 approved prescription drug plans available through Medicare’s database. This allows you to tailor which plan gives you the lowest out-of-pocket costs. WE CAN HELP YOU WITH THIS. Part D drug plans change formularies and costs during each Annual Enrollment Period (October 15th- December 7th). During this time each year, you can change your Part D plan to the one that will provide you with the best coverage and lowest out-of-pocket costs for the next calendar year.
Medicare (Medigap) Supplement PLAN F
Plan F is the best coverage and most popular plan with Original Medicare. It is no longer available to people turning 65 in year 2020 or later. If you already have a F plan, it will be grandfathered in. With this plan you will have no co-pays, no bills and no deductibles for anything Medicare A&B approved. It fills all the gaps of original Medicare. We recommend looking closely at Plan G.
Medicare (Medigap) Supplement PLAN G
Plan G offers the same coverage and benefits as Plan F, except for the Part B deductible. Plan G does not pay the Part B annual medical deductible of $198 for 2020. If you have paid or met the $198 medical deductible you are done. There will be no more co pays or out-of-pocket costs for Medicare covered services. Plan G will fill all the gaps in Original Medicare, except for the $198 annual deductible. The monthly premium tends to be about $40 less a month than with Plan F. (Example: If you are saving $40 a month, that would be $480 a year. So, $480 minus the $198 deductible would mean a total annual savings of $282. If you only use your Medicare and Supplement for preventative services, you may not even have to pay the Part B deducible that calendar year, and then you will have saved the full $480 for that year.)
Medicare Supplement Plans
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