January 28th, 20221/28/2022 2022 Medicare Costs: A Complete GuideWhat Medicare will cost you in 2022 depends, to some extent, on the amount and kind of medical treatment you need during the year. Because of that, no one can give you a 100% accurate, to the penny prediction of your Medicare costs. However, in this video, we’ll give you all the information you need to make an educated estimate of your Medicare healthcare costs for 2022. Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To...
Let’s go through the costs associated with Medicare Parts and Medicare plans so you can figure out what your Medicare coverage could cost you in 2022.
For each Part and plan, note which expenses are required and which are likely for you based on your normal healthcare needs. I’ll also mention the worst case scenario amounts where they exist, so you can be prepared if you have a catastrophic illness or injury and require far more care than usual. First, the Parts of Original Medicare, Part A and Part B. Medicare Part A Medicare Part A is inpatient or hospital coverage. If you or your spouse worked 40 quarters, which is 10 years, and had Medicare taxes taken out during that whole time, you will not have to pay a monthly premium for Medicare Part A. You prepaid that premium with your taxes. If you haven’t paid Medicare taxes for 40 quarters, you can still enroll in Medicare Part A, but you will have to pay a monthly premium for it. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $499 per month. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $274 per month. Medicare Part A has hospital deductibles and coinsurance amounts that are your financial responsibility if you need inpatient medical care. These costs are per benefit period, not annual charges, so you could potentially owe these amounts more than once in a calendar year. Here is a link to a video that explains Medicare Part A benefit periods: https://youtu.be/nhYpekW8OAA A very limited benefit for skilled nursing facility care is also covered under Medicare Part A. You only qualify for this coverage if you first had a three day inpatient hospital stay. These costs are also per benefit period, not per year. Hospice care is covered at no cost to you. Hospice drugs may have a copay of up to $5 and there may be a 5% coinsurance charge for respite care. Durable medical equipment is covered by Medicare Part A at 80% leaving a 20% coinsurance amount for you to pay. Medicare Part B Medicare Part B is outpatient insurance. The monthly premium for Medicare Part B in 2022 is $170.10 per month for most people. If you have high income, you may be charged more for Medicare Part B. The chart here shows which income levels qualify for the Income Related Monthly Adjustment Amount or IRMAA. Please note that Medicare looks at your Modified Adjusted Gross Income from two years ago to determine your IRMAA. There is an appeals process available if your income has declined significantly in the past two years. A link to the IRMAA appeal form is here: www.ssa.gov/forms/ssa-44-ext.pdf Medicare Part B covers preventive medical care at 100% with no cost to you. Here is a link to a pdf guide from Medicare that explains which preventive services are covered at 100%: https://www.medicare.gov/Pubs/pdf/10110-Medicare-Preventive-Services.pdf Medicare Part B has an annual deductible that you have to meet before Medicare will pay anything for outpatient medical care that is not preventive care. In 2022, that deductible is $233. You pay the full cost for outpatient care until you reach $233 in spending. Depending on the complexity of your outpatient care, it could take several office visits to reach that $233 deductible. If you do reach the Medicare Part B deductible, Medicare will pay 80% of your covered outpatient medical care for the rest of the year, leaving 20% as your responsibility. Medical care is billed to Medicare Part B for all outpatient care. Even if you are in a hospital, if you have not been admitted as an inpatient, your care will be covered by Medicare Part B rather than Part A and your costs will be 20% of the total cost after the deductible is met. Why Does Almost Everyone Enroll in Medicare Plans? Most Medicare beneficiaries do not have just Medicare Parts A and B. Almost everyone has additional coverage to protect themselves from the financial risks built into Medicare Parts A and B. There is no out-of-pocket spending limit with either Medicare Part A or Medicare Part B, so there's no limit to how much you can end up spending on your medical care with the Part A and Part B deductibles, copays, and coinsurance. In addition to not having any way to cap your spending with Original Medicare, Medicare Parts A and B do not cover some things that individual and group health insurance have evolved over the years to cover. If you only have Medicare Parts A and B, you won’t have coverage for most outpatient prescription drugs, most dental care, dentures, most vision care, long term care, routine foot care, or hearing care, including hearing aids. Medicare Supplements/Medigap Medicare Supplements, also known as Medigap plans, are the oldest type of Medicare plan offered by private insurance companies. These policies work with Medicare Parts A and B. Parts A and B are primary insurance, and a Medicare Supplement is secondary insurance. There are many different levels of coverage available with Medigap plans to help you cover the deductibles, copays, and coinsurance that would otherwise be your responsibility with Medicare Parts A and B. The monthly premium cost for a Medicare Supplement varies depending on what level of coverage you choose and where you live. A high deductible Medigap plan can have a premium below $50/month, while the most comprehensive Medigap plans’ premiums can be several hundred dollars per month. Unless you have a high deductible Medicare Supplement, you will have very few out-of-pocket costs through the year when you need medical care. You can budget for the Medicare Supplement plan premium and then expect very little in other costs for covered Medicare Part A and Part B care. For more information on the best Medicare Supplement plans for 2022, please see the video linked here: https://youtu.be/BGIQVEgszUQ Medicare Part D Medicare Part D is prescription drug coverage. Part D coverage can be purchased through a standalone Part D plan or as included coverage in a Medicare Advantage plan. Medicare Part D, like Part B, includes an IRMAA payment if you have a high income. The chart here shows how much you will pay in addition to the plan premium if you fall into one of the high income categories. This extra amount does not go to the Part D insurance company. It is paid to Medicare. Part D IRMAA applies whether you purchase a standalone Part D plan or have Part D coverage through a Medicare Advantage plan. The only way to avoid Part D IRMAA is if you have creditable drug coverage from another source like an employer plan, the VA, or a state pharmaceutical assistance program. If you don’t take any medications or take just a few inexpensive generic drugs, you may be tempted to skip Part D to save money. Unfortunately, that’s a risky move that could cost you a lot in late enrollment penalties down the line. More info on that in the video here: https://youtu.be/PtJ7-0EUqh8 Even though Part D is a Part of Medicare, Part D coverage is not offered through Medicare itself. Private companies contract with Medicare to offer Part D prescription medication insurance to Medicare beneficiaries. Part D plans have to meet annual Medicare standards before they are allowed to be marketed. Every Part D plan has to be at least as good as the Medicare Part D Defined Standard Benefit Plan. Because Medicare makes adjustments to the Part D Defined Standard Benefit Plan every year, all the Part D plans change, at least a little, every year. It’s very important to look at all your Part D plan options every year during the Annual Enrollment Period between October 15 and December 7. The best Part D plan for you this year might not be the best plan for you next year because they all can change every year. How do you shop for Part D plans? Do not start by looking at the monthly premium cost. The plan with the lowest monthly premium may not be the least expensive plan for you. Similarly, whether a Part D plan has a deductible or not might not matter. You have to look at your overall cost, not just premium or deductible amounts. Part D plans are complicated. There are four different coverage levels: deductible, initial coverage, coverage gap, and catastrophic coverage. How much your prescriptions cost to fill depends on which level you are in. How far you progress through those levels depends entirely on the cost of the medications you take. Looking at the premiums, deductibles, and copays of plans generically won’t give you any useful information. The only way to get an accurate cost estimate for Part D plans is to enter your prescription medications into a plan estimator tool, either at medicare.gov or through an insurance brokerage. These options will give you the best and fastest overall view of all plans available where you live. What you are looking for is the plan with the fewest restrictions and lowest overall cost for the year based on your medications. Medicare Part C/Medicare Advantage Medicare Part C is Medicare Advantage plans. These are, for the most part, the HMOs and PPOs of Medicare. Like Part D, Medicare Part C plans are offered by private insurance companies that contract with Medicare and have to meet yearly standards to market plans to the public. If you enroll in a Medicare Advantage plan, you have to continue to pay your Medicare Part B premiums, and Medicare Part A premiums, if you owe Part A premiums. Medicare Advantage plans may have a monthly premium, although many have $0 monthly premiums. There are deductibles, copays, and coinsurance amounts for all medical services received through a Medicare Advantage plan. These amounts vary from plan to plan. Use the plan’s Summary of Benefits and Evidence of Coverage documents to estimate how much you will likely spend in a year toward deductibles, copays, and coinsurance if you use your usual amount of medical services. Every Medicare Advantage plan also has a maximum out-of-pocket spending limit for the year. If you reach that limit, all further medical costs for the year will be covered by the plan. That maximum out-of-pocket spending limit is important to keep in mind when shopping for Medicare Advantage plans because it represents the absolute worst case scenario for that plan. In 2022, this limit cannot be higher than $7,550. If your Medicare Advantage plan includes Part D drug coverage, those costs will be estimated separately in the plan information, similar to quoting a standalone Part D plan. Medicare Coverage Choices You can’t have a Medicare Advantage plan and a Medicare Supplement at the same time. In most cases, you can’t have a Medicare Advantage plan and a standalone Part D plan. The most common choices for coverage are either Medicare Parts A and B plus a Medicare Supplement and a Part D plan, possibly with a dental, vision, hearing policy OR a Medicare Advantage plan. With either option, you have to pay your Medicare Part B premium and Medicare Part A premium, if you owe it. Beyond that, your costs for 2022 can be estimated by adding plan premiums and likely expenses based on plan deductibles, copays, and coinsurance. Have Questions? We Can Help! This can get complicated, but help is available! If you have questions about your Medicare coverage or would like some assistance figuring out how much Medicare is likely to cost you in 2022, give our office a call at 877-312-1414 or schedule a free, no obligation Medicare Plan Consultation. We’re here to help you sift through Medicare confusion to find the best possible coverage solution for you! January 21st, 20221/21/2022 New Idaho Medicare Supplement Annual Open Enrollment Period: New Policy Without Underwriting!Beginning March 1, 2022, Idaho residents have a new annual open enrollment period to switch Medicare Supplement, also known as Medigap, policies without having to answer health questions or pass medical underwriting. Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To... Starting March 1, 2022, if you live in Idaho and have a Medicare Supplement, you will have a brand new open enrollment period every year beginning with your birthday and running for 64 days. Here’s what you can do with this open enrollment period: Switch to a Medicare Supplement or Medicare Select Medicare Supplement with either the same level of benefits as your current Medicare Supplement or fewer benefits than your current Medicare Supplement. You can make this change during the 64 day open enrollment period without having to answer any health questions, provide medication lists, or go through any kind of medical underwriting. You can make a change to a different Medigap plan with the same insurance company, or you can purchase a plan from a different company. More info: This link will take you to a chart at the Idaho department of insurance website that shows what changes you can make using this new open enrollment period based on what plan you currently have: https://doi.idaho.gov/shiba/new-to-medicare/medicare-supplement-medigap/recent-changes-to-medicare-supplement-law-and-rules/ Other Idaho Medigap Changes The other big change for Idaho Medicare Supplements is Premium rates for new Medicare Supplement policies will no longer be based on the age of the applicant. That applies whether you are just aging into Medicare and buying a Medicare Supplement for the first time or if you are changing insurance companies or plans, the premium This type of premium structure is referred to as “community rating.” Community rating means premiums are based on a single rate for all ages and classes of individuals in the group, regardless of risk factors such as age or health. Idaho does permit rating based on smoker status – often referred to as standard and preferred. That will be the only rating method permitted going forward in Idaho for people age 65 and older. Idaho Medicare Beneficiaries Under Age 65 For Medicare beneficiaries who are under age 65 and qualify for Medicare due to a disability, Medicare Supplement rates can be as much as 150% of the community rate for people who are 65 or older. Once you turn 65, your rate will decrease to the community rate. App Fees and Discounts The proposed rule also prohibits charging application fees and higher premium rates based on the method of payment. Unfortunately, that means that some discounts based on paying by direct debit from a bank account, paying quarterly, semi-annually, and annually are going away for new policies. You Don't Have to Change Medigap Plans If you have a Medicare Supplement and don’t want to change your plan, you don’t have to. Medicare Supplements are guaranteed renewable, so as long as you pay your premium, your policy will continue. Any payment discounts you currently have and scheduled rate increases will continue as before. What Will Happen to Idaho Medicare Supplement Rates? The big question whenever a legislative change like this is made is “What will this do to Medicare Supplement rates?” It’s too early to tell. In general, community rating does make Medicare Supplements more expensive than other rating methods for younger people but less expensive for older people. The rates also depend on the claims experience of the group of insured people, so we’ll have to see what happens in Idaho to Medicare Supplement rates through this year and into the future. If you have Medicare Supplement questions, please feel free to give our office a call at 877-312-1414 or schedule a free, no obligation Medicare Plan Consultation. We’re here to keep you up to date on Medicare plan changes so you can find the best coverage option for you! January 21st, 20221/21/2022 2022 Medicare Basics: How Does Medicare Work? What Coverage Do You Need?Enrolling in Medicare can be overwhelming and confusing. This video goes through the basics of how Medicare works and how to find the best Medicare coverage for you. Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To...
What is Medicare?
Medicare is a government program that provides health coverage to people who are age 65 or older and also to people who are under age 65 but have certain disabilities. Original Medicare has two parts, Part A and Part B. We still refer to those as Original Medicare, as opposed to the new parts: Part C and Part D, which were developed in the early 2000s. Medicare Part A Medicare Part A is hospital or inpatient insurance. It doesn't cover everything at 100 percent. There are deductibles and co-insurance amounts that remain your responsibility with Medicare Part A. If you worked 40 quarters, which is 10 years, and had Medicare tax taken out through that time, then you will not have to pay a monthly premium for Medicare Part A. Medicare Part B Medicare Part B is outpatient insurance. Timing this enrollment is very important because you do have to pay a monthly premium to be enrolled in Medicare Part B. In 2022, most people have to pay $170.10 per month for Part B. The amount you pay for Part B is determined by your income. More info: https://www.cms.gov/newsroom/fact-sheets/2022-medicare-parts-b-premiums-and-deductibles2022-medicare-part-d-income-related-monthly-adjustment Because of this monthly cost, you don’t want to enroll in Medicare Part B until you actually need Part B coverage. For example, if you are going to continue working and be covered by a group employer health plan after you turn 65, you may want to delay enrolling in Medicare Part B. More information on that here: https://youtu.be/xghaDDt8qDE Original Medicare Problem One big issue with Medicare Parts A & B: There is no out-of-pocket spending limit with either Medicare Part A or Medicare Part B, so there's no limit to how much you can end up spending on your medical care with the Part A and Part B deductibles, copays, and coinsurance. Medicare Part C Medicare Part C is also known as Medicare Advantage plans. Private insurance companies contract with Medicare and provide plans that will cover your Medicare Part A and Part B coverage. Instead of having your care managed by Medicare itself, your claims are process and medical costs are covered by the independent health insurance company according to the plan’s contract. Most Medicare Advantage plans provide coverage for things that Original Medicare doesn’t cover. Benefits vary by plan. Most Medicare Advantage plans will also include Medicare Part D. Part D is prescription drug coverage. Those plans are known as MAPD plans. There are also some Medicare Advantage plans, known as MA only plans, that do not have the Part D drug coverage included. MA only plans can be a great option for people who have creditable drug coverage available through another source, like an employer plan, a government program like the VA, or a state pharmaceutical assistance program. Medicare Part D Standalone Plans Medicare Part D also offers standalone prescription drug plans. The standalone plans are for people who want Medicare prescription drug coverage but don’t want an MAPD plan. Like Part C, Medicare Part D plans are offered through private insurance companies that contract with Medicare. All of those plans have to be approved by Medicare before the insurance companies are allowed to offer them to the public. Medicare Supplements/Medigap Medicare Supplements are also known as Medigap plans, and they do just that: they fill in the gaps in coverage in Original Medicare to control your out-of-pocket spending. Medicare Supplements have higher monthly premiums than Medicare Advantage plans, for the most part. But, depending on the particular Medicare Supplement plan letter you choose, there are very few extra costs to you through the year if you need medical care. Your Options The two major routes for Medicare coverage chosen by Medicare beneficiaries are either a Medicare Advantage plan that includes Part D drug coverage or Original Medicare plus a Medicare Supplement and a standalone Part D plan, possibly with an extra insurance policy to cover dental, vision, and hearing. How to choose which is right for you: https://youtu.be/y_mxOGk7xH8 f you have Medicare Supplement questions, please feel free to give our office a call at 877-312-1414 or schedule a free, no obligation Medicare Plan Consultation. We’re here to help you understand your options and find the best Medicare plan for you! January 15th, 20221/15/2022 2022 Best Medicare Supplement/Medigap PlansToday, we’re going to take a look at Medicare Supplements, also known as Medigap plans, and go through how to figure out which is best for you in 2022. Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To...
Medicare Supplements
Medicare Supplements are much older than Medicare Advantage Plans and Medicare Part D plans and have different rules and laws governing them. If you have a Medicare Supplement, you don’t need to worry about network changes every year because if you have a standard Medicare Supplement, there are no networks. You can see any medical provider who accepts Medicare. This makes Medicare Supplements popular with people who don’t want their choice of doctors restricted by an insurance plan. You also don’t have to worry about benefit changes. Insurance companies can’t make any changes to Medicare Supplement benefits. These plans are standardized by law, so the only time benefits change is when a new law changes Medicare Supplements across all companies. There’s no need to take time to compare Medicare Supplements during the Annual Enrollment Period between October 15 and December 7 because Medicare Supplements are not affected at all by the Annual Enrollment Period. They are month to month contracts that you can change any time during the year. Changing Medicare Supplement Policies The rules for changing Medicare Supplements do vary from state to state and can depend on your health and how long you’ve been on Medicare. If you are beyond your first six months on Medicare Part B and don’t have a guaranteed issue right, you will have to answer health questions and go through underwriting to be able to purchase a new policy. For most people, that isn’t a barrier to changing. More information on Medicare Supplement underwriting can be found here:https://youtu.be/br-4S0U912U Medicare Supplement Coverage Medicare Supplements, or Medigap plans, describe what they do right in their names. They are supplemental insurance plans that fill in the gaps that would otherwise be your out-of-pocket costs in Original Medicare, Parts A and B. Medicare Parts A and B are your primary insurance coverage. If you have a covered medical expense, Medicare pays its responsibility first, then your Medicare Supplement pays based on its benefits. You can choose a Medigap plan that covers all or almost all of your Medicare Parts A and B deductibles, coinsurance, and copays, or a Medigap plan that provides catastrophic coverage only, or a Medicare Supplement plan somewhere between those extremes. Because the coverage is standardized by law, once you decide on the lettered plan that is the right coverage level for you, that lettered plan will provide the same benefits regardless of which company you purchase it from. I know it looks like there are a lot of Medicare Supplement plans to choose from with Plans lettered A through N, but in reality, several of these plans are not commonly sold. Insurance companies that offer Medigap plans have to offer Plan A, and beyond that, each insurance company gets to choose which other plans to offer. Some of the plan designs don’t make much sense financially for Medicare beneficiaries, so very few insurance companies even offer them. That’s the case with B, D, K, L, and M. Also, Plans F and C are only options for people whose Medicare Parts A and B effective dates are before Jan 1, 2020. Even if you have been on Medicare long enough to be eligible to purchase a Plan F, it’s not a good idea. More on why that is in the video linked here: https://youtu.be/M81-iDbIfpo Best Medigap Plans for 2022 After those eliminations, for 2022, the plans that offer the best value for consumers are Plan G, Plan N, and High Deductible Plan G. Let’s look at each of these plans in detail. Plan G Plan G is the most comprehensive of the three. For all medical care covered by Medicare Parts A and B, your out-of-pocket risk with a Plan G is limited to the Part B outpatient annual deductible. In 2022, this deductible is $233. If you reach that deductible, all outpatient expenses beyond that are covered at no cost to you between Medicare Part B and Plan G. This includes things like office visits, diagnostic testing, and all outpatient treatment. On the inpatient side, all covered expenses are split between Medicare Part A and Medigap Plan G. You have no out-of-pocket deductible for inpatient care. Because Plan G is the most comprehensive coverage with the least risk of out-of-pocket spending for you, it is the most expensive of these three Medicare Supplement options. Since Medicare Supplement prices generally go up once a year as you age, we need to think about future costs in addition to the initial cost when you first apply. Plan G is more expensive when you first enroll, and you can expect yearly increases in the premium to be larger than what a Plan N or High Deductible Plan G would have. So who would a Plan G be a good choice for? If you have very expensive, ongoing treatments like chemotherapy, treatment for rheumatoid arthritis, or any other medical condition that needs regular or costly treatment, a Plan G can be a good choice for you. That higher Plan G monthly premium is balanced out by the savings in out-of-pocket costs because you don’t have a big deductible to meet or any copays. High Deductible Plan G At the opposite end of the coverage, we have High Deductible Plan G. This Medicare Supplement provides exactly the same coverage as Plan G, with one big difference: you have to meet a high deductible with out-of-pocket spending before the High Deductible Plan G will pay anything. In 2022, that deductible is $2,490. If you have a High Deductible Plan G, you pay the Medicare Part A and B inpatient and outpatient deductibles, copays, and coinsurance up to $2,490. If you reach that amount in your spending, then the Medicare Supplement kicks in and pays just like a standard Plan G. Because this plan has the least amount of coverage and the biggest out-of-pocket risk for you, it has the lowest monthly premium cost. High Deductible Plan G also has the smallest premium increases every year. Who’s an ideal candidate for a High Deductible Plan G? If you are pretty healthy and don’t need much medical care, this can be a great way to protect yourself from catastrophic medical charges while saving a ton of money on monthly Medicare Supplement premium costs. In many parts of the country the difference in the premium cost between a Plan G and a High Deductible Plan G is well over $100 per month. Medicare Parts A and B have no out-of-pocket spending limit for beneficiaries. If you only have Medicare Parts A and B, there’s no limit to how much you can spend for your medical treatment in a calendar year. A High Deductible Plan G provides a cap on what you can spend in a year, and if you have a serious illness or injury, you have the assurance that your spending in addition to monthly premium costs, is capped at $2,490 for the year. Plan N Then, in the middle of the coverage options, we have Medigap Plan N. This is a somewhat newer Medicare Supplement plan, and it grows in popularity every year. It is similar to a G but slightly less comprehensive. There are two differences between G and N. Both are in the outpatient coverage. Inpatient coverage is identical between G and N. Excess Charges One difference is that Medicare Part B Excess Charges are not covered by Plan N. In most cases, that’s really not a big concern. The only time you can get an excess charge is if you see a doctor who contracts with Medicare as a non-participating provider. Only about 4% of Medicare providers contract with Medicare as non-participating providers. A non-participating provider accepts Medicare patients but doesn’t accept Medicare payments as payment in full and balance bills patients up to 15% more as an excess charge. To find out how your providers are contracted with Medicare, you can use the Physician Compare tool at medicare.gov. A few years ago, one of our Medicare Supplement carriers looked at all their claims for one year and found that 99.34% of claims had no excess charges. Of the 0.66% of claims that did include excess charges, the average cost of an excess charge was under $20. Excess charges are very rare, and they aren’t automatic if you are seeing a non-participating provider. The provider can decide whether to balance bill a patient on a case by case basis, and the amount is not always an extra 15%. The rule is the excess charge can be up to 15%, so it may be less. The risk of excess charges is so low that paying extra for coverage for excess charges generally doesn’t make much sense. Plan N Copays The other difference between G and N is that with Plan N, after meeting your Part B outpatient deductible for the year, you may have copays for office visits of up to $20 and for ER visits of up to $50 (waived if you are admitted to the hospital). These office visit copays are not charged at every visit. It depends on how your visit is coded by your provider’s office. So it isn’t guaranteed that you will have any copay at an office visit, but if you do, it is capped at $20. Because Plan N has middle of the road coverage between Plan G and High Deductible Plan G, it also has middle of the road premium costs. If you’re trying to decide between a Plan G and a Plan N, look at the difference in the premium cost between the two plans in your zip code and how many office visit copays you are likely to pay in a year. Premiums vary widely from one state to another. Here are a couple quick examples from rates in Illinois. For a male, age 70, a Plan N has a premium savings of about $35 per month over a Plan G, for a total of $420 per year. If he makes far fewer than twenty office visits per year, the Plan N is the better value. For a female, age 70, Plan N saves about $30 per month versus Plan G, for an annual savings of $360. If she makes fewer than eighteen office visits per year, Plan N is the better financial value. Considering future premium increases, because Plan N has slightly more out-of-pocket risk for policy holders, the premium costs increase more slowly than Plan G premiums. That has been the case every year since Plan N was introduced and is expected to continue. Comparison Shopping for Medicare Supplements Once you’ve decided on the Medicare Supplement Plan that has the right level of coverage for you, it’s time to comparison shop all the companies that offer that plan in your area. Although the coverage is standardized by law, the costs from company to company for the exact same plan are wildly different. Different companies use different pricing models, so it is really important to do detailed comparison shopping and research before applying. It can save you a lot of money initially and in future years. Have Questions? We Can Help! This is what we do for all of our clients as Medicare plan brokers. We work with multiple companies and can impartially comparison shop with you to find the plan and the company that’s the best fit for your situation. We do this completely free of charge to our clients. We’re able to do that because for every enrollment into a Medicare plan through our office, we are paid a commission by an insurance company. The commissions are very similar across plans and insurance companies, so we have no reason to push one company over another for our own gain. We are free to find the plan and the company that fits each client’s medical and financial situation best. The Medicare plan cost to you is the same whether you buy direct from an insurance company or purchase through a Medicare plan broker. Once you are a client of ours, you have ongoing free access to expert help whenever you have a question about your coverage or when premiums or plans change and you need to re-evaluate and possibly change plans. If you have Medicare Supplement questions, please feel free to give our office a call at 877-312-1414 or schedule a free, no obligation Medicare Plan Consultation. We’re here to help you understand your options and find the best Medicare plan for you! January 07th, 20221/7/2022 Five Medicare Supplement Myths: Know the Truth About Medigap PlansMedicare is confusing, and a lot of incorrect information about Medicare and Medicare plans gets passed around on the internet and in real life. Our goal with all videos is to give you accurate information so you can make informed choices about your Medicare coverage. So today, we are debunking five myths about Medicare Supplements, also known as Medigap plans. Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To...
Myth #1. This Medicare Supplement company pays really well.
With other health insurance products, knowing whether your claims will be paid quickly and correctly by a particular company is important before applying. With Medicare Supplements, it isn’t. Here’s why: Medicare Supplement companies are not allowed by law to make claim decisions. If you have Medicare Parts A and B and a Medicare Supplement, Medicare itself makes the decision whether to pay your medical claims. For you, that means no matter which Medicare Supplement company you have, it is a company that pays well. They all do. They aren’t making the decisions about your claims and can’t hold up payment to your providers. Medicare makes the decisions and the Medigap company pays. Myth #2. You can change your Medicare Supplement policy during the Annual Enrollment Period from October 15 through December 7 without having to answer health questions. Nope. Unfortunately, the advertising is unclear on this every year and confuses people. During the Annual Enrollment Period, you can change your Medicare Advantage plan or Part D plan. If you want to change your Medicare Supplement, unless you have a guaranteed issue right, you will have to answer health questions and pass underwriting to be able to purchase a new Medicare Supplement. Myth #3. Past Medicare Supplement rates predict future rate increases. Not really. Looking at old rates is sort of useful. If you see a company that comes into states with very low rates and then has significant increases after a few years, and that becomes a pattern in multiple states with that particular company, that can be somewhat helpful, but it doesn’t predict future rate increases. Medicare Supplements are highly regulated by the government. Your Medigap company can’t single you or anyone else out for a rate increase, no matter what happens with your health. Here’s how Medicare Supplement rates go up: Most Medicare Supplement companies have increases built into the premium based on age. You can see those increases on coverage charts before you apply. Other increases have to be approved by the state department of insurance. Because these rate increases are based on the future medical usage of a group of people and factors like inflation in health care costs, it’s difficult to impossible to predict accurately. Myth #4. Never give up Plan F or Plan G. Plans F and G are the most comprehensive Medicare Supplements sold. If your Medicare Parts A and B effective dates are January 1, 2020 or later, you are not able to purchase a Plan F. The most comprehensive plan you can get is a Plan G. Being the most comprehensive doesn’t mean these are the best plans. It just means that they have the most coverage. Because they have more coverage than other Medigap plans, and less out of pocket risk for you, they are the plans that start with the highest premiums and have the largest premium increases year over year. They are the best option for some people. Not for everyone. Medicare plans are not one size fits all. If a Plan F or G is the perfect fit for your friend, relative, or spouse, that’s great. It doesn’t necessarily mean it’s the best option for you. Myth #5. You can’t change Medicare Supplements after your first six months on Medicare Part B. Generally, that’s not true. Different states have different laws regarding changing Medicare Supplements. In most cases, once you are beyond your first six months on Medicare Part B, you will need to answer health questions, provide a list of medications, and pass underwriting to change Medicare Supplements. More information about Medigap underwriting and whether your medical conditions could be an obstacle to purchasing a new policy, can be found here: https://youtu.be/br-4S0U912U While you may not have the wide open field you did for Medigap plans during your first six months on Part B, there certainly are options to change your Medicare Supplement policy at almost all times. Those are five of the most common Medicare Supplement myths. There certainly is other misinformation out there regarding Medigap plans. If you have questions about Medicare Supplements, please feel free to call our office at 877-312-1414 or schedule a free, no obligation Medicare Plan Consultation. We’re here to take the confusion out of Medicare and provide you with accurate information to choose the best possible Medicare coverage. December 31st, 202112/31/2021 When Should I Start Learning My Medicare Options?This is a question we hear all the time from people who are close to age 65. Medicare is complicated, and how and when you enroll will depend on your unique situation: whether you will continue working once you are on Medicare, what, if any, group health insurance might be available to you, whether you are going to start taking Social Security at age 65, and the list goes on. In this video, we’ll discuss the ideal, realistic timeline to get you prepared for Medicare with the least amount of stress and confusion possible. Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To...
Most Important Advice
Here’s the most important thing: don’t wait until the last minute when it comes to enrolling in Medicare itself. By that, I mean Medicare Parts A and B. You can apply for Medicare Parts A and B online at https://www.ssa.gov/benefits/medicare. You can also call Social Security or visit your local Social Security office to apply for Medicare. For many people, applying any of those ways goes fairly smoothly and a Medicare ID number is assigned and a Medicare card arrives in the mail within about 30 days. However, sometimes the enrollment process does not go smoothly at all. Clients have had significant delays applying for Medicare using all three of those enrollment options. If you can’t log into the Social Security website, a card with an activation code will be mailed to you if you request one. In about 10 days. Both the phone centers and local offices in some places have been experiencing long wait times for appointments due to staffing shortages and the pandemic. Because having a Medicare ID number is the first necessary step before enrolling in any other Medicare coverage, if you wait until the last month before you want your coverage to start and run into any trouble with Social Security Medicare enrollment, there’s a good chance you won’t have everything completed when you’d like. So, if a month isn’t enough time, when should you start? The ideal time to start learning about how Medicare works, what your coverage options are, and when you should enroll in what, is three to six months before your Medicare eligibility begins. This isn’t to say that all your time should be spent learning about Medicare. That could drive you insane. By starting early, you can avoid potential Social Security office delays and break your Medicare learning into small chunks. We have a simple checklist to follow that can help. Enrollment Rules Although all the enrollment rules for Medicare and Medicare plans are publicly available, Medicare doesn’t guide you through all of them or give you specific instructions tailored to your particular situation. For most people, the most important time for making decisions about Medicare coverage is the 7 month period around your 65th birthday. The three months before your birth month, your birth month, and the three months afterward are your Initial Enrollment Period. If you want your Medicare coverage to start on the first day of your birth month, you have to apply before your birth month. That’s the government side of things. Individual Medicare Plans Medicare was never intended to cover all of your medical expenses. Because of that, most people also enroll in Medicare coverage beyond Medicare Parts A and B. By that, I mean Medicare Supplements, Medicare Advantage plans, and Medicare Part D plans. All of these are offered through private insurance companies. Medicare has rules governing when and how you can enroll in each of these plans too. The rules are not the same for every type of plan. Medicare Supplement vs Medicare Advantage With a few exceptions, the two major routes a person can take for individual Medicare plans are either a Medicare Advantage plan or a Medicare Supplement plus a standalone Part D prescription drug plan. To be able to decide which route is best for you, you have to take a look at what is available where you live and what type of plan fits your medical and financial situation best. This video explains the differences between Medicare Advantage plans and Medicare Supplements in more detail. Once you’ve decided which type of plan is right for you, you can start comparison shopping all the insurance companies that offer that type of plan in your zip code. Then, in the future, if you are covered by a Medicare Supplement, you can comparison shop again every time rates change. Or if you are in a Medicare Advantage or Part D plan, you can comparison shop every year during the Annual Enrollment Period. Internet Caution You can do all this on your own, but you don’t have to. And really, I don’t recommend that you do. The great thing about the internet is that anyone can put content here.... The bad thing about the internet is that anyone can put content here.... A lot of our time on the phone is spent debunking incorrect information that people found doing internet research into Medicare plans. Plenty of people who are successful in their fields of specialty have gotten themselves into real tight spots with Medicare by relying on information they found on the internet that was misleading or flat out wrong. If you see something online that claims to be a way to get around late enrollment penalties or income related monthly adjustment amounts or anything “secret” about Medicare that “they” don’t want you to know, it’s likely not correct. Any statement online made about Medicare or Medicare plans should be verifiable on medicare.gov or your state health insurance department website. If a Medicare plan broker can’t back up what he or she is telling you with documentation, look for another broker. Free Help is Available Honest, reputable brokers are here to help you every step of the way from learning about your options and answering your questions to enrolling in Medicare itself and Medicare plans and changing or renewing those plans in the future. We do this all at no cost to you. If you enroll through our office into a plan offered by any of the many insurance companies we contract with, we receive a commission for your enrollment. Because the commissions for Medicare plans are about the same regardless of which plan or company you choose, we can be impartial when comparison shopping plans and put your best interest first. The price is the same for you whether you purchase a Medicare plan by yourself direct from an insurance company or you purchase through our office, so why not take the extra free assistance? If you have questions about Medicare coverage, please feel free to give our office a call at 877-312-1414 or schedule a free, no obligation Medicare Plan Consultation. We’re here to help take the confusion out of Medicare and Medicare plan enrollment and find the best plan for your health and hard earned dollars! December 23rd, 202112/23/2021 New Illinois Medicare Supplement Annual Open Enrollment Period: No Health Questions Required!Starting January 1, 2022, if you are a resident of Illinois and are between the ages of 65 and 75, you may have a new annual open enrollment period when you can change your Medicare Supplement coverage without having to answer health questions. Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To...
The new Illinois Medicare Supplement Annual Open Enrollment Period is called the Birthday Rule: https://trackbill.com/bill/illinois-senate-bill-147-ins-medicare-open-enrollment/2023061/
Here’s how it works: You have to live in Illinois. You have to be between age 65 and age 75. If you meet both of those qualifications, you may have a Medicare Supplement open enrollment period every year that lasts 45 days with the first day being your birthday. During that time you can change your Medigap coverage with no underwriting and no health questions. Restrictions There are some restrictions on the changes your are allowed to make. 1. You have to move from higher coverage to lesser coverage. So if you have a Medicare Supplement Plan F, you can move to a G, an N, any plan with less coverage than F. Same for G, N, and any other Medicare Supplement. If you have a High Deductible Plan G, there isn’t any plan with less coverage, so this open enrollment wouldn’t be able to be used. You can’t move from less coverage to more coverage. So if you have a high deductible F or G or a Medigap Plan N, for example, you can’t purchase a standard G, without having to go through underwriting with health questions. 2. You have to stay with the same insurance company. This open enrollment period does not allow you to change Medicare Supplement companies. Only to change plans within the same company. This is an important restriction. If you purchased your current Medigap plan from a subsidiary company of a very large insurer, and that subsidiary is no longer accepting new Medicare Supplement applications in Illinois, then you can’t use this open enrollment period. If you qualify, your current Medigap company will notify you at least 30 days before your open enrollment period begins. What will this new law do to Medicare Supplement rates? In other states with broad Medigap open enrollment periods, rates for most Medicare Supplement policies are extremely expensive. It’s too soon to tell what will happen to IL rates. Because the IL Birthday Rule limits changes to moving from higher to lesser coverage and staying with the same insurance company, hopefully, this will not have an adverse effect on rates for everyone with a Medicare Supplement in IL. Have Questions? We Can Help! If you have questions about your Medicare Supplement coverage, or any other Medicare questions, please feel free to give our office a call at 877-312-1414 or schedule a free, no obligation Medicare Plan Consultation. We’re here to keep you up to date on your Medicare options, so you can find the best plan for your unique situation. December 17th, 202112/17/2021 Medicare Part D for People Who Take No (or Few) MedicationsMedicare Part D is the part of Medicare that covers prescription drugs. Part D plans are not offered by Medicare itself. Rather, Medicare authorizes Part D plans from private insurance companies that meet yearly standards set by Medicare to be sold to the public. If you take expensive prescription medications, it’s definitely to your benefit to enroll in a Part D plan when you become eligible for Medicare. But what if you take only a few inexpensive generic medications or no medications at all? Should you enroll in a Part D plan? Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To...
Part D Enrollment
Part D enrollment is not required by Medicare. However, enrollment in Part D is incentivized by Medicare. With any insurance product, the goal is to have as many people as possible in a group to spread financial risk around. That’s why, when Medicare Part D was set up about 15 years ago, a hefty late enrollment penalty was included to strongly encourage everyone eligible to enroll in a Part D plan, even those who take few or no medications. Initial Enrollment Period (IEP) Most people first become eligible for Medicare when they turn 65. The first opportunity to enroll in a Part D plan is your Initial Enrollment Period (IEP): if you are enrolling in a Medicare Part D plan when you turn 65 and are enrolling in Medicare Parts A and/or B, your IEP is the three months prior to your birth month, your birth month, and the three months following your birth month, for a total of seven months. It's important to make a note of those seven months because you aren’t able to enroll in a Medicare Part D plan anytime you might want to during the year. If you choose not to enroll during your Initial Enrollment Period, your next chance to enroll, unless you have something that triggers a Special Election Period, will be the Annual Enrollment Period between October 15 and December 7. Any enrollment completed during the Annual Enrollment Period takes effect on January 1 of the following year. Late Enrollment Penalty If you don’t enroll in Part D coverage during the seven months of your Initial Enrollment Period, and you don’t have creditable prescription coverage from another source like a group health plan from your employer or union or a government program such as the VA, your Part D late enrollment penalty kicks in. The cost of the late enrollment penalty depends on how long you didn’t have creditable prescription drug coverage. The late enrollment penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($33.06 in 2021, $33.37 in 2022) by the number of full, uncovered months that you were eligible but didn’t enroll in Medicare drug coverage and went without other creditable prescription drug coverage. The final amount is rounded to the nearest $.10 and added to your monthly premium. Since the “national base beneficiary premium” may increase each year, the penalty amount may also increase each year. After you enroll in Medicare drug coverage, the plan will tell you if you owe a penalty and what your premium will be with that penalty added. Penalty Examples So, for example, if your seven months of Initial Enrollment Period end March 30, 2022, and you don’t enroll in Part D coverage and don’t have creditable coverage from another source, the earliest you can enroll in a Part D plan is the next year, 2023, on Jan 1. The intervening 9 months without coverage are all subject to the late enrollment penalty. In 2022, that’s 30 cents per month for each month not enrolled in a Part D plan or creditable coverage, which adds up to an extra $2.70 per month that gets added to your Part D plan premium when you enroll. An extra $2.70 a month doesn’t sound too bad. However, remember though that the penalty amount is always calculated using the national base beneficiary premium for the year, and that almost always goes up, so your penalty amount will increase every year. Also, the big issue is that you will pay an extra $2.70 per month for as long as you are enrolled in Part D coverage. It never goes away. So, if our hypothetical person has Part D coverage for 20 years, and to keep the math simple, let’s assume the penalty stays at $2.70 a month for all twenty years, even though in the real world, that’s very unlikely. After 20 years, our person has paid an extra $648 in late enrollment penalty. Remember, that person only had 9 months of non-coverage. If you go for years without coverage, the penalty amount continues to grow. If someone didn’t have Part D coverage for 5 years and wants to enroll in a Part D plan for Jan 1, 2022, that person’s monthly late enrollment penalty would be an extra $18 tacked onto a Part D plan premium. If that person spends 20 years on a Part D plan, the total penalty paid would be $4,320. The longer a person doesn’t have Part D coverage, the worse the penalty gets. Ok, what are the alternatives? You can go without Part D coverage and plan to self-fund all prescription costs. We’ve had a few clients over the years who have chosen to do this and have the financial reserves to make that possible, but for most people, this is a risky option. Medications for some medical diagnoses are extremely expensive and can eat through retirement savings quickly. None of us knows what our health future holds, but for most people, as we age, we need more medical intervention, including more medications. The course of action we recommend is to enroll in the Part D plan with the lowest monthly premium in your zip code during your Initial Enrollment Period if you take no medications. The insurance companies know that there are a growing number of people who are in their 60s and don’t need maintenance medications. There are usually at least a few plans in every zip code with very low premiums. For 2022, there are plans that have premiums of less than $10 per month. If you take no medications and enroll in a $10 per month Part D plan for all of 2022, that’s a total of $120 spent to avoid the late enrollment penalty later. Enrolling does also give you, obviously, Part D prescription drug coverage. If you have illnesses or injuries during the year, you have coverage for any medications your doctor may prescribe. Have Questions? We Can Help! If you have questions about Medicare Part D prescription drug coverage, or any other Medicare questions, please feel free to give our office a call at 877-312-1414 or schedule a free, no obligation Medicare Plan Consultation. We’re here to help you understand your Medicare coverage options and choose the plan that’s the best fit for you. December 14th, 202112/14/2021 2022 Medicare Supplements Chart
Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To...
December 14th, 202112/14/2021 2022 Medicare Costs at a Glance
At A Glance: 2022 Medicare Costs
Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To...
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Tabitha MoldenhauerLicensed health and life insurance broker since 2005 serving Alabama, Arizona, California, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Michigan, Minnesota, Missouri, North Carolina, New Hampshire, New Jersey, New Mexico, Nevada, Ohio, Tennessee, Texas, Utah, Virginia, Washington, and Wisconsin. Categories |