Medicare Advantage or Medicare Part C is another way to receive Medicare. “Original Medicare” is a combination of Medicare Part A and Part B. It is called “Original Medicare” because that was its first plan in the late 60’s. Medicare Part A was hospital insurance and Medicare Part B was added later. It included doctor visits and outpatient procedures. Some people call it traditional Medicare. It became “Original Medicare” when a new form of Medicare was created–Medicare Advantage, also called Medicare Part C. What is the advantage of Medicare Advantage over Original Medicare?
The Advantage of Medicare Advantage vs Original Medicare
Let’s explain “Original Medicare” first. Medicare Part A covers hospital stays. The Part A has a deductible. It is currently $1,340 for every hospital stay for the same event in a 60 day period. If a completely unrelated event lands you in the hospital, e.g., car accident, heart attack, stroke, etc., even within the first events 60-day period, you will still pay the $1,340 deductible for those unrelated events. That kind of deductible schedule could add up to a significant cash outlay in a year. Likewise, Medicare Part B exposes you to a great deal of risk. While Medicare Part B pays 80% of doctor and outpatient costs, your 20% co-insurance has no cap on it. There is no maximum out-of-pocket. Sky is the limit. If you have a million dollars worth of bills under Part B, 20% is $200,000.
The Advantage of Medicare Advantage is a maximum out-of-pocket. The highest maximum out-of-pocket for Medicare Advantage plans in 2018 is $6,700. Some plans maximum out-of-pocket are much less, depending on the area, the company, and the type of plan. However, the easiest and clearest difference between Original Medicare and Medicare Advantage is a definite limit on what you pay out of your pocket. Medicare Advantage has a maximum out-of-pocket. Original Medicare does not.
Each Medicare Advantage Plan has its own schedule of co-pays, deductibles, and co-insurance. One co-pay that is standardized in all plans is the emergency room visit. In 2018, the emergency room visit co-pay is $80. I would rather pay $80 with a Medicare Advantage plan rather than 20% of any amount on Original Medicare. I broke my arm a number of years ago biking. My emergency room visit was $3,000. The advantage of Medicare Advantage I think is an $80 co-pay rather than 20% bill–$3,000 x 20% = $600.
Part D Prescription Drug Included
With Original Medicare, you still need to get a Medicare Part D prescription drug plan, even if you don’t take any medications. Otherwise, you will be penalized when you eventually do enroll in a Medicare Part D plan. The Part D plan is generally included in a Medicare Advantage plan at zero or little cost. If you purchase a Part D plan, you may pay between $21–$100 per month. The advantage of Medicare Advantage is paying zero or very little for your drug plan.
Vision and Dental
Most Medicare Advantage plans have additional benefits, such as vision, dental, and over the counter items. How would you like to get your teeth cleaned twice a year at zero cost? That is all most people are interested in when it comes to dental usually. They don’t want to spend $50 a month on a dental plan when cleanings are all they really want or need.
Compared to Original Medicare, the advantage of Medicare Advantage makes complete sense. It limits your maximum out-of-pocket, combines Part D at little or no cost most times, includes extra benefits, like dental and vision. There are usually many plans in your area. Here is Omaha there are eleven Medicare Advantage plans among five insurance companies. You should be able to find something that fits your needs among that variety. Call us to find out 402-614-3389.
100’s of Supplements to Pick From
Insurance companies offer hundreds of different Medicare supplements, Medicare Advantage plans, and Medicare Part D prescription drug plans. Picking Medicare plan means choosing between Medicare supplements and a Part D prescription drug plan OR Medicare Advantage/Part C. Next picking Medicare plan means choosing the plan type. Medigap plans range from plan A through the alphabet to plan N, which doesn’t include a Part D drug plan. The drug plans can be a little simpler because you can use the Medicare tool to narrow down the selection. The Medicare calculator bases the plan selection upon the prescriptions you enter into the system. The calculator picks the Medicare Part D plan that will cost the least in total costs for you. On the other side, Medicare Advantage plans consist of a wide variety of co-pays, co-insurance, deductibles, and maximum out-of-pocket costs and amounts that may or may not include a Part D plan.
Foreign Language of Medicare
Medicare itself is like a foreign language of Part A, Part B, and Part D with rules around enrollment that includes penalties when you do not comply. The Medicare.gov website is meant to be helpful, but the shear amount of information, jargon, legalese makes it a barrier to entry rather than a door. Even the Medicare handbook is hundreds of pages. Its size makes the evaluation of information almost impossible.
The Pain of Picking Medicare Plan
As a consequence, picking a Medicare plan is a frustrating and painful process for people. That is why I take people through a 3-step process. 1.) There is a brief, foundational explanation of Medicare and how it works. 2.) Look at ALL of the plans, but in an organized and ordered fashion. The first step helps you evaluate the plans. I share the story behind each company from my fifteen years of insurance experience because each company has a history in the market. 3.) I find out about you. Everyone is unique. Some people are risk takers. Others are not. Some have health concerns that are foremost of mind. Others do not have any.
The logic of the process enables people to narrow down choices and make the best one for them. I ask questions as we go along. Test and probe. Explain aspects of the plans as we go through each. Constantly test for understanding. So the process of picking a Medicare plan becomes clearer as we move through it. I generally meet with people twice. The first time is usually months before they can do anything. There is no pressure to make a decision or ‘buy right now.’ Clients have time to think, collect more information, verify what they’ve learned, talk with confidants. The next time we get together is to review with updated information. That is the time for picking a Medicare plan. By then you are comfortable and confident with your decision because your decision is well informed. It is logical. The decision is made over time without pressure. You know what you are doing when you pick your Medicare plan.
If you would like to go through this process, there is not cost or obligation. Call 402-614-3389 to find out more.
We’ve all experienced that less than happy holiday vacation spent ill. What’s worse is getting sick abroad and worrying about Medicare insurance coverage. If you’re planning a winter getaway, check out and share our healthy Medicare travel tips to ensure your vacation goes off without a hitch.
Whether you’re going foreign or domestic, Medicare travel tip #1. Always research your destination. Even learning about a stomach bug going around could help save your trip. Also be sure to take a look into potential health facilities by contacting the U.S. embassy in the country you’re going to visit or by getting help from your hotel. Know and have the contact information for the hospitals and urgent care centers that could be available to you during your trip.
Common Traveling Illnesses
Important Medicare travel tips is to know what to avoid on your trip. Here are some common illnesses you can bring back from your vacation:
- Malaria – Often found in tropical climates, Malaria is contracted though an infected mosquito bite. Although the disease has flu-like symptoms, it may become deadly. The CDC (Centers for Disease Control and Prevention) has the need-to-know information on Malaria for travelers.
- Traveler’s Tummy – One of the most common maladies foreigners experience when traveling abroad. Traveler’s tummy is common throughout Asia, Africa, Latin America and the Middle East. You can learn more about the gastro-intestinal sickness and how to avoid it from the CDC.
- Zika Virus – Zika is something we’ve all heard about on the news in the past year. Symptoms can range from flu-like to joint pain and rashes. It’s been linked to Asia, Brazil, Central America, Mexico, The Caribbean and The Pacific Islands. This CDC Infographic has tips on preventing Zika while traveling abroad.
You can read up on what to specifically watch out for depending on where you’re going on the travel section of the CDC website.
Check Your Coverage
Compare Plans and Explore Your Options
Your health coverage will vary depending on your Medicare plan. Original Medicare will usually only provide coverage within the U.S. Some Medigap plans have travel coverage. Some Medicare Advantage Plans may as well, but you’ll have to check your specific plan.
If you need some help navigating your Medicare coverage options, our agents can help and are available all year-round.
Doctor Knows Best
Before traveling, meet with your doctor to have a check-up, talk about any health concerns you may have, if you’ll need any vaccinations, etc. Your physician should be able to inform you on any must-know health concerns in regards to wherever you’re going.
Pack Smart Most Important of Medicare Travel Tips
Pack weather-friendly, and don’t forget your necessary prescriptions and medications in your carry-on luggage. That is the most important of Medicare travel tips. If you’re traveling by car, keep your meds in an easy-to-access designated location. If you have any special medical supplies that you need to use, get a note from your doctor that explains why you need them. It’s better to be safe than sorry! If you need help thinking through these Medicare travel tips or you want to invest in travel insurance, give us a call at OmahaInsuranceSolutions.com 402-614-3389
With these tips, you should be enjoying your vacation in no time. Happy travels!
One of the most common questions we receive is: “Am I eligible for Medicare?” Well, there’s no black and white answer to Medicare eligibility. Your Medicare eligibility may depend on several different situations. Luckily, we make Medicare easy—this post will show you how and when to apply for Medicare based on your unique situation.
You become eligible for Medicare when you turn 65 (or younger if you have certain disabilities or diseases). If you or your spouse ha worked in the U.S for more than 10 years, you qualify for Medicare benefits.
Make Comparing Medicare Plans a Breeze
Medicare has four parts: Medicare Part A , Part B, Part C and Part D. Parts A and B include doctor and hospital insurance. Together, Parts A and B are referred to as Original Medicare.
You can apply for Original Medicare the year you turn 65, but only if you meet one of the below requirements:
- You’re eligible to receive Social Security benefits or Railroad Retirement benefits.
- You’re already receiving your retirement benefits from Social Security or Railroad Retirement.
- You or your spouse are covered for Medicare through government employment.
Medicare eligibility doesn’t mean you have to start using it. People are different—some may be ready and waiting to get their Medicare benefits and some may not need coverage yet. If you’re getting ready to turn 65, read on to see your Medicare options.
I’m Turning 65 This Year…
If you’re turning 65 soon, you may want to do one of many things depending on your situation:
- You’re retired
- You want to retire
- You have other health coverage
- You are still working and don’t want to retire yet
See the options for your situation below.
…and Want to Apply for Medicare
If you’re planning to receive retirement benefits before or at the age of 65, apply for Medicare at the same time or at least 3 months before your birthday. That way you’ll become automatically enrolled in Medicare when you turn 65.
…and Am Still Working
If you’re still working when you turn 65, you might want to keep your current health coverage provided by your employer. You can keep your current coverage and still apply for Medicare Part A (most people don’t have to pay a premium for Medicare Part A, so you won’t have to incur a cost).
However, you may consider deferring Medicare Part B to avoid the monthly premiums. We recommend checking with your employer to see how your current coverage may work with Medicare Part B before you make any decisions.
…and Am Covered by My Spouse
If you’re still getting health coverage from your spouse that’s working, refer to the paragraph above.
…and Did Not Pay Medicare Taxes While Working
There are some cases where individuals are 65 and older and a permanent resident of the United States, but they (or their spouse) did not pay Medicare taxes while working. If this is your situation, you still have options.
- Medicare Part A with premiums
- You can purchase Medicare Part A.
- Medicare Part A without premiums
- You’re receiving Railroad Retirement
- Kidney transplant patients/dialysis patients may still be able to receive benefits per special circumstance.
I’m Over 65 and Haven’t Enrolled in Medicare
If your 65th birthday has come and gone, you still have several options and opportunities to receive your healthcare.
- If you’re within 3 months of your 65th birthday, you still qualify for enrollment under your initial enrollment period.
- Otherwise, you can wait until general enrollment (January 1 – March 3).
Medicare Changes Part B Deductible
Medicare changes came out in December. The Medicare changes Part B deductible was an increase. The Medicare Part B deductible for 2016 was $166. The 2017 Part B deductible is $183. While the $17 increase is small in dollar terms, it was a 10% increase. That’s big!
Part B Deductible
What is the Medicare Part B deductible? Medicare Part A and Part B have various deductibles and co-insurance costs that you pay. While Medicare covers the majority of medical cost, you have some significant responsibility, especially if there are frequent and/or high dollar medical need. Part B covers doctors visits and outpatient procedures, which is everything other than the hospital. Medicare will cover 80% of those costs. Your portion is 20%, but before the 20% starts, you have an annual deductible. The key to the Part B deductible is that it is an annual deductible. You pay the Part B deductible only once per year, which is different from the Part A hospital deductible.
Plan G Vs. Plan F
Medicare Supplement Plan G is becoming the most popular supplement plan available. Plan G covers all the Medicare Part A deductibles and Part B co-insurance EXCEPT the Medicare Part B deductible. You pay that directly to the provider after the Medicare discount. Once that is satisfied for the year, you pay nothing else out of pocket.
You may ask, ‘why don’t I do Plan F where the Part B deductible is also covered?’ If you were on a Plan F, your monthly premium would include the cost of the Part B premium and the increase. You also would pay a substantial fee to the insurance company for them to write the check for $183 for you. By being on Plan G as opposed to Plan F, you avoid the sizeable annual increase and the additional fee for paying the Part B deductible.
While the Medicare changes Part B deductible was not large in dollar terms, the reality is the cost of Medicare will continue to rise along with all medical costs. It is important to have an agent who can help you understand your plan and find the plan that best fits your needs at the lowest cost. Give us a call at 402-614-3389 for a free evaluation.
Medicare Changes Part A Deductible
Medicare changes for 2017 came out in December. One of the changes was for Medicare Part A. Part A is the hospital side of Medicare. It does not cost anything because you paid the Medicare Part A premium during your working years. It was part of your payroll taxes. The premium is zero if you have enough quarters of work and paid in to Medicare; however, Medicare Part A has a deductible. The deductible was $1,288 for 2016. The Part A deductible for 2017 is $1,316.
Remember the Medicare Part A deductible is for each event within a 60 day period. If you revisit the hospital 61 days later OR there is a different and separate event resulting in admittance to the hospital, you pay the $1,316 again.
Increases Passed On To You
The significance of the increased Part A deductible will be an increase in the cost of your Medicare Supplement. Most Medicare supplements cover the Part A deductible as many times as it may occur in a given year. Because the insurance company will now be on for more deductible, it will have to offset that expense and risk with higher premiums. Your premium may not increase significantly, but it does cost the insurance company more. Consequently it will ultimately cost you more.
Medicare Advantage Is Different
For those on Medicare Advantage plans, you are not directly effected. Your hospital co-pays, as well as the other co-pays, are determined by your individual plan. They are already set for 2017. Any increases may result in increases in hospital co-pays down the line because, like supplements, someone needs to pay for the additional expense. The actual co-pay is determined by your Medicare Advantage plan, and they are now set for 2017. Check the changes to your Medicare Advantage plan for 2017. You received your notification of changes in October. If you cannot find it, call the customer service phone number on the back of your card. They will send you a new statement of understanding with all the 2017 co-pays, deductibles, and co-insurance.
Consult with your agent or give us a call to see how any changes to Medicare may affect your situation.
Medicare Part B
Medicare changes almost every year. Medicare changes for 2017 are significant. The Medicare Part B monthly premium is the change that hits people first. For Medicare beneficiaries who were on Medicare before 2016, the increase will be from $104.90 to $109 per month. For those who began Medicare Part B in 2016, the premium will move from $121.80 to $134. There are some minor variations on these numbers out there. Eventually Medicare will catch everyone up to the same amount. I am getting a lot of calls as clients see the higher premium. For those with annual individual incomes above $85,000 and joint incomes above $170,000, the increases are much larger.
Part B Premium Increase
The reason for the increase is the rising cost of Medicare. Fewer persons are working in relationship to the number of new beneficiaries going on Medicare. The baby boomer population turns 65 at a rate of 10,000 per day in our country. The cost of health care also consistently grows at a rate well above inflation. The CPI (Consumer Price Index) is currently about 2%. It is safe to say that Medicare Part B premiums will continue to rise in coming years.
Protection Again Medicare Changes
Medicare Part B premium is just one of the costs that are going up. Other deductibles, co-insurance, and co-pays are increasing as well. More and more of the burden of health care is being placed upon consumers, so it makes it even more critical that you select the plan that best fits your needs and budget each and every year. It may make sense to take on some deductibles, co-pays, and/or co-insurance so that the monthly premium is not so burdensome, especially if your monthly income is limited. Medical emergencies do not occur regularly, but premiums do. You must pay them every month. One of the most common calls I get is ‘how do I reduce my monthly health care expenses?’
What is Medicare? A basic question. Or rather, why should anyone care about Medicare? The reason people should care is that most bankruptcies are medical bankruptcies. In other words, if you wish to protect your retirement nest egg from bill collectors, Medicare is important to know about. There are few things that are more disturbing than a pile of medical bills sitting on the kitchen table. The golden years could be tarnished with worrying about actual or potential medical expenses. Medicare–if implemented proper–will protect you from a potential catastrophe. It is critical for people entering into retirement to understand what is Medicare.
What is Medicare?
Medicare is a Federal health insurance program for people who are 65 and older (or on Social Security disability). It began in 1965 when President Johnson signed it into law. It was designed to provide medical covered to the elderly at a reasonable price. In 1965, few people had health coverage once they stopped working. As a result, many seniors fell into poverty because of burdensome medical expenses. Medicare was a solution to a national problem.
Medicare is divided into two parts: Medicare Part A and Medicare Part B. Medicare Part A has everything to do with the hospital. It doesn’t cost anything because you paid for it during your working years. It was one of the deductions in your payroll taxes. Medicare Part A covers a 100% of the medical expenses incurred in the hospital, but there is deductible that many people are not aware of. The Medicare Part A deductible is currently $1,288. This is NOT an annual deductible. It is a deductible per benefit period, and a benefit period is 60 days. So each event has a deductible, and the time for the event is 60 days. In other words, you could have multiple events and pay multiple deductibles because the event is not limited to just a 60 day period. Each new event, even if it overlaps with another event, has its own 60 day timeline. While rare, it could happen, and probably more importantly, you could pay the Part A $1,288 deductible more than once in any given year.
Medicare Part B, however, does cost something. For most people going on Medicare and Social Security in 2016, the Medicare Part B premium is $121.80 per month. It is generally taken out of your Social Security check. Medicare Part B covers doctors’ visits and outpatient procedures, such as X-rays, blood work, emergency room visits, etc. Medicare Part B covers 80% of the cost. Your portion is 20%. The 20% coinsurance, however, is unusual. There is no cap. There is no maximum out-of-pocket. Most group plans you were ever on probably had a maximum out-of-pocket. It may have been $1,000, $2,000, even $10,000, but at some point, you stopped paying and the insurance company covered everything. Medicare Part B does not have that, so 20% of a big number will be a big number. You keep paying your 20% coinsurance as long as the bills come in.
These are the basic building blocks to what is Medicare. You must understand Medicare, Medicare Part A, and Medicare Part B to understand the rest that follows. In the next blogs and videos, we will cover how to get Medicare, how to cover the Part A deductible, and how to fill the unlimited 20% gap in Part B coverage.
More Than Medicare Supplement Plans
I help people sign up for Medicare Part A and Medicare Part B. We go to Medicare.gov and run their medications. I check to make sure their doctors and hospitals are in network for the Medicare Advantage plans. I explain their Medicare eligibility and show All the Medicare supplement plans, Medicare Advantage Plans, and Medicare Part D Plans, but there is much more to being an independent insurance agent who offers Medicare insurance. It is about a long term relationship with my clients. It is more than Medicare supplement plans.
Losing a Medicare Client
I recently lost a couple of clients. They passed away suddenly. I happened to have spoken with one of them a few days before her passing. She had called about some photos she had seem on my personal Facebook page. It is painful when a client dies because I get connect with my clients, especially over time.
More Than Apply for Medicare
The recent loss also reminded me of the nature of my relationship with my Medicare clients. It is a relationship that is meant to last over time. It is more than helping them apply for Medicare. I tell my clients when I enroll them that this is a relationship until “Death do us part.” I will be checking in on them every six months to make sure their plan is working well. I check in especially during Open Enrollment Period when beneficiaries may make changes to their plans. I want to make sure that clients have the best possible plan that fits their needs at the best possible price because we know three things for certain. Medicare will change, the Medicare plans will change, and their needs will change. I want to be on top of those changes for them.
If you want someone who will take care of your Medicare needs over the years, give us a call 402-614-3389.
Delay Medicare Enrollment
Many people work past 65. They continue on with them employer group coverage. They delay Medicare enrollment. At 66+, they wonder what to do about Medicare.
How to Enroll after 65
Here is what to do. Go to Medicare.gov. Click on “Forms, Help, Resources” on the top right. Then click on “Medicare Forms” on the left middle. You will see the enrollment forms in the middle of the page in PDF form. There are two forms: one to enroll in Medicare Part B and a second for your employer to sign off on your coverage. You fill out the enrollment in Part B. Give the second form to your employer. Your employer will verify that you have had health coverage as good as Medicare since you turned 65. They will sign the form. It is important for you to write in the date that you wish your Medicare Part B to start. Give yourself enough time to find a Medicare plan and prescription drug plan. (There are much shorter and restrictive time limits when you have delayed Medicare Part B enrollment.) Drop the forms in the mail or hand deliver them to the local Social Security office.
Medicare Employer Enrollment Forms
Why do you want to involve your employer with your enrollment in Medicare Part B? If you do not have your employer verify that you had health coverage from the time you could have enrolled in Medicare until the time you did take Part B, Medicare will assume you did not have creditable coverage and will asset a penalty. The penalty is a 10% increase in Part B premium for every year you did not have coverage. That can be significant over time and completely unnecessary. Delay Medicare enrollment at your own risk. Get the form. Your employer is required to verify. The human resource department will know exactly what to do. It is a very simple matter.
At Omaha Insurance Solutions, we help clients who delay Medicare enrollment all the time. We can get this done quickly and easily. Give us a call 402-614-3389. We can email you the forms, walk you through filling them out, and explain what to do.