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Medicare 101

Medicare Updates for 2022

-Part B Premium in 2022 = $170.10 for most Americans

-Part B Deductible in 2022 = $233 annual deductible

-Part A Deductible in 2022 = $1,556 deductible per hospital admission

Enrollment Opportunities

Initial Election Period for Part C & D

When you first turn 65 (or become eligible for Medicare prior to age 65 through special circumstance) and have enrolled in Part A & B of Medicare, you will have a 7-month window to enroll in a Medicare Advantage Plan (Part C) or Prescription Drug Plan (Part D). This 7-month window is the 3 months prior to your Part A & B starting, the month they take effect, and the 3 months following that effective month.

Annual Enrollment Period (AEP) for Part C & D

Medicare Advantage and Prescription Drug plans can be purchased by all Medicare recipients between October 15th and December 7th each year. At this time, you can enroll into or change your Part D or Medicare Advantage plan and all those enrollments will take effect on January 1st.

Medicare Advantage and Prescription Drug Plans change from year to year, so it’s a good idea to check with us to see if there is a new plan that might save you money and/or get you additional benefits that you are entitled to!

What are the Open Enrollment periods?

AEP

The annual open enrollment period (AEP) is October 15th-December 7th and all plans will take effect January 1st.  Anyone can add switch, or drop a plan.  You are also allowed to enroll in as many plans as you want and each enrollment cancels the previous.

OEP

Think of this period as the “do-over” period.  If you don’t like the plan.   You may have many options to switch to another plan.  Coverage will begin the first day of the month following the month you make the change.  You are able to take advantage of this switch one time so it’s important you use this time wisely and get wise guidance.

Open Enrollment for Medigap

If someone would like to purchase a Medigap Plan (Medicare Supplement) instead of a Medicare Advantage Plan, they have a 6 month “Open Enrollment window” starting the day their Part B takes effect where they can do so without being subjected to medical underwriting by an insurance carrier. Medigap Plans can also be purchased at any time throughout the year, but they would be subject to underwriting if outside of the Open Enrollment.

Are there times I may be able to enroll outside the enrollment periods? 

Talk with someone about the following:

–If you have a qualifying chronic conditions

–If you have a low income subsidy or Medicaid

–If you’ve moved to a new zip code  

–changing to a plan with a 5 star rating

–change in extra help or Medicaid 

–leaving group coverage or retirement coverage

–If you have VA benefits

–if you move into or out of a Long-term care facility or skilled nursing facility.

Medicare Supplemental vs Medicare Advantage

Medicare Supplement Insurance Plans are also called Medigap Plans. These types of policies can help with the cost of your deductibles, copayments, coinsurance and excess charges depending on the coverage you choose, as there are several different Medigap options. Medicare Supplements are more “pay up front” with a higher monthly premium and very little cost as you use them. Medicare Supplements follow the coverage and freedoms of Medicare, meaning they work the same everywhere in the US and are not a network-based type of coverage.

Medicare Advantage Plans will minimize your overall risk, while keeping your monthly costs at a minimum due to being a network-based type of coverage. Medicare Advantage plans are more “pay as you go” with little to no monthly premium but have copays for most services and feature a cap on your maximum out-of-pocket expenses. Medicare Advantage plans also typically include additional benefits at no extra cost that are not included with traditional Medicare coverage (Part A & B). Those benefits can include dental, vision, hearing, transportation, over-the-counter allowance, free gym membership and even a Part B premium reimbursement.

What are the parts (A) and (B) referenced in Medicare?

Part A: HOSPITAL INSURANCE

• Inpatient care including skilled nursing facilities
• Hospice care

PART B: MEDICAL INSURANCE

• DOCTOR SERVICES (NOT ROUTINE PHYSICALS)
• OUTPATIENT SURGERIES
• DIAGNOSTIC TESTS
• ER VISITS
• AMBULATORY SERVICES
• DURABLE MEDICAL EQUIPMENT (like wheelchairs, walkers, hospital beds)
• OUTPATIENT MENTAL HEALTH
• OUTPAITENT PHYSICAL AND OCCUPATIONAL THERAPY 
• SPEECH/LANGUAGE THERAPY

FAQ with Medicare

I’m about to turn 65—WHAT DO I DO?

If you are currently collecting Social Security Income (SSI) congratulations you will be automatically enrolled in Original Medicare—parts A & B.

If not then you will need to actively sign up by the following:

• Calling the social security office
• Going to www.socialsecurity.gov and applying online
• Visiting your local social security office in person

How much will I pay for this coverage?

For most Americans there will be no monthly premium—If you’ve worked 40 quarters paying into medicare OR  you were married for 10 years to a spouse that worked and paid in during 40 quarters even if you are not currently married to them.

I received my medicare card is it important?

Yes!  Your medicare number is what allows someone to determine your current plan and enroll you into any additional plans.  Up until 2018 it was your social security number.  If you are looking at one with your social security number on it then that number has changed…you will want to find one that is a combination of letters and numbers.

I’ve got original Medicare A&B—does mean I don’t need to pay attention anymore?

Unfortunately while original medicare is cheap to have your out of pocket expenses are substantial.  Generally speaking you are covering 20% of costs.  More often than not, top carriers may offer plans that are low cost or no cost plan with more applicable benefits.

Why should I talk to a broker?

First and foremost the services of the broker are ABSOLUTELY FREE. Your broker will have access to dozens of top rated carriers to find that plan that suits you.  This can all be done over the phone in the convenience of your house.  There will be no need to spend hours filling out paperwork and everything you need to get started can be sent right to your doorstep.

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