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Medicare Basics 2021

 

Part A:  This covers hospitalization. After the $1,632 deductible is paid, Part A covers all of the in-patient expenses for the first 60 days.  Supplemental insurance is needed to pay the deductible any copays. After 60 days,  A new Part A benefit period starts. If you are out of the hospital or skilled nursing facility for over 60 days = A new deductible!

 

Part B:  This covers 80% of doctors and specialists after a yearly deductible of $240.   If you are taking Social Security, you automatically receive a Medicare card with Part A and B on it a couple of months prior to turning 65.  If you are not taking Social Security, but do want to enroll in Medicare, you have to contact Social Security and tell them you want to enroll in Part B.  This will likely cost you (in 2024) $174.70/month.  There are 3 different enrollment periods available to you.  They will bill you quarterly.  Once you start taking Social Security the Part B premium will automatically be deducted from your monthly Social Security deposit.

 

Part C:  Medicare Advantage Plans –  These plans combine your Part A and B benefits, and also include drug coverage (Part D), along with vision and Dental.  They are low to no cost premiums. These plans are come with copays, deductibles, and out of pocket costs leaving you to pick up the 20% Medicare does not. Along with having to follow the provider networks.  If you sign up for these plans, you will give up your  Original Medicare benefits, moving you to private insurance. They will bill Medicare, and then what is left is your responsibility.  The plans are very inexpensive and can combine many benefits together for an all in one plan.  Along with low deductibles they can leave you with max out of pockets up to $9,000. These plans can only be changed at the end of the year during open enrollment. 

 

Part D:  Prescription Drug Plans – You must have credible drug coverage after you enroll in Medicare.  If you do not, you will face a penalty for late enrollment. This will be added to your cost after you sign up and will remain for life.   There are 31 drug plans in Illinois, and Wisconsin.  – They are very different and can change dramatically.  *That is why I help each of my clients with the plan each year.  If a client of mine is on no medications, or only those of a generic variety, I put them on Silverscript or a Wellcare  plan which is around $0- 14 per month.  These are the least expensive Part D programs.  The intent is to save you money.  This can get confusing, but I am well versed in how to use it.

 

Finally, the area of Medicare Supplements.  Medicare is good insurance, but it is an 80/20 system with no cap.   Supplements are intended to cover what Medicare does not. 

  

There are also several varieties of Supplements:

  

• Plan G- $240 Part B yearly deductible, then no copays or additional deductibles.

• High Deductible Plan G– Lowest priced.  The deductible is regulated by the government.  This high deductible plan has a deductible that hovers around $2,800/year.  Coverage is 100% after the deductible. Some companies have different variations of this plan.

• Plan F- no deductible, no copays. (Only available to those born 1954 or before due to Medicare limitations)

 

What to look for in a Supplement:

 

• Preventive Care – Most companies won’t even mention Preventative Care.  Ask your agent about this very important part of the plan.

• Ability to use ANY doctor or hospital in the US

• Rate increase history – Be careful of companies with low introductory prices.  They rise dramatically, especially at age 70.

• An agent that is available when needed (We are).

• An agent that will help with your Part D plan each year.

• Financial Rating of Company. Look for a company that has an A+ rating with AM Best. 

When are you “Guaranteed Issue”? – At age 65, or when you leave a group plan or if a Medicare Advantage plan is terminated.