Turning 65?
Tired of Rate Increases?
Thinking About Retirement?
We think about these things all day. Reach out for help.
Overcoming the Medicare Noise
Whether it is Joe Namath scaring you on television commercials, a telemarketer blowing up your phone, or daily mail littering your countertop, Americans 64 and older are inundated with messages about Medicare.
We are honored to be a trusted voice to help you with your Medicare choices.
One way that helps us understand Medicare is breaking it into two pieces: Uncle Sam’s piece and the private marketplace’s piece.
U.S. Government: Original Medicare
Policy makers in 1965 could not have imagined the complexity of modern medicine when creating Original Medicare. It all started with two simple parts: Part A hospital insurance and Part B physician insurance.
Part B
Most medical services we use throughout life happen outside of an inpatient hospital stay. That’s Part B. Today this coverage includes physician visits, outpatient services, preventive services, and some home health visits. Lab work, physical therapy, and ambulance trips are also examples.
Part B comes with a monthly premium based on household income ($164.90 for a majority of seniors in 2023). Part B is an 80/20 – and the 20% you’re responsible for has no max-out-of-pocket.
Part A
Once you are admitted to the hospital and given inpatient status, your care will be filed under Part A – hospital insurance. Today Part A also includes coverage for skilled nursing facilities, some home health care scenarios, and hospice care.
Part A insurance is free if you’ve worked 10 or more years in the U.S. economy, but it does have a $1600 deductible for each stay in the hospital.
Signed into law by Lyndon Johnson, Original Medicare was an enormous gift and relief to the seniors of 1965, but in the light of modern medicine, we recognize the significant gaps it left. Between the Part A deductible, Part B’s no-cap 20% , and prescription drug coverage completely missing, many gaps have had to be filled over the years. This job was given to private the insurance marketplace with significant government oversight.
Private Marketplace
This is where we’ll help you navigate your options.
Medicare Advantage
Medicare administered thru Insurance Companies
Medicare Advantage
Medicare Advantage (Part C) plans are provided by Private insurance companies. These plans replace the coverage provided by Original Medicare (Part A & B) with many additional benefits. Advantage plans are highly regulated to be actuarially equivalent to Original Medicare, but there are tradeoffs. With Original Medicare, you have total control of your healthcare and total freedom to go to almost all doctors or hospitals in the U.S., but you also have a Part A deductible and Part B 20% coinsurance (that has no ceiling). With Medicare Advantage, these are replaced with small copays and you have a maximum out of pocket to serve as a stop gap.
Medicare Advantage include a regional network of providers (e.g. HMO or PPO plans). Depending on where you live, many plans include additional benefits not part of Original Medicare.
Medicare Supplements
Original Medicare: primary
Private insurance (Medigap): secondary
Medicare Supplements
Medicare supplements, also called Medigap insurance, are for those that want to keep the freedom and control of Original Medicare, but without the financial exposure. These supplements fill in the the financial gaps left with Original Medicare. There are 10 Medigap plans, each with different outlines of coverage. They are designated as Plans A, B, C, D, F, G, K, L, M, N. The vast majority of people in 2023 utilize Plan G or N.
While these plans do not provide for prescription drugs, they do provide unmatched coverage for all other major medical services.
Important note to remember: The coverage provided by each letter plan is determined by the government, not the insurance carriers. A Plan G or Plan N will offer the exact same coverage – whether on Aetna, Humana, or Mutual of Omaha – by law.
Part D
Drug Plans
Medicare drug coverage administered through Insurance Companies
Part D Prescription Drugs
Part D plans are federally funded prescription drug plans administered through private insurance companies. Medicare beneficiaries may supplement Original Medicare by enrolling in a stand-alone Part D plan, or they may get Part D coverage as part of a Medicare Advantage plan.
Part D plans are famous for having a “donut hole”, a coverage gap between their initial coverage max and their catastrophic coverage.
These plans are specific to networks of doctors and pharmacies. It is important to shop the plans with your list of medications and preferred pharmacy to make sure you have the coverage for your scenario.
Reach out and let us walk you through making the best decision for your prescription drug coverage.