MEDICARE

Medicare

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Medicare Costs 2023

What is Medicare and how can it help me?

Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those with disabilities and those who have permanent kidney failure. You may click here to view useful information about Medicare on the government’s Medicare website. Many Americans who choose to work beyond age 65 can continue to be covered by their Employer-sponsored group health insurance plans, or sign up for Medicare. Since Medicare Part A (Hospitalization Coverage) has no charge if a worker has paid enough into the system and has enough credits (40 quarters or 10 years) many people sign up for Part A when they turn age 65 if there is no charge and delay enrolling in Part B (Professional Charges and fees) until they retire or the employer coverage is no longer available. However, you must have Part B coverage (or the equivalent of Part B coverage) or you run the risk of paying a penalty when you do want to enroll in Part B. The same goes for Part D (Prescription Drug Coverage) you must sign up for Part D coverage when you become eligible (unless you maintain equivalent coverage) or you will be assessed a penalty when you do want to enroll in a Part D Prescription Drug plan.

What is the Medicare ‘Initial Enrollment Period’?

The Medicare ‘Initial Enrollment Period’ is a 7-month period that begins 3 months prior to your birthday month – your birthday month and continues for the 3 months following the month you turn age 65. If you do not enroll in Medicare Parts B & D during this time and do not have equivalent coverage in force you will face a penalty when you decide to enroll. In addition, you must wait for an ‘Open Enrollment Period’ and coverage will not be effective until a future date.

If you have Employer-sponsored group health coverage available to you and you will continue working beyond age 65 it is important to analyze the cost for you and your dependents between Medicare and the employer plan. As mentioned above there is no cost for Medicare Part A if you have 10 years of credits paid into the system. You may buy into Part A if you do not have enough credits paid into the system. The cost of Medicare Parts B & D varies and is now means tested, the regular cost of Part B in 2023 begins at $164.90 and increases based on your Modified Adjusted Gross Income. The cost for Part D is the plan premium you select up to certain income levels and then increases. Please click here to view the CMS Publication that lists the cost for Parts B & D for those with higher incomes.

Kelley Insurance will help you navigate your Employer-sponsored plan

We will review this information along with the information from your Employer-sponsored group plan (if applicable) with you in order to determine if staying in your group plan or enrolling in Medicare is best for you. If you elect to delay your Part B & D enrollment you must maintain equivalent coverage and when you later decide to enroll in Parts B & D you will have a ‘Special Enrollment Period‘ in which to enroll in Parts B & D. A Certificate of Coverage will be required from your prior plan in order to prove that you have had equivalent coverage so the penalties will not apply.

Will Medicare alone cover everything I need?

Original Medicare Parts A & B may not be enough coverage – along with a Part D Prescription Drug plan. Many people elect to purchase a Medicare Supplement plan in order to provide additional coverage for the gaps in Original Medicare. Here at Kelley Insurance & Financial, we specialize in working with you to select the best Medicare Supplement for your situation. We are independent brokers and provide a wide range of Medicare Supplement carriers and plans for your consideration.

How does being self-employed impact my Medicare status?

Many of the people that we work with who purchase Medicare Supplement and Part D Prescription Drug coverage are still working and self-employed. Self-Employed individuals may be able to deduct a portion or all the premiums they pay for tax purposes. Therefore we will work with you to be sure you are getting every possible deduction and paying premiums as efficiently as possible.

In addition, so that you do not have to spend your valuable time on hold waiting for a ‘Call Center’ representative after your enrollment – we provide you with professional customer service and support by assisting you with claims issues, billing, and administrative questions. Please contact our office today in order to get the information you need for you and your family to make the best decision for your health care.

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Medicare Providers

Medicare Supplements

Medicare Supplements, sometimes referred to as ‘Medi-Gap’ insurance policies, are designed to cover the gaps in Original Medicare (Medicare Part A and Part B). Medicare Supplements are offered by private insurance companies and are available in a wide range of plans. These plans have been Standardized by Center of Medicare Services (CMS), so that the plans offer the same benefits between insurance carriers. If you are comparing ‘Plan G’ with ABC company – then Plan G with the XYZ company has to offer the same benefits. This makes comparison shopping easier since the benefits are identical.

While original Medicare pays for a sizable portion of the healthcare services, you will need a Supplement to cover ‘out of pocket expenses’ you are exposed to, such as coinsurance, copays, etc., which can add up without supplemental coverage.

With a Medicare Supplement you can see any Provider that accepts Medicare, there are no separate or restricted networks such as a Medicare Advantage plan. Coverage is Nationwide as you travel, you would just need to see an In Network Provider. Please review the Medicare Provider link in Quick Links.

Am I Eligible for a Medigap Plan?

To be eligible, you must be enrolled in Original Medicare Parts A & B.

You will need to pay a premium for the Supplement policy. These policies cover individuals not couples, so both spouses must have a
policy. You must also be in one of the following categories:

Age 65 and older.
Under 65 and receiving disability benefits for 24 months.
Under 65 and diagnosed with amyotrophic lateral sclerosis (ALS).
Under 65 and diagnosed with end-stage renal disease (ESRD).

There is no underwriting or medical screening questions during your ‘Initial Enrollment Period’ or a ‘Special Enrollment Period’ into Medicare. You can switch or change Supplement policies after your
initial or special enrollment period ends, however there will be screening questions and underwriting to make the change. Therefore, you want to enroll in the best plan possible in case your health prevents
you from changing plans in the future.

If your Medicare Supplement company no longer offers coverage, you generally have a limited ‘Guaranteed Issue’ period, where you could purchase a policy with no medical screening or underwriting. If you are covered by a group health plan offered through your employer, you will need to decide if it is best to enroll in Medicare or continue the Employer plan. Sometimes a spouse or other dependents are also covered under the employer plan that are not Medicare eligible. We assist people making these decisions every day.

Kelley Insurance & Financial will work with you to determine your best options and course to follow. Please contact us today to easily navigate the Medicare system and enroll in the plan of your choice.

Part D Prescription Drug Plans

Medicare has many parts that make up the full package. For instance, Part A covers Hospitalization, Part B covers Providers Professional Services – these parts are referred to as ‘Original Medicare’. Neither Part A nor B cover Prescription Drugs. Prescription drugs are covered under ‘Part D’. Part D Drug Plans are offered through insurance companies on a ‘Stand Alone’ basis or can also be included in a Medicare Advantage (Part C) plan.

You need to enroll in a Part D Prescription Drug plan during your Initial Enrollment Period, or a Special Enrollment Period if you have one. Failure to enroll in a plan on a timely basis could result in penalties being assessed when you do want to enroll in a Medicare Part D Drug plan.

It is also important to shop this coverage during the Annual Election Period (AEP), which runs from October 15th through December 7th each year. This is the time when you can make changes to your Part D Drug coverage, changes will be effective January 1st of the following year. Even if your medications have not changed, it is important to review plans and coverage available to you because the plans, drug formulary, drug tiers, etc. can change from year to year.

Am I Eligible for Part D Drug Plan?

To be eligible for Part D coverage, you must be enrolled in Original Medicare Parts A & B. You will need to pay a premium for ‘Stand Alone’ Part D coverage. In addition, depending on your income, there could be an IRMAA adjustment charged by CMS on top of the drug plan premium charged by the insurance company. Part D Drug plans cover individuals not couples, so both spouses must have their own plan.

If you have Prescription Drug coverage offered through your employer, you will need to decide if it is best to enroll in Medicare or continue the Employer plan. Sometimes a spouse or other dependents are also covered under the employer plan that are not Medicare eligible.

We assist people making these decisions every day. Kelley Insurance & Financial will work with you to determine your best options and course to follow. Please contact us today to easily navigate the Medicare system and enroll in the plan of your choice.