There are a lot of acronyms in Medicare, and even more in insurance. We know, it can get very confusing when you are not hip to the “Medicare/ insurance world” lingo. As a result, one of the most repeated acronym questions we hear is: What is MAPD?
Medicare MAPD plans are private insurance plans offered by Insurance Carriers to replace Original Medicare. Also called Medicare Part C, they offer a single payer option to beneficiaries. In addition, they offer extra benefits to members above and beyond what is covered in Medicare Part A and Part B. Finally, they also include a Part D drug plan.
If the plan does not offer drug coverage, then it is just called a MA (Medicare Advantage) Plan. As mentioned, these plans are also called Medicare Part C, and insurance companies offer Medicare MAPD plans with extra benefits to take the place of Original Medicare.
What Do Medicare Advantage Plans Cover?
Medicare Advantage Plans are regulated by the CMS (Centers for Medicare and Medicaid Services). This agency makes sure that every plan offers at least the same standards of care and coverage that Original Medicare offers. Most plans offer additional benefits, not covered by Original Medicare, such as vision, dental, hearing and even gym memberships such through organizations like SilverSneakers or Renew Active.
Medicare Advantage Plans are often set up as managed care plans with networks of doctors and hospitals members have access to. To learn more about how these networks work, please read, HMO vs PPO – Which is Better?
Costs of MAPD
Medicare Advantage Plans often come with lower premium costs than Supplement Plans. Some of them even offer “zero premium” options. They are not technically “free” because everyone still has to pay their Medicare Part B Premiums directly to the government each month.
However, they are low cost options because the government is paying the insurance company to take beneficiaries onto their books and off the government books. Essentially, the Medicare Advantage Insurance companies are replacing beneficiaries Original Medicare with their Part C plan and becoming a single-payer.
Just like Medicare Advantage (Part C), PDP plans are not administered by the U.S. government, but instead by private insurance companies. Just like MAPD Insurance plans, you can shop to find the best PDP plan for your needs each year.
And also, just like Medicare Advantage Insurance plans, you do not have to go through medical underwriting to be accepted into a Part D plan.
Differences Between Medicare Advantage and Part D Plans
First, if you have Original Medicare, you will need a PDP plan in addition to Parts A & B to cover your prescription drugs needs. They are not included.
Additionally, beneficiaries on Original Medicare + a PDP Part D Drug Plan often also have a Medigap Plan (Supplement) to cover the 20% of costs, co-pays and co-insurances that Medicare does not cover.
MAPD Healthcare Insurance Plans, on the other hand, include all three of these options in one (Parts A + B + D).
As a result, you will not need a standalone PDP plan or a Medigap Plan in addition. All you need is your MAPD Plan (aka Medicare C).
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Carly Cummings is a licensed insurance agent and former financial adviser. Carly is the Creator of MedicareLifeHealth.com where she helps her readers (of all ages) find the best health care and create the best cash flow in retirement. Carly has worked in finance and insurance for a Fortune 500 company as well as for a Berkshire Hathaway company. Before finance, she was an entrepreneur that owned a wellness licensing company and two yoga studios.
With so many rules, regulations, exceptions and unique situations, Medicare enrollment can get confusing. We are here to make it simple and easy. Here is how to apply for Medicare.
How to enroll in all part of Medicare – including:
Let’s get right to it! If you are ready to enroll in Medicare, there are three ways to do it: in person, online, or by phone. Alternatively, if you are already on Social Security before you turn 65, your enrollment will be automatic.
(Read our FAQ’s below if you still need to determine if you are ready to enroll, or to see if you enrollment is automatic.)
Automatic Enrollment into Medicare
If you are already taking your Social Security benefits before you turn 65, then your enrollment into Medicare will be automatically started.
“If you already get benefits from Social Security, you’ll get Medicare Part A and Part B automatically when you’re first eligible and don’t need to sign up. Medicare will send you a “Welcome to Medicare” packet 3 months before you turn 65. You’ll still have other important deadlines and actions to take, so read all of the materials in the packet. (If you live in Puerto Rico, you’ll only get Part A. If you want Part B, you need to sign up for it.)”
If for some reason you do not get automatically enrolled, and you think you should have, please call or visit the nearest Social Security office.
Medicare Enrollment Preparation
Before you head over to apply in person, online or by phone, you might want to gather the necessary documents needed to apply.
The SSA has created a helpful checklist of what you will need to apply for Medicare. You can find it here.
How to Apply for Medicare in Person
For those that are not automatically enrolled (still working or not taking social security yet on your 65th birthday) you will need to enroll yourself. Your first option is to do this in person.
While appointment wait times in the SSA lobby can make this a longer application process, it is often the fastest way to get your benefits started. For example, I will have clients that walk into the SSA office needing their Part B instated, and leave the office that same day with their benefits active. If you are in a time crunch (i.e. sudden retirement via layoff!) this is the fastest way to get your benefits in place.
In addition, if you run into any problems or concerns with your enrollment process, visiting Social Security in person might also be the fastest way to resolve any issues.
The Social Security Administration (SSA) has partnered with CMS (The Centers for Medicare and Medicaid Services) to offer you an online enrollment option. It is a fast process (about ten minutes) and is safe and secure.
If you are retiring and need both Social Security Benefits and Medicare, you can complete one application for both here.
____________________
According to the Social Security Administration, when you apply for benefits online, you will get a receipt. Moreover, you will have the ability to check the status of your application with the confirmation number on your receipt. This is a big benefit to applying online, but if you prefer, you have one more enrollment option: phone.
How to Apply for Medicare by Phone
Finally, you can apply for Medicare by phone. However, this is the slowest option, as you will likely have to use “snail mail,” the U.S. postal system that is, to receive and send paperwork.
If you decide to enroll by phone, just understand that it will take a while. Confirm with the SSA representative you are talking with that you will have enough time to complete enrollment this way. It is important to have your benefits in place in time for when you need them so you are not without coverage.
To apply for Medicare by phone, call 1-800-772-1213. (TTY 1-800-325-0778) from 7 AM to 7 PM Monday through Friday. (Source: SSA website.)
Enrollment in Medicare Part D
Next, you may be wondering, how do I enroll in Medicare Part D – Prescription Drug Coverage?
Part D is actually run by Private Insurance Companies, not the CMS (Center for Medicare and Medicaid Services). For this reason, you will need to enroll in a Prescription Drug Plan (Part D) separately from your enrollment in Original Medicare Parts A and/or B.
You can only enroll in a Part D plan if: – You are in your Initial Enrollment Period (IEP) – Have a Special Enrollment Period (SEP) – Or are in the Annual Enrollment Period (AEP) – Oct. 15 – Dec 7
How to Apply for Medicare Part D
To enroll in a Part D, Drug Plan, we highly suggest working with an agency, either online, by phone or in person, instead of just doing this on your own.
The main reasons we suggest using an agent, is…
First, if you ever have a problem with your policy, you can call your agent for support and they can talk to the carriers with you and for you.
Second, the Part D drug plans change often, and your agent will have the ability to stay on top of changes and premium rates. They can make sure you always have the best coverage and costs for your unique situation.
Finally, like we saw in 2019, there are sometimes issues with policy comparison technologies. An independent agent can help you compare plan information correctly.
How to Apply for Medicare Advantage & Medigap Plans
After you enroll in Original Medicare, you will need to decide if you want:
Original Medicare + A Supplement + Part D Drug Plan
Or a Part C Medicare Advantage Plan (includes Parts A, B, & D)
There are benefits to going both routes, and you will need to decide which plan fits your needs the best. We do advise seeking the help of a licensed, independent insurance agent to help you in your decision making process. Moreover, your agent can then help you to enroll in your plan and be your support into the future.
In the meantime, here are some articles to help you decide which Medicare Plan is best for you:
The Initial Enrollment Period (IEP): You will have a seven month window to apply for Medicare if you are not already on Social Security or Railroad Retirement Benefits. (Remember, if you are on Social Security/Railroad Benefits, you will be automatically enrolled.)
Your Seven Month Enrollment Window:
Starts 3 Months Before Your 65th Birthday Month
Continues Through Your Birthday Month
And Then Lasts Until 3 Months After Your Birthday Month
During this time, you will need to apply for Parts A & B from the SSA or RRB (Social Security Administration or Railroad Retirement Board) and then decide if you want a stand alone Part D with a Supplement, or a Medicare Advantage Plan.
How to Apply for Medicare Without Claiming Social Security?
You have access to Medicare at age 65, whether or not you decide to claim your social security benefits. You can do this in person, by phone, or online here.
To avoid these penalties, make sure you apply for Medicare during your Initial Enrollment Period (IEP) if you are not automatically enrolled through SS or RRB benefits.
What if you have health care with your employer at 65?
Make sure your employer’s insurance is considered “credible coverage.” Then, if it is you will let the government know you will be delaying your use of Medicare Part B until that coverage ends. (Part A does not cost you anything in most cases, so starting Part A when you are eligible is always a good practice, even with employer coverage. In this case, you would not have a penalty when you eventually begin Part B.
Dual Eligible? How to Apply for Medicare & Medicaid
People who meed the low income levels set by CMS may be eligible for both Medicare and Medicaid. If you are eligible for both programs, you have special plans that help to coordinate your care and make things easier to manage. Please contact an independent insurance agent to see what plans are available to you in your area.
How Long Does it Take to Get Medicare?
It depends on when and how you enroll. Sometimes, you can have your Medicare Benefits start the same day you apply, if you do so in person and are already eligible.
How long does it take to get a medicare card?
If you are wondering, where is my medicare card? It is probably on its way. If you need to apply for Part D or supplemental coverage while you are waiting for it, you can have your independent agent call CMS with you to confirm your eligibility while filling out an application.
If you are being automatically enrolled in Medicare, you will receive a card in the mail typically at least a month before your birthday.
Carly Cummings is a licensed insurance agent and former financial adviser. Carly is the Creator of MedicareLifeHealth.com where she helps her readers (of all ages) find the best health care and create the best cash flow in retirement. Carly has worked in finance and insurance for a Fortune 500 company as well as for a Berkshire Hathaway company. Before finance, she was an entrepreneur that owned a wellness licensing company and two yoga studios.
The Medicare and Medicaid Difference Guide helps you understanding both services, so you can make the best decisions for yourself and your loved ones.
The United States has two separate national health care systems: Medicare and Medicaid. The government created the two programs for two different kinds of people. However, they often overlap. Let’s look at both programs, including their similarities and difference. We will also look at who needs or qualifies for each program.
Let’s Start with Medicare vs Medicaid.
What is Medicare?
Medicare is the U.S. national health care program that provides seniors age 65 and older, and some disabled people, with health insurance.
The U.S. government started the program in 1966. The Centers for Medicare and Medicaid Services runs these programs. Medicare also covers people with end stage renal disease and amyotrophic lateral sclerosis.
The programs are both National Health Care Systems. In fact, they are the only two nationalized heath care systems the United States has. Many other countries around the world have much more extensive national coverage for their citizens. The U.S. has a limited program for specific age, income, and health groups, and the rest of the country relies on private health insurance.
In addition, both programs cover specific hospital services, doctor services, and other health care related services.
Medicare has four parts. First, Medicare Part A, also known as “Hospital Insurance,” helps with coverage regarding: inpatient care, home health care, nursing facilities, and hospice.
Second, there is Medicare Part B, also known as “Medical Insurance.” Part B helps with coverage related to doctor and other provider services, including: doctors visits, health care providers, outpatient, prevention services, and medical equipment. Medicare Beneficiaries pay for Part B.
Both Medicaid and Medicare Advantage Plans can be set up as managed care plans with networks of doctors and hospitals members have access to. If you would like to learn more about how these networks work, please read, HMO vs PPO – Which is Better?
How are the programs different?
One of the biggest differences between the two programs is who runs them. Medicare is run on a national level, by the Federal government. On the other hand, Medicaid is run by each state individually.
Of course, the biggest difference is the the different populations the programs serve:
Medicare – For Seniors over age 65, and some disabled people
Medicaid – For people with low income and few resources
Medicare and Medicaid Differences in Beneficiaries – Who Gets What Program?
The U.S. government created Medicare and Medicaid to take care of different “vulnerable” populations – the poor, the disabled, and the elderly. Let’s look at each program and population.
Who should get Medicare?
Anyone who is a citizen or qualified resident of the U.S. can enroll in Medicare when they turn 65 years old. There is a seven month window of time starting three months before turning 65, the month of your birthday, and then three months after your birthday month.
How do I Sign-up for Medicare?
First, you may be automatically signed-up if you are already receiving Social Security (SS) or Railroad Retirement (RRB).
Second, if you are not already receiving SS or RRB benefits, you must sign up for it when you turn 65 years old.
Conversely, if you are not ready for Medicare when you turn 65, you must notify the government that you want to delay your benefits. If you do delay, it must be because you have credible coverage in place. An example of this would be an employer plan.
Medicare picks up about 80% of the health care costs for its beneficiaries. For the other 20%, seniors turn to either Medicare Supplements (aka Medigap Plans) or Medicare Advantage Plans. Click here to read our article on Medicare Advantage vs. Medigap, or see the informational articles below.
Who should get Medicaid?
Medicaid is for people with limited income and resources. Medicaid is run on a state level, not on a federal level. As a result, in order to qualify for Medicaid, you will need to determine what your state defines as a qualifying income level.
How Do You Enroll in Medicaid?
Again, since Medicaid is run by State Governments, you will need to contact your state’s agency to start see if you qualify to enroll.
People of any age who have certain qualified disabilities and people over 65, who are also below their states Medicaid income levels, can qualify for both Medicare and Medicaid.
For example, Henry is a 55 year-old disabled man who is also unemployed and living below the poverty level set by his state. Consequently, he would most likely qualify for both Medicaid (because of his income level) and Medicare (because of his qualified disability).
People that qualify for both programs are called “Dual Eligible.”
Who Can Help?
Navigating one (let alone both) of these systems can be confusing. But there is help available.
Finally, if you need help finding a Medicare Supplement or Medicare Insurance Plan, or if you are dual eligible for both Medicare and Medicaid, then please contact an Insurance Agent. An Independent Medicare Insurance Agent will help you explore your options, and help you make the right choice for your unique situation.
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Carly Cummings is a licensed insurance agent and former financial adviser. Carly is the Creator of MedicareLifeHealth.com where she helps her readers (of all ages) find the best health care and create the best cash flow in retirement. Carly has worked in finance and insurance for a Fortune 500 company as well as for a Berkshire Hathaway company. Before finance, she was an entrepreneur that owned a wellness licensing company and two yoga studios.
One gentleman came up to me and said, “The Pharmacist sent me over to you to ask you: Why did my drugs cost more this month? I get the same drugs each month, but this month, they cost me more!”
Yes sir, you have reached the Medicare Donut Hole in your Part D Prescription Drug Coverage. It was November, and this gentleman had been able to make it his other five years on Medicare without reaching the coverage gap.
However, this year, his drug costs were a little higher, and he hit the gap before the end of the year.
Will I hit the Coverage Gap?
The price changes in the coverage gap can be a shock if you have not experienced it before. So, let’s go over a little more information to prepare you for what might come.
When Does the Donut Hole Begin?
In 2020, the Part D Coverage Gap begins when you and your plan have spent $4,020 on prescription drugs. (In 2019, it was $3,820.) Thus, if you only spend $1,000 a year on drugs, the donut hole will not affect you.
Who Does the Coverage Gap Not Apply to?
People who pay less than $4,020 in drugs each year.
In addition, people who get extra help in paying for their drug plans (for example, low income subsidies and Medicaid beneficiaies) will not enter into the coverage gap.
When Does the Donut Hole End?
In addition, you may be wondering, when does medicare donut hole end? It ends once you and your drug plan have spent $6,350 in 2020 ($5,100 in 2019). You are then out of the coverage gap and have entered into Catastrophic Coverage.
During Catastrophic Coverage you will pay a much smaller amount of money for your drugs. This includes smaller co-insurances and smaller co-payments for the rest of the calendar year.
What am I Paying in the Coverage Gap (Medicare Doughnut Hole)?
As of 2020, Medicare will pay for 75% of BOTH brand name and generic drugs in the coverage gap. As a result, you will pay 25% of the cost of your drugs in the coverage gap.
However, there is a generic to brand name drug difference in what counts towards your out-of-pocket costs to get your out of the donut hole:
For generics, only your copayment counts towards getting you out of the coverage gap.
Conversely, with brand name drugs, 95% of the total price of the drug (your co-payment and what your plan pays) counts towards your out-of-pocket costs to help you reach the end of the gap.
There are some Medicare drug plans that includes coverage in the gap. According to CMS, ” you may get a discount after your plan’s coverage has been applied to the drug’s price. The discount for brand-name drugs will apply to the remaining amount that you owe.” You will need to speak to your plan to learn more.
What Costs Counts Towards the Coverage Gap?
Here are the costs that apply to your out-of-pocket expenses:
First, Your Annual Drug Plan Deductible
Second, Your Co-insurance and Co-Payments
Third, Your Discount on Brand-name Drugs in the Donut Hole Coverage Gap
Carly Cummings is a licensed insurance agent and former financial adviser. Carly is the Creator of MedicareLifeHealth.com where she helps her readers (of all ages) find the best health care and create the best cash flow in retirement. Carly has worked in finance and insurance for a Fortune 500 company as well as for a Berkshire Hathaway company. Before finance, she was an entrepreneur that owned a wellness licensing company and two yoga studios.
Medicare Open Enrollment runs from October 15th to December 7th. These are the same dates every year.
What is Medicare Open Enrollment?
Also called AEP – Annual Enrollment Period is the time of year Medicare Beneficiaries can make changes to their Medicare Advantage Plans and Prescription Drug Plans.
Information for new plans starts to become available each year on or around October 1st, but changes can not be made until AEP actually starts on October 15th.
What Changes Can you Make During the Annual Enrollment Period?
If you are in Original Medicare, you can join a Medicare Advantage Plan during this time.
You can also join or switch Part D Prescription Drug Plans.
In addition, if you have a Medicare Advantage Plan, you can switch to another plan.
Finally, you can drop a Medicare Advantage plan to return to Original Medicare during this time.
Are Medicare Supplements Affected by Medicare Open Enrollment?
This enrollment period does not apply to Medicare Supplements (Medigap) Plans. You are free to change these plans when you please. However, if you are outside of a Special Enrollment Period (SEP) then you will need to go through medical underwriting to get into a new Medigap Plan. Medical Underwriting usually entails answering basic health questions by phone or in person with an agent.
What is the January – March Open Enrollment Period?
Sometimes also called Open Enrollment, the government created a new time period that runs from January 1st to March 31st each year where you can make limited changes. According to the Medicare and You Book,
If you’re in a Medicare Advantage Plan, you can make a change to a different Medicare Advantage Plan or switch back to Original Medicare (and join a stand-alone Medicare Prescription Drug Plan) once during this time. Any changes you make will be effective the first of the month after the plan gets your request.
The important thing to note here, is that you can only make ONE change during this time. Lawmakers created this time period to give you the opportunity to fix any problems you may have found in your current plan or any new plan you may have adopted.
Carly Cummings is a licensed insurance agent and former financial adviser. Carly is the Creator of MedicareLifeHealth.com where she helps her readers (of all ages) find the best health care and create the best cash flow in retirement. Carly has worked in finance and insurance for a Fortune 500 company as well as for a Berkshire Hathaway company. Before finance, she was an entrepreneur that owned a wellness licensing company and two yoga studios.
Here is what you need to know about Railroad Medicare Benefits to be successful in your retirement planning.
Introduction to Railroad Medicare
So, you are retiring from the Railroad? Congratulations! Mostly, your options for Medicare planning will be the same as everyone else’s. Our articles on Medicare Basics, Medicare Supplements and Medicare Advantage will all apply to you.
However, there are just a few differences between Social Security and the Railroad when it comes to Medicare. Let’s look at what these similarities and differences are.
What is the Same
Signing-up
Already Retired: Signing-up for Medicare is the same on SS or RRB. If you are already receiving benefits from Social Security or the Railroad you will be automatically enrolled in Medicare Part A and Part B. You can then decline Part B if you want to. (Read about declining Part B here.)
Not Yet Retired or Not Receiving Benefits: For those of you that are not already retired and/or not yet receiving benefits, you will need to notify the local Railroad Board (RRB) office before you turn 65 that you would like to sign-up for Medicare. You can sign-up up to 3 months before you turn 65, and even if you are not planning on retiring at 65.
Your Medicare Path Choices
Just like Social Security Medicare, you will have two options for setting up your Medicare:
Original Medicare: You have the option of choosing to keep Original Medicare and then enrolling in a stand-alone Part D Drug Plan. In addition, you can then add a Medicare Supplement (Medigap) plan to pick up the costs Original Medicare does not cover. You can read more about Original Medicare here.
Medicare Advantage: You also have the option of moving to a “bundled” Medicare Advantage plan. These plans are run by private insurance companies and bundle together Parts A, B & D all into one plan with one point of contact. They are also called Medicare Part C. You can read more about Medicare Advantage here.
The major difference in Medicare for Railroad Board vs Social Security, is how the Part B claims are handled. Unless you are enrolled in a Medicare Advantage Plan (where the private insurance company you use handles all of your Medicare claims), you will deal with a different claims handling entity than those enrolled in SS Medicare.
The Railroad Medicare program uses an outside company for medical insurance claims that fall under Part B services. (Read more about the different parts of Medicare and what they cover here.) This company Palmetto GBA. They are a subsidiary of Blue Cross and Blue Shield. You will need to submit claims directly to them if you are under Original Medicare through the RRB.
How to Contact Palmetto GBA for RRB Original Medicare Beneficaries
If you need to submit a claim for a Part B service or ask a question, you can contact Palmetto GBA here:
Palmetto GBA Railroad Medicare Part B Office P.O. Box 10066 Augusta, GA 30999-0001
Toll Free: 1-800-833-4455 TTY/TDD: 1-877-566-3572 Website: www.palmettogba.com/medicare According to the RRB website, you will click on “RRB Specialty MAC Beneficiaries” on the website above
Carly Cummings is a licensed insurance agent and former financial adviser. Carly is the Creator of MedicareLifeHealth.com where she helps her readers (of all ages) find the best health care and create the best cash flow in retirement. Carly has worked in finance and insurance for a Fortune 500 company as well as for a Berkshire Hathaway company. Before finance, she was an entrepreneur that owned a wellness licensing company and two yoga studios.
Medicare and You 2020 & 2021 Guidebook – Read This First
Your Introduction to the Medicare and You 2020 & 2021 Book, and where to get a copy.
The Medicare and You 2021 Guidebook details what you need to know about Medicare benefits for the current year. In it you will find the basics of Medicare, how to get it, and what changes the program is implementing in the calendar year.
However, it is 120 pages long and very detailed. It is also very dry and technical.
So, if you are trying to learn more about Medicare – without falling asleep in the process – we have on-topic website article suggestions for you here that follow the elements of the Medicare and You 2020 Guide.
Where to find the guide
If you would like to follow along with the Guide itself, you can find it online here: Medicare & You Handbook 2021
Related Article: For an illustrated overview of the four parts of Medicare, visit our medicare parts infographic and article “Medicare Parts A B C D.”
What are my Medicare options?
Intro Section on Original vs Medicare Advantage (pages 6-8)
Many online comparisons are between Medicare Supplements and Medicare Advantage plans as those are the additions that are in your hands to choose.
However, all these comparisons are in their simplest form between having Original Medicare vs Medicare Advantage. This section does a side-by-side comparison of the two (with or without a supplement).
Related Article: For a more in-depth discussion to help you decide what Medicare options are right for you, please read the “Medicare Advantage vs Medicare Supplements” article here.
How do I get Medicare?
“Section 1: Signing up for Medicare” (pages 15-24)
People get Medicare in different ways. Some are signed-up for it automatically if you are already receiving Social Security or Railroad Retirement. Some people must sign up for it when they turn 65 (or delay it if they are not ready at 65).
This section gives you people to call (Social Security at 1-800-772-1213) and places to visit (online at ssa.gov/benefits/medicare) if you need to sign yourself up.
Other topics covered include, when to sign-up, what to
sign-up for, and what does each part cost?
Hey, Medicare and You 2021, Will Medicare Cover My…?
“Section 2: Find out if Medicare covers your test, service or item” (pages 25-50)
This section lists all Medicare Benefits you will receive if you are signed-up for both Medicare Parts A and B. These benefits are universal, meaning they are the standards of care you will receive whether you are receiving Medicare from the federal government or through a private carrier with a Medicare Advantage Plan.
If you are looking to see if a specific benefit is included in Medicare, this is the section to search for it.
2020 New Offering Alert: One interesting change noted in the Medicare and You 2020 book is that many Medicare Advantage programs are now offering “telehealth” benefits where you can see a provider at home instead of at their facility. The guidebook notes that this is typically beyond what Original Medicare can offer.
Related Article: To see the basics of what Medicare Covers, please see our article “Medicare Parts A B C D.”
What exactly is Original Medicare?
“Section 3: Original Medicare” (pages 51-54)
The Original Medicare section explains how our Federal Health Insurance for Seniors works. If you have Original Medicare, with or without a supplement, you are a beneficiary of a nationalized health care system and the government is the primary payer of your health benefits.
Read this section to learn how that works and how to use your benefits once you are on Medicare.
“Section 4: Medicare Advantage Plans & other options”
The other option than being on Original Medicare is to be on a Medicare Advantage Plan. In this case, a private insurance company becomes your primary payer and main contact. Medicare Advantage (MA/MAPD) Plans are called “bundled plans” because they combine parts A, B and D to form one “Plan C.”
They often have reduced costs for premium payments, with some of them even offering “$0” monthly premiums. In addition, they often include extra benefits, not included by government Medicare, such as dental, hearing and eye care. “Silver Sneakers” and similar fitness/wellness programs are also often an included benefit.
CLICK HERE to see more about the various Medigap plans and what they offer.
When you opt for keeping Original Medicare (instead of a Medicare Advantage Plan) you will most likely want to pair that with not just a stand-alone drug plan, but also with a Medigap Plan. These plans are also called Medicare Supplement Plans.
They are supplemental insurance plans that pick up paying where Original Medicare leaves off – such as with the 20% coinsurance, co-pays and deductibles.
The government sets the requirements for each supplement plan and then the private insurance companies decide what price they can offer for each plan in each market they are in. These plans are labeled with letters, and offer the exact same benefits no matter what private insurance company you choose.
“Section 7: Get help paying your health & prescription drug costs” (pages 83-88)
The government has set up several ways for Medicare Beneficiaries to get help in paying for their health insurance. Read this section to see if you qualify for the various tiers of assistance.
How can I protect myself?
“Section 8: Know your rights & protect yourself from fraud” (pages 89-100)
The U.S. government understands that health insurance can be confusing, and there are people out there that will try to take advantage of this confusion. Read this section to know how to protect yourself from health care and insurance fraud.
In addition, Section 8 also explains your rights under Medicare and how to make an appeal if you decide your rights have been violated. The Medicare and You 2020 book defines an appeal as “…the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare plan.”
How do I get my questions answered?
“Section 9: Get more information” (pages 101-112)
Next, if you have questions related to Original Medicare, the handbook offers you the following numbers to call:
1-800-MEDICARE (1-800-633-4227) TTY users call 1-877-486-2048 Get information 24 hours a day, including weekends
Medicare and You 2021
Additionally, for questions regarding insurance plans like Supplement (Medigap) or Medicare Advantage (MA/MAPD) then we suggested talking to a licensed insurance professional.
If you are lucky enough to live in our headquarters of Nebraska or our neighboring state of Iowa, you can give Carly a call/text or email.
Do you just live to read a good glossary? Well, here you go. You will find here definitions to all the health care and insurance lingo you need to know to navigate your health care effectively.
We hope our review of the 2020 & 2021 Medicare and You Book has been helpful.
Our one hope for next year is that the book might be more helpful in pointing beneficiaries towards ways to find LICENSED independent insurance professionals that can help them in making decisions. These agents are the only ones required to stay licensed, tested and up to date on the plans that are out there. Moreover, this applies especially for the Medicare Advantage approved agents as they have to be re-tested every year on changes.
Finally, we are MedicareLifeHealth.com just don’t understand how people can be offering advice on plans – that change yearly – they have not be certified to explain.
Our advice? Find yourself a good agent, and make them work for you.
Further Medicare and You 2021 Topic Relevant Reading
Attained Age vs Issue Age Medicare Supplement Insurance Companies all price their plans differently. One of the biggest differences between ... Read More
Carly Cummings is a licensed insurance agent and former financial adviser. Carly is the Creator of MedicareLifeHealth.com where she helps her readers (of all ages) find the best health care and create the best cash flow in retirement. Carly has worked in finance and insurance for a Fortune 500 company as well as for a Berkshire Hathaway company. Before finance, she was an entrepreneur that owned a wellness licensing company and two yoga studios.
Medicare has four different parts: Medicare Part A B C D. Each of these parts serve a different function in our national health care system for seniors.
If you are interested in the costs associated with Original Medicare Parts A and B, please visit our article “How Much Does Medicare Cost?“
Medicare Part A Hospital Insurance Covers
Part A is dedicated to Hospital Insurance and covers care for…
Inpatient Hospital
Skilled Nursing Facilities
Hospice
Home Health
When you visit the hospital, Medicare will help you pay for the above services. However, Original Medicare does not pay for all of it. There are copayments, coinsurance, or deductibles may apply to each service. This is why most Medicare Beneficiaries will supplement Original Medicare with either a Supplement (Medigap) plan or a Medicare Advantage Plan.
Remember, Medicare does not cover Long-Term Care costs such as Nursing Home or Assisted Living Expenses.
Medicare Part B Medical Insurance Covers
Part B consists of Medical Insurance and covers the care of…
Now that you understand the components of Original Medicare (Parts A & B), let’s look at the two additional parts of Medicare – Parts D and C – Drug Coverage and Medicare Advantage.
Medicare Part D Prescription Drug Insurance Covers
Part D is regulated by the government but handled by private insurance companies. This part includes care for…
Medicare Part C – Also Known as Medicare Advantage (MA/MAPD)
MA / MAPD Plans are becoming more popular and more accessible to Medicare Beneficiaries all over the United States. Moreover, as more and more people are joining them, they are becoming very affordable options.
These plans offer additional benefits and services to what Original Medicare can offer such as dental benefits, vision benefits and hearing benefits. They also often include wellness benefits such as free gym memberships.
Carly Cummings is a licensed insurance agent and former financial adviser. Carly is the Creator of MedicareLifeHealth.com where she helps her readers (of all ages) find the best health care and create the best cash flow in retirement. Carly has worked in finance and insurance for a Fortune 500 company as well as for a Berkshire Hathaway company. Before finance, she was an entrepreneur that owned a wellness licensing company and two yoga studios.
The 5 Biggest Medicare Mistakes and How to Avoid Them
No one wants to make a mistake that will cost them hundreds (or thousands) of dollars down the road if they can help it! However, Medicare can be very confusing, and even very knowledgeable people can miss things. Here are the five biggest Medicare mistakes people make, and how you can avoid them!
#1 in Our Biggest Medicare Mistakes: Missing Enrollment Deadlines
Although the government gives us all a little wiggle room around each Medicare Milestone we pass, there are certain deadlines you must mind to avoid late penalties and inconveniences.
Original Medicare Coverage Deadlines
You will need to sign-up for Medicare when you turn 65 if you are not already getting Social Security. You will be automatically signed-up for Medicare if you are getting Social Security. In addition, you will need to tell the government if you are delaying Medicare because of other credible coverage (such as an employers coverage).
You will have three months before your birthday to sign-up, the month of you birthday, and then three months after to sign-up. However, what some people do not understand, is that if you enroll after you turn 65, your coverage will not start until the first of the month after you enroll. This could lead to a gap in your health care coverage.
A NOTE ON CREDIBLE COVERAGE: Some people will delay Medicare coverage if they have a good health plan from their employer. This is usually okay, but there is an exception for small business employers to be aware of: If your employer has less than 20 employees, you will need to enroll in Medicare right away when you turn 65.
This is because when you work for a small business, their insurance will become secondary insurance and Medicare will be your primary payer. If this is the case, you will need to enroll right away in Medicare to avoid a penalty. (Also note that Cobra is not credible coverage.)
Medigap Guaranteed Enrollment Deadlines
The last Medicare Enrollment Mistake people make is missing their Guaranteed Enrollment period for a Medigap Plan. You will have six months, from the beginning of the month you first turn 65, to enroll in a Medigap plan with a guarantee to be issued a policy. If you apply after this window, you will have to go through medical underwriting. This means that companies have the right to deny issuing you a policy based on your medical history after your open enrollment is over.
It is important to remember that Medicare Advantage Plans have a different enrollment process than Medigap. The Medicare Advantage Annual Election Period is not for Medigap Plans. Which lead us right into Mistake #2…
Medicare Mistake #2: Not Understanding Medigap Plans vs. Medicare Advantage Plans
There are two main ways you can set up your Medicare Health Care Plan: Medicare Advantage (Part C) and Original Medicare with a Medigap Plan. You either have one or the other, not both. Both can be good ways to set up your health care, but not understanding how they work can lead to making on of our biggest Medicare mistakes.
We have a whole article on Medicare Advantage vs. Medigap Plans here. I suggest reading it if you are unfamiliar with the two plan types. Considerations with these plans include how you get your Prescription Drugs and how you want to budget your money. Cash flow can be different plan to plan with premium payments and out of pocket expenses to consider when making a decision. Your lifestyle needs and travel patterns also need to be considered when making a choice between MA and Medigap.
Mistake #3: Assuming Your Doctors and Drugs are Covered
We all know what assuming can lead to… mistakes! It is very important to make sure that your doctors are covered with the Medicare option you choose. The carrier will be able to help you confirm that you will be able to continue with your current doctor if you so desire. If you are working with an Insurance Agent, they will have the ability to do this for you as well.
Checking your drug options with a plan is also an important part of finding coverage. The government does make sure that at least two kinds of drugs are available per category of treatment. Moreover, carriers will have a process for you to make an exception for a drug not on its list (called a formulary). However, it makes for a smoother transition to check ahead of time to see what is covered for your specific needs.
Biggest Medicare Mistake #4: Assuming Medicare Covers Long-Term Care
It is a common mistake to assume that your Medicare coverage includes long term care – it does not. Skilled nursing facilities for recovery from a certain event are covered (and come with different co-insurances based on different plans). However, long term stays in assisted living and nursing homes are not covered. You will need to have a plan in place to cover these needs. Your planning may include:
Another option, for those that do not have a lot of resources saved up for retirement, is to “spend down” your assets to qualify for Medicaid to help you in paying for your care. However, I would not suggest this option for those that have the means to plan ahead for the level of care they desire or those that want to pass money on when they pass.
Biggest Medicare Mistake #5: Enrolling Directly with a Carrier
Ok, follow me on this one. When you first turn 65, you are bombarded with advertisements for different Medicare plans. Sometimes, it feels easiest to just pick up the nearest postcard and give that insurance company a call. Or maybe you have done your research on your own (which is just fine!) and decide to enroll directly with the carrier you want to go with. Here is where you should stop and consider this as a mistake.
Here is the problem: when you enroll with an insurance company for one of their plans directly, you have to deal with them alone. On the other hand, when you enroll with that same company through an independent insurance agent, you now have an advocate and support system to help you work with that carrier.
Here is how an independent agent helps:
First, if something goes wrong, you can call your agent for help! You are not on your own, and this is a big deal. As we all know, everyone can make mistakes – you, your doctor’s office, your insurance company. When these mistakes happen, you can call your agent for support and they can work with you and the insurance company to make sure you are taken care of.
Second, rates and plans change! A good independent agent will keep on top of industry changes and plan changes for you. They can stay on top of your premium rates and what might be new or changing in your area to make sure you always have the best coverage. You will not get this level of service when you work directly with a carrier.
Finally, you do not pay anything extra for working with an independent agent. They are still paid as an independent agent from Whichever company you are placed with at no charge to you.
Carly Cummings is a licensed insurance agent and former financial adviser. Carly is the Creator of MedicareLifeHealth.com where she helps her readers (of all ages) find the best health care and create the best cash flow in retirement. Carly has worked in finance and insurance for a Fortune 500 company as well as for a Berkshire Hathaway company. Before finance, she was an entrepreneur that owned a wellness licensing company and two yoga studios.
Medicare costs can be different person to person, depending on which type of plan you choose. After you have a basic understanding of Medicare and it’s basic components, you will want to know how much does Medicare cost? The answer is, it depends on how you structure it. Let’s break down what you could be paying.
Medicare Costs Broken Down & Made Simple
When you set up your Medicare, you will decide if:
Medicare Part A – For most people, there is not a cost or premium you pay for Part A. Your Part A is premium free if you worked in the US and paid Medicare taxes for at least 30 quarters. (You will pay between $252 – $458 a month depending on your work history for Part A if you do not meet the premium free requirements in 2020).
There is also a $1,408 yearly deductible for Part A services and coinsurance tiers on hospital stays.
There is also a $198 Part B deductible and a 20% coinsurance (co-pay) for most approved services.
Late penalties may also apply to Part B (and less commonly, Part A) if you do not sign-up when you are first eligible.
How Much Prescription Drug Costs
Medicare Part D – Prescription Drug Coverage needs to be obtained from a private insurance company. Each company will price their service differently and you can shop for the best plan and price for you. In addition, you will pay more for your Part D coverage, on a sliding scale, if you make more than $85,000 a year while on Medicare.
Other costs to consider with your Part D coverage are co-pays and coinsurance, in addition to deductibles.
There are also late enrollment penalties associated with not signing up for Part D coverage when you are first eligible if you do not have “credible coverage.”
How Much Medicare Supplements or Medicare Advantage Plans Cost
On top of your Original Medicare, you will need to make a decision to either participate in a Medicare Advantage (Part C) plan or to consider having a Medigap (Medicare Supplement) Plan. If you need help deciding on which one is best for your needs, please read our article on Medicare Advantage Vs. Medicare Supplements.
Medicare Supplement Plan Costs – Medicare Supplements will each have a different cost depending on the Letter Plan you choose and the company you go with. The government decides what benefits are offered by each letter plan. Then, each private insurance company decides what price they can offer for each plan in each market. It is a good idea to compare multiple plans by multiple carriers (insurance companies) in your area before choosing a plan. An independent insurance agent will be able to help you do this.
Medicare Advantage (MA/MAPD) Costs – Part C, or Medicare Advantage Plans are also offered by private insurance companies and stand in place of Original Medicare. In addition, they often include Part D Prescription Drug Coverage. Some of these plans have low or zero premium plan options. A few even cover Part B premiums. All of them are required to have max out of pocket expenditures and deductibles. It is a good idea to talk to an independent insurance agent on MAPD plans in your area to help you choose your best option.
Medicare Costs Summary
In summary, Medicare will cost you something, unless you are on full benefits from Medicaid. Moreover, you have already been paying into the Medicare system during your working career with Medicare taxes. Common set-up for Medicare beneficiaries include:
Having Original Medicare, Part A Premium Free, Part B Premium at $135.50 /month and a stand alone Part D Premium to pay. Then, adding on a Supplement Plan to cover the expenses Original Medicare does not pay.
Or having a Part C Medicare Advantage Plan that includes a drug plan with a premium to pay (sometimes a $0 premium). Most commonly, you will still pay your Part B premium with Medicare Advantage.
Get More Help Understanding How Much Medicare will Cost You
One good resource for learning more about the costs of Medicare is the Medicare and You Book published by the government every year. It is a large book, so please star with our Medicare and You User’s Guide to learn what it offers and to get a copy if you need one.
In addition, finding the best Medicare options for your budget can be a lot to take on, but hopefully this breakdown is helpful. I strongly suggest talking to a professional to help you in setting up your Medicare plan. As an independent agent myself, I suggest using an independent agent. They are not tied to one company, so they work for you, not one carrier and can help you in considering many different carriers and plans.
As always, if you live in Nebraska or Iowa, please give me a call, and I can help you out either in person or over the phone.
Carly Cummings, NE/IA Licensed Independent Insurance Agent for Life and Health.
Carly Cummings is a licensed insurance agent and former financial adviser. Carly is the Creator of MedicareLifeHealth.com where she helps her readers (of all ages) find the best health care and create the best cash flow in retirement. Carly has worked in finance and insurance for a Fortune 500 company as well as for a Berkshire Hathaway company. Before finance, she was an entrepreneur that owned a wellness licensing company and two yoga studios.
