Things to know about Medicare….

Every year, thousands of Americans become eligible to get health coverage through Medicare, and the more you know about the program, the better equipped you’ll be to make the most of your benefits. Medicare covers or will eventually cover all Americans who have worked 40 quarters (fulltime). If you are married and you have not worked 40 quarters full time, but your spouse has, you are eligible for Medicare. Unfortunately, this massive healthcare program is not well understood by those who are eligible for Medicare, what it covers (and doesn’t). the costs associated with your plan and also the penalties for not signing up in time. The plans which we will discuss later, can in fact change from year to year or doctors can decide to not accept your existing plan. This will cause you to either change your plan to stay with your doctor or may make you start over with finding a doctor that accepts your existing plan to make the most of your health and financial needs.

Who And When Can I Get Medicare?

As previously discussed, if you or your spouse have worked 40 quarters full-time, the answer is 65 years old. Another qualifying event to be eligible for Medicare is if you have been on disability for at least two years. A common misunderstanding among Americans is that you can get Medicare as soon as you claim your SOCIAL SECURITY BENEFITS, which can be as early as age 62. Even if you make the decision to retire and claim your Social Security benefit early, you’ll have to wait until 65 before you’ll be covered for Medicare.

How to sign up for Medicare Online

If you’re receiving Social Security benefits at age 65, you should be signed up automatically for Medicare Parts A and B. However, if you aren’t receiving Social Security yet, you’ll need to sign up. You can sign up for coverage on the Social Security Administration website. You can also call 800-772-1213 to get help. Your initial enrollment period begins three months before the month of your 65th birthday and extends three months after. If you wait too long to enroll you’ll be responsible for paying a penalty for the rest of your life.

There are different parts to Medicare

Medicare isn’t just one insurance policy and it can be confusing what does what. Together, Medicare Parts A and B are often called original Medicare or traditional Medicare. Both Medicare Part A and Medicare Part B are managed by Centers for Medicare and Medicaid Services. You also have additional coverage options.
There are different parts to Medicare that provide different types of coverage and they include:

  • Medicare Part A, which covers inpatient hospital care, inpatient care at skilled nursing facilities, hospice care, and some home healthcare services. Part A has a $1,408 deductible for 2020. Additional costs for hospital stays exceeding 60 days or for stays in a skilled nursing facility that exceed 20 days.
  • Medicare Part B, which covers basic routine care including doctor visits, lab services, preventative care, health screenings, physical therapy, occupational therapy, and other routine outpatient care. Part B has a $183 deductible and also includes a 20% coinsurance cost (this can get pricey!!). The standard monthly premium for Medicare part B is $144.60. Does everyone pay the same amount for part B? NO! If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you will pay the adjusted standard premium amount and an Income Related Monthly Adjusted Amount (IRMAA). IRMAA is an extra charge added to your premium. Your part B premium will be automatically deducted from your benefit payment if you get benefit from one of these:

Your part B premium will be automatically deducted from your benefit payment if you get benefit from one of these:

  • Social Security
  • Railroad Retirement Board
  • Office of personal management
  • Medicare Part C: Medicare Part C is also called Medicare Advantage. Medicare Part C allows you to get a plan from a private insurer subject to Medicare guidelines.
  • Medicare Part D: Medicare Part D covers some prescription drugs. It can be purchased as a standalone plan or combined with other Medicare plans. Part D has a maximum annual deductible of $405.00. Important things to know about part D:
  • Copayment/coinsurance in drug plans
  • Costs in the coverage gap
  • Catastrophic coverage
  • Medicare Supplemental Plans: e.g Plans G and N which cover costs that original Medicare does not pick up. These plans come with an additional cost and do not include a prescriptions drug plan. It is important to remember to select drug coverage to avoid lifetime penalties.
  • Penalties: If you’re not eligible for premium-free Medicare Part A, you can sign up to buy it but need to do so as soon as you become eligible at age 65. If you sign up later, you’ll pay a penalty equal to 10% of your monthly premium. You’ll owe the penalty for twice the number of years you could’ve been covered by Medicare Part A but didn’t sign up. There’s also a penalty for failing to sign up for Part B on time. The penalty equals 10% of your premium amount for each full 12-month period you were eligible to enroll but didn’t. The penalty will be in effect for as long as you have Part B coverage. You could also owe a penalty for part D, which is equal to 1% of the national base beneficiary premium multiplied by the number of months you were eligible but didn’t have coverage. The national base beneficiary premium can change annually, the penalty for late enrollment can also change each year. The penalty you owe will be added onto your Part D premium for the whole time you’re covered. While there are some exceptions to penalties if you’re eligible to sign up during a Special Enrollment Period, it’s important to make sure you sign up when you’re required to so you can avoid high costs.

When can you change your Medicare coverage?

You don’t have to stick with the same Medicare coverage every year forever. We suggest reviewing your coverage annually to make certain that your health needs are being met . You could decide, for example, that you don’t want Medicare Part C anymore and would prefer to get covered by original Medicare and select Medicare supplemental plan

If you decide you want to make a change to your coverage, you can do so during open enrollment. Open enrollment runs from Oct. 15 to Dec. 7 each year. Once open enrollment ends, you likely won’t be eligible to make a change to Medicare coverage again for a whole year.

Special Enrollment Period

Since Business Owners Policies apply only to special types of businesses with specific needs, operations, and risks, it’s important to contact a specialist at Ideal Insurance Agency who can help you determine whether a BOP is right for your small or medium-sized business.

What if I have complaints about the quality of care I receive?

How do I file a complaint/appeal?

You can file a complaint if you have concerns about the quality of care or other services you get from a Medicare provider. How you file a complaint depends on what your complaint is about.

Medicare has many coverage exclusions

Unfortunately, not only do you incur costs because of premiums, copays, and deductibles, but Medicare beneficiaries also have to pay for many medical services out-of-pocket because Medicare has many exclusions from coverage.

Some of the things that Medicare does not cover include:

  • Routine nursing home care (called custodial care)
  • Unskilled long-term care at home
  • Prescription drugs (unless you sign up for Part D coverage)
  • Most types of dental care
  • Hearing aids
  • Eye care, including eye exams, glasses, and contacts unless you have diabetes or have had certain types of cataract surgery
  • Medical care while you’re traveling outside the U.S.

You may end up paying a substantial amount of money for these services, unless you’ve purchased additional coverage to complement your Medicare benefits.

Understanding Medicare is critical

While you may not think Medicare is something you need to think much about, the reality is that it’s critical you understand how Medicare works, what it covers, and what it’s likely to cost you. By learning more about Medicare, you’ll be better able to get the right benefits as a American — and you can make a plan to pay for things Medicare won’t cover.

Why should I choose Ideal Insurance Agency to help me with selecting my Medicare plan?

Ideal Insurance Agency has been in the insurance business servicing all of AZ since 1983. Being a family-owned agency, we pride ourselves on providing our clients with the power of knowledge giving them the ability to make certain that their health needs are being met. With the constant changes to Medicare, what it does or does not cover, the costs associated with Medicare, or Doctors not accepting plans, Ideal Insurance Agency gives you the peace of mind knowing that we stay up to date with training and knowledge of the changes on an annual basis. 

Ideal Insurance Agency offers superior coverage across the Phoenix area including Surprise, Glendale, Peoria, Avondale, Buckeye, Goodyear, Phoenix, Sun City, Sun City West, AZ and Wickenburg.