Medicare
Medicare
Let’s Create a Strong Foundation!
Medicare Insurance Options:
Let’s Discuss Some Medicare Basics
In my opinion, maybe the most important point to consider is that original Medicare for some services does not have any maximum out of pocket limit. This means that if you have a costly medical service or procedure (such as a heart surgery, chemo, etc.), then your portion of 20% could be very high. There is no need to put your financial future at risk, especially when there are so many Medicare options in our area. Plus, another important thing to understand is that original Medicare Part A and Part B, does not include prescription coverage.
Part A
(Hospital Insurance)
Helps cover:
• Inpatient care in hospitals
• Skilled nursing facility care
• Hospice care
• Home health care
Download to Large Print Medicare and You Handbook 2023
Part B
(Medical Insurance)
Helps cover:
• Services from doctors and other health care providers
• Outpatient care
• Home health care
• Durable medical equipment (like wheelchairs, walkers,
hospital beds, and other equipment)
• Many preventive services (like screenings, shots or vaccines,
and yearly “Wellness” visits)
Part C
(Medicare Advantage)
Medicare Advantage is a
Medicare-approved plan from a
private company that offers an
alternative to Original Medicare for
your health and drug coverage. These
“bundled” plans include Part A,
Part B, and usually Part D.
• In most cases, you can only use
doctors who are in the plan’s network.
• In many cases, you may need to get
approval from your plan before it
covers certain drugs or services.
• Plans may have lower out-of-pocket
costs than Original Medicare.
• Plans may offer some extra benefits
that Original Medicare doesn’t
cover—like vision, hearing, and dental
services.
Part D
(Drug Coverage)
Helps cover the cost of prescription drugs (including many
recommended shots or vaccines).
Plans that offer Medicare drug coverage (Part D) are run by
private insurance companies that follow rules set by Medicare.
Choosing between Medicare Supplements and Medicare Advantage, as well as selecting specific plans, can be complex and confusing. Also, Part D prescription coverage has separate rules and regulations for different coverage phases (deductible, initial, coverage gap, catastrophic coverage). It functions much differently than employer plans or individual health insurance. We offer many Medicare Supplements and all of the Medicare Advantage plans available in our area. Why try to tackle this alone? Let us help simplify the process for you. We provide assistance with plan selection, and we can provide ongoing support in case your needs change.
Your Two Options: Which one is right for you?
Medicare Supplements
Medicare Supplements (Medigap) are standardized across the nation by Medicare. For example, a Plan G is a Plan G, no matter what company you choose. However, there are a few things that can set the same plans of various companies apart: premium, customer service, and sometimes a few added benefits (such as gym memberships). When I say premium, I also stress the importance of finding a company that has a good track record of not raising the premium too much in any given year. Some companies have plans that start out at lower prices, but they soon have dramatic increases in premium.
Keep using original Medicare (the Red, White, and Blue Medicare Card). Plus, get a Medicare Supplement Policy (also known as Medigap). With this option, you would show both your original Medicare card and your Medicare Supplement card to the providers (doctors, hospitals, etc.). The providers would bill original Medicare, and then receive payments from Medicare. For the coinsurance or percentage (usually 20%) for which you are responsible, the providers would also send the bill to the insurance company handling your Medicare Supplement. The insurance company would pay the bill according to which Medicare Supplement plan you had chosen. If you had chosen a Plan G, then they would pay everything, according to the Medicare allowable amounts, except for a small annual deductible of $226 for the year 2023.
Medicare Supplements (Medigap) are standardized across the nation by Medicare. For example, a Plan G is a Plan G, no matter what company you choose. However, there are a few things that can set the same plans of various companies apart: premium, customer service, and sometimes a few added benefits (such as gym memberships). When I say premium, I also stress the importance of finding a company that has a good track record of not raising the premium too much in any given year. Some companies have plans that start out at lower prices, but they soon have dramatic increases in premium.
- Most plans do not have any network of providers; so, they may be used, even for non-emergency situations, anywhere that accepts Medicare in the country. This could be an advantage if the beneficiary owns more than one home and spends extended time in more than one location.
- Another advantage is the simplicity of how to pay providers. Using the Plan G Medicare Supplement as an example, once the $226 annual deductible (for 2023) has been met, then the beneficiary does not have any more Medicare approved medical bills (Part D or prescription is treated differently) for the rest of the year. This can be a benefit if a beneficiary receives many medical bills and doesn’t want to be responsible for keeping up with multiple copayments and coinsurance payments.
- If the beneficiary has many medical services, such as certain chronic illnesses, then the overall costs to the beneficiary might be lower in some situations.
- Premium is much higher than most Medicare Advantage plans.
- Premium typically continues to go up every year.
- Medical underwriting may be required (not in some situations).
- Prescription plans are not included, and must be purchased separately.
- You will probably have at least three cards: original Medicare card (part a & b), Medicare supplement card (from the insurance carrier), and a separate prescription card for the stand-alone prescription plan.
- Medicare Supplements do not have many of the added benefits that Medicare Advantage may include (such as dental, vision, etc.).
Or Call: (435) 668-3984
Medicare Advantage Plans
Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare
Medicare Advantage may include prescription coverage (MA-PD), or it might not have prescription coverage (MA). These plans are also known as Part C of Medicare. Regarding Medicare Advantage, Private insurance carriers are contracted directly with Medicare, and Medicare is paying the insurance carriers hundreds of dollars each month for each beneficiary that enrolls into one of their Medicare Advantage plans. In return, the insurance carrier provides the coverage for the part a, part b, and often part d, all under one umbrella.
Some of these types of plans may not have a plan premium from the insurance carrier. However, a person would still be responsible to pay the monthly part b premium to Social Security.
- An insurance carrier’s plan premium may be as low as $0. However, a beneficiary still needs to continue to pay their part b premium each month. Whether you choose Medicare Advantage or Medicare Supplements, the part b premium ($164.90/mo for most people in 2023) needs to continue to be paid. But, with some of these Medicare Advantage plans, there is no additional plan premium. Sometimes a beneficiary will save a substantial premium, by selecting a Medicare Advantage plan, even after factoring in their copayments and coinsurance .
- Coverage for prescriptions is often included in these plans. So, you do not have to pay for a separate prescription plan.
- Medicare Advantage plans frequently include additional benefits that are not normally covered by Medicare. Some of these benefits may include dental, vision, hearing and hearing aids, over-the-counter quarterly benefits, fitness amenities, and many more.
- Often provides some reimbursement for emergency coverage outside of the country.
- Some plans have networks in multiple states.
- For some medical needs, copayments and coinsurance could potentially add up to a plan’s maximum annual out-of-pocket limit. However, the maximum out-of-pocket limit could also be viewed as an advantage. If it is ever reached, then all Medicare approved medical costs will be covered for the rest of the year, without incurring any additional copayments or coinsurance for the beneficiary.
- Because these plans have copayments and coinsurance, there is the potential for the total annual costs to add up to more than a Medicare Supplement, especially for individuals that have specific chronic medical conditions.
- Plans vary by service areas (sometimes by zip codes), and may only be selected if the beneficiary lives in the service area. However, once the person qualifies for enrollment, then many of the plans have a national network that may be used.
Or Call: (435) 668-3984
The information listed above is to provide some general education. It is in no way meant to be all inclusive. Medicare can be complicated. Let me help simplify the process for you. We offer all of the Medicare Advantage plans available in our area and many Medicare Supplements. We’ll narrow down the options, and focus on finding a plan that fits your specific needs. The consultation is free.
- Disclaimer – Regarding Part D stand-alone prescription drug plans, “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”
Helpful info & Links
If You Are New to Medicare, Here Are the Ways to Sign Up:
Online (at Social Security) – It’s the easiest and fastest way to sign up and get any financial help you may need. (You’ll need to create your secure my Social Security account to sign up for Medicare or apply for benefits.)
- Call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.
- Contact your local Social Security office
- Located in: Sunset Corner Properties, LC
- Address: 1091 N Bluff St #1100, St. George, UT 84770
- Hours: Closed ⋅ Opens 9 AM Mon
- Phone: (800) 772-1213
- Phone: 866-446-7085
- If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.
About 2 weeks after you sign up, we’ll mail you a welcome package with your Medicare card.