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 CONTENT SHORTCUTS 

  1. What is Medicare?
  2. Part A
  3. Part B
  4. Part C
  5. Part D
    1. Other Prescription Drug Plan Options
      • GeniusRXSave up to 80% on most prescriptions at most pharmacies. Click here and see how you can save.
  6. Medicare Supplements
  7. 12 Medicare Scenarios
    1. Still Working
    2. No Group Coverage
    3. Keeping Group/ Spousal Coverage
    4. Keeping COBRA/ Spousal Coverage
    5. Soon Retiring
    6. Needs Medicare but waiting on SSI
    7. Offered Employer Retirement Insurance
    8. Need Medicare and SSI
    9. Veterans
      • Veterans with TRICARE
    10. Disability
      • Disability & Extra Help
    11. Supplemental Security Income
    12. Medicaid
  8. Frequently Asked Questions
  9. Resource Page
  10. Contact Us

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Medicare is health insurance for people 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD) or Lou Gehrig’s disease.1

Medicare is made up of four parts, each of which pay for or cover different services

What are the different parts of Medicare?

  • Part A - hospital or inpatient coverage
  • Part B- medical or outpatient coverage
  • Part C- Medicare Advantage plans
  • Part D - Prescription Drug Coverage.  

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Part A

What is Medicare Part A?

Medicare Part A is most commonly referred to as hospital insurance.

Part A will cover semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment in addition to hospital services and supplies.

Part A covers up to 150 days total hospitalization for a lifetime. You are responsible for a $1,316.00 deductible as well as coinsurance. It also covers up to 100 days in a skilled nursing facility2 as well as:

  • Hospital Services
  • Hospital Care
  • Skilled Nursing Facility Care
  • Inpatient Rehabilitation Facilities
  • Home Health Care Services
  • Hospice

How much does Part A cost?

If you or your spouse has worked 40 quarters (10 years) of Medicare-covered employment, Part A is premium-free. For people with 30-39 quarters of Medicare approved covered employment, the Part A premium is $226.00 per month.* For people with less than 30 quarters of Medicare covered employment, the Part A premium is $413.00 in 2018.2

You will be responsible for a $1,316.00 deductible (this amount may change annually) when you are admitted to the hospital. This may happen several times a year.

Besides the deductible, most confinement costs are covered for days 1 through 60. Days 61-90 you will be responsible for $329 per day coinsurance, and days 91-150 you will be responsible for $658 per day coinsurance.2

Beyond lifetime reserve days: all costs2 You have a total of 60 reserve days that can be used during your lifetime. For each lifetime reserve day, Medicare pays all covered costs except for a daily coinsurance1.

If you already receive benefits from Social Security or Railroad Retirement Board (RRB), you do not have to sign up. You will automatically get Part A benefits starting the first day of the month you turn 65. Your red, white and blue Medicare card will be mailed to you three months prior to your 65th birthday.
If you are disabled you automatically receive benefits after your 24th month of receiving Social Security disability benefits. Your card will be mailed to you three months prior to your 25th month of disability.1   Avoid long lines and lengthy phone calls with Social Security. One of our agents can help you today.

Note: If your birthday is on the first day of the month, your coverage will begin the first day of the prior month.

*These number reflect 2018 costs

How do you sign up for Part A?

You may sign up for Part A during:

  • Initial Enrollment Period (IEP)this is a 7-month period that includes the three months prior to the month you turn 65, the month of your 65th birthday, and three months after the month you turn 65.
  • Special Enrollment Period (SEP) - if you or a spouse is still working, you may sign up anytime while you have group health coverage or during the 8-month period that begins the month after employment or coverage ends, whichever occurs first
  • General Enrollment Period - between January 1 and March 31 each year. Your coverage will start in July 1 of that year. 1 You can apply for Medicare only, Social Security only or both Medicare and Social Security.

Download the Complete FREE Medicare Guide

 

You can apply for Medicare Part A by calling us at 1-855-474-6234 TTY 711. 

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Part B

 

What is Medicare Part B?

Medicare Part B is often referred to as medical insurance. Part B covers your doctor and specialists visits, outpatient care, home health services, preventative services, as well as medical procedures when admitted to the hospital.

What does Medicare Part B Cover?

Part B helps cover medically necessary doctor services, outpatient care, home health services and some preventive services. It also covers durable medical equipment, which includes: home oxygen equipment, hospital beds, walkers and wheelchairs. Part B also covers many preventive services 1.

It also covers things such as:

  • Clinical Research
  • One Time “Welcome to Medicare” Wellness Exam
  • Annual “Wellness” visit every 12 months
  • Laboratory Test (X-rays, blood work)
  • Durable Medical Equipment (DME)
    • Wheelchairs
    • Walkers
    • Hospital Beds
    • Home Oxygen Equipment
  • Prosthetics & Orthotics
  • Mental Health Care
    • Inpatient, Outpatient and Partial Hospitalization
  • Ambulance Services
  • Preventive Services:
    • Care to prevent illness like flu or pneumonia; screenings to detect an illness at an early stage when treatment is most likely to work best

You will be responsible for an annual deductible of $183.00. After your deductible is met, Medicare will pay 80% of approved services. Typically, you are responsible for paying the other 20%2. Most people choose a secondary plan, to give peace of mind. This would either be a Medicare Advantage or Medigap plan.

To determine your 2018 income-related monthly adjustment amounts, we use your most recent federal tax return the IRS provides to us. Generally, this information is from a tax return filed in 2018 for tax year 2018.SSA.gov

How much does Part B cost?

The standard Part B premium amount in 2018 is $134 (or higher depending on your income). If you are already receiving Medicare and pay your Part B premium through your monthly Social Security benefit or RRB, you’ll pay less ($109 on average). This is because there was not a cost-of-living increase in 2018. You will be notified by Social Security of your exact amount. You'll pay the current standard premium amount if:

  • You enroll in Part B for the first time in 2018
  • You don't already receive Social Security benefits
  • CMS bills you directly for your Part B premium
  • You have Medicare and Medicaid, and Medicaid pays your premiums. (Your state will pay the standard premium amount of $134.)
  • If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above $85,000 your premium may be higher. This is referred to as IRMAA (Income Related Monthly Adjustment Amount). IRMAA is an extra charge added to your premium. 

How do you sign up for Part B?

You may sign up for Part B at the following times:

  • Your IEP, Initial Enrollment Period – You have a 7 month window that begins 3 months before your 65th birthday, your birth month and continues 3 months after. Medicare.gov
  • If you qualify for an SEP, Special Enrollment Period - if you or a spouse is still working, you may sign up anytime while you have group health coverage or during the 8-month period that begins the month after employment or coverage ends, whichever occurs first. Medicare.gov •
  • During the GEP, General Enrollment Period – If you missed your IEP and don’t have an SEP, you will need to enroll between January 1 to March 31 each year. Your coverage will start in July 1 of that year. Medicare.gov
  • In most cases, if you don’t sign up for Medicare Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You'll have to pay this penalty for as long as you have Part B and could have a gap in your health coverage.Medicare.gov

You can apply for both Social Security and Medicare at the same time. Social Security suggest that you begin this process as early as three months before the month you turn 65.
It takes less than 15 minutes to complete the application. If you need help with this process, give one of our agents a call.   Give Us a Call

Part C


Also known as Medicare Advantage Plans, Part C is offered by private insurance companies approved by Medicare and must follow rules that are set by Medicare. These plans provide Part A and Part B, and in most cases Part D.


Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and other health and wellness programs. Medicare and You This will vary by carrier and service area.

There are several different types of Medicare Advantage Plans. You can use the information on the following pages to compare the different types of plans to help determine which plan may best meet your needs.

On October 1, 2018 start comparing your coverage with other options. You may be able to save money. See page 4 of the Medicare & You Handbook

Medicare Advantage Plan Types

Health Maintenance Organization (HMO) Medicare and you

  • Generally, you must go to a doctor or hospital in the plan’s network. In some plans, you may be able to visit a provider who is out-of-network for a higher cost which is referred to as an HMO with a point-of-service (POS) option
  • Prescription drugs are usually covered with these plans. Ask before joining if you need drug coverage to be sure.
  • In most cases you will have to select a primary care doctor
  • You will need a referral from your primary care doctor in order to be seen/treated by a specialist except for certain annual preventative screenings.

With most HMO plans you will require a referral for out of network services except emergency care, out-of-area urgent care, or out-of-area dialysis . 

Preferred Provider Organization (PPO) Medicare and You

  • While PPOs do have network providers, you may go to any doctor or hospital you choose that accepts Medicare. If you elect to go out-of-network, you may experience a higher co-pay or co-insurance
  • These plans typically include prescription drugs. Ask before joining if you need drug coverage to be sure the plan you are enrolling does
  • You will not need to select a primary care doctor
  • You are not likely to need a referral in order to be seen/treated by a specialist.

Medicare PPO plans usually offer more benefits than Original Medicare, but you may have to pay extra for these benefits. Medicare and You

 

Private Fee For Service (PFFS) 

  • You can go to any Medicare-approved doctor or hospital that accepts the plan’s payment terms and agrees to treat you. NOT ALL WILL! 
  • Sometimes prescription drugs are covered. Ask before joining. If not included, you may join a Medicare Prescription Drug Plan (Part D) to get coverage
  • You will not need to select a primary care doctor
  • You will not need a referral in order to be seen/treated by a specialist

NOTE: Even though you may choose any doctor or hospital that accepts Medicare, A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap.Medicare.gov

Medical Savings Account Plan (MSAP)

  • You can go to any doctor or hospital you choose. Some plans may have preferred providers you can go to for a lower cost
  • Prescriptions are not covered. You would have to join a Medicare Prescription Drug Plan (Part D) to get coverage
  • You will not need to select a primary care doctor
  • You will not need a referral in order to be seen/treated by a specialist.2


Special Needs Plan (SNP)Medicare and You

  • Generally, you must get care from doctors or hospitals in the plan’s network. Urgency and Emergency situations would be the exception
  • Prescription drugs are always covered. Part D must be included in all SNPs
  • You will need to select a primary care doctor
  • In most cases, you will need to get a referral from your primary care doctor in order to be seen/treated by a specialist.

These plans limit enrollment to those who are considered “dual eligible”, may live in an institution or have specific chronic conditions. Plans will coordinate the services and providers you need to help you stay healthy and follow doctors’ or other health care providers’ orders. Medicare and You

How much does Part C cost?

Cost will vary dependent on the following:

  • Whether the plan charges a monthly premium in addition to your Part B premium
  • If the plan pays any of your Part B premiums for you, referred as a buy down
  • Whether the plan requires a deductible to apply to medical or prescription services
  • Your copayment or coinsurance that will be applies for each doctor visit or service
  • The plan's annual out-of-pocket costs for all medical services

Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you’ll pay nothing for covered services. This limit may be different between Medicare Advantage Plans and can change each year. You should consider this when choosing a plan. Medicare and You

How do you sign up for Part C?

Medicare Advantage Prescription Drug (MAPD) plans require you meet the following conditions:

  • An enrollee must have Medicare Part A & B
  • Live in the service area of the plan
  • You don’t have End-Stage Renal Disease (ESRD)
  • If you used the General Election Period to sign up for Part B or Part A and B, you can enroll in a plan from April 1- June 30. Coverage begins on July 1st

Note: There are specific times when you can sign up for these plans, or make changes to coverage you already have. Medicare.gov

You can join a Medicare Advantage Plan during the following times:

  • When you are first eligible for Medicare, this is your IEP, Initial Enrollment Period
  • During the three months before, to three months after, of your 25th month of disability
  • Any qualifying SEP, Special Election Period
  • Between October 15 and December 7 each year, this is AEP, Annual Election Period. Your new coverage will become effective on January 1
  • If you signed up during the General Election Period, you can enroll from April 1- June 30. The plan will be effective July 1st . Medicare.gov .

You can switch your Medicare Advantage plan during the following times:

  • Any qualifying SEP, Special Election Period
  • From December 8 – November 30 for a 5-Star SEP
  • Between October 15 and December 7 each year, this is AEP, Annual Election Period. Your new coverage will become effective on January 1. 

You can drop your MAPD from January 1 – February 14 and elect a PDP. You cannot join another MAPD during this time.

NEW: If you switch to Original Medicare during this period, you'll have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form. Medicare.gov 

 

  Part D

What is Medicare Part D?

 Medicare Part D is prescription drug coverage. Part D covers prescription drugs, and is provided by private insurance companies that are approved by Medicare. You must have Medicare Part A or Part B to join a Medicare Part D Prescription Drug plan.

What does Medicare Part D cover?

Part D is prescription drug coverage that is offered to everyone with Medicare. To get prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. You must also have Part A, B or in some cases both.

How much does Medicare Part D cost?

Each plan can vary in cost by premium and deductibles and drugs that are covered.1 Rates may vary by zip code, pharmacy, etc. Should a penalty be imposed you will be responsible for paying that penalty for the entire time you have Medicare.

How do you sign up for Medicare Part D?

There are two ways to get Medicare prescription drug coverage:

  • Medicare Prescription Drug Plans - these plans add drug coverage to Original Medicare, some Private Fee For Service Plans (PFFS), and Medical Savings Plans (MSA)
  • Medicare Advantage Plans - these are your Part C plans that offer all of your Part A and Part B, as well as your Part D drug coverage.1

Part C plans and Part D plans are graded a star rating system. A plan can be awarded up to five stars based on chronic ailment management, preventive services, complaints, customer service and more.

How do you sign up for Medicare Part D?

You may join a Part D prescription plan at the following times:

  • When you are first eligible for Medicare, this is your IEP, Initial Enrollment Period
  • During the three months before, to three months after, of your 25th month of disability
  • Any qualifying SEP, Special Election Period
  • Between October 15 and December 7 each year, this is AEP, Annual Election Period. Your new coverage will become effective on January 1.
  • During the Medicare Advantage Dis-enrollment Period from January 1 – February 14
  • If you signed up during the General Election Period, you can enroll from April 1- June 30. The plan will be effective July 1st. Medicare.gov

You can switch your prescription Drug plan during the following times:

  • Any qualifying SEP, Special Election Period
  • Between October 15 and December 7 each year, this is AEP, Annual Election Period. Your new coverage will become effective on January 1.

Even if you don’t take many prescriptions now, you should consider joining a Medicare drug plan. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. Medicare and You 

Should a penalty be imposed you will be responsible for paying that penalty for the entire time you have Medicare.

 

1. Other Prescription Drug Plan Options

  • GeniusRXSave up to 80% on most prescriptions at most pharmacies. Click here and see how you can save.

 

Medicare Supp 

What is a Medicare Supplement?

 

Medicare Supplements, also known as Medigaps, are supplemental policies sold by private insurance companies that helps pay some of the health care cost  (“gaps”) that Original Medicare doesn’t cover.

How much does a Medicare Supplement cost?

In order to purchase a Medigap policy you generally must:

  • Have Part A and Part B
  • Pay a monthly premium for your Medigap policy to the private insurer in addition to your monthly Part B premium.
  • The best time to buy a Medigap policy is during the 6-month period that begins on the first day of the month in which you are both 65 or older and enrolled in Part B.
  • Most do not have prescription drug plans. You will need a separate plan for your medications.5

An agent or company cannot sell you a Medigap policy if they know you’re in a Medicare Advantage Plan (like an HMO or PPO) unless your coverage under the Medicare Advantage Plan will end before the effective date of the Medigap policy. Choosing a Medigap policy

How much does a Medicare Supplement Cost?

Every Medigap policy must follow federal and state laws designed to protect you. Medigap insurance companies can only sell you a “standardized” Medigap policy identified by letters A through N. 

All plans offer the same basic benefits but some offer additional benefits as well. You will want to choose the one that best meets your needs. 
Note: Starting June 1, 2010 there will be two new Medigap plans M & N. Plans E, H, I and J will no longer be available to buy. If you already have a one of these plans by that date you will be able to keep it.5

How do you sign up to a Medicare Supplement?

There are many things to consider when selecting a Medigap policy. One of our Trusted Senior Specialists will be glad to help you select and enroll in the best plan for you.

 

The chart found on the following page shows the benefits of each Medigap policy available, as of October 2018. If you have plan E, H, I or J you can keep it, however, if you drop it to join a new plan and are not satisfied you will not be able to get it back.

 

Image_056.jpg

*Plan F also offers a high-deductible plan. If you choose this optio, this means you must pay for Medicare-covered costs up to the deductible amount of $2,200 in 2018 before your Medigap plan pays anything.

** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.

*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in inpatient admission.

Be ready when the time comes, download your Medicare checklist now!

 Medicare Checklist - Trusted Senior Specialists 

Medicare Scenarios

 

Image_060-1.jpg Still Working

1. No Group Coverage

You are like many Medicare eligibles; you desire to continue working, however, your 65th birthday places you in your ICEP, which is, Initial Coverage Election Period with Medicare. Your full Social Security retirement age will be at 66. Waiting to receive your retirement until your full age can increase your monthly benefits from Social Security.  

When you turn 65 and worked 40 quarters, this is 10 years, you are entitled to Medicare Part A, no premium required; and eligible for Part B, which does have a monthly premium. So, what if you want to wait on your Medicare until you are at your retirement age? Should you wait? Can you wait? Will it cost you if you do?

The answer; NO, you should not wait. Yes, you can wait. Yes, it will cost you, unless you carry Creditable Coverage. Medicare has a rule that if you delay your Part B enrollment for more than 12 months of your eligibility date, you will pay a 10% penalty of the premium, indefinitely. This is a costly mistake that can be easily avoided.

Did you know your eligibility window is only open for seven months? Don’t let it close on you. The next opportunity to enroll won’t be until the General Election Period, known as GEP. 

We look forward to helping you through your Medicare journey. Lets work together to get you enrolled and taken care of. Give us a call 1-855-474-6234 TTY 711.

2. Keeping Group/Spousal Coverage Until Retirement

Most Medicare eligibles we speak with have decided to continue working until they reach their full retirement age, which has recently increased to 66. Many are covered under their group or their spouse’s group health plan. Do you need to worry about Medicare at this point? Does Medicare need to know about you? Is there a benefit for you to have some Medicare?

There are two options. You could delay both Medicare Part A and B until you retire, AS LONG as you have Creditable Coverage, which means, as good as Medicare. Or you could elect your Part A, which is premium free and delay Part B until retirement.

 

Is there a benefit to electing Part A now? Yes. Depending on the size of your group, one plan will become primary while the other will be secondary. On your spouse’s coverage? You will receive the same benefit, two payers. We have found that deductibles continue to increase, especially once someone reaches the age of eligibility, having Medicare as a payer will significantly reduce your out of pocket exposure.

What is your next step? First, you need to speak with your HR department and verify if your, or spouse’s coverage is Creditable. The next step is to call us at 1-(855)-474-6234 TTY 711 to apply for Medicare Part A or Part A and B. No need to stand in line or to stay on the line with Social Security.

 

3. Keeping COBRA/Spousal COBRA

COBRA, Consolidated Omnibus Budget Reconciliation Act of 1985. This is a great benefit that was created for the temporary continuation of insurance for transitioning employees, their spouses and dependents, until they are enrolled into a new group plan or individual plan.

There are many Medicare eligible that we speak with who have COBRA while they are deciding their options. You should know that delaying your Medicare enrollment until your COBRA coverage ends, usually eighteen months, can land you a lifetime penalty. You have 8 months to sign up for Part B without penalty, whether or not you choose COBRA.

 

If you are currently on COBRA, enrolling in Medicare may end your coverage and anyone else covered on the plan. If you enroll in Medicare, and become eligible for COBRA, you have the right to elect COBRA as a secondary payer. (Unless you have ESRD, it will be primary).

What should you do? The first step is to speak with your HR department and ask them about your COBRA plan options. Determine if this is a cost you are willing to accept, it is usually higher than your current plan.

Next, ask yourself who else will be carried on the plan? If you have a younger spouse or dependent child, you need to explore more options. We can help, while you may be eligible for Medicare, you still need coverage for other family members. Our team of experts will help you and our Affordable Care Act department will find an affordable plan for your dependents without compromising benefits.


We look forward to helping you through your Medicare journey. Let’s work together to get you enrolled and taken care of. Give us a call 1-855-474-6234 TTY 711.

Image_066.jpg Soon Retiring

4. Need Medicare But Waiting to Receive Social Security 

You did it! You are turning 65, worked the required quarters and earned your Medicare entitlement. You have decided to start enjoying a well deserved retirement, but wait another year for your full Social Security benefits.

You may already know this, but just in case, you should NOT delay your Medicare benefits beyond your seven month window. This will result in an indefinite penalty if you don’t have Creditable Coverage or what the  Affordable Care Act considers Basic Essential coverage. Medicare Part A alone or Medicare Part B alone will not fulfill this requirement.

 

You are now ready to enroll with Medicare. So where and how do you get started? The answer, ironically, is with Social Security. It is their job to verify you are eligible.
How? There are a few ways to enroll, it is important that you don’t apply for your retirement benefits while enrolling in Medicare, since you intend on waiting.

You can go to your local Social Security office and wait to be seen. You could choose to enroll online. The most simple option, enroll by phone with one of our agents. One of the services we offer is assisting you with the application process, it takes less than fifteen minutes.

The next step will be deciding how you will pay your Part B premium. Medicare offers a few options, we will go over this once we get your enrollment completed.

5. Employer is Offering Retirement Insurance


Retirement Insurance is what we have worked for along 
with all of the benefits that come with it. There are 5 important things that you have to know about Retirement Insurance before deciding what to do next.

  1. Your employer controls the benefits, which means, they are required to provide the coverage, however, they can cancel it at anytime
  2. You will need to discuss the price. Does the price include your spouse? Is there a “stop loss”? This means the policy will start paying its share after you have spent a maximum out of pocket
  3. Once you or your spouse are eligible for Medicare, how will your Retirees insurance be affected? Should you carry both? This will depend on co-pays, deductibles, and coinsurance
  4. You need to get a copy of the plan’s benefit book to learn exactly how it works with Medicare. Will the plan co-manage with Medicare? Will the Retirees insurance stay in effect if you elect Medicare?
  5. What is in place should your former employer becomes insolvent or goes out of business? Is there a COBRA continuation plan?

As you can see, there are a lot of factors to consider when deciding on a plan. The wrong information will cost you, Give us a call and you can expect clear, up to date information on Medicare.

 

6. Need Medicare AND Social Security Retirement

Did you know the entitlement to retirement also gives you Medicare Part A, premium free? If you worked 40 qualifying quarters, which is 10 years, you are entitled, meaning you earned the right to receive Medicare Part A

and eligible for Medicare Part B.


Your full retirement age is 66, however, you are allowed to begin retirement distribution from SS as early as age 62. Receiving your benefits early will cause a lower monthly check but will not reduce the overall benefit.

When you apply for your retirement, your Medicare benefits will be activated. Social Security will notify Medicare that you wish to begin your benefits. Going forward, Medicare will deduct your Part B premium from your Social Security check prior to depositing your benefits, unless you choose another payment option.

 

Original Medicare does not come with Part D, prescription drug coverage. In order to prevent a lifetime penalty, you will need to have Creditable coverage for Part D. This would also be the best time to discuss

secondary plan options with an agent to reduce your exposure to Original Medicare costs. Experience our service. We will help you apply for your retirement and Medicare benefits. Remember, the wrong information will cost you.


We look forward to helping you through your Medicare journey. Lets work together to get you enrolled and taken care of. Give us a call 1-855-474-6234 TTY 711.

Image_073.jpg Veteran

7. Currently Receiving VA Benefits

We would like to begin by offering a sincere THANK YOU for your service to our country. The VA, Veterans Affairs, provides many services for those who served and their dependents. The VA may provide health care, financial assistance, homes loans, education or training assistance, and burial benefits.

There are limitations to the services you may receive from the VA. The VA has a priority list, which means, you will need to meet certain military service requirements to be eligible for enrollment in the VA health care system. The VA only pays for services performed at the VA hospital or clinic.

Medicare does not consider the VA to be Creditable Coverage for Part B. This will place a penalty on you if you needed to elect Medicare for a treatment not covered by the VA after your Initial Election Period. You have a decision to make. We will help you know all of the facts before you make this very important decision and we will help you make the right one.

If you are receiving VA benefits, the Veterans Administration does not recommend that veterans cancel or decline coverage in Medicare solely because they are enrolled in VA health care. Unlike Medicare, which offers the same benefits for all enrollees, VA assigns enrollees to priority levels based on a variety of eligibility factors, such as service connection and income. There is no guarantee that in subsequent years Congress will appropriate sufficient medical care funds for VA to provide care for all enrollment priority groups.


This could leave veterans, especially those enrolled in one of the lower-priority groups, with no access to VA health care coverage. For this reason, having a secondary source of coverage may be in a veteran’s best interest. 4 Secondary coverage could include Part B and possibly Part C. To learn how you can benefit from enrolling in one of these plans,call one of our Trusted Senior Specialists at 1-855-474-623 TTY 711.

Call and speak with one of our licensed agents to learn about plans that work with VA benefits.

  

8. Currently Receiving TRICARE for Life Benefits 

I would like to begin by offering a sincere THANK YOU for your service.

TRICARE is a robust health plan for Uniformed Service members, National Guard, Reserve members, Medal of Honor Recipients, and those registered with the Defense Enrollment Eligibility Reporting System. This coverage is available to their families and spouses/former spouses. The benefit and plans will vary depending on your beneficiary category.

TRICARE for Life is the plan designed for those who are also Medicare eligible. In fact, you will need to have both Medicare Part A and Part B to utilize your plan.

This is very different than VA coverage. First, you must have Medicare, secondly, you can choose ANY doctor or hospital that accepts Medicare. Medicare will pay first and TRICARE will pay second, in most cases, you will pay nothing for your care. You can choose a Military Hospital or Clinic, providing there is space available. If you decide to utilize the VA Hospital or Clinic, you will have a higher out-of-pocket expense because the VA is not permitted to bill Medicare. TRICARE for Life is considered Creditable to Medicare, it is advised to NOT cancel your Part B.

It would be our pleasure to work with you, call us and let's discuss additional coverage options.

 

Image_079.jpg Disability & Extra Help

9. Receiving Medicare from Disability and Under 65

When Social Security awards an individual disability benefits, that person will also be awarded Medicare after two years, regardless of age. IF someone was diagnosed with ESRD or ALS, known as Lou Gehrig's Disease, benefits will begin almost immediately.

Turning 65 puts you in a unique position. Although you are already receiving Medicare, either Part A or B or both Parts, you will have a seven month Initial Election Coverage Period because of your 65th birthday. 

Which means:

  • You have the opportunity to enroll in both Parts of  Medicare if you are currently only receiving one.
  • You can elect or change your Part D plan.
  • Your Open Enrollment Period for a Medi-gap plan will begin. This lasts for six months and your premium is NOT dependent on your health. You will be able to select ANY of the Plans your state sells. Some states restrict plan options prior to age sixty-five.
  • You can elect a Medicare Part C plan.
  • If you received ANY type of penalty from Medicare prior to age sixty-five, it will be omitted and you will begin as if you are new to Medicare.

If you have ALL of the Parts of Medicare and are happy with your current plan, you don’t have to do anything, your plan will renew the following Medicare year. However, it is always recommended that you use this enrollment period and the Annual Election Period, AEP, to review your current plan and compare your available options.

Lets work together to get you enrolled and situated. We look forward to helping you through your Medicare journey. Give us a call 1-855-474-6234 TTY 711.


Fixed Income

10. On a Fixed Income and Need Financial Assistance

There are several programs that can assist you with some of the cost in this situation. Each program has income and resource limits in order to qualify. Review the following pages for information on these plans.

You may qualify for Extra Help, also known as Low-Income Subsidy (LIS), to pay for Medicare prescription drug coverage. Extra Help is estimated to be worth an average of $4,000 per year.

To qualify, you must reside in one of the 50 states or the District of Columbia; Your annual income must be limited to $18,090 for an individual or $24,360 for a married couple living together. Even if your annual income is higher, you still may be able to get some help. Your resources must be limited to $13,820 for an individual or $27,600 for a married couple living together. We do not count your home, car, or any life insurance policy as resources SSA.gov

These amounts are current as of October 2018 and are subject to change.

To see if you qualify for Extra Help, you must complete Social Security’s online application for Extra Help with Medicare Prescription Drug Plans Costs, form #SSA-1020. To avoid the inconvenience of standing in line at the Social Security office, you can contact our office to apply: 1-855-474-6234 TTY 711.

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Supplemental Security Income

11. On a Fixed Income and Need Financial Assistance

You can receive a monthly paid amount if you have limited income resources, are disabled, blind or 65 and older. This monthly paid amount will take care of basics needs such as food, clothing and shelter. Although, Supplemental Security Income benefits are not the same as Social Security benefits or Social Security Disability benefits.

To get SSI benefits you must also meet the following conditions:

  • Be a resident of the United States but not live in Puerto Rico, Guam or American Samoa.
  • Not be out of the country for a full calendar month or for more than 30 consecutive days.
  • We can help you find out if you may be eligible for SSI benefits and apply. Call our office and we will make the process easy for you!

Medicaid

12. On a Fixed Income and Considering Medicaid

In this situation, you may qualify for Medicaid as well as Medicare if you have a limited income and resources. If you have limited resources and your gross income is under $1,500 per month you may be eligible for assistance. This is called ‘dual eligible’.

Medicaid is a joint federal and state program that will help you to pay for medical costs. If you are a dual-eligible you may qualify for enhanced benefits by joining a Part C plan.

Medicaid programs vary by state and may be called by different names such as Qualified Medicare Beneficiary (QMB), Medi-Cal or Medical Assistance.1

Applying and checking to see if you qualify for Medicaid can be a confusing process. If you have an expert with you, you will know the right questions to ask. Give us a call and we will contact your State Medical Assistance office and take care of the process for you.

 

 Top 7 FAQ's - Frequently Asked Questions

 

1. I am turning 65 but I am still employed! Should I sign up for Medicare Parts A & B?

Even if you are still working you should sign up for Part A, which may help pay some costs not covered by your group plan. Before deciding whether or not to join Part B, you will need to take into consideration your current health care coverage.

Ask your human resources or union representative If you on a group plan, ask yourself: Does Medicare offer at least the same or better coverage than your current plan? Will joining Medicare be more cost effective? Is your coverage creditable to Medicare?

Call your benefits administrator before you make any changes, or sign up for any other coverage. 1

 

2. At age 65, does Medicare cover everyone or only those who choose to have this coverage?

If you are already receiving Social Security or Rail Road Retirement Benefits when you reach age 65, you will automatically be enrolled in Medicare unless you opt out.

If you are still employed and do not receive Social Security, you will most likely have to choose to enroll in order to begin receiving Medicare benefits.1

If you’re close to 65, but not getting Social Security or Railroad Retirement Board (RRB) benefits, you’ll need to sign up for Medicare. Contact Social Security 3 months before you turn 65.

 

3. Will Medicare cover all my healthcare costs?

Medicare does not cover all of your costs. Your insurance plan—whether you have Original Medicare, Medicare Supplement/Medigap or a Medicare Advantage plan—will determine exactly what benefits you receive. There is always a portion you are responsible for, such as:

  • Original Medicare
    • 80/20 Rule (Look at Medicare & You Handbook)
      • Part A - You pay a $1,340 deductible and no coinsurance for days 1–60 of each benefit period.1
      • Part B - If you have Part B, it generally covers 80% of the Medicare-approved amount for doctor’s services you get while you’re in a hospital.1
  • Premiums
    • Part A - You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working.1
    • Part B - The standard Part B premium amount in 2018 is $134 (or higher depending on your income). However, most people who get Social Security benefits pay less than this amount.1
  • Out of Pocket
    • Part A - You pay $329 per day for days 61–90 of each benefit period. You pay $658 per “lifetime reserve day* after day 90 of each benefit period (up to 60 days over your lifetime).1 You pay all costs for each day after you use all the lifetime reserve days. Inpatient psychiatric care in a freestanding psychiatric hospital is limited to 190 days in a lifetime.1
    • Part B - Under Original Medicare, if the Part B deductible ($183 in 2018) applies, you must pay all costs (up to the Medicare approved amount) until you meet the yearly Part B deductible before Medicare begins to pay its share. Then, after your deductible is met, you typically pay 20% of the Medicare-approved amount of the service, if the doctor or other health care provider accepts assignment. There’s no yearly limit for what you pay out-of pocket.1

4. Does Medicare cover my prescriptions?

Part B covers a limited number of drugs such as injections you would get in a doctor's office, certain oral cancer drugs, drugs used with durable medical equipment such as a nebulizer or external infusion pump and certain drugs you receive in a hospital outpatient setting.

Other types of drugs such as those you take on your own, depends on whether you have a Part D plan or a Medicare Advantage Plan that includes prescription drug coverage.1

Original Medicare does not generally cover prescriptions except in certain settings and situations. Self- administered drugs, or drugs you are prescribed will be covered by a Medicare Prescription Drug Plan known as Part D or a Medicare Advantage Prescription Drug Plan. Each plan will have a formulary which is a list detailing the drugs it will cover. It is important to review a plan’s formulary annually as it may change for the next Medicare Year.

Medicare covers a limited number of drugs like injections you get in a doctor’s office, certain oral anti-cancer drugs, drugs used with some types of durable medical equipment (like a nebulizer or external infusion pump), immunosuppressant drugs (see pages 58–59), and, under very limited circumstances, certain drugs you get in a hospital outpatient setting.1

5. I live on a fixed income and I'm concerned about extra costs not covered by Medicare, how will I pay for them?

There are several programs available to help low-income individuals with medical and prescription costs. You may qualify for programs such as Low-Income Subsidy or Extra Help, Supplemental Security Income (SSI), Qualified Medicare Beneficiary (QMB) which help lower your prescription costs, and/or Medicaid.1

There are several State and Federal programs available to help low-income individuals with Part B and Part D deductibles, co-insurance and premiums costs. These programs are means and asset based. An example of a few of the programs would be SSI, QMB and LIS.

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year.

 

6. What is the difference between Medicare and Medicaid?

Medicare is health insurance for people 65 years or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD) or Lou Gehrig's disease.1

Medicaid is a joint federal and state program that helps pay medical costs for some people with limited incomes and resources . In certain circumstances, you may qualify for both programs and people who do are called Dual Eligibles.

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. (SSA.gov). 
Medicaid is a joint federal and state program that helps pay medical costs if you have limited income and resources and meet other requirements.1

Those who become eligible for both Medicare and Medicaid are referred to as “dual eligible” and will have most of their medical costs covered and may qualify for additional services.

 

7. I still have questions and concerns regarding Medicare. Where can I find more detailed information?

Further information can be found in our New to Medicare Guide 2018. You may also speak with one of our Trusted Senior Specialists by calling toll-free 1 (800) 686-6199.

 

Resources

1Centers for Medicare and Medicaid Services: Medicare and You 2018 handbook. Department of Health and Human Services. November 2017. 15, 19, 21-22, 41, 48, 63, 72-73, 75, 77-80, 87-88, 90, 94-95, 103-104,108, 110.

2 Medicare.gov - The Official U.S. Government Site for People with Medicare. U.S. Department of Health and Human Services. November 2017. http://www.medicare.gov.

3 Social Security - The OfficialWebsite of the U.S. Social Security Administration. U.S. Social Security Administration. November 2017. http://www.ssa.gov.

VA Health Care: Health Care Benefits Overview 2014 handbook. U.S. Department of Veterans Affairs.December 2016. 15.

Centers for Medicare and Medicaid Services: 2018 Choosing a Medigap Policy guide. Department of Health and Human Services. December 2016. 5, 9, 10-14.