Medicare
Medicare is a big switch to make and along with that comes a lot of questions.
We take the complicated world of Medicare and simplify it for you so that you can feel great about making the right decisions for your life and health!
Learn the Basics of Best Medicare Advantage Plans
Original Medicare
(Parts A & B)
- The federal health insurance program for US residents ages 65+ or those with certain medical conditions
- Part A - Hospital Insurance
- Part B - Medical Insurance
Medicare Advantage
(Parts C)
- Bundles Parts A, B & sometimes D into one convenient plan
- Added benefits may include:
- Dental
- Vision
- Hearing
- Free Gym Membership
- Most plans have a $0/monthly premium
Medigap Supplement
(Parts A-N)
- A standalone plans that "fill in the gaps" of Original Medicare
- Freedom to choose doctors without referrals
- No Co-pays
- Coverage anywhere in the U.S.
Prescription Drug Plans
(Parts D)
- A required plan that helps cover the cost of certain medicines
- Plans start at less than $10/month
- Extra Help program may reduce drug costs to as low as $0 for low income individuals
Please reach us at info@rickiwilliams.com if you cannot find an answer to your question.
Original Medicare FAQs
- Hospital stays
- Emergency room visits
- Care in a skilled nursing facility
- Hospice
- Some at-home health care
Part B* (Medical Insurance) which covers:
- Primary & Specialist doctor visits
- Outpatient care
- Medical supplies
- Preventive services
*Monthly premiums, deductibles and co-insurance may apply
Part A Premiums: For the majority of working Americans, you will be eligible for premium-free Part A benefits if you or your spouse paid Medicare taxes for at least 10 years (40 quarters) and are eligible to receive Social Security benefits now or in the future. In some instances, a senior may have to pay a monthly premium. Go here to get more info on Part A premiums.
Part A Deductibles/Coinsurance: This is the amount your must pay first before Medicare pays for eligible services. For 2023 this amount was $1600. Go here for the most recent info on Part A deductible and coinsurance costs.
Part B Premiums: Every person who is eligible to receive Medicare will face a Part B premium which is based on the beneficiary’s yearly income. For instance, in 2023 your Part B premiums were based on your 2021 income. Those who are above the income threshold will face IRMAA (Income Related Monthly Adjustment Amount). Find out more about the current and upcoming Part B premiums and income limits by going here.
Yes, you are required to have a qualifying drug plan in place once you become eligible for Medicare. Failure to do so means that you will likely face a penalty if you are without coverage for more than 63 days in a row after turning 65.
Part D prescription drug coverage is not included in Original Medicare, which means you will need to pay a separate premium to have a plan that covers the cost of your prescription drugs, unless you choose a zero or low cost Medicare Advantage plan that includes coverage for prescription drugs.
You become eligible to enroll in Medicare when you turn 65 or have been fully disabled for two years. Some people will be automatically enrolled in Parts A & B, while others must enroll themselves. Once you become eligible, the initial enrollment period is a 7-month timeframe that includes the three months prior to your birthday, the month of your birthday, and the three months after your birthday.
Set up your free account at ssa.gov to get an estimate of your Social Security benefits and to register for your A & B benefits. Remember, you must also buy either a standalone Part D drug plan or a Medicare Advantage plan with drug coverage, otherwise you may incur a penalty.
It depends. There may be help available to you if you meet certain income requirements. You may qualify for:
Low Income Subsidies, also called Extra Help, which can help cover some of your out-of-pocket prescription drug costs. Click here to learn more about how Low Income Subsidies work.
Medicaid, which is state-sponsored coverage that may pick up the costs of your Part B monthly premium, as well as other services like hearing, eyeglasses, prescription drugs, and some long-term care. Go here to learn more about Medicaid income eligibility requirements. If you do not qualify for Medicaid, Low Income Subsidies may still be a good option to apply for.
Medicare Advantage FAQs
Medicare Advantage is a “bundle of services” offered by private insurance companies which include your Part A & B coverage, usually Part D coverage, and often times many added benefits that are not included in Original Medicare, such as hearing, dental, vision, complimentary gym memberships, and more!
The other advantage to having a Medicare Advantage plan is that your out-of-pocket expenses for covered services are capped (varies by plan and company), whereas Original Medicare has no such cap and out-of-pocket expenses are unlimited.
Many Medicare Advantage Plans have a $0 monthly premium. If you choose a plan that does have a monthly premium, it is generally still very low.
* Remember: Any monthly costs are in addition to your monthly Part B premium.
An HMO, or Health Maintenance Organization, is coverage that restricts the beneficiary to a plan-approved network of doctors. HMO’s will also require that you obtain a referral by your Primary Physician in order to see any specialists. The main benefit of this type of coverage is that out-of-pocket expenses are typically lower and it usually has richer benefits. There are also hybrid plans called HMO-POS that do not require referrals.
A PPO, or Preferred Provider Organization, is a type of coverage that allows more flexibility to the beneficiary because they are less restricted to a network and referrals are not required. The main downside to a PPO is that out-of-pocket expenses tend to be higher and benefits are not as rich.
The Medicare Annual Enrollment Period runs from October 15th – December 7th every year. Beneficiaries have the option to auto-enroll to stay in their current Medicare Advantage plan, enroll in a new plan or go back to Original Medicare Parts A & B only.
Go here to learn why we suggest not auto-enrolling before speaking to a licensed broker.
If you are a current Medicare Advantage plan member, you may make a one-time change to your plan by either:
Disenrolling in your current Medicare Advantage plan and switching to a different one, or
Go back to having Original Medicare only
The Medicare Advantage Open Enrollment Period runs from January 1 – March 31.
Special Enrollment Periods depend upon certain circumstances, and may be available outside the usual enrollment periods year-round. Some ways you may qualify for a Special Enrollment Period include:
Retire and lose your employer coverage
Move to a new plan service area, even if it’s within the same state
Newly qualify for extra financial assistance
Have been diagnosed with certain qualifying chronic health conditions
Live in a federally declared disaster area
If any of the above scenarios apply to you, please reach out to us and we’d be happy to help you understand your options!
It depends. There may be help available to you if you meet certain income requirements. You may qualify for:
Low Income Subsidies, also called Extra Help, which can help cover some of your out-of-pocket prescription drug costs. Click here to learn more about how Low Income Subsidies work.
Medicaid, which is state-sponsored coverage that may pick up the costs of your Part B monthly premium, as well as other services like hearing, eyeglasses, prescription drugs, and some long-term care. Go here to learn more about Medicaid income eligibility requirements. If you do not qualify for Medicaid, Low Income Subsidies may still be a good option to apply for.
Yes! Although many people think they will lose their TFL benefits, that isn’t the case at all! In fact, many insurance carriers have created Medicare Advantage plans designed specifically for retired military veterans.
These plans are unique because they have been designed to work in tandem with your Original Medicare and TFL benefits, while offering many other additional benefits that only Medicare Advantage has to offer.
Medigap Supplement FAQ's
Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare. You must have Original Medicare – both Part A (Hospital Insurance) and Part B (Medical Insurance) – to buy a Medigap policy.
You may not have both a Medicare Supplement plan and a Medicare Advantage plan at the same time.
You become eligible to enroll in a Medigap Supplement when you turn 65. There are NO enrollment period restrictions, meaning, you may enroll or choose a new plan at anytime of the year. However, you may be asked a series of health questions, and it is possible to be denied coverage for those that turned 65 more than 6 months ago. Beneficiaries have guaranteed acceptance into a Medigap policy beginning the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B.
Set up your free account at ssa.gov to get an estimate of your Social Security benefits and to register for your A & B benefits. Remember, you must also buy a standalone Part D drug plan, otherwise you may incur a penalty.
Plan benefits are structured uniformly across all 50 states, however the monthly premiums will vary from company to company. As an example, a Plan G Supplement in North Carolina must have the same coverage benefits as a Plan G in Florida, however the monthly premium will vary between those states. Similarly, a Plan G in the same state may be offered by many companies, but the premium prices will likely differ. And keep in mind, Medigap Supplement plan premiums are paid separately and in addition to your Medicare Part B & D monthly premiums.
*Also, as a special note, if you are enrolled in a Medigap Supplement, you may elect to switch to a a different insurance company at any time of the year without penalty. Underwriting may be required.
Prescription Drug Plan FAQs
Yes, you are required to have a qualifying drug plan in place once you become eligible for Medicare, or you may face a penalty if you are without coverage for more than 63 days in a row after turning 65.
Part D prescription drug coverage is not included in Original Medicare, which means you may need to pay a separate premium to have a plan that covers the cost of your prescription drugs, unless you choose a zero cost Medicare Advantage plan that includes coverage for prescription drugs.
It depends. There may be help available to you if you meet certain income requirements. You may qualify for:
Low Income Subsidies, also called Extra Help, which can help cover some of your out-of-pocket prescription drug costs. Click here to learn more about how Low Income Subsidies work.
Medicaid, which is state-sponsored coverage that may pick up the costs of your Part B monthly premium, as well as other services like hearing, eyeglasses, prescription drugs, and some long-term care. Go here to learn more about Medicaid income eligibility requirements. If you do not qualify for Medicaid, Low Income Subsidies may still be a good option to apply for.
Medicare Basics Brochure Downloads
Your Medicare Benefits Booklet (pdf)
More Questions?
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When it comes to your healthcare choices, you deserve to have a trustworthy advocate on your side. Medicare can be a complicated issue, and because of that, we are committed to taking the time to understand your needs and get you in the right plan (or keep you in the right plan).
If you’re ready to speak with someone who can help simplify the process and clearly explain your options, please click the button below to request a free, no-obligation policy review. Or, if you just need a question answered, we’d be happy to help with that too!
Contact us today and we’ll get right to work for you!
