Everything You Need to Know About Medicare
Voelker Insurance Agency LLC is here to explain Medicare and its advantages. Call (574) 310-9718 today. We proudly serve the Michiana area, along with clients in 8 states.
Confused About Medicare?
Two Directions You Can Go!
Original Medicare
Part A Hospital
Part B – Medical
Medicare RX Plan
Medigap Plan
Medicare Advantage
Also Called Part C
Common Benefits
Medicare Roadmap & Basics
Medicare is for people aged 65 and up and those with a specific disability. Medicare comprises Part A (Hospital) and Part B (Medical). Medicare generally covers 80% of your medical expenses. The premium on Part A may be zero if you have worked in the US and paid Medicare taxes for at least ten years (40 quarters). If you have worked in the US for less than ten years, you may have a monthly premium for your Part A.
Most people pay for Part B ($164.90 in 2023). It may be more if you have a high level of income, and Part B may be covered by your state if you also qualify for Medicaid. You may also postpone having Part B if you plan to continue working and you are enrolled in your employer’s group health insurance plan.
When you have your Medicare A & B, you may enroll in a Medicare Supplement + Prescription (Part D) plan OR a Medicare Advantage plan (with Part D included). You have three months before your birth month + your birth month + 3 months after. (Example – If you were born in April, your Initial Enrollment Period = Jan, Feb, Mar + April + May, June, July). Contact Me to help you get your Part A & B and look at your options. You’ll want to find a plan tailored to your needs, which includes your doctors and prescriptions at the lowest possible cost.
Is your income low enough to qualify for Extra Help? If you aren’t sure,
Contact Me, and we can help you begin that process.
Medicare Supplement/Medigap Plans
You can choose to have a Medicare Supplement plan (also known as Medigap) to go with your Medicare Part A & B. The Medigap plan pays the other 20% of medical expenses, with Parts A & B covering 80%. You should also know that you will pay the first $226 for the year (2023 Part B Deductible) and that if A & B does not cover it, the Medigap plan does not cover it either. (Dental, Vision, Hearing). Medigap plans also do not include Part D, so you’ll need that, also. Any doctor who accepts Medicare should also accept your Medigap plan.
You can expect your monthly premiums on your Medigap plan to increase each year with age. Because a Medigap plan agrees to cover the other 20%, an application typically includes questions on your health and prescriptions. When you first turn 65, you’ll have an initial enrollment period where you may enroll in a new Medigap plan without needing to answer health questions. Some states, such as Nevada, also include a Birthday Period, which may allow you to shop for lower rates without health questions.
Contact Me for more information and rates on Medigap plans in your area.
Medicare Advantage Plans
Most TV ads you see for Medicare are Medicare Advantage (also known as Part C) plans. With these plans, your Medicare A & B is managed by a Health Insurance carrier instead of the US Government. The health carrier usually also includes your Part D drug coverage and may also include added benefits – Routine visits for Dental, Vision, and Hearing, along with allowances to cover basic needs in these areas, Over the Counter Allowances, Tele Health, and Senior fitness programs are other common benefits. Some plans may even offer benefits such as a Healthy Groceries allowance or a Part B Giveback, which lowers what you may pay for Part B. Contact Me to learn what plans are in your area, along with benefits.
Advantage plans also include copays for things such as hospital stays, emergency care, and outpatient testing or treatment. There is also a Max Out of Pocket which limits your medical costs. Contact Me to learn ways of covering these types of copays.
Medicare Advantage plans are subject to an Enrollment Period. The most common is Annual Enrollment (October 15 – December 7). There is also Open Enrollment (January 1 – March 31), where you may change from your current Medicare Advantage to another one. You may have a Special Enrollment Period when you retire from your employer and give up your group insurance, move to a new area, or have a chronic illness, such as diabetes. Contact Me to see if you may qualify for a Special Enrollment Period.
Medicare + Medicaid Plans
Are you on Medicaid AND Medicare? Medicaid is sponsored by the state and may apply if you receive a very limited income. If you qualify, Medicaid may help cover your costs on prescriptions and Part B premium. Most states offer special Medicare plans (also called Dual Eligible or DSNP) for someone on both programs. These plans usually offer even more benefits, along with lower copays (often may be 0). Someone on both plans may also have an opportunity to enroll in a new plan once every 3 months if they choose.
Contact Me
to see if you want to learn more about how to apply for Medicaid or if Dual Eligible Medicare plans are offered in your area.
Medicare Prescription Drug Plans
Medicare DOES require that you have a Part D Prescription plan while you receive Medicare. If you DO NOT have Part D and add it later, you will be subject to the Part D penalty. There are two basic ways to get your Part D plan. Many opt to include this as part of a Medicare Advantage plan. For those who are using the Medicare Supplement type of plan, you will need a separate Part D plan. Part D plans will look at the prescriptions you use to determine your costs. Prescriptions are grouped into Tier levels, generally Tier 1 through Tier 5. Contact Me with a list of your medications, and we can use those to figure out which plan will give you the lowest possible costs on those drugs.
If you are a military veteran, you may already be using the Veterans Administration (VA) for prescriptions. This can be used to fulfill your Part D requirement. You may still get a Medicare Advantage plan for benefits in addition to Medicare A & B.
Contact Me for details.