Turning 65 and Medicare Eligible now?  Congratulations, your health plan situation is about to get better!  How often can you say that these days? Here’s what you need to do to get started:

 

Medicare has four parts: Parts A, B, C, D. These four parts together provide the basic medical coverage to those who are 65 years and older.  However, you must consider what is covered and what is not covered to truely understand what your out of pocket costs will be. 

 

Step 1)   First you must make sure you have ‘Medicare Part A’, and then next you need to elect ‘Medicare Part B’   

 

To enroll in Medicare/Medicare Supplement at age 65 the individual with the Federal Social Security Department you must have both of these pieces in place.

 

1) What is Medicare Part A (Hopsital Care)?

 

Medicare Part A is the part you pay into automatically when you work all your life through w2 payroll.  Once you have 40 w2 payroll quarters completed you qualify for Medicare Part A.

 

Medicare Part A is the portion of your plan which mainly covers Hospitalization.  The Part A Hospital deductible is currently $1,288 per year. It also includes coverage for areas such as:

 

• Skilled Nursing Coverage

• Hospice Care

 

2) What is Medicare Part B (Doctors, Medical Procedures, Equipment)?

 

Medicare Part B is the Physician Services and Outpatient portion of the Medicare plan coverage.  It has a $183 annual deductible this year. After the deductible is reached you are responsible for 20% of the costs.  Medicare Part B provides you with coverage for areas such as:

 

• Outpatient Surgery

• Doctor’s Office Visits

• Medical Supplies

• Physical Therapy

 

This is done by contacting your local social security office or online at the Federal SSA website.  To look the office up by city or county here’s the location directory:

 

MEDICARE.GOV

 

 

Or at website apply for Medicare Benefits online:

 

https://www.ssa.gov/onlineservices/

 

You can also apply over the phone by calling 1-800-772-1213

visit a local social security office

 

Step 2) Once your ‘Medicare Part B’ is elected you can enroll in a ‘Medicare Supplement’ to cover the gaps in Medicare.  This is also somes referred to as Medigap coverage. It pays for your Hospital deductibles and the 20% out of pocket on physicians services coinsurance, surgeries, office visits etc..  If you get a good Medicare Supplement plan, you can eliminate many general medical expenses from your out of pocket costs.

 

3) What is Medicare Part D (Prescription Drug)?

Most people enroll automatically in Original Medicare Part A and Part B when they reach 65 years old.  However, what most don't realize that Original Medicare Part A and Part B do not cover many of the medications you many need with the exceptions of those medications you get if you are hospitalized or sometimes for outpatient care).  Medicare Part B does cover some prescription drugs in an outpatient capacity for instance in a setting like a physician's office for medication such as infusion drugs.

 

You will need to be enrolled in Original Medicare Part A and Part B in order to purchase Medicare Part D Prescription coverage.  Medicare Part D is an optional coverage that if you take regular prescriptions will be a valuable benefit to have.  In order to enroll in Medicare Part D, you will need to sign up at the same time as when you sign up and become eligible for Original Medicare Part A and Part B.  If you miss this enrollment window, you may have to pay a late enrollment penalty.

 

4) What is Medicare Part C, also known as a Medicare Advantage Plan?

 

Medicare Part C Plans are also known as Medicare Advantage Plans. These are private insurance plans approved by the federal Medicare agency.  These plans are for those individuals who are enrolled in Original Medicare Part A and Part B.  If you enroll in a Medicare Advantage plan you remain enrolled in Original Medicare Part A and Part B and you will need to continue paying for your Part B premiums.

 

A Medicare Advantage plan will cover all of your Part A (hospital) and Part B (medical). These Medicare Advantage will usually offer other benefits such as Vision, Dental, Hearing and some prescription drug coverage.

 

With a Medicare Advantage you many save some money in out of pocket costs because they are usually lower than with Original Medicare Part A and Part B.  There are many Medicare Advantage plan options including cost, plan type, services etc., therefore it is important to get a comparison of all available Medicare Advantage plan in your area.  

 

Medicare Advantage Plans offer HMO, PPO, Private fee for service, Special needs plans, HMO point of service, and Medical Savings Accounts.

 

You can enroll and join a Medicare Advantage Plan if you:

• Live in the service area of the plan

• Must be enrolled in Original Medicare Part A and Part B

• You don't have end stage renal disease (there may be exceptions to this rule)

 

What are Medicare Supplements and Why You Need Them

 

With Original Medicare Part A & Part B, many consumers do not understand that Part A and Part B does not cover all medical expenses.  Deductibles, co-pays and co-insurance are not covered by Original Medicare Part A and Part B, therefore leaves the consumer with a "gap" in coverage with out of pocket cost that are not covered.  On average Part A and Part B only covers about 80% of medical costs.  A Medicare supplement plan is meant to help fill in the "gaps" of coverage and are often referred to as Medigap coverage.  There are many options for Medicare Supplements in California.  We will review each one for their benefits and coverage sum

 

Medicare Supplement Comparison Chart

 

The chart below shows basic information about the different benefits Medigap policies cover.

 

Yes = the plan covers 100% of this benefit
No = the policy doesn't cover that benefit
% = the plan covers that percentage of this benefit
N/A = not applicable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,240 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 an inpatient admission.

 

*source: medicare.gov

 

 

 

MEDICARE SUPPLEMENT "F" PLAN

 

Why buy the F plan?

 

We recommend the Medicare Supplement F plan for lots of good reasons.

 

Exact Same Coverage Available Everywhere

 

The plan benefits for Medicare supplement ‘F’ plans, which is by far our most popular Medicare Supplement plan, are all the same.  So, it doesn’t matter what insurance company you buy from: the F plan medical coverage at any of them is exactly the same.

 

No Guesswork!

 

This takes the guesswork out of comparing the coverage once you’ve decided this is the right plan for you. Just focus on the all the other little things like customer service, pricing, website services, and reputation.   These areas are not as confusing as health plan benefits and the comparison comes more easily to most people. The Medicare Supplement F plan is available from some of these leading California insurance companies who have great options:

 

-AARP/United Healthcare PPO

 

-Blue Shield of CA PPO

 

-Anthem Blue Cross PPO

 

-Health Net of CA PPO

 

-Aetna PPO

 

We look at these different companies for different reasons in each individual case.

 

When does the F plan pay medical bills?

 

In general, the Medicare Supplement F plan pays whenever Medicare pays on a claim, and the F plan supplement picks up your out of pocket costs with only foreign travel expenses as the exception.   This is great, because you’re typically not left wondering when your supplement will kick in and cover you when you need it.

 

What are some examples?

 

Let’s take a look at some examples.  Let’s say disaster hits and you have a car accident.  The hospital stay is $64,000 and you are hospitalized for 4 days.  Here’s how Medicare + the Medicare Supplement F plan will cover you:

 

Hospitalization

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Whoa! Wait a minute...you pay $0?  Correct, unlike regular health plans where you pay the deductible, with Medicare + supplements the F plan pays your deductible for you.  Your inpatient hospital charge out of $64,000 is zero out of pocket for a 4 day stay.

 

Outpatient Surgery

 

 

 

 

 

 

 

 

 

 

 

 

 

What is Medicare Supplement vs. Medicare Advantage? Which is better? 

 

There isn't one plan that is better than the other, however, one might be better for your needs than the other.  Look at it this way, A Medicare supplement plan (Medigap) is insurance coverage that you can add to your Original Medicare Part A and Part B to give you additional benefits coverage.  A Medicare Advantage plan or Part C should be looked at as an alternative option to Original Medicare Part A and Part B.

 

Both of these options,  Medicare supplements, and Medicare Advantage plans are private insurance plans that are not part of the federal Medicare program. However, Medicare has approved these private insurance plans.

You need to remember that you will need to continue to pay your Medicare Part B premium to Medicare even if you choose a Medicare Supplement plan or a Medicare Advantage plan.

 

Here's a closer look at the differences between a Medicare Supplement and a Medicare Advantage Plan.

 

 

Doctors and Hospitals:

 

Medicare Supplement: As long as the provider is accepting Medicare patients, you have the freedom to select your doctor or hospital

 

Medicare Advantage Part C:  You may not have a choice, you may have to use a doctor or hospital in the insurance carrier network.

 

Specialist Referrals:

 

Medicare Supplement:  You can see any specialist without a referral from a primary care physician as long as they are accepting Medicare patients

 

Medicare Advantage Part C:  You may need a primary care referral and you many only be able to see an in-network specialist.

 

Provider Network:

 

Medicare Supplement:  Your plan covers you where you go, anywhere in the United States without any network restrictions.

 

Medicare Advantage Part C:  There are network restrictions, however, your plan should cover emergencies across the United States and possibly abroad.

 

 

Enrollment Process:

 

Medicare Supplement:  You can enroll anytime after you turn age 65 AND join Medicare Part B.

 

Medicare Advantage Part C:  There are specific enrollment periods throughout the year in which you can enroll or make changes.

 

Cost:

 

Medicare Supplement:  In addition to paying your monthly Medicare Part B premium to Medicare, you will most likely have an additional premium for a Medicare Supplement plan.  The out of pocket costs will be limited when you use your plan.

 

Medicare Advantage Part C:  In addition to paying your monthly Medicare Part B premium to Medicare, you will likely have a low to $0  monthly premium for your Advantage plan.  You will pay each time you use your plan, co-pays, deductibles, and co-insurance.

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Prescription Drug Coverage:

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Medicare Supplement:   Your prescription drugs are not covered.  You may want to consider a Medicare Part D, Prescription Drug plan.

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Medicare Advantage Part C:   With most Advantage plans, most prescription drugs are covered.