Source
A very good video: https://go.medicareschool.com/20-minute-workshop-page-v2?first_name=melva&last_name=gifford&email=Melva%40melvagifford.com
Here are my notes:
- Initial enrollment plan: starts at 65 or when you retire. Medicare supplement
- enrolls at 3 mo. before 65th
- j-l-564 > is the proof employee has had insurance.
- Medicare started in 1965
- At 65 starts IEP must enroll within 7-month windows. starts 3 mo. before birthday. If still working. you take SEP if you are working. L-564 creditable coverage and CMAS-409 B
- See if it would be better to use your work insurance or Medicare. influence by deductibles and a monthly cost.
- Use a broker to help you choose your plan. captured agents promote their own products.
Alternatives:
- A & B only. A is a $0 premium B is $164 a month. Choosing this is discouraged because of high risks.
- A & B w/ supplemental plan and rx (prescription plan). Will need to pay a premium. May range from $90 to $125 a month.
The prescription plan is one you get to choose. This is Medicare Part # (Rx plan) It also has a premium running between $5-$30.
And afford the premium. It is recommended to choose this over A&B only.
- A & B replaced by “C” plan which is an advantage plan.
A prescription plan with be included with C.
- Medicare part # (RS Plans
has a network of pharmacies.
some pharmacies will be labeled preferred because they have better prices.
other pharmacies are labeled as standard. Your copays will be a little higher
Formulary: is nothing more than a list of medications that are covered by the plan. One not covered by the plan will sell at a higher price.
Term: Prescription plans are set for a year. If you want to change prescription plans you must do so between the dates of Oct 15 to Dec 7th
Phases:
a deductible is phase one $505. and your copays are applied to the deductible.
- copay. go to this is you met the $505 of the deductible. If the cost of the prescriptions paid by insurance reaches $4660 we move to the coverage gap
- coverage gap (donut hole) We have to pay 25% of drug cost. insurances are supposed to cover 70″% of the cost. If you go past this level you go to a catastrophic phase.
- catastrophic is 5%
select which is best
Do not be tempted to avoid prescription plans. You can’t predict what you’ll need.
Two options for prescription: supp _ rx or Advantage.
If you want to move from one to the other the insurance co has to options to reject having you.
Supp + RX
- must be enrolled in A&B
- will take any Medicare provider
- premium based.
- you get to choose your own rx plan.
- do not require pre-authorization. If the doctor says you need it you can do it.
- is a lifetime policy. the only way to break it is if you don’t pay the premium. It folow you no matter where you go.
Advantage:
- must be enrolled in A & B
- must choose hmo or ppo.
- pay as you go.
- the advantage plan will select your prescription provider.
- requires pre-authorizations Isurnce has control if they accept what the dr. recommends or not. 70% of dr. requests have to be approved. The provider has to provide paperwork to support their recommendations. Sometimes they’ll suggest alternative action or straight reject it.
- is renewed annually, do open enrollment each year.
A&B
A&B: A is $0 premium B is $164 a month
Part A is hospitalization, hospice or extended care
- Gaps in coverage $1600 deductible for first 60 days.
- If longer than 60 days second gap is 400- $800 hospital copay a day.
- $200 skilled nurse copay per day.
- Part B doctors etc. $164.90 mo. Premium
- 225 deductible resets in Jan of each year
- You pay 20% of the medical bills if you don’t have other insurance. No max.
- Excess charge pay 15% charged by some doctors
- Many people don’t want to pay all the part B so thei will by Medigap G to fill in the gap of medical costs. Medigap G will cover all expenses of Part A and Part B except for the $226 deductible of Medicare B. All else is paid for a and b.
- You pay a premium to an insurance company to have medical coverage. Told its reasonable costs.
- Medigap N is an alternative to Medigap G. Medigap N covers all expenses for Plan A and plan b excetps part B deductible (225) and excess charge of $15%.
- Medigap N will require you to pay $20 copay for adr. and $50 for specialists.
- When you start Plan B you have six months to choose between plans without an exam.
Medicare Advantage Plan:
10 features on Advantage plans
- Advantage plans replace original Medicare.
- Is provided by a private insurance company.
- You have to be enrolled in A & B. premium of $164.90
- Must live in th plan’s service area.
- You must choose a network of Providers (HMO or PPO) So doctors do not subscribe to hmo or ppo.
- advantage plans have Low or No monthly premiums. Some may be less than $30 a month.
- You pay-as-you-go system which includes copays and deductibles.
- There is an annual max-out-of-pocket (called NOOP) All premiums and copays go toward the max out-of-pocket. Max will reset every January.
- Each plan includes prescription costs determined by the plan you choose. including drugs for in-patients or out-patients.
10 Perks included. they might put in a dental or vision allowance. May be a hearing aide or a guy membership. Maybe over-the-counter meds.
Changes in 2024:
Part A monthly premium $174.20. If your income was higher than $97K (single) Irmaa your will also increase.
Part A deductible $1632 monthly premium 1-60 days.
Part A Daily hospital copay 21-100 days cost $204.
Medicare Part B from 226 is now $240 mo. Premium. Resets each Jan.
- Medicare Part B deductible $408-$816.
- Part B $204 for days 21-100. An average day is 35 days.
- Low income people can apply to MSP (Medicare saving programs) or LIS (low income subsidy. More people are eligible.
Part C (advantage plan or replacement sales. Offered by private insurance plans. Oct 15 to Dec 7th.
Part D (prescriptions) : $0 copay for castrpadic Is now $2K max deductible.
Supplemental: F, G or N. If you move to part C (Advantage) there is a preauthorization needed)
3 Changes to social security
- Max taxable income $168,600
- COLA (cost of living Adjustments) cost of services is increased to 3.2. increase from $50-110.
- Earnings Test: age 62 to retirement.) if get insurance before age of retirement.
- 22,320 take 1 Dollar of 2 earned.
- 59,250 of 1 dollar from every 3 earned.
- At retirement age: The Earnings test does not apply. has nothing to don pension income, annuity, 401 K, distribution of ira. Only wages and net self-employment income.