Making Sense of Medicare

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Full disclosure: I am an independent insurance agent licensed to offer many variations of coverage with all the top insurance companies. I highly suggest working with a licensed, experienced, knowledgeable insurance agent. Agents are paid by the insurance company, and you usually pay nothing for the help and assistance of an agent who can help you choose coverages from one year to the next based on your needs, preferences, risk tolerance, and budget.

There is a lot of confusing information out there and in some cases contradictory. That can be due to different rules and regulations of different states. In many cases it is simply misinterpretation of information read on the interweb and then shared among friends and family.

To begin: one becomes eligible for Medicare either at age 65 or after 2 years of being disabled. Eligible individuals have the 3 months prior to turning 65 to begin the enrollment process. The effective date will be the first of the month you turn 65, or if your birthday is on the 1st day of that month, your Medicare will begin the prior month. Part A (Hospital) is almost always zero cost, Part B does though have a monthly cost. In 2024, the base cost is $174.70 a month per person. That cost can be higher or even lower based on personal or household income.


Generally speaking, there are two directions to choose from when it comes to Medicare coverage: Medicare Advantage (Part C) or a Supplement (Medi-gap) plan with a Part D drug plan. Part C plans are usually zero premium and often include extra benefits including dental, eyewear, OTC allowance, and even reimbursements for buying items supporting activity and exercise. Most part C plans have little to no deductible, with fixed copayments for each category of service received. Part C plans often include drug coverage as well. These plans have provider networks. Some cover you only in network (HMO), others have out of network (PPO) benefits as well as local or national provider networks to consider. Emergencies are usually covered across the globe on all plans. DON’T PANIC: Currently one popular insurance company is going through its normal negotiations with provider groups but must inform their members that there is potential for a change in the network. This is causing anxiety among those members, however, they nearly always come to an agreement and no change in the network occurs.

The other option is a combination of a Supplement plan and Part D plan. If you or anyone you know has a Plan F supplement, they should really consider changing plans and saving money! There are 2 very popular plans now offered by many companies. Those plans are exactly the same from one company to the next but are offered at different prices. So, choose the best priced supplement for the plan you want. LITTLE KNOWN FACT: The supplement can be changed any month during the year. So, if your needs change or the prices change you can adapt to the best option from one month to the next. The part D drug plan can only be changed during the fall annual election period, unless income is low enough to allow more frequent changes.

Many people I speak with are deciding on when to retire and part of that decision is how much medical coverage will cost. GOOD NEWS: Medicare is often less expensive and has better coverage than the employer plan they are contemplating leaving. I also strongly suggest, all Medicare beneficiaries review options and needs each fall to make the most informed decision for the following year as needs and plans do change from year to year. MORE GOOD NEWS: There is strong likelihood that beginning in 2025 prescription costs for those on Medicare will be significantly reduced to a much lower cap than the current out of pocket limit.

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