Turning 65? Looking at Medicare?
3 Part Helpful Guide
by Ron Davis at Davis Insurance
January 1,2018; I was welcomed to Medicare as one of the programs newest beneficiaries. Hard to believe 65 years have passed and I reach this stage of my life. There were times I never thought I could have gotten this far, but I did. So, let’s talk about Medicare.
Since 1998 I have been involved in advising clients about the benefits of Medicare and what each Medicare beneficiary needs to do as an individual. The working parts of Medicare are strangely hard to navigate if you don’t have any clue what to do when you reach your Medicare eligibility date.
Medicare eligibles start on the first day of the month of your 65th birthday or the preceding month if your birthday falls on the 1st day of your birthday month. If you are disabled and drawing Social Security Disability benefits for 2 years, then you will automatically will be enrolled in Medicare.
So, what happens next? When you are enrolled you receive Part A benefits which covers your hospital type benefits which covers hospitals, skilled nursing, blood in hospital, and hospice. You receive Part A automatically when you turn 65 and then you must enroll in your Part B benefits by either contacting Social Security or doing your own enrollment by going to www.SSA.org and enroll online. It is simple to do, I did it in less than 10 minutes. Part B benefits include all your outpatient benefits, doctors, testing, diagnostics, outpatient rehabilitation and several other items. You will pay a premium for Part B benefits that is generally deducted from your Social Security check if you are drawing Social Security. If you haven’t started drawing Social Security, you will be billed by Medicare on a quarterly billing cycle. Your premiums are generally $134.00 for 2018, but could be higher if your income is higher than $170000.00 for a household of 2.
Next, you must be reminded that Medicare only covers 80% of your medical claims. That is why you need to have a licensed insurance agent to help you finish your benefits. You have 3 choices to finish out your benefits. 1st, is a Medicare Supplement. 2nd is a Medicare Advantage or 3rd, is go naked. Every agent will make sure that taking the 3rd option is a bad move. Why? Because Medicare has NO liability limits. If you have a $100000.00 event, you owe $20000.00. So, it is very important how you determine what to do next.
Medicare Supplements are the original extension of Medicare. Medicare Supplements cover the balance of what Medicare covered, so that covers the $20000.00. Medicare Supplements have no networks, you can go to any provider that accepts Medicare.
Medicare Advantage (MA) plans are issued by private insurance companies and cover all benefits that Medicare approve. Most Medicare Advantage plans include prescriptions (MAPD). MAPD plans have networks that must be used except emergency or urgent care. The most common MAPD plans are HMO (Health Maintenance Organizations) and PPO (Preferred Provider Plans). HMO plans, you must have a PCP (Primary Care Physician) that coordinates your care. PPO plans, have both in and out of networks, you do not need a PCP. MAPD also have additional benefits that Medicare generally does not cover. And those non-covered benefits, like routine services IE, eye exams, hearing exams, foot care, and dental. With MAPD plans you pay copays at time of service with a MOOP (Maximum out of Pocket). MOOP’s vary by plans and insurance companies but range from $2800.00 to $6700.00. A MOOP means if your copay total reaches the MOOP, the insurance company pays generally 100% for the rest of the year.
My experience with Medicare. First off when you become eligible for Medicare, every insurance copay wants your business. And generally, 3 to 6 months before your birthday, they start sending you advertisements to encourage you to contact them. I personally received from October 1 to current, over 100 marketing pieces in the mail. For the average person, this makes your decisions very complicated. Complications like this could be very detrimental to each Medicare beneficiary decisions. That is why a licensed insurance agent, trained in the Medicare arena will be to your benefit.
All agents go through extensive training and certification each year. Medicare requires that a comprehensive training and testing approved by Medicare must be completed. Then every insurance company requires another set of training and testing for their plans. So, I would estimate that every agent should have between 40 and 120 hours of trainings and testing each year.
Now since I am a licensed insurance agent, trained and certified, I pretty much knew what way I was going to receive my Medicare benefits. The first thing I did, in October I went online to www.SSA.org and enrolled in my Medicare benefits. Remember, when you turn 65 you automatically receive your Part A benefit of Medicare, but you must do your enrollment in Part B. Why would you have to do Part B on your own? Well if you are still covered through an employer or under a spouse’s insurance you may not need Medicare Part B. Therefore, I advise all clients, in that situation to review your benefits both ways. Sometimes Medicare is more beneficial than your employer or spouse insurance. So, because I travel a lot through the year in the US, I decided that a Medicare Supplement and a Stand-Alone Prescription Plan (PDP) would be the most prudent way for me to go. This way I would never have to worry that I may be out of network anywhere I was.
My first Medicare appointment with my doctor is always called the “Welcome to Medicare Appointment”. My doctor went through a short questionnaire with me. It goes through the questions you probably have been asked before. Most questions are concerned about the things you do in your everyday life. Do you exercise, smoke, drink alcohol, socialize with others, are you depressed, what medications do you take and so on. Then a complete physical with doctor, eye test, weight and height, and full lab tests. Then after the physical, any other conditions that may need to be explored further with other specialist doctors would be suggested and maybe scheduled.
So, in conclusion, I hope that this 3 Part explanation of Medicare, Medicare Supplement and Medicare Advantage Plans and your Medicare Wellness Examination helps you get through the mire of Medicare. Remember that a licensed insurance agent helps you navigate through all the Medicare issues and concerns. An agent is a means for you to feel confident that your Medicare benefits are right.