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 65^th
• 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:

1. A & B only. A is a $0 premium B is $164 a month. Choosing this is discouraged because of high risks.
2. 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.

3. A & B replaced by “C” plan which is an advantage plan.

A prescription plan with be included with C.

4. 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.

1. 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
2. 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.
3. 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

1. must be enrolled in A&B
2. will take any Medicare provider
3. premium based.
4. you get to choose your own rx plan.
5. do not require pre-authorization. If the doctor says you need it you can do it.
6. 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:

1. must be enrolled in A & B
2. must choose hmo or ppo.
3. pay as you go.
4. the advantage plan will select your prescription provider.
5. 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.
6. 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

1. Advantage plans replace original Medicare.
2. Is provided by a private insurance company.
3. You have to be enrolled in A & B. premium of $164.90
4. Must live in th plan’s service area.
5. You must choose a network of Providers (HMO or PPO) So doctors do not subscribe to hmo or ppo.
6. advantage plans have Low or No monthly premiums. Some may be less than $30 a month.
7. You pay-as-you-go system which includes copays and deductibles.
8. 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.
9. 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 7^th.

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.