New to Medicare 

 Medicare 101

 

 Why use a licensed local agent

Learning about Medicare can be a daunting process. You are not alone.

Did you know the services of an agent are FREE to you?

Yes, it’s true. All medicare plans COST THE SAME whether you enroll directly or use an agent to guide you.

Why a local agent is better than calling the nation-wide ad campaigns you have been seeing.

Those TV ads are run by national agencies staffed with hundreds of teleagents that are certified to sell products in many states and geared to closing business as fast as possible. They will not offer the in-depth knowledge of a local agent who has expertise on the local Utah hospital networks, doctors, and regional understanding of what Utahns may be looking for in a plan. 

After Enrollment – Your Agent for life

After enrolling, Utah Med Benefits will always be there to help you with issues that may arise and keep you abreast of  changes in the market to ensure you have the best plan available year after year.

Our job is to take the headache out of enrollment, and save you time researching and figuring out what is needed. We will be there for you when you have questions about plan benefits, and need our help resolving issues.

 A GREAT agent will be there for you long after enrollment for years to come.

 

Learn the A,B,Cs of Medicare

If you are new to Medicare, the first thing you need to do is understand the 4 Parts of Medicare and what they mean and what they cover. When deciding on Medicare Coverage, it is important to keep in mind these top 7 criteria you want from your plan.

Part A

Medicare Part A Covers:
– Inpatient hospital stays
– Care in a skilled nursing facility
– Hospice care
– Some home health care

2020 Costs:
– No monthly premium if you paid Medicare taxes for 40 quarters
– 2020 Deductible: $1,408 for each benefit period
Hospital Co-Insurance:
Days 1-60: $0
Days 61-90: $352 co-insurance per day for each benefit period
Days 91 and beyond:  $704 coinsurance for each lifetime reserve day. (up to 60 reserve days over your lifetime)

*Example: If you were hospitalized for three days you must pay $1,408 for your Part A deductible but no co-insurance.

For more Information:  https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance

Part B

Medicare Part B Covers:
– Doctor visits
– Outpatient care
– Medical supplies
– Preventative services
– Mental Health services
– Ambulance services
– Laboratory tests and X-rays
– Rehabilitation services
– Home Health Care

2020 Part B Costs:
– Monthly Premium for most people is $144.60
If you earned over a specific amount in 2018, you may be subject to an extra charge added to your premium called “Income Related Monthly Adjustment Amount” (IRMAA). To check if IRMAA applies to you: https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance. 

Late Enrollment Penalty: In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll have to pay this penalty for as long as you have Part B. 

– Annual Part B Deductible: $198
– 80%/20% coinsurance of Medicare-approved amount
*Example: If the Doctor bill is $100, the beneficiary pays $20 or 20%.

Part C = Part A + Part B + Part D (usually)

Medicare Part C (Also called a Medicare Advantage Plan)

Covers:
– Combines Part A (hospital) and Part B (medical insurance) in one plan.
– Usually includes Part D prescription drug coverage.
– May offer additional benefits not provided by Original Medicare (Part A and Part B) such as dental, vision, hearing aids, fitness membership, over-the-counter products, transportation, and/or telemedicine. Benefits vary by plan.
– Worldwide emergency care
– Coverage is all under one plan administered by a private insurance company.

Cost:
– Monthly premium varies between private insurance companies. Some plans available for $0 monthly premiums
– If it includes Part D Prescription Drug coverage, there may be a prescription Annual Deductible
– Co-pays for different services
– Limits your maximum annual out-of-pocket costs

 

Part D

Medicare Part D (Also called Prescription Drug Plan)

Covers:
– Medications

Cost:
– Part D monthly premium varies by plan. High income consumers may pay more.
-Late Enrollment Penalty: You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these:  1) Medicare Advantage Prescription Drug Plan (Part C plan that includes Part D Prescription Drug Plan), or 2) stand-alone Part D drug plan, or 3) creditable prescription drug coverage – normally through a group health employer plan. 

*Part D Prescription Drug Plan, although part of the Medicare Program, is not offered directly through CMS – The Center for Medicare and Medicaid Services. If one wishes to enroll in Part D program, it is done through a private insurance company’s approved plan.

Frequently Asked Questions

What is a Medicare Advantage Plan?

Medicare Advantage Plan, also known as Part C, is a Medicare Plan run by private insurance companies.  A Medicare Advantage Plan offers all of the benefits covered under Original Medicare and more. Medicare pays a fixed fee to the plan you choose in accordance with the 2003 Medicare Prescription Drug, Improvement, and Modernization Act. It covers all of the benefits covered under original medicare and more, like Dental, Hearing, vision and Gym Memberships.

What is the difference between Medicare Advantage & Medicare Supplements?

Medigap and Medicare Advantage both protect against bills for health care costs Medicare doesn’t cover. Medicare Supplement Insurance, also called Medigap coverage, charges a premium in addition to what the person already pays for Medicare Parts A, B, and D.

With a Medicare Advantage Health Plan (Medicare Part C), a patient enrolls through a private company that usually covers what’s in Parts A, B, and D. 

Medigap coverage usually has a higher monthly premium but could result in lower out-of-pocket expenses than some Medicare Advantage plans. Medicare Advantage plans, on the other hand, generally cost less and cover more services, which can be the better option for your budget.

What types of Medicare Advantage Plans are there?

  • Health Maintanence Organizations (HMOs) require you to use health care providers in your network and may require referrals from a primary care physician in order to see a specialist
  • Preferred Provider Organizations (PPOs) recommend the use of “preferred providers” in an established network and these plans are more likely to cover most of your medical costs if you stay in-network.  You do not need a referral to see a specialist.
  • Private Fee For Service (PFFS) plans determine how much they will pay health care providers and how much the client is responsible to pay for out-of-pocket costs.
  • Medical Savings Plans (MSP) deposit money into a “health care checking account” that combines high-deductible health plans with a medical savings account to help pay for costs.
  • Special Needs Plan (SNP) are tailored health insurance plans designed for clients with certain health conditions

Why do I need Dental, Hearing, and Vision insurance?

Consider the advantages to your health – our oral, eye, and ear health can be key indicators in deteticing early stages of many health risks and diseases along with preventing other health issues.

If I have Part D, are all of my drugs covered? How much will they cost?

  • It depends on the federal government guidelines on the type of prescription drugs that must be covered which does not necessarily mean your prescriptions are covered.
  • Each insurance company has a different formulary (list of drugs they cover), depending on which plan you enroll in and the area you live in.
  • Costs of each plan varies depending on the plan and drug formulary.
  • Senior Med Benefit agents will review your prescriptions, benefits, and the cost plans prior to enrolling you in a Part D Prescription Drug Plan.

I have a Disability - is there Medicare coverage for me?

You may qualify for Medicare before age 65 if: 

  • You’re disabled and have received disability benefits from the Social Security Administration (SSA), or certain Railroad Retirement Board (RRB) disability benefits, for at least two years.
  • You have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS).
  • You have end-stage renal disease (ESRD).

Make an appointment with us to go over specfics and ask any questions you may still have.

I have have a low income - is there Medicare coverage for me?

A low-income subsidy (called Extra Help) is available to help pay the premiums, deductibles, and co-payments of the Medicare prescription drug benefit. The amount of the subsidy varies depending on income.

To qualify for Extra Help, you must meet the following criteria:

  • Your annual income must be no more than $18,210 for an individual or $24,690 for a married couple living together (in 2018).
  • Your resources must be no more than $14,100 for an individual or $28,150 for a married couple living together (in 2018). Resources do not include your home, car, and personal possessions.

You automatically qualify for Extra Help if you are enrolled in Medicaid (you are a “dual eligible”), you are enrolled in Medicare Savings Programs (MSPs), or you get Supplemental Security Income (SSI).

%

PERCENTAGE OF AMERICANS COVERED BY MEDICARE IN 2018