Medicare

What is the difference between a Medicare Advantage Plan and a Medicare Supplement (Medigap)?

The easiest way to describe this is to say that a Medicare Advantage Plan is a primary insurance plan and you do not need any other plan with it. They take over your Medicare benefits and agree to pay all of your claims, so Medicare can no longer be billed. Some Medicare Advantage plans will also include drug coverage for no extra cost. A Medicare supplement plan is a secondary insurance plan and is billed secondary to Medicare. Supplement insurance plans will only cover Medicare covered medical items and, depending on which plan you choose, help either cover some or all of the deductibles or co-insurance that Medicare doesn’t cover. Supplement plans do not include drug coverage. If you want prescription drug coverage then you will need to enroll in a Stand Alone Prescription Drug plan.


You can read more about this on https://Medicare.gov

When do I become eligible for Part A and how much does it cost?

 As long as you have worked in the United States for ten years and paid into Medicare taxes, you will be enrolled into Part A at no cost. Part A will start on the first day of the month of your 65th birthday. However, if your birthday falls on the 1st day of the month, then your benefits will start on the first day of the previous month. If you do not qualify for Part A at no cost, e.g. you didn’t work here long enough to pay into it, then it can be purchased in 2019 for $437 a month. 

What is the Medicare Part D penalty and how do I avoid it?

The late enrollment penalty is calculated by multiplying the amount of months you did not have creditable prescription drug coverage when you were eligible to, under a Part D plan, by 1% of the national average drug price. Medicare will contact your Medicare prescription drug plan and tell them the proper penalty to charge you. This penalty never goes away. As long as you have a drug plan, you will have to pay this penalty, in addition to the monthly Part D premium.


The best way to avoid this penalty is to make sure that when you are first eligible,  you either enroll in a Medicare Advantage plan that includes drug coverage, enroll in a Stand Alone Prescription Drug Plan, or make sure your employer drug coverage qualifies as creditable drug coverage with Medicare. You have 63 days once your Part A or Part B starts to enroll in a creditable prescription drug plan to avoid paying the penalty.

When do I apply for Medicare Part B?

"Avoid a Medicare Penalty,  Sign Up at Age 65. Even if you don’t plan to receive monthly benefits, be sure to sign up for Medicare three months before turning age 65. If you don’t sign up for Medicare Part B (medical insurance) when you’re first eligible, your coverage may not start right away and you may have to pay a late enrollment penalty for as long as you have it. You can apply online.   Please visit www.socialsecurity.gov/medicareonly for more information and to apply." 


There are two time frames you will want to follow to apply for Part B:


The first would be up to three months before you turn 65. If you are either retired, planning to retire, not receiving social security benefits yet or if your employer requires you to enroll in Part B. If this fits your needs then you can apply online to start Part B.  However, the quickest way to enroll in Part B is to apply in person at  your local social security office three months before you turn 65, so that you begin your coverage effective on the first of your birthday month.


The second would be if you have worked past age 65 and were not required to have been on Medicare by your employer. Now you will have to apply in person at a local social security office to start your Part B and have it start the month following your retirement. You will need a two part form to be able to do this. One form is to be filled out by your HR department to prove you had creditable medical insurance coverage. The other form is one you fill out and submit to the social security office.  If you need this form, please contact us and we will provide it for you.


Additionally, if you are already drawing social security benefits before you turn 65 you will be automatically enrolled in Part B. You will receive your Medicare card in the mail with both Part A and Part B on it.  The card is mailed approximately 3 months prior to the effective date of coverage.

What is the Medicare Part B penalty and how do I avoid it?

The Part B penalty is a 10% higher Part B monthly payment for every 12-month period that you could have had Part B but didn’t sign up for it. The best way to avoid this is to either sign up for Part B when you are first eligible or make sure that you have creditable medical coverage through your employer.

How much will Part B cost me?

The standard amount for 2019 is $135.50. This is based off of Modified Adjusted Gross Income (MAGI) of $85,000 or less for individuals or $170,000 or less for married couples . 


The Part B premium may be higher if your income falls above these levels.  Also your Part D premium may be higher if your income falls above these levels.


Please see the most up-to-date income charts below:

Part B IRMAA Chart

image79

Most people will pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you'll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.  (Medicare.gov) 

Part D IRMAA Chart

image80

If you have a higher income, you might pay more for your Part D coverage. If your income is above a certain limit ($85,000 if you file individually or $170,000 if you’re married and file jointly), you’ll pay an extra amount in addition to your plan premium (sometimes called “Part D-IRMAA”). This doesn’t affect everyone, so most people won’t have to pay a higher amount. You’ll also have to pay this extra amount if you’re in a Medicare Advantage Plan that includes drug coverage. (Medicare & You 2018)

Which type of insurance does my doctor accept? Which plans are they contracted with?

We can look this up for you easily. Please either fill out the ‘Contact Us’ box at the bottom of the page or give us a call and we will do the research for you.

How many plans do you represent?

I represent ten different insurance companies. I can help you select a Medicare Advantage, Medicare Supplement (Medigap) or Prescription Drug Plan that will fit your needs and one that is accepted by your doctor.

Medicare vs Medicaid?

Medicare is administered by the federal government while Medicaid is administered by the state. Medicare is for anyone who qualifies at age 65, under age 65 upon collecting Social Security Disability Income for 24 months or anyone with ALS or End Stage Renal disease. Medicaid provides medical assistance for those who qualify based on income and asset requirements. Based on your qualification, the state may help pay your Part B premium or some or all of your medical co-pays or co-insurance. To view the income and asset requirements and to see if you qualify for Medicaid in Washington state for 2017, please go to: https://Medicare.gov

What is Extra Help or LIS (Low Income Subsidy)?

If you meet certain income and resource limits, you may qualify for Extra Help from Medicare to pay the costs of Medicare prescription drug coverage. In 2018, costs are no more than $3.35 for each generic/$8.35 for each brand-name covered drug. In 2019, costs are no more than $3.40 for each generic/$8.50 for each brand-name covered drug. Other people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level.

 

In 2018, you may qualify if you have up to $18,210 in yearly income ($24,690 for a married couple) and up to $14,100 in resources ($28,150 for a married couple).


If you don't qualify for Extra Help, your state may have programs that can help pay your prescription drug costs. Contact your Medicaid office or your State Health Insurance Assistance Program (SHIP) for more information. Remember, you can reapply for Extra Help at any time if your income and resources change.


Countable resources include:

  • Money in a checking or savings account
  • Stocks
  • Bonds

Countable resources don't include:

  • Your home
  • One car
  • Burial plot
  • Up to $1,500 for burial expenses if you have put that money aside
  • Furniture
  • Other household and personal items

Apply for Extra Help.  (Medicare.gov)