Medicare’s Open Enrollment period is in full swing. Do you know what your best options are?


Why not start with the basics?

Open enrollment runs through December 7th. I cannot stress enough the importance of reviewing the costs and satisfaction of your healthcare services. If you need ANY changes to your plan, NOW is the time to do it!

If you are turning 65, you are automatically eligible for Medicare. You have probably heard about the alphabet soup that Medicare (especially with Medigap!) has become; however, let’s start with the BASIC choices you have when you turn 65. You are eligible for Medicare Parts A & B if:

  • You are turning 65 OR qualify on the basis of a disability such as end-stage renal disease or ALS

  • You are a US citizen or have been a permanent resident for five consecutive years

  • You have 10 years of work in the US

The most common types of Medicare are:

Medicare Part A:

  • Covers inpatient hospital service, skilled nursing, home health care and hospice care. The monthly premium is typically $0 if you or your spouse have been working for at least 10 years. If you do not qualify for premium –free Medicare, the cost can be up to $422/month.

Medicare Part B:

  • Generally covers outpatient services such as doctor’s visits, surgeries, ER/urgent care, radiology & lab tests and transportation. The average monthly premium is between $130 - $135 for 2019. The cost typically goes up every year according to cost of living increases.

Medicare Part D (prescriptions):

  • Helps cover the cost of prescription drugs. The cost will depend on your unique circumstances, so make sure that you consult with someone who has been in the insurance business and is up to date on the latest information.

  • The cost of the prescriptions varies, depending on the plan. Each plan has a list of drugs it covers, and drugs that are covered one year might not be covered the next.

  • You are NOT enrolled in Part D automatically as is the case with Medicare. Chances are there will be a penalty for late enrollment, so make sure you have a list of your prescriptions and compare.

  • Part D coverage starts over each year on January 1.

No, we didn’t skip Part C, also known as Medicare Advantage Plans:

  • A Medicare Part C, or Advantage plan cover parts A, B & D into one plan, making it easier to manage and avoid ANY unexpected costs. They are designed to provide the full scope of benefits in a seamless manner.

  • If you sign up for an Advantage plan, there is NO need to pay for any additional plans.

  • Advantage plans typically cover items that may not be considered in Medicare plans A,B & D, specifically dental, hearing and vision benefits. Some organizations go out of their way to make sure you enroll in them, so research the company before you sign up!

  • These offerings work very similar to how your previous insurance worked. The big plus is that the cost is significantly less!

“We are implementing an outreach effort that looks to provide a summary of the benefits of Medicare. I am finding that many are confused about what is the best strategy and their healthcare needs; anywhere from the deductibles, to the changes allowed on open enrollment season. For example, I just had a discussion with a gentleman last week. He had received his Medicare card, but is waiting to draw from his Social Security until he is 66. He wasn’t aware that, in that case, he will be billed directly by the Social Security Administration, rather than having his fees deducted and reflected in his Social Security Check. “

“No question is the wrong question. Please come and ask away! Have lunch with me (our treat), and let’s get you the information YOU need to make the right decision!”

There are a couple of areas that need clarification regarding Medicare:

  • Medicare was designed and implemented to help cover our health costs. It was never intended to cover ALL of them. Keep this in mind when you are signing up or changing your Medicare plan.

  • Know the differences between Medicare and Medical: Medicare is a Federal program. Medi-Cal is a STATE benefit program.

  • Medi-Medi is a commonly used term, and it refers to being eligible to continue enjoying the benefits of Medi-Cal when you turn 65. Medicare and Medi-Cal are meant to complement health care benefits for low income individuals. Research the requirements to see if you qualify for Medi-Medi.

  • Many people confuse skilled nursing services with those provided by a long term care insurance policy. Skilled nursing services are determined by your health care team. Do not confuse services regarding nursing facilities at home or a post –operative skilled nursing facility with long term care.

  • Of VITAL importance is realizing that Medicare DOES NOT cover all of your health expenses. Depending on YOUR particular situation, you may purchase additional Medicare insurance, also known as Medigap. It is intended to help cover expenses partially covered by the original Medicare plans. Medigap can be used only by people enrolled in traditional Medicare, but not in Medicare’s Advantage plans.

  • Medicare’s advantage plans are very similar to your previous health coverage –that is, PPO, HMO and Private fees for service, or PFFS and are offered and managed by private companies and not the government. It generally includes all the services offered by Medicare, and usually includes Part D. Some companies offer additional services that Medicare doesn’t cover, such as vision, dental and hearing coverage.

  • If you decide to go with the traditional Medicare Parts A&B, Part D is always a must. Most of Medicare’s Advantage Plans include prescription coverage. The out-of-pocket amount will depend on your particular situation.

  • If you decide NOT to enroll in Medicare Part B, you will be held to penalties. A late enrollment penalty is based on 10% of each full 12-month period that you could have had Part B, but didn’t sign up for it.

So ultimately, what IS the best option for you?

Susana Leon Krieger will be presenting an overall summary through her “Lunch and Learn” series held every Wednesday. If you are unable to attend, give her a call, and she can gladly discuss the best option for you, based on YOUR personal circumstances. Please contact her for more information.

“Perhaps the most important question that I get is related to the cost. There are many moving parts to determine the exact costs as it will depend on YOUR personal circumstances. I am weary of providing any specifics; having said that, this is an excellent resource for you to get an idea:

“My function is to be your partner. The basic Medicare plans mentioned above are just a very basic summary of what Medicare entails. As with many care plans, there are other alternatives that might meet your requirements better that are definitely worth the while to look into; however, it all starts with the basics.

By providing you with all the information related to Medicare, and by taking the status of your own situation into consideration, I can help you strategize what the best option will be for you.”

Ready to start looking? Give me a call!

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