Medicare
Health insurance for individuals 65 and older or under 65 with a disability.
Confidently Transition to Medicare
When it comes to Medicare, the misleading advertising, the onslaught of junk mail, and the bogus phone calls can create anxiety and fear. We want to empower our clients with confidence as they enter this new healthcare arena.
In its simplest form, Medicare is health insurance that beneficiaries have been paying for their entire working life. Medicare just functions differently than employer plans or individual health insurance. Using open dialogue, education, and your needs assessment, we work together to find plan(s) that are best fit your individual needs.
Original Medicare
When transitioning from an individual or employer health plan where all benefits are covered under a single plan, it can be surprising to learn that Medicare separates hospitalization, doctor visits, and prescriptions into different parts. Learning the Medicare “alphabet” will help you understand your new benefits.
Original Medicare includes Part A and Part B
Part A
Hospital Insurance
Helps Cover
* Inpatient Hospitalization
* Skilled Nursing
* Home Healthcare
* Hospice
2025 Costs
Premium: $0 – if “entitled”
Part A Deductible – $1676/year (days 1-60)
Part A Hospital Costs – $419/day (Days 61-90)
Skilled Nursing Costs – $0/day (Days 1-20)
Home Health Care – $0 for covered services
Hospice – $0 for covered services
Part B
Doctor & Outpatient Medical Insurance
Helps Cover
* Preventative Services
* Doctor Visits
* Outpatient Doctor Services
* Lab, Radiology, Durable Medical Equipment
2025 Costs
Premium: $185/month*
Higher Earners Pay More – IRMAA Adjustment*
Part B Deductible – $257/year
Part B Cost Share – 20% of approved Expenses
*IRMAA – Income Related Medicare Adjustment Amount. Higher earners will pay more for Medicare Part B and Part D.
I Have My Medicare Card. Now what?
Whether you are turning 65 or are eligible for Medicare due to a disability or health condition, Original Medicare (Part A + Part B) is designed to cover about 80% of healthcare costs. The remaining 20% can leave Medicare Beneficiaries financially exposed. Many are surprised to learn that Original Medicare does not cover prescription drugs (exceptions apply), dental or vision benefits. Each enrollee will need to decide how to cover those “gaps”.
Part C – Advantage Plans
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All in one Alternative to Original Medicare
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Must be enrolled in Part A and Part B
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Low Premiums – $0/month plans available
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HMO & PPO Plans
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Extra Benefits may be included – Dental, Vision, Hearing, Silver Sneakers, Etc.
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Annual Out of Pocket Maximums – $3400 – $9550
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Option to change plans annually
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Plans sold by private insurance companies
Part D – Stand Alone Prescription Drug Plans
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Must be enrolled in Part A and/or Part B
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Helps cover the cost of prescription drugs
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Things to consider
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Premium
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Formulary
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Preferred Pharmacy
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**Every Medicare Beneficiary is required to enroll in prescription drug coverage. Failing to enroll when first eligible may result in a penalty.
Part E – Supplemental – MediGap Plans
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Must be enrolled in Part A and Part B
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Fills in the “gaps” left by original Medicare
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Monthly premiums vary
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Low out of pocket costs
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Prescription coverage is not included
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Once set, keep plan for life
New Medicare Requirements
Effective October 1st, 2022, per Medicare requirements – Medicare phone calls must be recorded.
We do not offer every plan in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Medicare Open Enrollment
AEP – Annual Enrollment Period – October 15th – December 7th.
This is the time every year that Medicare Beneficiaries can select and enroll in a new Medicare Advantage Plan or PDP – Stand Alone Prescription Drug Plan. Year over year, your health needs change, formularies change, prices change – this is your opportunity to enroll in a plan that will best meet your needs as we enter a new year. Of course, best laid plans cannot predict the future.
Carriers We Work With
