SERVICES
Senior Health Solutions
All About Medicare (An Overview)
Retirement Health Solutions
What does your Healthcare look like after age 65?
- We believe that understanding Medicare prior to aging into Medicare will make you better prepared to make the best decision to meet your health situation.
What You Need To Know
Medicare is a health insurance program for:
- persons aged 65 or older.
- persons under age 65 with certain disabilities
- people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Medicare consists of 3 major parts. It’s important to understand each part and select the best options based on your personal needs. At Showers Financial Services, LLC, our agents help you do just that! Consultations include an overall review of your current healthcare situation, and we connect you with a licensed agent that can assist you with your healthcare goals.
(1) Part A Hospital Insurance
(2) Part B Medical Insurance
(3) Prescription Drug Coverage
Continue scrolling for more information and scheduling options.
The 3 Parts of Medicare
- Part A Hospital Insurance –A Part A premium may be applicable. Oftentimes it has been previously paid by the individual or their spouse through payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.
- Part B Medical Insurance- There is a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A DOES NOT cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
- Prescription Drug Coverage – There is a monthly premium associated with this coverage. In January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. This coverage is to help you lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible.
- Reference: https://www.cms.gov
Medicare Advantage Plans
Medicare Advantage Plans, (Part C) are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through the Medicare Advantage Plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:
- Medicare Health Maintenance Organization (HMOs)
- Preferred Provider Organizations (PPO)
- Private Fee-for-Service Plans
- Medicare Special Needs Plans
When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, there generally are extra benefits and lower co-payments than in the Original Medicare Plan. Most Medicare Advantage Plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO) and you may have to see doctors that belong to the plan or go to certain hospitals to get services.
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you may have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. In 2020, the standard Part B premium amount is $148.50 (or higher depending on your income).
When Can I Enroll?
- Keep in mind that Medicare limits when you can join, switch, or drop a Medicare Advantage Plan. You can join a plan when you first become eligible for Medicare. This is anytime beginning 3 months before the month you turn 65 and ends 3 months after the month you turned 65.
- For example, if you turn 65 on May 5, your eligibility period starts on February 1 and ends on August 31.
- If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after month 25 of your disability.
- You can switch or drop your Medicare Advantage during an enrollment period between October 15 and December 7 of each year.
This information obtained from www.medicare.gov (See The “Tools & Links” Section Of This Page For More Information and Sources)
What is Medicare Supplement (Medigap) Insurance?
A Medicare Supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare DOES NOT cover, like co-payments, coinsurance, and deductibles.
If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Your Medigap policy pays its share.
A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
What you need to know about Medicare Supplement policies?
- You must have Medicare Part A and Part B.
- If you have a Medicare Advantage Plan, you can switch to a Medicare Supplement insurance policy, but make sure you can leave the Medicare Advantage Plan before your Medicare Supplement insurance policy begins.
- You pay the private insurance company a monthly premium for your Medicare Supplement insurance policy in addition to the monthly Part B premium that you pay to Medicare.
- A Medigap policy only covers one person. If both you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
- You can buy a Medicare Supplement insurance policy from any insurance company that’s licensed in your state to sell one.
- Any standardized Medicare Supplement insurance policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medicare Supplement insurance policy as long as you pay the premium.
- Medicare Supplement insurance policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
- It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you’re switching back to Original Medicare.
Part D Prescription Drug Plans
- You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday.
- It’s important to do this on time because there’s a permanent premium surcharge for enrolling more than three months after your 65th birthday if you don’t have equivalent drug coverage from another source, such as a retiree plan.
- If you are already enrolled in a Part D “standalone” plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the open-enrollment period, which runs from Oct. 15 to Dec. 7 every year.
Making Part D Work
- In 2021, you are facing higher out-of-pocket drug costs before you can qualify for catastrophic coverage. The out-of-pocket spending threshold will increase by $200, from $6,350 to $6,550 in 2021.
- You will also face higher out-of-pocket costs in 2021 for the deductible and in the initial coverage phase before reaching the catastrophic coverage. The standard deductible is increasing from $435 in 2020 to $445 in 2021, while the initial coverage limit is increasing from $4,020 in 2020 to $4,130 in 2021.
For costs in the coverage gap phase:
1) Brand Name Drugs
Beneficiaries will pay no more than 25% for brand-name of the total cost of the drug, the manufacturer pays 70% to discount the price for you. Then your plan pays 5% of the cost. Together, the manufacturer and plan cover 75% of the cost. You pay 25% of the cost of the drug.
There’s also a dispensing fee. Your plan pays 75% of the fee, and you pay 25% of the fee.
What the drug plan pays toward the drug cost (5% of the cost) and dispensing fee (75% of the fee) aren’t counted toward your out-of-pocket spending
2) Generic Drugs
- Medicare will pay 75% of generic drug costs—during the coverage gap. You’ll pay the remaining 25% of the price. For total drug costs above the catastrophic threshold, Medicare pays 80%, plans pay 15%, and enrollees pay either 5% of total drug costs or $3.60/$8.95 for each generic and brand-name drug, respectively.
Choosing A Plan
- It pays to review your Part D coverage every year, especially if you have started taking new drugs.
- Start at Medicare.gov (See The Tools & Links Section Of This Page), where you can find the basics about the benefit and Part D plans. which allows you to compare offerings and coverage options in your area and includes a helpful formulary finder that allows you to compare plans based on their coverage of your personalized list of drugs. It will even show you your monthly out-of-pocket drug cost for the year
Getting Financial Help
- Individuals with annual incomes of less than $19,320 and financial resources of less than $14,790, or married couple with incomes of less than $26,130, might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.
- Download Medicare’s instructions on applying for the Extra Help program.
- Additionally, read about the six ways to lower your drug costs on Medicare.gov.
Are You Eligible For Medicare?
Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:
- You already get retirement benefits from Social Security or the Railroad Retirement Board
- You are eligible to get Social Security or Railroad benefits but have not yet filed for them.
- You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if:
- You have received Social Security or Railroad Retirement
- Board disability benefit for 24 months. You are a kidney dialysis or kidney transplant patient.
While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.
Consultations include an overall review of your current healthcare situation, and we connect you with a licensed agent that can assist you with your healthcare goals.
Different Types of Medicare Advantage Plans
Medicare Advantage is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.
- Health Maintenance Organization (HMO) Plan
- In most HMO Plans, you can only go to doctors, other healthcare providers, or hospitals on the plan’s list except in an emergency. You may also need to get a referral from your primary care doctor to see other doctors or specialists. Find and compare HMO Plans in your area.
- Preferred Provider Organization (PPO) Plans
- A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You pay more if you use doctors, hospitals, and providers outside of the network.
- Private Fee-for-Service (PFFS) Plans
- A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
- Medicare Special Needs (SNP) Plans
- Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. Find out who can join a Medicare SNP.
Frequently Asked Questions
Medicare is a federal U.S. health insurance program that provides coverage to individuals who are age 65 and over, under age 65 with certain disabilities, and individual of all ages with end-stage kidney disease.
- Medicare Advantage plans are an alternative to Original Medicare (Part A and B)
- When you enroll in a Medicare Advantage plan, you receive your Part A and Part B benefits through a single plans old by a private insurance company.
- Many Medicare Advantage plans may also offer additional benefits, such as prescription drug coverage plus hearing, dental, and vision benefits.
Certain circumstance may make you eligible to enroll into a different plan.
Schedule your free consultation below, or call us at (904) 330-4051
One of our associates will be happy to assist you!
Schedule Your Free Consultation
Please take a quick moment to schedule your free Senior Insurance Consultation below.
//
Other Services
//
Tools & Links
(1) Part A Hospital Insurance
(2) Part B Medical Insurance
(3) Prescription Drug Coverage
The 3 Parts of Medicare
- Part A Hospital Insurance –A Part A premium may be applicable. Oftentimes it has been previously paid by the individual or their spouse through payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.
- Part B Medical Insurance- There is a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A DOES NOT cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
- Prescription Drug Coverage – There is a monthly premium associated with this coverage. In January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. This coverage is to help you lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible.
- Reference: https://www.cms.gov
Medicare Advantage Plans
Medicare Advantage Plans, (Part C) are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through the Medicare Advantage Plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:
- Medicare Health Maintenance Organization (HMOs)
- Preferred Provider Organizations (PPO)
- Private Fee-for-Service Plans
- Medicare Special Needs Plans
When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, there generally are extra benefits and lower co-payments than in the Original Medicare Plan. Most Medicare Advantage Plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO) and you may have to see doctors that belong to the plan or go to certain hospitals to get services.
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you may have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. In 2020, the standard Part B premium amount is $148.50 (or higher depending on your income).
When Can I Enroll?
- Keep in mind that Medicare limits when you can join, switch, or drop a Medicare Advantage Plan. You can join a plan when you first become eligible for Medicare. This is anytime beginning 3 months before the month you turn 65 and ends 3 months after the month you turned 65.
- For example, if you turn 65 on May 5, your eligibility period starts on February 1 and ends on August 31.
- If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after month 25 of your disability.
- You can switch or drop your Medicare Advantage during an enrollment period between October 15 and December 7 of each year.
This information obtained from www.medicare.gov (See The “Tools & Links” Section Of This Page For More Information and Sources)
What is Medicare Supplement (Medigap) Insurance?
A Medicare Supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare DOES NOT cover, like co-payments, coinsurance, and deductibles.
If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Your Medigap policy pays its share.
A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
What you need to know about Medicare Supplement policies?
- You must have Medicare Part A and Part B.
- If you have a Medicare Advantage Plan, you can switch to a Medicare Supplement insurance policy, but make sure you can leave the Medicare Advantage Plan before your Medicare Supplement insurance policy begins.
- You pay the private insurance company a monthly premium for your Medicare Supplement insurance policy in addition to the monthly Part B premium that you pay to Medicare.
- A Medigap policy only covers one person. If both you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
- You can buy a Medicare Supplement insurance policy from any insurance company that’s licensed in your state to sell one.
- Any standardized Medicare Supplement insurance policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medicare Supplement insurance policy as long as you pay the premium.
- Medicare Supplement insurance policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
- It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you’re switching back to Original Medicare.
Part D Prescription Drug Plans
- You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday.
- It’s important to do this on time because there’s a permanent premium surcharge for enrolling more than three months after your 65th birthday if you don’t have equivalent drug coverage from another source, such as a retiree plan.
- If you are already enrolled in a Part D “standalone” plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the open-enrollment period, which runs from Oct. 15 to Dec. 7 every year.
Making Part D Work
- In 2021, you are facing higher out-of-pocket drug costs before you can qualify for catastrophic coverage. The out-of-pocket spending threshold will increase by $200, from $6,350 to $6,550 in 2021.
- You will also face higher out-of-pocket costs in 2021 for the deductible and in the initial coverage phase before reaching the catastrophic coverage. The standard deductible is increasing from $435 in 2020 to $445 in 2021, while the initial coverage limit is increasing from $4,020 in 2020 to $4,130 in 2021.
For costs in the coverage gap phase:
1) Brand Name Drugs
Beneficiaries will pay no more than 25% for brand-name of the total cost of the drug, the manufacturer pays 70% to discount the price for you. Then your plan pays 5% of the cost. Together, the manufacturer and plan cover 75% of the cost. You pay 25% of the cost of the drug.
There’s also a dispensing fee. Your plan pays 75% of the fee, and you pay 25% of the fee.
What the drug plan pays toward the drug cost (5% of the cost) and dispensing fee (75% of the fee) aren’t counted toward your out-of-pocket spending
2) Generic Drugs
- Medicare will pay 75% of generic drug costs—during the coverage gap. You’ll pay the remaining 25% of the price. For total drug costs above the catastrophic threshold, Medicare pays 80%, plans pay 15%, and enrollees pay either 5% of total drug costs or $3.60/$8.95 for each generic and brand-name drug, respectively.
Choosing A Plan
- It pays to review your Part D coverage every year, especially if you have started taking new drugs.
- Start at Medicare.gov (See The Tools & Links Section Of This Page), where you can find the basics about the benefit and Part D plans. which allows you to compare offerings and coverage options in your area and includes a helpful formulary finder that allows you to compare plans based on their coverage of your personalized list of drugs. It will even show you your monthly out-of-pocket drug cost for the year
Getting Financial Help
- Individuals with annual incomes of less than $19,320 and financial resources of less than $14,790, or married couple with incomes of less than $26,130, might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.
- Download Medicare’s instructions on applying for the Extra Help program.
- Additionally, read about the six ways to lower your drug costs on Medicare.gov.
Are You Eligible For Medicare?
Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:
- You already get retirement benefits from Social Security or the Railroad Retirement Board
- You are eligible to get Social Security or Railroad benefits but have not yet filed for them.
- You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if:
- You have received Social Security or Railroad Retirement
- Board disability benefit for 24 months. You are a kidney dialysis or kidney transplant patient.
While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.
Consultations include an overall review of your current healthcare situation, and we connect you with a licensed agent that can assist you with your healthcare goals.
Different Types of Medicare Advantage Plans
Medicare Advantage is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.
- Health Maintenance Organization (HMO) Plan
- In most HMO Plans, you can only go to doctors, other healthcare providers, or hospitals on the plan’s list except in an emergency. You may also need to get a referral from your primary care doctor to see other doctors or specialists. Find and compare HMO Plans in your area.
- Preferred Provider Organization (PPO) Plans
- A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You pay more if you use doctors, hospitals, and providers outside of the network.
- Private Fee-for-Service (PFFS) Plans
- A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
- Medicare Special Needs (SNP) Plans
- Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. Find out who can join a Medicare SNP.
Frequently Asked Questions
Medicare is a federal U.S. health insurance program that provides coverage to individuals who are age 65 and over, under age 65 with certain disabilities, and individual of all ages with end-stage kidney disease.
- Medicare Advantage plans are an alternative to Original Medicare (Part A and B)
- When you enroll in a Medicare Advantage plan, you receive your Part A and Part B benefits through a single plans old by a private insurance company.
- Many Medicare Advantage plans may also offer additional benefits, such as prescription drug coverage plus hearing, dental, and vision benefits.
Certain circumstance may make you eligible to enroll into a different plan.
Schedule your free consultation below, or call us at (904) 330-4051
One of our associates will be happy to assist you!
Schedule Your Free Consultation
Please take a quick moment to schedule your free Senior Insurance Consultation below.
