Understanding Medicare

Posted on

Oct 27, 2015

Share This
Turning 65 can be a monumental time in our lives. Some are excited to retire and relax. Others just cant believe that they are now at retirement age. But either way, dont worry. Its just a part of life. I think the baby boomers are the most shocked. It seems like just yesterday we were driving our kids to school, and then hopping on the Harley to play hooky for a day.

There are many facets to Medicare and you will have several choices to make. This article will help you understand a small part but also give you some very good tools. I can not stress enough how much information the Medicare.gov website has to offer. I urge every one of you to investigate this site and it should answer just about any question you have concerning Medicare.

First of all, once you are eligible you will automatically be enrolled in Medicare Part A. There are some exceptions but this article is meant to be a simple overview. Typically no premiums are paid for Part A yet once again there are some exceptions.. Part A pays for hospitalization, skilled nursing care to a certain point, hospice and limited home health care. However there is a deductible.

Once enrolled in Part A you should then enroll in Part B. Once again, there are some exceptions. Your premium for part B. is $115.40 for 2011. This usually comes out of your SS check. If you are covered under a group plan you may delay enrolling in part B with no penalty. Part B helps cover medically-necessary services like doctors services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. There is also a deductible for Part B.

Now the next decision you will want to consider is whether to purchase a pure Medicare Supplement or utilize a Medicare Advantage plan. There are pros and cons to both programs so it is best to speak to an insurance professional. They can assist in deciding which program fits your particular needs.

The Medicare Supplements are alphabetically categorized as well as standardized. Each lettered plan offers a few different benefits. However the only difference from the plan you choose are the premiums charged by the insurance companies for the exact same coverage. Also, some companies may not offer certain plans.

It sometimes seems a bit overwhelming and it is easy to understand why. There is Medicare Part A, Medicare, Part B, Part C (Medicare Advantage) and Part D (drug benefits). Then if you do choose to purchase a Medicare Supplement you will need to decide which supplement plan you would like such as Plan A, B, C, D, F, G, K, L, M, and N. Wow can we make this any more confusing?.

As mentioned in the beginning, the goal of this article is to give you a general overview. However, there is one piece of information that some folks are not aware exists. There is a High Deductible Plan F. Not all of the insurance companies offer this in Collier or Lee County. The deductible is usually $2000 a year but some companies are offering an incentive for this year and the deductible is $1500. The nice aspect of this plan is the premiums are around $66 per month vs. $185 per month for a regular plan F.

The really fun part comes in when you choose the High Deductible Plan F. Not only do you save money but you are also able to contribute to a reserve fund annuity. You can choose how much you would like to contribute. The money is earning 3% and you can take it out for anything you would like. But is very useful to help off set any co-pays and deductibles encountered with the high deductible plan F.

Medicare.gov is a very informative website. Welcome to Retirement!

Editors Note: This article was written by Linda Jaikes, Jaikes Financial Group, 239-263-9195.

Other Articles You May Like

Does Medicare Cover Home Care Services? Paying for In-Home Care

Finding a home care service for yourself or an aging loved one is one of the most important decisions you can make. Over three-quarters of adults want to age in place, and you want to ensure that youre receiving the highest level of care. But in this time of transition, one aspect of the senior care search tends to weigh heavy: the cost.At ComForCare, we understand that financing care is one of the most pressing concerns families have during this process. Thats why weve created this guide with several frequently asked questions about affording in-home care. What In-Home Care Services Does Medicare Cover?Medicare eligibility can be quite limited when it comes to home health services. Part-time or intermittent home health aide services are listed as eligible home health services. However, you must meet all of these criteria to qualify:You are under a doctor's care, and care services are created and reviewed regularly by that doctor.A doctor must certify that you need:Intermittent skilled nursing care other than drawing blood, ORPhysical therapy, speech-language pathology, or continued occupational therapy services.You must be homebound.Of course, not all seniors who need a helping hand also need skilled nursing care. Thats where home care services come in. We can assist with daily living activities for seniors who need it, even if they arent homebound or need regular at-home medical care.What is Skilled Nursing Care and How is it Different from Home Care?Home care services like ComForCare help with eating, dressing, personal hygiene, shopping, cleaning, and more. The care is non-medical and intended for older adults who need a helping hand around the house for their safety.Skilled nursing care can provide these services as well, but the key difference is that medical care is also involved. A doctor can prescribe home health care and determine if you or your loved one requires such services.Does Medicare Reimburse Home Care Service Provided by Family Members?Medicare does not cover any care unless it is provided by a licensed caregiver. Thats part of what makes finding a home care provider an appealing option. Taking care of someoneeven someone you loveis labor for which you dont receive compensation without certification. While paying for home care may seem intimidating, it can save you a great deal in the long run. Heres How:Decreased chance for your loved one to experience falls or condition complications, preventing hospital expenses and pain.Decreased need to take PTO or leave work to provide care. Fewer costs related to your own health and stress levels.Is Home Care Affordable Compared to Other Senior Care Services?Believe it or not, home care tends to be the least expensive senior care option available. According to the Genworth Cost of Care Survey, the average national cost of a private room in a nursing home was an astronomical $108,405 in 2021. Assisted living facility costs, meanwhile, came in at an average of $54,000 for the same year. While home care costs vary depending on the persons specific needs, they typically fall below these numbers. Plus, you get the advantage of receiving high-quality care in the comfort and dignity of your own homenot competing for space in a basic or shared facility room.How Can I Get Help Paying for In-Home Care Services?Financing home care for yourself or a loved one can, understandably, feel impossible at first. If so, youre not aloneup to 41% of Americans over 50 dont believe that they will be able to stay in their current home and community. But at ComForCare, we hope to change that.We offer flexible home care options, from full-time to part-time care. Our caregivers can start by filling in gaps when family members are handling other obligations like work. If your familys needs change, we can always work with you to change the schedule. Were also happy to share resources for financing care, which may include:Veterans benefitsLong-term insuranceWorkers compensation Life insuranceReverse mortgage or home equity loansAnnuities, investments, and savingsBottom Line: Home Care is a More Realistic Option Than You Think!Respecting the wishes of your loved ones isnt impossible. At ComForCare, we work with each family to create a top-quality home care plan that wont cause an undue financial burden. Even if youre just beginning your journey to in-home care, call us at (800) 886-4044 today to ask us anything, 24/7. Were ready to help you find the perfect caregiver!

The Parts Of Medicare Broken Down

Medicare is a federal health insurance program that provides coverage to millions of seniors and individuals with disabilities. Since its inception in 1965, it has evolved into a multifaceted system with several complex and often confusing components. Each part covers specific healthcare needs. Lets break down the parts of Medicare and what all they entail.Part A: Hospital InsurancePart A is often referred to as hospital insurance. It primarily covers inpatient hospital care, skilled nursing facility care, home health services, and hospice care. When you first sign up for Medicare at the age of 65, youre usually automatically enrolled in Part A. To be eligible for Medicare, you or your spouse must have paid Medicare taxes while working. Part A coverage typically does not require a monthly premium if you or your spouse paid enough taxes during your working years.Key services covered under Part A include:Hospitalization: Coverage includes hospital stays, critical access hospitals, and inpatient care.Skilled Nursing Facility Care: Medicare covers skilled nursing care after a hospital stay.Home Health Services: Limited home health services are covered, such as skilled nursing care and therapy.Hospice Care: Part A covers hospice services for terminally ill patients.Part B: Medical InsurancePart B is known as medical insurance. It covers outpatient services and preventative care, including doctor visits, laboratory tests, medical equipment, and some preventative services. Unlike Part A, however, Part B does require a monthly premium, which the federal government sets but can vary based on your total income.Key services covered under Part B include:Doctor Visits: Coverage includes visits to physicians, specialists, and other healthcare providers.Outpatient Services: Part B covers outpatient surgery, medical tests, and preventive services.Durable Medical Equipment (DME): This includes items like wheelchairs, walkers, and oxygen equipment.Ambulance Services: Emergency and non-emergency transportation when necessary.Preventative Services: Many preventative screenings, like mammograms and prostate cancer screenings, are covered, as well as preventative services, such as vaccinations and Annual Wellness Visits.Part C: Medicare Advantage PlansPart C, also known as Medicare Advantage (MA), is an alternative to traditional coverage. It allows beneficiaries to receive their Part A and Part B benefits through private insurance companies that contract with Medicare. Its almost like a two-in-one plan. But in addition to having Part A and B benefits, MA often includes prescription drug coverage (Part D) and may offer additional benefits like dental, vision, and fitness programs. MA plans usually have their own costs, such as premiums and copayments, in addition to the Part B premium. However, many Medicare Advantage plans have a $0 or lower monthly premium as well as a limit on out-of-pocket costs, helping to control your healthcare spending.Key Features of Medicare Advantage Part C:Comprehensive Coverage: Medicare Advantage plans may offer a broader range of services than Original Medicare.Prescription Drug Coverage: Many Part C plans include Part D prescription drug coverage.Additional Benefits: Some plans provide extra services like dental, vision, and hearing care.Simplicity of One Plan: All healthcare needs are covered under one plan.Part D: Prescription Drug CoveragePart D is a standalone prescription drug plan that helps cover the costs of prescription medications. These plans are offered by private insurance companies approved by Medicare. You must enroll in this plan separately if you receive Original Medicare. Part D coverage requires a monthly premium, which varies depending on your chosen plan.Key Features of Part D:Medication Coverage: Part D plans cover a wide range of prescription drugs, including brand-name and generic medications.Formulary: Each plan has a formulary, which is a list of covered drugs.Cost-Sharing: Beneficiaries pay copayments or coinsurance for prescription drugs in addition to the monthly premium.Coverage Gap: There is a coverage gap, often called the donut hole, which has specific cost-sharing requirements.Medigap (Supplemental) PlansMedicare Supplement Insurance, commonly known as Medigap, is a type of private insurance that helps cover the out-of-pocket costs associated with Original Medicare (Part A and Part B). These plans fill the gaps in coverage left by Medicare, such as deductibles, copayments, and coinsurance.Key features of Medigap include:Cost Reduction: Medigap plans help reduce or eliminate your out-of-pocket expenses for Medicare-covered services.Standardized Plans: There are several standardized Medigap plans labeled by letters (e.g., Plan F, Plan G), each offering different levels of coverage.Guaranteed Issue Rights: There are specific enrollment periods and guaranteed issue rights to sign up for Medigap plans without medical underwriting.Get The Medicare Coverage You Need And DeserveUnderstanding the different parts of Medicare, including Part A, Part B, Part C (Medicare Advantage), Part D (Prescription Drug Coverage), and Medigap plans, is crucial for making informed healthcare decisions. Its important that you understand what your options are and what exactly they will provide you. Your health is a priority, and by exploring the specifics of each part, you can choose the coverage that best meets your unique healthcare needs.

Navigating Your Health: Why Pennie Is Your Best Bet for Health Insurance in Pennsylvania

In todays rapidly evolving healthcare landscape, finding the right health insurance plan can be daunting. Fortunately, for residents of Pennsylvania, the Pennsylvania Health Exchange, commonly known as Pennie, offers a robust platform that simplifies the process and provides many benefits. In this comprehensive guide, well delve into the advantages of using Pennie for your health insurance needs and explain why reaching out to a local Pennie-certified broker is wise for securing your health and financial well-being.Understanding Pennie: A Gateway to Quality Healthcare1. **Customized Plans to Fit Your Needs**Pennie offers diverse health insurance plans, ensuring you find one tailored to your specific requirements. Whether youre a young professional seeking basic coverage or a family with specific medical needs, Pennie provides many options. These plans span from comprehensive coverage to more focused programs like dental and vision insurance.2. **Affordability and Financial Assistance**One of the most significant advantages of choosing Pennie is the potential for substantial cost savings. You can access premium subsidies and tax credits through the platform, significantly lowering your monthly premiums. Additionally, Pennie can connect you with Medicaid and CHIP programs if you qualify, further expanding your options for affordable coverage.3. **Transparency and Consumer-Friendly Interface**Pennies user-friendly interface is designed to make the enrollment process straightforward and intuitive. You can make informed decisions about your health coverage with clear explanations of plan details, costs, and benefits. The platform also allows you to compare plans side-by-side, empowering you to choose the best option for your unique situation.4. **Coverage for Pre-Existing Conditions**Thanks to the Affordable Care Act, Pennie ensures that individuals with pre-existing conditions cannot be denied coverage or charged exorbitant rates. This provides peace of mind for those with chronic health conditions, knowing they can access the care they need without financial hardship.5. **Access to a Network of Trusted Providers**Pennie works with a network of reputable insurance carriers and healthcare providers, ensuring that you have access to a wide range of doctors, specialists, and hospitals. This network spans Pennsylvania, giving you the flexibility to receive care where its most convenient.How to Get Started with Pennie: Connecting with a Local BrokerWhile Pennies platform is user-friendly, navigating the nuances of health insurance can still be complex. This is where a local Pennie-certified broker can be an invaluable resource. These brokers are experts in the Pennsylvania healthcare landscape and can provide personalized guidance to help you select the best plan for your needs.Why Choose a Pennie-Certified Broker?1. **In-Depth Knowledge**: Certified brokers are well-versed in Pennies offerings and can provide expert advice tailored to your circumstances.2. **Personalized Recommendations**: They take the time to understand your health and financial situation, ensuring you receive a recommendation that aligns with your needs.3. **Assistance with Application Process**: Navigating the application process can be confusing. A broker can streamline this process, saving you time and frustration.4. **Ongoing Support**: Even after enrollment, a certified broker can answer questions, assist with claims, and help you understand your coverage.Conclusion: Secure Your Health and Financial Future with PennieChoosing the right health insurance plan is crucial to safeguarding your well-being. With Pennie, residents of Pennsylvania have a powerful tool at their disposal, offering affordable, customizable, and transparent coverage options. By connecting with a local Pennie-certified broker, you can confidently navigate the process, knowing you have expert guidance at every turn. Dont waittake the first step towards a healthier future today.For more information or to find a certified broker near you, visit Baker Consulting Services, Inc.s web page, a family-owned agency and local broker in PA.*Disclaimer: This blog post is for informational purposes only and does not constitute professional advice. Please consult a certified broker or a licensed insurance agent for personalized recommendations.*