A Step-by-Step Guide Navigating The Health Insurance in Boise

Steps To Navigate Medicare Into Success

As you get closer to retirement age, it's important to know what your health care choices are. Medicare is a health insurance program run by the federal government for people over 65 or with certain illnesses. It can be hard to figure out how Medicare works, but if you follow these five steps, you can make sure you are making the best decisions about your health care.

Step 1: Determine Your Eligibility

The first step in figuring out Medicare is figuring out if you are eligible. To get Medicare, you must be 65 or older, or you must have a disability or a long-term health problem. You must also be a U.S. citizen or a legal permanent resident who has lived in the country for at least five years.

Step 2: Understand the Different Parts of Medicare

Part A, Part B, Part C, and Part D are the four parts of Medicare. Part A talks about time in the hospital, skilled nursing care, and care at a hospice. Part B covers visits to the doctor, care outside of the hospital, and preventive treatments. Part C, also called Medicare Advantage, is an option to Parts A and B that is offered by private insurance companies. Part D is for authorized drugs.

Step 3: Compare Medicare Plans

Once you understand the different parts of Medicare, it's important to compare plans to find the one that best fits your needs. You can use the Medicare Plan Finder tool or work with a qualified insurance agent to do this. The Medicare Plan Finder tool is a free online tool that helps you compare plans based on your location, prescription drug needs, and other factors. Working with a licensed insurance agent can also be beneficial as they can help you navigate the process and find the best plan for you.

Step 4: Get signed up for Medicare

It's easy to sign up for Medicare, but you need to know when and how to do it. You can enroll in Medicare during the Initial Enrollment Period, which is the seven-month period that begins three months before your 65th birthday and ends three months after your 65th birthday. If you miss your Initial Enrollment Period, you may face a late enrollment penalty, so it's essential to enroll on time.

Step 5: Stay Informed

Once you are enrolled in Medicare, it's essential to stay informed about changes to your coverage and any new benefits that may become available. Medicare is a complex system, and changes can occur frequently, so it's important to stay up-to-date on the latest news and developments. You can do this by visiting the official Medicare website, signing up for newsletters, or working with a licensed insurance agent who can keep you informed.

Who Can Get Medicare?

Anyone age 65 in the U.S. and older, even permanent residents who have lived within the U.S. at least 5 years qualify. Also, if you have qualified for 24 months of Social Security disability, you’re also eligible. It doesn’t matter if you are taking Social Security benefits and are aging to 65, you qualify. Once you’ve confirmed you qualify for Medicare, it’s important to understand the basics. Your original Medicare consists of Part A and Part B.

These are provided to you by the federal government. You are entitled to Part A, but need to enroll in Part B. Enrollment occurs through the social security office or online. Remember to keep anything that the Social Security office or the Centers for Medicare & Medicaid Services sends you in the mail. It’s important documentation you will need to apply for Medicare.

• What is Medicare - Part A? Part A is your hospital coverage. The coverage pays for your (qualifying) hospital stays or senior living.
• What is Medicare - Part B? Part B is your Outpatient coverage. This includes things like doctors' visits, equipment, lab-work, surgeries, diagnostic tests, etc.
• What is Part D? Part D is your drug coverage. This is a pharmacy card you will use to purchase prescriptions at a lower cost. It is insurance you buy for present and future medication needs.

Medications can be vital to your care, so it’s very important to have this coverage. You’ll need to Address Medicare’s A, B & D. You are eligible for these 3 parts of Medicare on the first day of the month of your 65th birthday or earlier if you qualify due to disability.

Understanding The Costs For Parts A, B & D

A Cost Breakdown. It’s important to decide whether to stay employed past 65 with an employer that offers health benefits or determine whether you will retire and make Medicare your primary insurance.

• Cost for Part A. Medicare Part A is free for most people, as long as you or your spouse has worked in the U.S. for at least 10 years.
• Cost for Part B. People new to Medicare (2019) have a base rate of $135/month. However, people in a higher tax bracket income pay an income adjustment.

Basically, people with higher incomes pay more for their coverage. How is your rate calculated? Social Security will base your income on your income as reported on your tax returns. They typically look at the income of the past two years.

Disputing the Premium

If your income has decreased since then, you can file a reconsideration request. You’ll present proof of a lower income to Social Security to lower your Part B premium. They will look at your documentation and reconsider the premium and notify you of their decision. Once Social Security has determined what your premium is, they will deduct Part B from your monthly income benefits.

If you have delayed social security enrollment, they will invoice you for Part B on a quarterly

basis. When you switch to receiving social security, they will then start the monthly deductions. Do you need Part B?

Part B is necessary, as it will be your primary insurance at age 65. Also, you can’t buy supplemental insurance unless you have both A and B.

If you work for a large employer (over 20 employees), that will continue to be your primary insurance, Medicare will be your secondary. You could consider delaying Part B since your group insurance probably includes outpatient benefits already without penalties. Costs for D. There are multiple options, based on your prescription needs, so you’ll choose one that offers the lowest cost for your needs. Part D premiums are paid directly to the insurance carrier. You can request that Social Security deducts this monthly premium from your check.

Just to Recap. Both Part B and D have a base premium and are an income-related additional cost for higher tax brackets.

What's Covered? What's Not? 

What are you paying for? What are you getting? Medicare is very similar to employer coverage you have had in the past. You pay your share of premiums via paycheck deductions. When you used your company-sponsored insurance, you had co-pays and deductibles. It works the same with Medicare.

What does Medicare (Part A) cover?

• Part A pays for your first 60 days in the hospital. Your share would be a hospital deductible, which is $1,364 in 2019. After 60 days in the hospital, Medicare pays a diminishing share of your benefits. You begin to pay a larger share of the daily hospital copay. This can add up to hundreds/thousands of dollars, so this is where you likely will want to obtain supplemental coverage to protect you.

What does Medicare (Part B) cover?

• Part B pays for outpatient care like doctor visits, lab work, imaging, surgeries, medical equipment, chemo, radiation, etc. After your deductible is met, you pay once per year (2019 was $185), Part B will cover 80% of these services for you.

What does Medicare (Part D) cover?

• Part D pays for retail prescription medications. These are medications you would get from your local pharmacy or plan’s mail order pharmacy. You may not need supplemental insurance for Part D. However, if you don’t get your prescription drug coverage when you are first eligible,

you may pay a late penalty.

What Is Supplemental Coverage Options

What is supplemental Medicare Insurance Coverage? There are two main types of plans.  They cover costs Medicare doesn’t and can provide more flexibility and customization to your healthcare needs. The great thing is that there are plans for all types of budgets.

Let’s review the two types of plans.

Option 1: Medigap Plans (aka Medicare Supplements).

Medigap plans pay after Medicare. They pay for things that you would normally cover. For example, all Medigap plans cover 20% of your 80/20 Medicare coverage. Some plans also cover your Part A and B deductibles. You can also choose a Part D drug plan to supplement. You will also be able to see any physician or healthcare provider that participates in Medicare. These plans cost more than the Advantage Plans because their coverage is more comprehensive. 

Option 2: Medicare Advantage Plans (aka Part C).

Medicare Advantage Plans can seem confusing because they are also called Part C of Medicare. They pay instead of Medicare. They were created to give a lower-cost alternative to Medigap. How do these plans work? Advantage plans are private insurance plans with their own local network of providers, generally, HMO or PPO based. When you join these plans, you’ll see certain providers so that you can get the lowest co-pays. You’ll pay co-pays for hospital stays, doctor visits, and other Medicare-approved services. Advantage plans have lower premiums than Medigap Plans. This is achieved because you share the costs in co-pays for services as you receive them. With Medigap Plans, you typically will not have a co-pay.

Most Medicare Advantage Plans have a Part D drug benefit.

This can be both good and bad depending on the medications your lifestyle and health requires. It’s important to base your decisions on your lifestyle, budget, and projected health.

Talk to Chris Antrim Medicare Insurance Broker

Navigating the Medicare Maze. Boise Life & Health Insurance Agency Group of professionals can help you navigate the Medicare maze. There is no reason to try navigating the maze on your own. Because we work with a variety of insurance companies, we can find you the best plan at the lowest costs for your lifestyle. How do we get compensated? Our commissions come directly from the insurance companies, not from you. They are not inflated or reduced based on the coverage we refer to. The commissions are based on the product we collectively choose that fits your lifestyle and your budget. Don’t navigate this maze alone, call us today at 208-409-338!