Medicare Simplified
We believe that the better educated you are about Medicare, the easier it will be for you to make the right decisions about your Medicare health insurance choices. That's why we've created this resource section.
This Medicare information section is here to educate you about your insurance options and provide you with the resources you need to help you select the right plan for your unique needs.
If there's anything you need or if you have any questions, please feel free to contact us. We are here to help.
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WHAT YOU NEED TO KNOW
Medicare is a health insurance program for:
- people age 65 or older,
- people under age 65 with certain disabilities, and
- people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
COVERAGE OPTIONS
Part A - Hospital Insurance Coverage
Most people don't pay a premium for Part A because they or a spouse already paid for it through their 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 D - Prescription Drug Coverage
Most people will pay a monthly premium for this coverage. On 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. If a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.
Part B - Medical Insurance Coverage
Most people pay 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 doesn't 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.
(This information comes from: www.cms.gov)
By contacting the phone number on this website you will be directed to a licensed insurance agent.
Medicare Supplement Insurance Coverage
A Medicare Supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't 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 during certain enrollment periods or if you meet certain criteria (underwriting may apply), 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 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.
(Information obtained from www.medicare.gov)
By contacting the phone number on this website you will be directed to a licensed insurance agent.
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, or if you are under 65 and eligible for Medicare.
It's important to do this on time because there' may be a permanent premium surcharge for enrolling after your initial enrollment period if you don't have equivalent drug coverage from another source, such as a retiree plan.
Let us help you with your enrollment!
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 2025, several significant updates will affect Medicare Part D enrollees, including a substantial improvement with the implementation of a $2,000 out-of-pocket cap. This means that once you reach $2,000 in prescription expenses, you will not have additional out-of-pocket costs for the remainder of the year. This change represents a notable reduction from previous thresholds, aimed at helping individuals manage high prescription costs throughout the year.
Additional changes include the elimination of the “coverage gap” phase, sometimes referred to as the “donut hole,” where beneficiaries previously faced a change in cost-sharing. Starting in 2025, you will continue to pay consistent cost-sharing percentages in the initial phase, removing the complex transition to higher out-of-pocket costs that had occurred mid-year. The deductible is also rising slightly to $590 for many plans, although this may vary depending on individual plan details.
Part D drug benefits in 2025 are structured into three phases:
- Annual deductible. If your plan has a deductible, you will pay 100% of your gross covered prescription drug costs until the annual deductible is met.
- Initial coverage. Once the annual deductible is met, you will pay 25% coinsurance for covered Part D drugs. This phase ends when you have reached the annual out-of-pocket cap of $2,000 for 2025.
- Catastrophic. Once you meet the $2000 out-of-pocket cap, you will pay no cost sharing for covered Part D drugs.
These updates aim to make Part D costs more predictable and manageable, especially for those with high-cost medications. The changes are part of the broader Inflation Reduction Act adjustments, which bring greater financial relief to Medicare enrollees in need of costly prescriptions.
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, where you can find the basics about the benefit and Part D plans. There's a link to the Medicare Part D Plan Finder, 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
Call us to help you understand your options.
GETTING FINANCIAL HELP
Individuals with 2024 annual incomes of less than $22,590 and financial resources of up to $17,220 or married couples with incomes of less than r $30,660 and financial resources of up to $34,360 might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.
See Medicare's instructions on applying for the Extra Help program.
Additionally, read about the ways to lower your drug costs on Medicare.gov.
This information was obtained from www.medicare.gov
By contacting the phone number on this website you will be directed to a licensed insurance agent.