As an independent broker, I can help you enroll with most of the major carriers offering Medicare Supplements (Me, Medicare Advantage, and Prescription Drug Plans. I also offer individual Dental, Vision, and Hearing Plans from multiple carriers along with Hospital, Critical Illness, Cancer, or Accident Indemnity Plans.
Medicare Part A may cover inpatient care in hospitals, nursing homes, and skilled nursing facilities, hospice or home healthcare.
Medicare Part B may cover medically necessary services, clinical research, ambulance, mental health, durable medical equipment, and some outpatient drugs.
MA or MAPD are plans that combine Medicare coverages, usually offered as an HMO, PPO, PFFS (private-fee-for-service), or special needs and may include prescription drug coverage.
Part D plans began in 2006 when credible drug coverage became mandatory. Late enrollment carries a lifetime monthly penalty. There are four phases of part D coverage.
Medigap plans are standardized plans offered by private insurance carriers. These plans pay some or all of the "gaps" in original Medicare and can not be combined with a Part C plan.
Election periods may occur when first eligible for Medicare, during Open Enrollment periods, when termination of credible coverage occurs, qualifying for Medicaid, or if another special election period applies (depending on plan type).
Most people qualify for Part A (premium-free) at age 65.
The hospital deductible is $1484 per benefit period, then $0 copay days 1-60, $371 days 61-90, then $742 beginning day 91. After day 90 the lifetime benefit is 60 (reserve days). Inpatient mental health is covered the same.
Skilled nursing facility stays are $0 copay for days 1-20, $185.50 copay days 21-100, and all costs from day 101 and beyond are not covered.
Hospice care is covered in full (not including room & board).
The Part B premium for 2021 is $148.50 per month (higher for some) and the deductible is $203.
Once the deductible is met, you pay 20% for most covered services (you pay $0 for home health care and Medicare-approved laboratory services).
There is no maximum out-of-pocket limit.
In addition to the service mentioned above, Part B covers preventive services like an annual wellness exam, screenings, immunizations for flu, pneumonia, hepatitis B, and tobacco cessation counseling.
Medicare Advantage plans are required to have coverage at least as good as original Medicare.
Premiums will vary between different plans and carriers (you must still pay Part B premiums).
Income over $88,000 ($176,000 if filing jointly) is subject to Part D IRMAA (income-related monthly adjustment amounts) if prescription drugs are covered by the plan (Part D coverage rules apply).
You must live within the plan's service area.
Plans may include coverage for services not covered by Original Medicare.
Medicare Advantage plans have different deductibles and maximum out-of-pocket limits.
You may not combine a PDP with Medicare Advantage (unless it is a private-fee-for-service plan).
Premiums vary between plans, and income over $88,000 ($176,000 jointly) are subject to IRMAA.
PDP's may have a deductible, not to exceed $445.00.
You must live in the plan's service area.
Formularies list covered drugs by tiers, which may or may not be subject to the deductible.
Tier one drugs have the lowest copayment, usually generic, and your costs increase with each tier.
PDP's have four coverage phases: deductible, initial coverage, coverage gap (donut hole), and catastrophic coverage during each calendar year.
Routine foot care, hearing aids (and exams), long-term or custodial care, dentures, cosmetic surgery, acupuncture, dentures (and most dental care), eyeglasses (and fitting exams).
Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,370 before your policy pays anything.
Plans C and F aren't available to people newly eligible for Medicare on or after January 1, 2020.
Some states only offer Medigap plans to age 65+ or have an alternative to the plans listed in the chart.
For Plans K and L, after you meet your out-of-pocket yearly limit (K - $6220, L - $3110) and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.
Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in an inpatient admission.
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