Do I Need to Review My Medicare Plan?

As we approach 2025, significant changes are on the horizon for Medicare Part D that will impact how prescription drug coverage is managed for seniors. In this blog, we'll breakdown the upcoming changes mandated by the Centers for Medicare & Medicaid Services (CMS) and what they mean for you or your loved ones. Here is everything you need to know about Medicare Part D Changes in 2025. How is Medicare Part D Changing in 2025 1. Prescription Payment Plan Beginning January 1, 2025, the Inflation Reduction Act mandates all Medicare Part D plans, including standalone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage, to offer a Prescription Payment Plan. This plan allows enrollees to pay out-of-pocket prescription drug costs through capped monthly installment payments instead of all at once at the pharmacy. This option is particularly beneficial for those facing high cost sharing early in the plan year, as it spreads out expenses over time. 2. Removal of Coverage Gap/Donut Hole Thanks to the Inflation Reduction Act, starting in 2025, annual out-of-pocket costs for Medicare Part D enrollees will be capped at $2,000. The coverage gap (commonly known as the "donut hole") will now be eliminated. This means you will no longer experience a gap in coverage where you are responsible for higher out-of-pocket costs for prescription drugs. 3. Impact on Prescription Drug Costs Seniors enrolled in Medicare Part D can expect potential savings on their prescription drug expenses due to these changes. The redesigned benefit structure aims to address the rising costs of medications and ensure that beneficiaries have access to necessary treatments without facing excessive out-of-pocket expenses. What You Need to Do As these changes take effect, it's important for Medicare beneficiaries to stay informed and proactive. Here are steps you can take to stay ahead of the curve: Review your current Medicare Part D plan to understand how it may be affected. October 1st start consulting with a trusted insurance advisor to explore new plan options that align with your healthcare needs and budget. Stay updated on communications from CMS and your healthcare providers. Look out for your Annual Notice of Change letter from your carrier in September, which will detail any coverage and cost changes effective January 1st. Senior Insurance Advisors is Here to Help At Senior Insurance Advisors, we specialize in navigating Medicare and are dedicated to helping you understand and benefit from these new Medicare Part D changes. Our team can provide personalized guidance, evaluate your coverage options, and ensure you have the right plan in place for 2025 and beyond. The upcoming changes to Medicare Part D in 2025 represent a huge step forward in enhancing prescription drug affordability and access for seniors. By staying informed, you can navigate these changes confidently and ensure that your healthcare needs are met effectively. To schedule a free consultation and learn more about how these changes may impact you, contact Senior Insurance Advisors today. We're here to support you in making informed decisions about your Medicare Part D coverage.

Why is there so misconception about Medicare Advantage Plans Medicare Advantage also known as Part C of Medicare can be a polarizing topic. Some people will say they love their Medicare Advantage Plan and others will warn you to stay away. They have a bit of misconception. If you’ve been checking with some of your doctors about what plans they take, chances are, you have heard some of your providers tell you why Medicare Advantage plans are bad. Over the years, we’ve heard from many providers that do not like Medicare Advantage plans because their payments come slower than they do for Original Medicare or there is so much more paperwork involved to receive approvals. So, are Medicare Advantage plans bad? Not really - they are just misunderstood. All too often, Medicare beneficiaries try to enroll in coverage on their own without free help from a Medicare insurance broker like Senior Insurance Advisors. They often miss some really important details when they do this. Then they are later unhappy with the plan, but it’s not the fault of the plan. It’s simply that they didn’t know the rules before they enrolled. So, let’s dive in on some of the reasons why Medicare Advantage plans are bad for certain individuals. We’ll go over some of the most common things that Medicare beneficiaries have reported to us that they don’t like about these plans. Then you can decide for yourself if you wish to enroll in one or not. Constantly Paying Out of Pocket for Services Medicare Advantage plans usually have copays and coinsurance. When you enroll in a traditional Medicare Supplement like Plan G, you pay a higher premium upfront, but very little out-of-pocket on the back end. No copays for doctor visits, lab work or daily hospital copays. You are only responsible for the Part B deductible. When you enroll in a Medicare Advantage plan, you pay a much lower premium and now, you will pay copays and coinsurance for services as you go along. For example, you might pay $20 for a primary care doctor or $40 to see a specialist. Then that doctor may order an MRI, and you must pay a $200 copay for this service. When you pay a copay at the time of service, the copay gets deducted from the annual out of pocket maximum. Each Medicare Advantage Plan has a Summary of Benefits. This Summary lists all the costs in detail. Your agent will review this information with you. If you carefully review the summary up front, then there should be no surprise to you. Unfortunately, people fail to read the fine print, and then they end up thinking that their Medicare Advantage plan is bad. This is not the fault of the plan but rather a failure by the enrollee to do his due diligence upfront. They Mistakenly Think They Don’t Have to Pay for Their Medicare Part B Premium Medicare Advantage plans are paid by Medicare. When you enroll in a plan, Medicare pays the insurance company to take on your health risk. Many Medicare Advantage plans will set very low premiums or a $0 premium for the plan itself. However, the $0 premium is confusing to beneficiaries. Many of them think that a $0 premium means they don’t have to pay for Part B. This is false. You will still pay for Part B the entire time that you are enrolled in a Medicare Advantage plan. Smaller Networks and Referrals Most Medicare Advantage plans have local, or nationwide networks, so the plan’s entire network might only have a few thousand providers. However, if you stay with Original Medicare and enroll in a Supplement plan, you would have access to nearly a million providers nationwide. Many people enroll in a Medicare Advantage plan without realizing this. They fail to check with their favorite doctors and hospitals to confirm they participate in the plan’s network. Then they go to use their coverage, and their doctor turns them away because they don’t accept that coverage. This one is really easy to avoid by checking the plan’s provider directory online before you enroll in the plan. Be sure that you confirm the doctor’s participation in the EXACT plan name of the plan that you are thinking about. Some insurance companies operate multiple networks. For example, United Healthcare may have an HMO plan and a PPO plan in your area. Your doctor may participate in one but not the other. If you check the wrong directory, you could come up with a false result. If you travel often, a Medicare Advantage plan may not be right for you. However, most plans do have nationwide networks. Which means, if you see a doctor and they accept your plan it will be consider in network even though you’re outside the service plan area. Getting a referral If you enroll in a Medicare Advantage plan with an HMO network, then you will usually have to choose a primary care provider. Most plans do not require a referral to see a specialist. High Out-of-Pocket Maximums Medicare Advantage plans all have an Out-of-Pocket Maximum (OOPM) limit to protect you from high out of pocket costs. This is a good thing! It protects you from spending beyond a certain dollar amount each year on Part A and B services. The downside is that plans can set that OOPM as high as $8,850 in 2024. For people on fixed incomes, coming up with $8,850 in a calendar year is a lot. Prior Authorizations Insurance companies are always looking to make sure something is reasonable and necessary. These plans typically involve a greater requirement for your provider to get pre-authorizations before approving services. Sometimes that authorization request might get denied. We see this a lot on medications. The drug is listed in the plan’s formulary, but in the fine print, it requires prior authorization or a quantity limit. The Expertise of a Local, Licensed Agent Senior Insurance Advisors offers a valuable opportunity for beneficiaries to get ready and plan for Medicare . By understanding the basics of Medicare, evaluating your current coverage, exploring your options, reviewing your medications, and seeking professional guidance, you can make informed choices that ensure you have the right coverage for your healthcare needs. Meet with our advisor so you can secure the peace of mind and financial security that proper healthcare coverage offers. With careful consideration and proactive planning, you can confidently navigate your Medicare Enrollment, knowing that you've optimized your healthcare coverage. Call us to schedule a consultation and secure your medical future today!

Today, it’s not uncommon for people who leave the workforce around Medicare eligibility age (age 65) to return to work later on. Maybe it’s a passionate side-gig, a part-time job or full-time. In any case, when you go back to work, what does that mean for your Medicare coverage? Can you have employer coverage again when on Medicare? Yes, if you or spouse go back to work for an employer who offers health insurance, you can take it. You are allowed to have both Medicare and employer coverage, and you can use them together. One will act as primary coverage and the other as secondary coverage. The employer health insurance must be a credible health plan. The only thing to keep in mind is that when you have Medicare and an employer plan, you cannot contribute to a health savings account (HSA) if it’s offered. Can I drop Medicare if returning to work? If you’re going back to work and can get employer health coverage that is considered credible primary coverage, you are allowed to drop Medicare and re-enroll again without penalties. If you drop Medicare and don’t have credible employer coverage, you’ll face penalties when going back on Medicare. An employer health coverage is credible when the prescription drug coverage is expected to pay, on average, at least as much as Medicare drug coverage. Before you decide to drop any part of Medicare, there are some things you’ll want to think about, especially as some choices could end up being costly. · Pre-Existing Conditions: If you decide to drop Medicare Part B, you’ll also have to drop your Medicare Supplement plan (Medigap) if you have one. This could make it difficult to enroll in another later on as your pre-existing health conditions will be considered when applying. · Health Savings Accounts (HSAs): If you want to contribute you an HSA, you will have to drop Part A. You could end up having to repay the government for medical services Medicare covered as well as repaying any Social Security benefits. · Premium Payments: If you are currently paying premiums for Part A, you cannot disenroll from Part B without also disenrolling from Part A. Additionally, should you decide to disenroll from Medicare, you’ll need to talk with Social Security directly. You can do this either in-person or on the phone. Social Security requires that you consult with them while you fill out the Part B disenrollment form. Re-enrolling in Medicare when working after 65 Medicare has rules for re-enrolling after you’ve dropped it for an employer-sponsored health plan. You’ll have an 8-month Special Enrollment Period in which to re-enroll in Medicare Part A and Part B. If you miss this window, you’ll have to wait to enroll in the Medicare General Enrollment Period (January 1 – March 31) and you could face late enrollment penalties if you end up going too long without credible coverage. NOTE: While you have eight months for Parts A & B, you only get two months after losing the employer coverage or leaving work to re-enroll in a Medicare Part D prescription drug plan or a Medicare Advantage (Part C) plan. If you enroll later, you’ll face late enrollment penalties for Part D. Finally, if you wish to re-enroll in a Medicare Supplement (Medigap) plan, you’ll be able to do so any time after re-enrolling in Parts A & B. Learn more about the Special Enrollment Period for people working past 65 .  There are a lot of things to consider when it comes to Medicare and returning to work. Take your time thinking through your options. Any decision is right so long as it’s what’s best for your health and lifestyle. If you still have questions about you options, we would love to provide you with a no-cost consultation! Give us a call or easily request more information through our website.

Navigating your health insurance can feel like you’re learning a foreign language that changes every year. For many people who qualify for Medicare (age 65 and older), they’re beginning to wonder, “Can I have both employer insurance and Medicare?” The answer (thankfully) is yes, but you must maximize your coverage.

Do you have to apply for Social Security to get Medicare? Millions of seniors rely on Medicare for health benefits in retirement, and depend on Social Security as a key income source. But while the two programs are interrelated, participation in one doesn’t necessarily hinge on being signed up for the other. Many people think you must enroll in Social Security before applying for Medicare; fortunately, that’s not the case. Social Security and Medicare are tied together in some ways, but in others, they are separate programs. In this post, we’ll go over what you need to know about how the two go together. At what age do I qualify for Social Security? You can begin collecting Social Security retirement benefits as early as age 62. Doing so, however, is often not advisable, since it means lowering your monthly benefits. To collect the full monthly benefit, you must wait until full retirement age to sign up for Social Security. Your full retirement age depends on your year of birth. For each month you file for Social Security ahead of full retirement age, you’ll face a reduction in your monthly benefits. At what age do I qualify for Medicare? In order to qualify for Medicare, you must meet one of the following requirements: 65 or older, qualify disability, or at any age with End Stage Renal Disease or ALS. Your initial enrollment period for Medicare begins three months before the month of your 65th birthday, and ends three months after the month you turn 65. If you miss your initial Medicare enrollment window, you can sign up during the general enrollment period of January 1 through March 31 of each year. The longer you hold off, the more it could cost you. If you wait too long to sign up for Medicare Part B, you’ll face a 10 percent increase in your Part B premiums for every year-long period you were eligible. If you’re still working and have creditable coverage under a group health plan, you’ll get a special enrollment period that begins when you separate from your employer or your group coverage ends. At this time, you will not have to worry about penalties. Do I Need to Enroll in Medicare if I’m Receiving Social Security Benefits before 65? If you are receiving Social Security benefits prior to 65 then you will automatically be enrolled in Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). You will receive your card in the mail 3 to 4 months prior to your 65 th birthday. You’ll still need to make important decisions about your coverage, like whether you need to add drug coverage. If you’re not receiving Social Security benefits at the time you are ready to sign up for Medicare, you will need to apply yourself . There are a couple of ways to apply; you can contact us , schedule an appointment with your local Social Security office or visit www.ssa.gov . Make your decisions independently Again, collecting Social Security is by no means a prerequisite to getting Medicare. In fact, it’s often advisable to sign up for Medicare as soon as you’re eligible (assuming you don’t have other creditable health coverage) but wait on Social Security to avoid a reduction in benefits.  If you sign up for Medicare alone, the only downside is having to make your premium payments directly, as opposed to having them deducted from your Social Security benefits. Trust Our Licensed Medicare Advisors Understanding Medicare coverage doesn’t have to be complicated or intimidating! Our licensed advisors are dedicated to helping you make informed decisions about your healthcare coverage. We’ll gladly support you when enrolling , comparing plans , and navigating rate changes at your convenience. Our advisors are here for you every step of the way. If you’re turning 65 soon or simply have questions about delaying Medicare, then please feel free to give us a call , send us an email , or contact us online for a free consultation . We believe everyone deserves personalized Medicare support, and we’d love the opportunity to help you, too.

This is one question we get when a client is nearing or at 65 and is not on Medicare yet. They are considering retirement but want to continue on the company’s COBRA medical and prescription coverage instead of enrolling in Medicare. If you remain employed and on your employer group plan past age 65, you do not need to enroll in Medicare Part B (Medical Coverage). Medicare Part B has a monthly premium. If you’re not contributing to Health Savings Account (HSA), then we suggest you to enroll in Medicare Part A (Hospital Coverage). Medicare Part A is premium free if you or a spouse have worked and paid in taxes for 10 years or longer. If your employment ends and enrolling in your company’s COBRA medical and prescription coverage may be an available option. But you need to beware that you’re possibly creating a problem for yourself. The government does not consider COBRA to be creditable medical coverage (medical or prescription drug coverage that has minimum coverage requirements). Group coverage and prescription drug coverage from your employer, while you are employed, is typically considered creditable coverage. COBRA medical coverage is not, although COBRA prescription drug coverage may be. Once you lose your employment group coverage, Medicare will allow you an 8-month period to enroll in Medicare Part B. This 8-month period is called Special Enrollment Period. If you wait until after this 8-month period has expired, you may be subject to a late enrollment penalty. Enrollment in COBRA does not extend this 8-month period. Even though COBRA can last 18 months or longer, it does not extend the 8-month period to enroll in Part B. We recommend our clients to enroll in Part B within 8-months of losing their employment. That way there will be no penalty for late enrollment. Trust Our Licensed Independent Advisors Understanding Medicare coverage doesn’t have to be complicated or intimidating! Our licensed advisors are dedicated to helping you make informed decisions about your healthcare coverage. We’ll gladly support you when enrolling , comparing plans , and researching additional coverage options at your convenience. Our advisors are here for you every step of the way. If you’re turning 65 soon or simply have questions about your current Medicare coverage, then please feel free to give us a call , send us an email , or contact us online for a free consultation . We believe everyone deserves personalized Medicare support, and we’d love the opportunity to help you, too.

Medicare coverage for home care requires meeting stringent requirements. Plus, Medicare doesn't readily cover long-term home care services unless they’re directly associated with skilled care needs.

Each year, the designated period known as Medicare Open Enrollment allows these beneficiaries to be ready and select different policies. However, many Americans aren’t sure how to navigate these sophisticated plans, which is why we’re here to help you choose the best possible plans.

Medicare plays a vital role in ensuring access to necessary medical services for Americans aged 65 and older. However, many people are often left wondering about the cost associated with this program. Understanding the expenses involved with Medicare is crucial for seniors and their families to make informed decisions about their healthcare needs. That's why we're going over the various aspects of one's Medicare cost, shedding light on what beneficiaries can expect. The Four Main Medicare Costs Medicare, the federal health insurance program, is comprised of four main parts - Parts A, B, C, and D - each serving specific purposes to provide comprehensive healthcare coverage. Understanding each part's cost , purpose, and benefits, is essential to navigating the complexities of Medicare. Medicare Part A Medicare Part A , also known as hospital insurance, covers inpatient hospital stays, skilled nursing facility care, and some home healthcare services. For most individuals, Part A is premium-free, as they have previously paid Medicare taxes. If you haven't worked long enough to qualify for premium-free Part A, you may have to pay a premium. In 2023, the Part A premium is capped at $506 per month. It's worth noting that Part A also has deductible and coinsurance costs. The deductible for each benefit period in 2023 is $1,600, and this amount covers the first 60 days of inpatient hospital care. Beyond 60 days, beneficiaries are responsible for daily coinsurance amounts. Medicare Part B Medicare Part B covers outpatient services, including doctor visits, preventive care, medical supplies, and some outpatient procedures. Unlike Part A, Part B requires beneficiaries to pay a monthly premium . The standard premium for Part B in 2023 is $164.90 per month. However, this amount can vary based on income. In addition to the premium, Part B also includes an annual deductible, which is $226 in 2023. After meeting the deductible, beneficiaries typically pay 20% of the Medicare-approved amount for most services. Medicare Part C (Medicare Advantage) Medicare Part C, also known as Medicare Advantage , is an alternative way to receive Medicare benefits from approved private insurance companies. The costs associated with Medicare Advantage plans can vary depending on the specific plan you choose. While some plans have no monthly premiums, others may require a monthly premium in addition to the Part B premium. Furthermore, Medicare Advantage plans often have different copayments , coinsurance, and deductibles, when compared to Parts A and B. It's crucial to review the details of each plan to understand the specific costs involved. Medicare Part D Medicare Part D provides prescription drug coverage . This coverage is offered through private insurance companies approved by Medicare. The costs associated with Part D plans can vary depending on the specific plan, the drugs you take, and the pharmacy you use. Part D plans generally have a monthly premium, an annual deductible, and copayments or coinsurance for medications. It's important to carefully compare Part D plans to ensure they cover the medications you need at a cost that aligns with your budget. Additional Considerations of Your Medicare Cost In addition to the costs mentioned for Medicare Parts A, B, C, and D, it's important to consider other factors that may affect your overall healthcare expenses. Medicare Supplement Insurance, also known as Medigap, is available to help cover the gaps in Original Medicare (Parts A and B). These policies, sold by private insurance companies, can help pay for expenses such as deductibles, copayments, and coinsurance. The cost of Medigap plans can vary depending on the coverage level and the insurance company. It's essential to compare Medicare Supplement and Advantage plans to find one that suits your needs and budget. For individuals with limited income and resources, there are various programs available to provide financial assistance with Medicare costs. The Medicare Savings Programs (MSPs) help pay for premiums, deductibles, and coinsurance for eligible individuals. The Low-Income Subsidy (LIS), also known as Extra Help , assists with prescription drug costs under Medicare Part D. These programs can significantly reduce the financial burden associated with Medicare. Additionally, it's worth exploring whether you qualify for any state or local assistance programs that may provide further support with healthcare expenses. To fully understand the costs and potential assistance available, seek guidance from a trusted independent insurance agent . They can provide personalized information based on your specific circumstances and help you navigate the complexities of Medicare costs. By considering these additional factors and exploring available assistance programs, you can ensure that you have a comprehensive understanding of the potential expenses associated with Medicare and make informed decisions about your healthcare coverage. We Take the Confusion Out of Medicare Understanding the cost of Medicare is crucial for anybody seeking or possessing enrollment in the program. While Medicare Part A may be premium-free for most beneficiaries, Parts B, C, and D involve various premiums, deductibles, and coinsurance amounts. By familiarizing themselves with these costs, seniors and their families can better plan for their healthcare expenses and make informed choices about their coverage options. It's always advisable to consult with an experienced independent insurance agent for the most up-to-date information on costs and coverage details. If you have any questions about any Medicare components, give us a call today to arrange a free consultation. With this knowledge in hand, beneficiaries can navigate Medicare confidently and ensure their healthcare needs are met.