MEDICARE FUN FACTS & FAQ'S ABOUT MEDICARE

---

Medicare is a national health insurance program established and administered by the federal government.  It operates under the same rules and regulations no matter where you live in the US. 

Medicare operates under CMS (The Centers for Medicare and Medicaid Services) under the umbrella of the United States Department of Health and Human Services. 

You generally become eligible for Medicare when you turn 65.  Some people may qualify earlier if they receive Social Security Benefits or have been diagnosed with ALS (Lou Gehrig's Disease) or end-stage renal disease.

Once you turn 65, you have two Credible choices for Health Insurance, Medicare and your Employer Group Health Insurance as long as your employer has over 20 employees.

If your employer has less than 20 employees, you will need to join Medicare as soon as you turn 65 to e in compliance and to avoid Medicare Late Enrollment Penalties..

For many people, Medicare is a much better choice than their employers Health Plan and many employers offer to reimburse employees working past 65 for their Monthly Medicare Part B and their Medicare Supplement. And the most comprehensive plan for those new to Medicare is Medicare Supplement Plan G!

We recommend everyone who is planning on working past age 65 to request a meeting with their Human resources or Benefits Administrator so you can see what options you will have. Compare your weekly/bi-weekly charges for your Group insurance, list what your deductible is and find out if you can how much your employer pays for your plan.  In just about every case your employer will save money by taking you off of their plan roles and just reimburse you for your monthly Medicare premiums.  Then, when you are finally ready for retirement, there is nothing for you to do, you will already be enjoying the benefits and peace of mind from having the most comprehensive healthcare available.

Medicare has  different parts that cover different things: Medicare Part A covers In-Patient Costs, Medicare Part B covers Out-Patient costs.  Medicare Part C refers to Medicare Advantage plans and Medicare Part D covers Prescription Medications.

Original Medicare consists of Medicare Part A and Medicare Part B. Original Medicare is an 80/20 Healthcare plan.  This means that Medicare will pay for 80% of all Medicare covered expenses and all medically necessary procedures.  Then, after Medicare pays, you are responsible for the remaining 20%.

Medicare is not free. There are monthly premiums and cost sharing for things such as deductibles and coinsurance. Today there are over 57 million people on Medicare, there are over 900,000 doctors and hospitals who accept Medicare in the United States. 

 Your Initial Enrollment Period (IEP) for Medicare is 7 months long beginning 3 months before your "Birth Month" and continues until 3 months after you turn 65.   Some conditions may qualify some people for Medicare benefits before they reach 65.  

During your IEP you are GUARANTEED issue into Medicare and any Medicare Supplement Plan or Medicare Advantage Plan you choose. During this special period, there are no medical questions to answer and nothing about your past or present health status needs to be disclosed! 

After your IEP, anyone on Medicare is welcome to apply for any Medicare Supplement plan they choose, but; everyone will be subject to Medical Underwriting approval in order to join.  If you care in good overall health, are not dependent on Insulin, have not had Cancer for at least 5 years and have no Cardiac issues (Pacemakers, Stents, Defibrillators) and you do not have ALS or End Stage Renal Disease you should qualify.

There are late penalties if you miss your IEP and do not have any other credible health coverage (such as employer coverage).  You can apply for Medicare from the Social Security Administration in person, online or by telephone.

MEDICARE PART A 

Pays for hospital stays, skilled nursing care, blood and hospice. About 99% of people enrolled in Medicare Part A never will have to pay a premium for Medicare Part A coverage because of the Medicare Taxes they paid through payroll deductions throughout their working careers. The Medicare Deductible for Medicare Part A is $1,600.

MEDICARE PART B 

Covers outpatient services such as preventative care, doctor visits, lab work, diagnostic imaging, outpatient surgery, durable medical equipment, chemotherapy, radiation treatments, Drug Injections for various ailments and more.

EVERYONE who enrolls in Medicare Part B must pay their monthly Medicare Part B Premium and their Annual Part B Deductible, regardless of whether they participate in Original Medicare, a Medicare Advantage Plan or; even if they choose Original Medicare with a Medicare Supplement policy. Your Medicare Part B premium can be Paid by Credit Card, Direct Bill, EFT Transfers or can be paid from your monthly Social Security Benefits.

For 2023 the monthly Medicare Part B premium is $164.90, and the Annual Part B Deductible will be $226. This means you must meet the annual Deductible before Medicare begins to pay.

Both Medicare part A and Medicare Part B are 80% paid for by the government and 20% is the responsibility of the beneficiary or the patient. With Original Medicare you are free to choose and Doctor or Hospital that accepts Medicare Terms for payment. (Approximately 94% of all Doctors accept Medicare.

MEDICARE PART C 

Medicare Part C is most commonly referred to as Medicare Advantage or MA. Medicare Advantage plans are still 80/20 plans but instead of the government, these plans are offered and managed by private insurance companies. where the private insurance company pays for 80% of covered services and you are responsible for the other 20%. You must pay your 20% share whenever you receive medical services. You are also responsible to pay for any/all co-pays and deductibles.  

M/A plans are either HMO (Health Maintenance Organization) or a PPO network (Preferred Provider Organization). With these plans you must use the Doctors and Hospitals listed in their network in order to receive full coverage for any procedure.  

The company decides which services they will pay for and honestly, they are well known for denying claims and coverage, they just do not disclose that in their TV commercials or Marketing flyers/Postcards/Brochures.

Medicare Advantage plans each have their own MOOP.  MOOP stands for Maximum-Out-Of-Pocket expenses. This is the amount you must pay for before your insurance company pays for all of your healthcare services.  And, for 2023 the average for MOOP for In-Network care is $5,700 and over $12,000 for Out-Of-Network care.

MEDICARE PART D 

Covers Prescription Drugs. Because there is no prescription drug coverage with Original Medicare (except for those drugs and medications that are provided during a hospital stay).  

On October 8, 2003 President George W. Bush signed Medicare Prescription Drug coverage into law.

 Medicare Part D  covers retail prescription drugs for Medicare beneficiaries through unique, stand-alone drug insurance plans. . 

 You pay a monthly premium to join any Medicare Part D Prescription Drug plan available in your area that fits your needs the best choose in addition to the discounted price for your prescription medications.   These plans range from $5.40 - $139 per month. We strongly believe that it is best to work with an experienced Medicare Broker like BradenMedicare.com to find the best plan at the lowest cost for your own individual needs.

Each Insurance Company offering Medicare Part D Prescription Drug Plans must have at least 1 Plan that offers the Senior Savings Model which caps the monthly maximum you can spend on Insulin at $35.00. 

You should review your plan annually and you can change your plan in the fall and the new plan will begin on January 1st every year.

All Medicare Supplement (Also referred to as Medigap) plans are identified by a letter and each plan has the exact same coverage coast to coast.  The only difference is the price the insurance companies charge in each state.  

Medicare Supplement Plans became available in 1990 and these plans are all standardized and must follow the guidelines set by Medicare itself.  Medigap Plans are lettered and although the coverage is the same from each Insurance Company their prices will vary.  These are Plans A, B, C, D, F, G, K, L, M and N. The most common plans sold are Plans C, F, G and N, however only Plan G and N are available for those new to Medicare after January 1st, 2020.

Medicare Supplement Plan G or Medigap Plan G is the best and the most comprehensive Medicare Supplement available to new Medicare Beneficiaries as of 1/1/2020. 

Plan F used to be considered the Best Medigap plan available, and it is still popular, however, the annual premiums for Plan F are usually $400-$1,200 more per year than Plan G.  The only difference in the plans (aside from the price) is that Plan F automatically pays your Annual Part B Deductible for you. Medicare sends you a bill for you to pay your Part B Deductible. With Plans F and G you will never have a bill from Medicare for any Medicare approved/Medically Necessary procedure, aside from your Annual Part B Deductible, which everyone has to pay, regardless of what Plan they enroll in.  

With a Plan G Medicare Supplement plan, Medicare pays their 80% share and your Plan G policy,  pays the remaining 20% (your share) and you pay nothing! 

Medicare will pay their share and your Medicare Plan G Supplement will pay the rest.  Honestly, this is the best deal in Healthcare in the US. The best way to look at this is your Maximum Out-Of-Pocket Expense is your monthly premium.   The majority of Plan G beneficiaries pay well under $2,000 a year in premiums and when you realize that the lowest MOOP (Maximum Out-Of-Pocket Expense)  you can find with a limited no-cost Medicare Advantage plan is $5,700 based on the 2022 nationwide average. comparison. 

Perhaps the biggest benefit is choice and portability. A Medicare Supplement or Medigap plan allows you to choose ANY Doctor, go to ANY Hospital ANYWHERE in the United States and you are covered, as long as the Doctor and Hospital both accept Medicare's Assignment/Fee Structure.

  Why would anyone choose a limited Medicare Advantage plan with local networks and limited choices for Physician's and Healthcare Facilities when you have less exposure and better coverage with a Medicare Supplement Plan G? And, not just that but once you are approved and enroll in a Medicare Supplement, your plan  can never cancel your policy, as long as your premiums are paid. That is true peace of mind for you and your family.

 You must continue to pay your Medicare Part B premium even if you are enrolled in a Medigap Plan.  

 Items not covered by Original Medicare include:  

• Routine Dental, Vision and Hearing exams
• Hearing Aids
• Eyeglasses or Contact Lenses
• Long Term Care or Custodial Care
• Retail Prescription Drugs

Medicare does cover Cataract Surgery, Macular Degeneration, and a limited amount of Chiropractic and Acupuncture therapies. So for the sake of Medicare it is easiest to remember that Medicare will cover anything at an Ophthalmologists office, but they will not cover anything at an Optometrists office.

Did you know that all Medicare Supplement Plans (aka Medigap Plans) are standardized by Medicare? This means that every Medicare Supplement Plan available in the US is the same from coast to coast. What is not the same is what each individual insurance company charges in premiums in a specific market (State). So you can feel safe knowing that a Medicare Supplement Plan G from ACE Healthcare has exactly the same benefits as the plan from Blue Cross. 

Many companies who offer Medicare Supplements have extra added services and benefits such as Health Club Memberships, Discounts for Dental and Vision, etc. If these are important to you make sure to ask your Broker.

Medicare Supplement Plans F, G and N will also pay the $1,600.00 Medicare Part A Deductible for you and Plans F and G will also cover any Excess Medicare Part B charges for you.

Lastly, many Medicare Supplement insurers request a $20-$25 Application/Policy Fee when applying for one of their plans.  Although this is quite common it is not necessary.  There are plenty of other quality companies who do not require you to pay these unnecessary fees. 

Medicare Advantage plans are not Medicare.  They are Medicare inspired Healthcare plans offered by private insurance companies.  These companies decide what procedures they will cover! There are limited networks, with annual Out-Of-Pocket Expenses (MOOP) between$5,700 - $12,000 annually. 

A Medicare Advantage Plan is a private health insurance plan approved by Medicare.  You have the option to receive your Part A, Part B and Part D benefits from a Medicare Advantage Plan instead of Original Medicare.  Originally these private insurance company offerings were referred to simply as Medicare Part C.  Medicare Advantage plans usually have and HMO or PPO network of physicians and hospitals. All Medicare Advantage Plans are 80/20 Plans where the insurance company pays 80% of the covered charges and you are responsible for paying your 20% share as you go. Each year you in the fall Annual Enrollment Period you will need to choose a new plan for the coming year 

MA and MA/PD (Medicare Advantage Plans) were created as an alternative to Original Medicare and Medicare Supplemental/Medigap insurance.  By joining one of these plans, you direct Medicare to pay the Advantage Plan a set monthly amount for your care.  In return, the plan will deliver all of your Part A & Part B benefits and services.  Essentially your care and services are managed by a private insurance company instead of the government.  The Insurance carrier takes on all of the risk. And, unfortunately, each Insurance Company makes it own rules and they have final say on what procedures are covered and which ones are not.

You must continue to pay your Medicare Part B premium each month, you must be enrolled in Medicare Part A and Part B and you must live in the Medicare Advantage Plan' service area.

Medicare Advantage plans are NOT Medigap plans.  They work differently because your insurance company pays all of your bills instead of Medicare, which means they also decide what they will and will not cover.

There are some great advantages for people choosing a Medicare Advantage plan.  First and foremost is that most of their plans offer $0 monthly premiums, the majority of Medicare Advantage plans also include Prescription Drug coverage.  And there are many other benefits including Dental, Vision and Hearing benefits, Over The Counter (OTC) Benefits, Transportation and more.  

At Braden Medicare we are legally contracted by the best Medicare Companies who offer Medicare Advantage plans in Arizona. It is important to mention that we do not offer every plan available in every county in the United States. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.” 

Medicare Part D is a Voluntary Prescription Drug Plan that was introduced in 2006 to help Seniors on Medicare with a way to help them cut down on the costs associated with Prescription Drugs. 

Any beneficiary who is enrolled in Medicare Part A or Medicare Part B is eligible to enroll in a Part D Plan.

Medicare Part D is simply insurance for your medications.  You pay a monthly premium to an insurance company for your Part D Plan. In return, you use the insurance carriers' network of pharmacies to purchase your prescription medications.  Instead of paying full price, you will pay a copay, or a percentage of the drugs cost and the insurance company pays the rest.

Plans vary by state but most start around $25-$35 per month.

Two things we always recommend to our clients are:

 #1 You should never overpay for a Part D Medicare Prescription Drug Plan that covers more than you need because you are always able to change or switch your Part D plan each year during the Fall Medicare Annual Enrollment Period that runs from October 15th through December 7th.  Then, if you decide to change plans because either the costs went up or your prescription medications changed, your new plan will begin on January 1st for the upcoming year. 

#2 Everyone should download a copy of the Good RX app onto their Phone, Tablet or PC. Then, whenever a medication is prescribed check the price on Good RX and compare that with what your new medication would cost with your Part D Drug plan.  In many cases, it is less expensive to use a free Good RX coupon than using your plan.  That is why we compare every medication our clients have to ensure they are in the best plan, to save them the most money and we gladly review their plans each fall to ensure they are always in the right Part D plan that saves them the most money on their prescription medications every year.

In our home State of Arizona we are proud to offer every Medicare Prescription Drug plan available.  However, we do not offer every Medicare Prescription Drug plan available in every State. Any information we provide is limited to the Medicare Part D plans that we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.” 

Often times people who have not done any homework on Medicare come to the conclusion that Medicare is a   sub-standard form of Healthcare that is only for old people or for those who cannot afford Health Insurance. In reality Medicare is arguably the best Health Insurance you will ever have. That is why Medicare is the only Healthcare Program available if you are over 65 and no longer covered under your Employers Group Healthcare Plan.

Medicaid is a different animal altogether. Medicaid programs are managed by each Individual State, while Medicare is a National Healthcare solution.

Medicaid is typically used for Single Mothers, Aid for dependent children, those with a disability and yes, Medicaid offers assistance for those whose income level is lower than various Poverty Level Standards.

Medicaid also will come into play for individuals who need 24-Hour Care in a Nursing Home or Skilled Nursing Facility and they do not have the means to pay for the costs themselves. Medicare  Insurance Medicare Broker