Compare Medicare Supplements

IMPORTANT NOTE: Starting January 1, 2020, Medigap plans sold to new people with Medicare won’t be allowed to cover the Part B deductible. Because of this, Plans C and F will no longer be available to people new to Medicare starting on January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans.

Compare Medicare Supplement (Medigap) policies side-by-side

If you live in Massachusetts, Minnesota, or Wisconsin, Medigap policies are standardized in a different way.

Would you like my help?

If you would like help finding the right plan or just want to ask a few questions, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message. The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.

I am paid by the insurance companies in the form of a commission when you enroll in a plan. You will not pay anything to meet with me and you will pay the same price for your insurance that everyone pays whether they had my help or not.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

2019 Medicare Costs

Medicare Part A

Most people don’t pay a monthly premium for Part A (sometimes called “premium-free Part A”).  If you paid Medicare taxes for 40 or more quarters and you have earned your Social Security Benefit then you will not pay the Part A premium.  You have earned it through your taxes.

However, if you paid Medicare taxes for less than 30 quarters, the standard Part A premium you will pay is $437.  

If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $240. 

Medicare Part B

The standard Part B premium amount for 2019 will increase by $1.50. The premium will increase from $134 to $135.50.

Medicare Deductibles

The annual deductible for all Part B beneficiaries will be $185.00 in 2019.  However, depending on the insurance plan you choose, this deductible may be covered by your supplmental insurance plan.

The Medicare Part A annual deductible that beneficiaries pay when admitted to the hospital will be $1,364.00 in 2019.. The Part A deductible covers your share of costs for the first 60 days of Medicare-covered inpatient hospital care per stay in the hospital. After this 60 day period the daily coinsurance amount will be $341 for days 61 through 90 and $682 for each lifetime reserve day used.  Again, depending on the insurance plan you choose, these deductibles and some coinsurance amounts may be covered by your insurance plan.

Higher income households will pay more.

If your household income is more than $85,000 and you are single or more than $170,000 and married you will pay a higher monthly premium for Part B that will be between $189.60 to $460.50 depending on your income.  Click here to download a pamphlet from Social Security titled, “Medicare Premiums: Rules for Higher-Income Beneficiaries for more information.”

Your income is based on your tax return from 2 years prior.  Meaning for 2019 Social Security will use your tax return from 2017 to determine your household income.  But you may be able to get the high-income surcharge reduced or eliminated if your income has decreased since then because of certain life-changing events, such as the death of a spouse, divorce, retirement or reduced work hours.  In that case, you can ask Social Security to use your more recent income instead.  Contact the Social Security Administration, estimate your 2019 income, and provide evidence of the change, such as a marriage or death certificate, a signed statement of retirement from your employer, or pay stubs showing your reduced income.nk is external)

Are you retiring in 2019?

There is no cost or obligation for you to talk to me and get the answers to your questions.  I welcome all questions and it is my goal to be the single best resource in the state for such questions. And when the time comes for you to enroll in a Medicare Supplement and Prescription Drug Plan, I will help you with that too.

I am a licensed insurance agent working in Maine and New Hampshire.  I have contracts with the top health insurance companies available in the area.  I am able to help you via email, on the phone, or in person.

If you would like to review your options over the phone or schedule a meeting at your home or office you can reach me at 207-370-0143 or schedule an appointment on my booking website here.(link is external)

“The best part about working with me is that it costs you nothing and you benefit from my full knowledge and experience.”

That’s right.  You pay nothing to meet with me.  I am paid by the insurance companies in the form of a commission when you enroll in a plan. You pay the same price for the insurance whether you go direct to the insurance company or take advantage of working with someone who has experience and knowledge to help guide you. My goal is to help people and I have found great joy in being able to offer my services to people who need my help.

Would you like my help?

If you would like to talk to me or schedule a meeting at your home or a nearby meeting place, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.  The best part about working with me is that it will not cost you anything to meet with me to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.

“My goal is to help you and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

2019 Part D Costs

The Centers for Medicare and Medicaid Services (CMS) has released the 2019 costs for a standard Part D prescription drug plans.

Here are the highlights for the CMS defined Standard Benefit Plan changes from 2018 to 2019. This “Standard Benefit Plan” is the minimum allowable plan to be offered by insurance company who has a contract with Medicare to offer Part D prescription drug insurance.

  • Initial Deductible:
    will be increased by $10 to $415 in 2019.
  • Initial Coverage Limit (ICL):
    will increase from $3,750 in 2018 to $3,820 in 2019.
  • Out-of-Pocket Threshold:
    will increase from $5,000 in 2018 to $5,100 in 2019.
  • Coverage Gap (donut hole):
    begins once you reach your Medicare Part D plan’s initial coverage limit ($3,820 in 2019) and ends when you spend a total of $5,100 in 2019.
    In 2019, Part D enrollees will receive a 75% discount on the total cost of their brand-name drugs purchased while in the donut hole. The 70% discount paid by the brand-name drug manufacturer will apply to getting out of the donut hole, however the additional 5% paid by your Medicare Part D plan will not count toward your TrOOP (True Out Of Pocket).
    For example: if you reach the donut hole and purchase a brand-name medication with a retail cost of $100, you will pay $25 for the medication, and receive $95 credit toward meeting your 2019 total out-of-pocket spending limit.
    Enrollees will pay a maximum of 37% co-pay on generic drugs purchased while in the coverage gap (a 63% discount). For example: If you reach the 2019 Donut Hole, and your generic medication has a retail cost of $100, you will pay $37. The $37 that you spend will count toward your TrOOP (True Out Of Pocket).
  • Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit**:
    will increase to greater of 5% or $3.40 for generic or preferred drug that is a multi-source drug and the greater of 5% or $8.50 for all other drugs in 2019.
  • Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees:
    will increase to $3.40 for generic or preferred drug that is a multi-source drug and $8.50 for all other drugs in 2019. 

If you live in Maine or New Hampshire and would like to learn more about the new Medicare plans for 2019 or to go over the changes in your plan, you can call me at (207) 370-0143 or CLICK HERE to send me an email message.

You can also use the BOOK APPOINTMENT(link is external) button below to set up a time to speak with me on the phone or in person. I can also send you information in the mail if you choose. 
Have a question that needs to be answered right away?  You can talk to a licensed insurance agent by calling (207) 370-0143 or toll free 866-976-9038.
Book an appointment with Maine Medicare Options using SetMore

C.O.B.R.A.

Everything you need to know about COBRA

COBRA provides the ability for you and the dependents covered on your health plan to keep coverage after you lose your job or lose coverage for other reasons.

You are eligible for COBRA if your employer’s health plan covers at least 20 employees and you have had an acceptable “qualifying event.”   

A qualifying event is something that causes you or your dependents to lost health coverage, such as termination of employment, loss of full-time status, divorce or legal separation, or turning 26 (in the case of your children.)

If you have one of these events, your employer will notify you of your option to enroll in COBRA coverage within 14 days of the plan ending.  You will then have 60 days to decide if you want to enroll.

You can keep COBRA coverage for 18 or 36 months, depending on the qualifying event.

In general, COBRA only applies to employers with 20 or more employees. 

But, some states require employers covering employers with fewer than 20 employees to let you keep your coverage for a limited time.  This is often referred to as “Mini-COBRA” and you can read more about how Maine handles this here:  https://www.maine.gov/pfr/insurance/faq/cobra_faqs.html
 

Your Employer’s Responsibility:

The employer must tell the plan administrator if you qualify for COBRA because of one of these reason:

  • The covered employee dies
  • The covered employee lost her/her job
  • The covered employee becomes entitled to Medicare
Once the plan administrator is notified they must let you know you have the right to choose COBRA coverage.
 

Your Responsibility:

You or the covered employee are responsible to notify the plan administrator if you qualify because of on of the following reasons:
  • You’ve divorced or legally separated from the covered employee
  • You were a dependent child or dependent adult who is no longer a dependent.
You will need to tell the plan administrator about your change in situation within 60 days of the change in order to qualify for COBRA.
 
 

COBRA and MEDICARE:

Something really great about COBRA that is not widely known is that if the covered employee becomes entitled to Medicare and the spouse is a few years younger, you do not have to keep working to keep your spouse insured.   Your spouse and dependents may keep COBRA for up to 36 months if you lost coverage due to enrolling in Medicare!
 
You may also keep COBRA coverage for services that Medicare does not cover, such as vision and dental. 
 
You may – for example – if you have COBRA dental insurance, the insurance company that provides your COBRA coverage may allow you to drop your medical coverage but keep paying the premium for the dental coverage as long as you are entitled to COBRA coverage.
 
If you have Medicare Part A or Part B when you become eligible for COBRA, you must be allowed to enroll in COBRA if you choose.   Medicare will be the primary insurance and COBRA will be secondary.  You should keep Medicare because it is responsible for paying the majority of your health care costs.
 
NOTE:  COBRA is typically much more expensive than the most expensive Medicare plans so it makes sense to talk to an agent or broker like myself to know your options before you decide to go with COBRA and compare costs.

 

Read more about working with an agent.

 

 
If you have questions about Medicare or COBRA, you can reach out to me using the CONTACT button on the menu at the top of this website or by calling (207) 370-0143.  You can also reach out to the government agencies below.
 
If you are leaving a government employer contact:
The Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627.
 
If you are leaving a private employer contact:
The US Department of Labor at 1-866-487-2365
Maine DOL: (207) 623-7900
New Hampshire DOL: (603) 271-3176
 
 
If your employer group health plan coverage was from a state or local government employer then call
The Centers or Medicare and Medicaid Services (CMS) at 1-877-267-2323 extension 61565.
 
 
 

Would you like my help?

If you would like help finding the right plan or just want to ask a few questions, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.  The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay anything to meet with me and you will pay the same price for your insurance that everyone pays whether they had my help or not.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

 

Moving to Maine?

Are you moving to Maine or another state, and enrolled in Medicare?

Moving can be a stressful time and you have a lot of things to change and update. You will want to make sure your Medicare and Social Security benefits continue smoothly so here is some important information that I hope will help make it easier.

First, what kind of Medicare plan do you have?

 

Lettered Plans (Plan G, Plan F, Plan N, etc…)

If you have a Medicare Part D Prescription Drug Plan, with a Medicare Supplement plan that is a “lettered plan” which works in combination with Original Medicare and you move to another state, you will most likely be able to keep the same supplement policy but you will have to change your Part D plan.

When to start shopping for a new plan.

If you’re enrolled in a Medicare Advantage plan under Part C of Medicare, a change in residence, such as moving to another state, could qualify you for a Special Election Period (SEP). During this period of time, you are able to find a new plan that is offered in your new home.

If you permanently move somewhere that your current Medicare plan does not cover (outside the service area), you should call your insurance company immediately and begin looking for a new plan. The phone number for customer service is located on the back of your insurance card.

If you call your insurance company before you move and tell them you are moving, you will have one month before the month you move and three more months after you move to find a new plan but your insurance company may end your coverage at the end of the month that you move. So be sure to ask when your plan will end.

If you notify your plan after you move, you can switch plans the month you provided notice of the move and up to two months after that. Again, your insurance company may end your coverage at the end of the month, so it’s important to ask when it will end.

Medicare Advantage or Part C

If your current insurance plan is not offered in the new area, your plan is required by Medicare to dis-enroll you.  If you don’t enroll in a new Medicare Advantage plan during your SEP, you’ll return to Original Medicare (Part A and Part B).

If you miss this window and do not choose a new plan before it ends you may have to wait for the Annual Election Period (October 15 – December 7) and your coverage will begin January 1st.

Medicare Part D Prescription Drug Plan

The same rules for the Medicare Advantage plans above apply to your Part D plan. If you don’t enroll in a new Medicare Prescription Drug Plan during your enrollment window, you might find yourself without Medicare prescription drug coverage, and you could face a Medicare Part D late-enrollment penalty if you pick up this coverage later on.

You may be able to enroll in a stand-alone Medicare Part D Prescription Drug Plan, or to get your Medicare coverage through a Medicare Advantage Prescription Drug plan – but if you don’t do it within a couple months of your move, you may miss your opportunity to change and would have to wait for the Annual Election Period (October 15 – December 7). Again, if you enroll in a new plan during this period your coverage will not begin until January 1st.

What if you move to an address that’s still within your plan’s service area, but where new Medicare Advantage or Medicare Prescription Drug Plan options are available to you?

This will also qualify you for a Special Election Period. You may use this SEP to enroll into the new plan that is offered in your new service area or do nothing and remain on your current plan.

When should I notify Social Security about my address change?

Make sure you notify Social Security of your change of address. The Social Security Administration handles Medicare enrollment. You can change your address by calling the Social Security Administration at 1-800-772-1213 (TTY users 1-800-325-0778) and speak to one of their representatives from Monday through Friday, from 7AM to 7PM. You can also visit the Social Security office nearest you and fill out a change of address form or visit them online at www.ssa.gov

How do I find a new plan?

You can use the Planfinder tool on the Medicare.gov website and put in your new zipcode and list out all your medications and the tool will give you a list of plans in that area that cover your drugs. This is just very basic information based strictly on the financial costs.

To find out the details on how the plans work and what doctors and hospitals accept the plan you will have to call each insurance company directly and ask the right questions.

Or …

You can call me and save yourself the time and headache. I will help you review all the plans available to you and I will explain each one and how it works. I have many clients who are using the different plans out there and I know from talking to them which plans have the best customer service and which are easiest to use. I can help you like I have helped all of them. Give me a call today. I will be happy to help you. My number is 207-370-0173.

Best of all – it does not cost you anything!

I do not charge anyone for my help, whether you enroll with me or not.  I get paid by the insurance company when I deliver your application so once we pick the right plan I will help you fill out the application and I will turn it into the insurance company for you. I get paid for helping you and it does not cost you anything. You do not pay higher rates or any additional costs. You pay the same rate as everyone else whether I help you or not. So, why not get some great advice and benefit from my experience?

You can use the BOOK APPOINTMENT(link is external) button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started. 
 
Book an appointment with Maine Medicare Options using SetMore
 
 
 
Have a question that needs to be answered right away?  Call me!
 
You can talk to me at (207) 370-0143
or call toll free 866-976-9038. 
Or send me an email using this form: https://www.mainemedicareoptions.com/contact
 
 
 

Are you turning 65 and still working?  Read this.

 

VA Benefits and Medicare

Learn how your VA Benefits and Original Medicare work

VA Benefits and Medicare: What You Need to Know

As a Medicare-eligible Veteran, you have options when it comes to healthcare. The transition to Medicare can be confusing, so this article will list a few points that all vets should know when they become Medicare eligible.  To confirm your options call the Veterans Administration directly at 1-877-222-VETS (8387).

VA Benefits and Medicare

It is important to note that Veteran’s (VA) plans and Medicare do not supplement each other. In other words: VA plans only cover care at VA facilities, and Medicare only covers care at Medicare assigned doctors and hospitals. These plans do not overlap.

Should You Enroll in Medicare Part A If You Have VA Benefits?

Yes. You can have both Medicare and Veterans (VA) benefits at the same time.  It is strongly recommended that all veterans enroll in Medicare Part A (Hospital Coverage) when they turn 65 and generally there is no additional cost for Part A. This will allow you receive hospital coverage should you go to a non-VA facility.  According to the VA’s website “[We] encourages you to keep your private [Medicare] health insurance.Source: VA.gov

Should You Get Medicare Part B If You Have VA Benefits?

Yes, It is strongly recommended that all veterans enroll in Medicare Part B (Medical Coverage) as well as part A when they are eligible. (Click here to learn more about when to enroll.) There is a monthly fee for Part B but it is worth it. If your VA Benefits are dropped at some point OR, and this is important, if your local VA facility does not cover all health services, you could pay 100% out of pocket for a serious illness. The VA highly recommends that you enroll in Part B as well. Please contact Veterans Affairs directly (1-877-222-VETS (8387)) with questions about specific care at Togus or another local facility.

Should You Get a Medigap or Medicare Advantage If You Have VA Benefits?

If you would prefer to see a local doctor or go to a local hospital or healthcare facility for your care then you should consider a Medicare Advantage or Medigap plan to supplement your Medicare coverage. Read more about these types of plans here.

Most people agree that veterans do not need a Medigap plan if they qualify for ChampVA. However, if you aren’t enrolled in ChampVA, a Medigap plan will fill in the gaps such as deductibles, copays, and coinsurance, as well as other benefits when seeking care outside of the VA, or outside of the U.S. and its territories. Make sure to speak with your Tricare or CHAMPVA representative before enrolling in any supplemental plan to ensure that it is actually beneficial for you. Here are two reasons why you may want to enroll in a private Medicare Supplement plan:

  1. You do not live near a VA facility

  2. You are enrolled in one of the VA lower priority groups, and could potentially lose your benefits*

* “There is no guarantee that in subsequent years Congress will appropriate sufficient funds for VA to provide care for all enrollment Priority Groups. This could happen if you are enrolled in one of the lower Priority Groups. This would leave you with no health care coverage.” Source: VA.gov

Learn More about Medigap Get a Medigap Quote

VA Benefits and Medicare Part D

The choice of whether to enroll in Part D is up to you. In most cases, you don’t need a Medicare Prescription Drug Plan, aka Medicare Part D, as VA plans may offer more coverage than Medicare’s Rx coverage. Remember that any prescription prescribed by a non-VA doctor needs to be approved by your VA doctor for the VA to approve it.  This may take extra time and your VA doctor can say that prescription is unnecessary. 

What about the Part D Penalty?

Good news! Your VA drug coverage is considered creditable coverage so the Part D late enrollment penalty does not apply to you. If you choose not to enroll in Part D when you are first eligible you can still enroll later on in Part D without paying a penalty.

For further questions about Medigap, Medicare Advantage or Medicare Part D, please call the number above or book an appointment to meet and discuss your options. You can use the BOOK APPOINTMENT button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started – your choice!

Book an appointment with Maine Medicare Options using SetMore

Please note: We are only able to give general information about Medicare related issues. If you have questions about your VA coverage, please contact Veterans Affairs directly.

Still have questions or want help comparing the different health insurance plans?  I can help you!

Have a question that needs to be answered right away?
Just give me a call at your convenience.  
You can talk to a licensed insurance agent at (207) 370-0143
or call toll free 866-976-9038. Or send me an email using this form –> https://www.mainemedicareoptions.com/contact

The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available. I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you talk with me.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

Dental & Vision Coverage

Medicare wasn’t designed to include coverage of routine dental care and coverage of expenses is very limited.

Here’s what you need to know.

For just over 50 years now, Medicare has provided health insurance coverage to America’s seniors. But dental coverage was never included in Original Medicare.

So even with a very solid health plan via Original Medicare + Medicare Supplement (Medigap) + Part D prescription drug coverage, dental care is an out-of-pocket expense.

Coverage for dental care is limited

Medicare’s coverage of dental expenses is limited to situations where the dental treatment is integral to other medical treatment (for example, an extraction prior to radiation treatment for oral cancer, or jaw reconstruction following an accident).

While health insurance plans generally pick up the tab for large medical bills, it’s rare to find dental coverage that doesn’t leave enrollees on the hook for significant bills if they need extensive dental work.

This is generally true across a wide range of plan types, including Medicare Advantage plans which often have added dental coverage or stand-alone dental plans which commonly have benefit maximums of $1,000 or $1,500 per year, and a single root canal can cost between $800 and $2,000, while an implant can be $2,000 to $3,000 per tooth.

But some coverage is better than nothing. Even with low benefit maximums, people who have dental insurance are more likely to receive routine preventive dental care, and are less likely to have untreated dental problems that get worse over time.

Sources of dental coverage

Some retirees can retain dental coverage from their former employer or a spouse’s employer. But there are other options available for seniors who don’t have access to employer-sponsored dental coverage.

Medicare Advantage is an alternative to Original Medicare for enrollees who want dental coverage. The three top plans in Maine offer some routine dental coverage and one plan offers additional comprehensive coverage.

If you’re considering Medicare Advantage instead of Original Medicare + Medigap + Medicare Part D, be sure to familiarize yourself with the pros and cons of both options.

Click here to learn more about the differences between Medicare Advantage Plans and Medicare Supplement (Medigap) Plans

Stand-alone dental plans are available for purchase, and some carriers offer dental plans that are specifically designed for seniors. But again, it’s typical for them to have relatively low annual benefit maximums (here’s an example of such a plan, offered by Delta Dental in Maine and New Hampshire – the benefit maximums range from $1,000 to $2,000 per year, depending on the plan selected, and the premiums range from $30 to $90 per year, including vision discounts).

For low-income seniors who are dual-eligible for Medicare and Medicaid, limited dental benefits (including dentures) may be provided by Medicaid, but coverage varies considerably from state to state.

Programs that can help

For seniors who have no dental coverage, a variety of programs can help them obtain dental care:

Dental schools will often provide treatment at a reduced price.

You can find a list of accredited dental schools in Maine or New Hampshire by clicking here: http://www.ada.org/en/coda/find-a-program/search-dental-programs

For low-income seniors, dental care is available on a sliding fee scale at community health centers. You can use this tool to find a community health center near you: http://findahealthcenter.hrsa.gov/

The Dental Lifeline Network (http://dentallifeline.org/our-state-programs/) coordinates dental care nationwide for elderly, disabled, and medically fragile populations. More than 15,000 dentists donate their time to provide dental care for patients who would not otherwise be able to afford treatment.

Many dentists offer payment plans, or will refer patients to a credit source, often with low initial interest rates. Read the fine print though, because interest rates can reach credit card-levels after the introductory period is over sometimes going up by as much as 30%!

Dental savings plans are readily available, without waiting periods or restrictions on their use. But they are not considered insurance, and they don’t pay anything on your behalf when you receive treatment.

Instead, dental discount plans simply utilize a network of dentists who agree to charge a reduced rate for plan members. And although some discount plans offer significantly reduced rates for routine care like x-rays and exams, they typically provide smaller rate reductions for more extensive dental work.

The good news is that they discounts are upfront and published before you enroll so you know what to expect. You can see the dental plans available in your area here.

Would you like help?

If you would like to talk to me or schedule a meeting at your home or a nearby meeting place, you can reach me at 207-370-0143 or use my simple online form to send an email message. The best part about working with me is that it will not cost you anything to meet with me and have things explained to you. I am paid by the insurance companies in the form of a commission when you choose a plan and enroll. You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.

“My goal is to help you and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

Medigap vs. Medicare Advantage

“What’s the differences between Medicare Supplements and Medicare Advantage?”

Questions like this are the reason I do what I do.  You need to know what your options are in Maine when you turn age 65 and enroll in Medicare – and there are a lot of options!

There are many differences between Medicare Supplement plans or Medigap as they are called in the Medicare literature.

One difference between Medigap and Medicare Advantage plans is that Medicare Advantage contracts operate on a calendar year basis and can have changes from year to year just like the health insurance plan you had prior to Medicare.  Medicare Supplement policies are standardized and are the same year after year.

Feeling overwhelmed?  Get local help.  Click here.

Another difference is the cost. Medicare Advantage Plans generally have much lower monthly premiums (sometimes $0, yes you read that right – zero!)  While Medigap plans can be much higher, often in the $200/month range.

With Medicare Advantage plans you are required to share in your medical costs by paying co-pays as you use the plans.  These plans operate very similar to the Medical insurance you may have had before you retired if you had an HMO or a PPO plan on the Healthcare marketplace (Obamacare) or with an employer.  Most Medigap plans have no or few out of pocket costs but they cost much more up front.

This is why most people turning 65 choose to meet with someone like myself who has the knowledge and experience with the different plans and can help you decide which plan is best for you. Choosing between these two types of Medicare insurance plans is just the first step.

Once you’d decided on Medigap or Medicare Advantage then you much choose which Medigap plan or which Medicare Advantage plan best fits your needs.  You may also need to pick a separate Part D prescription drug plan if the plan you choose does not include drug coverage.

Also, the best plan for you may not always be the best plan for your spouse so you with have to do the same research for both of you. For more information you can click here to compare the Medicare Advantage plans & drug plans in your area.  You can also schedule a meeting with an agent at the bottom of this page.

And if you have a question that needs to be answered right away, just give me a call.  My number is (207) 370-0143 or call toll free 866-976-9038.

Want to know more?

If you would like help comparing your needs against the many Medicare plans out there or if you just want to ask a few questions, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.

The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay anything to meet with me and you will pay the same price for your insurance that everyone pays whether they had my help or not.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

Are you turning 65 and still working?  Read this.

Medicare 101 – The Basics

What is Medicare:  Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Medicare is divided into four parts A, B, C & D.

Click here to learn more about the different parts.

Who is eligible?

You are eligible for Medicare if:

  • You are 65 or older
  • You are under 65 and have certain disabilities
  • You have End-Stage Renal Disease, which is permanent kidney failure that requires dialysis or a kidney transplant

What does Medicare cost?

Part A is free and Part B can be too if you qualify.  In most cases, you’ll automatically get Part A and Part B starting the first day of the month you turn 65 if you are already getting Social Security benefits.

If you don’t get Social Security benefits and you are 65 or older, you’ll have to sign up for Part A and Part B.  To sign up, call Social Security at (800) 772-1213.

To find out more about qualifications, click here.

What does Medicare cover: 

There are four parts to Medicare. They are:

Medicare Part A is Hospital Insurance and it:

  • Helps cover inpatient care in hospitals (room cost, hospital meals and supplies), including critical access hospitals, and skilled nursing facilities.  It does not cover custodial or long-term care.
  • Helps cover hospice care and some home health care You must meet certain conditions to get these benefits.
  • There is a $1,288 deductible for Part A, but once met, days 1-60 of hospitalization are covered 100%. After 60 days, you must pay a daily amount set by Medicare.  You can read more about the 2016 costs here.

Medicare Part B is Medical Insurance and it:

  • Helps cover doctors’ services, hospital outpatient care, and home health care.
  • Helps cover tests, shots and some preventive services to maintain your health and to keep certain illnesses from getting worse (flu shots, PAP tests).
  • There is monthly premium of $121.80, and a $166 annual deductible. Once the deductible is met, Part B generally pays 80 percent of the Medicare-approved amount for covered services, which means you pay 20 percent.

Part A and Part B together are commonly referred to as “Original Medicare”. Original Medicare is offered by the government, and again, in most cases you’ll automatically get Part A and Part B starting the first day of the month you turn 65 if you are already getting Social Security benefits.

Medicare Part C is Medicare Advantage Plans

Instead of getting Medicare Part A and Part B, you have a choice and you can purchase a Medicare Advantage Plan (also called “Part C”).  Medicare Advantage Plans are health plans run by Medicare-approved private insurance companies, and have different rules and costs, but offer at least the same benefits of Medicare Part A and Part B, and in some cases, offer more benefits such as a prescription drug plan.

Why would someone opt to buy a Medicare Advantage Plan over getting Medicare Part A & Part B?

When it comes to Medicare the decision is yours however, you may want to get a Medicare Advantage Plan instead of Original Medicare if:

  • You take prescription drugs. With a few exceptions, most prescriptions aren’t covered in Original Medicare. Many Medicare Advantage Plans include prescription drug coverage.
  • You want a cap on your out-of-pocket health spending. Original Medicare has no out-of-pocket maximum. You keep paying a portion of the cost of services as you use them. Medicare Advantage plans, by law, have an out-of-pocket maximum of no more than $6,700 per year. Once you hit that limit, the plan pays for all covered expenses.
  • You want an alternative to the 20-percent coinsurance charged by Original Medicare for most services. Medicare Advantage plans structure costs differently and may offer a lower (or higher) coinsurance, or may charge copays instead – which are fixed costs you pay for services. A trade-off could be a higher monthly premium.
  • You want coverage for vision and dental. Original Medicare doesn’t cover these services. Certain Medicare Advantage plans do.
  • To find Medicare Advantage plans in your area, click here.

Medicare Part D is Prescription Drug Coverage

There are two ways to get prescription drug coverage through Medicare – either as an add on known as Medicare Part D to your Original Medicare Plan (Part A and Part B), or as part of your Medicare Advantage Plan (Part C). There are several different Part D plans offered, and they vary in cost and medications covered. Also note that Medicare Part D is provided by private insurance companies that have contracts with the government, unlike Medicare Part A and Part B, which is provided directly by the government.

Each Medicare Prescription Drug Plan has its own list of covered drugs. Many Medicare drug plans classify drugs by tiers and each tier has a different cost associated with it. Before you choose a Prescription Drug plan, it’s best to look at the plan’s list of drugs to see if your medication(s) is covered, and how much it will cost.

To find out more about Part D coverage, click here.

What is Medicare Supplement Insurance (also known as Medigap)?

A Medicare Supplement Insurance (Medigap) policy is sold by private companies and can help pay some of the health care costs that Original Medicare doesn’t cover, such as copayments and deductibles.  Medicare Supplement policies fill in the gap between what Original Medicare covers and what it doesn’t. 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. Then your Medigap policy pays its share.

A Medigap policy is different from a Medicare Advantage Plan. A Medicare Advantage Plan is a way to get Medicare benefits. A Medigap plan simply supplements your existing Original Medicare coverage.  Medigap plans differ in price and coverage.

How can I find out more about Medicare and have my questions answered?

Would you like my help?

If you would like to talk to me, ask a question or schedule a meeting at your home or a nearby meeting place, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.  The best part about working with me is that it will not cost you anything to meet with me to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.

“My goal is to help you and I have found great joy in being able to offer my services to people who need my help.”

Book an appointment with Maine Medicare Options using SetMore

Turning 65 and still working?

Should I apply for Medicare even though I have insurance at work?

 
Yes.  If you’re not retiring and you are continuing to work then you may want to consider enrolling in Medicare Part A and delaying Part B until you retire and leave your employer sponsored health insurance plan.  Even if you’re not receiving Social Security benefits at age 65, you’re still eligible for full Medicare benefits. This includes the Part A (hospitalization), as well as Part B (doctors’ visits and outpatient care) and Part D (prescription drugs); you pay a premium for each.  But if you are not collecting social security benefits then it’s up to you to contact Social Security to sign up for Medicare only.  You must do this within your “initial enrollment period.” This period starts three months BEFORE the month you turn 65, includes the month you turn 65 and continues three months AFTER that — a seven-month period.
 

Do you have an HSA?

If you enroll in Medicare Part A and/or B you can no longer contribute to your Health Savings Account (HSA). Whether you should delay enrollment in Medicare so you can continue contributing to your HSA depends on your circumstances. Carefully weigh the savings of enrolling in Medicare against the advantages of continuing to save money in a tax-free HSA.
 

You don’t have to enroll in all parts of Medicare.

Only the parts you need.

In a situation where you are still working at age 65 and have health insurance through your employer you don’t have to enroll in all parts of Medicare until you retire. If you have creditable insurance coverage through an employer plan, you can apply for Part A only. Part A might help pay for some of the costs not covered by your group plan such as your deductible if you go into the hospital for a surgery or if you need to stay in a skilled nursing facility.  And as long as you have group coverage, you won’t be penalized for delaying Part B or Part D (Medicare Prescription Drug Coverage). When your employment or group coverage ends, you then have eight months in which to sign up for Part B and enroll in a Medicare Supplement or a Medicare Advantage plan.  This is where I come in!   There are a lot of different plans available and finding a plan that covers your doctors and your specific medications at the best price is what I do best.  I’ve helped hundreds of people find the right plan and saved THOUSANDS in the process.
 
Your decision to enroll in Medicare Part B if you are still working is really a cost/value decision. The standard monthly premium for Part B is $121.80 in 2016. Where as Part A in most cases has no monthly premium.  So your decision to enroll in Part B while you’re still working might depend on how much money you’re making and what your current costs are with your employer health insurance plan.  You also need to consider what you’re getting. If you work for a company with 20 or more employees, your group health plan is still the primary payer of your medical bills, making your Medicare benefits of limited value. However, if your company has fewer than 20 employees, Medicare would be the primary payer and your company’s plan the secondary payer. In this case, it’s best to talk to your employee benefits administrator to see how Medicare would work with your insurance.  The Part B coverage may well be worth the monthly premium.
 

What if I retire and then go back to work?

It’s not unheard of for insurance needs to change as people move in and out of the work force. So what happens if you retire, enroll in Part B and then find yourself back at work with employer coverage once again?
 In this situation, you can drop Part B while working and re-enroll at any time while you have group coverage or during the eight months after your employer coverage ends, without risk of penalty or higher premiums.
 

 

For now, I suggest you mark the dates of your initial enrollment period on your calendar.

 
Then when the time comes, call the Social Security Administration at 800-772-1213 to sign up for Medicare Part A and/or Part B.  You can also go to www.ssa.gov for more information.
 
No matter how long you choose to work, there’s no reason not to take advantage of the benefits you’ve earned.  Keep in mind, this information is no substitute for an individualized consultation. You can Contact Me to schedule an appointment and we can sit down and talk about your individual needs and answer any of your questions. There is no cost or obligation to talk or meet with me.  I would be glad to talk to you and answer questions about your options.  You can reach me toll free at (866) 976-9038 or CLICK HERE if you would prefer e-mail.  I am looking forward to answering your questions and helping you get the coverage that you need.

-Todd 🙂

 

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