“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) And some Medicare Advantage plans pay you!  (Yes you read that right!)  Medigap plans can cost much more, 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 very small out of pocket costs while they cost much more up front.

This is why most people turning 65 or planning retirement 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 must 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 will have to do the same research for both of you.  I can explain everything you need to know so that you can make the best choice.  You can schedule a meeting quickly and easily using this button.

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.”

Are you turning 65 and still working?  Read this.

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 more 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 know 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.

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 “All Veterans are encourage you to enroll in 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 one of our agents 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

READ MORE ABOUT HOW VETS ARE WINNING WITH MEDICARE ADVANTAGE

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 cover it.  This may take extra time and your VA doctor can say that prescription is unnecessary.  Many veterans use a Medicare Advantage plan as a back up because they don’t cost you any extra. [READ MORE]

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 (207) 370-0143 or schedule a phone call to discuss your options.

CLICK HERE TO SCHEDULE A PHONE CALL

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?

Are you turning 65 and still working?  Read this.

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.

Need 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.”

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?

• Call 1-800-MEDICARE (1-800-633-4227)
• Go to the government’s helpful web site, Medicare.gov or the Centers for Medicaid and Medicare Services 

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.”

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?

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

Only the parts you need.

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 🙂