Simply speaking a Medicare Savings Account (MSA) plan is the Medicare equivalent of a traditional HSA plan. The biggest difference is that your insurance company deposits the money in your health savings account, instead of you.

I’ve been getting a lot of questions about this new plan with a Medicare Savings Account offered in New Hampshire in 2021. So here is some information on this type of plan and how it works. If you’d like more information or have additional questions click the button below and we’ll set up a time to chat or I can mail you more information.

How does a Medicare MSA work?

MSA plans are required to provide you with the same basic coverage as Original Medicare. They are a Medicare Advantage plan under Part C of Medicare with a high-deductible plus a medical savings account.

Your MSA plan makes an initial deposit each year into your account. This money is yours to spend, move to your own bank and/or invest as you choose. And if you change plans later during open enrollment, you keep the money.

MSA plans annual deposits typically range from $2,000 to $3,000 each year, reducing your out of pocket costs to between $3,000 and $5,000 which can be much less than other Medicare Advantage plans.

MSA plans come with a high deductible health plan (HDHP) and a bank account to help pay your medical costs. These plans typically have deductibles that range from $5,000 to $8,000.

HDHPs, as you might have figured out, have a high deductible that you must pay in full before receiving coverage. After you pay off the deductible, the HDHP covers all of your costs for the remainder of the year.

As stated earlier, MSA plans also come with a bank account where the plan provider deposits funds each year for your medical expenses. You can use these funds to pay on the deductible. (See some examples at the bottom of this page.)

Who should consider a MSA Plan?

MSA plans are great for people who are fairly healthy or who do not use traditional medicine. There are generally three main groups of people who choose MSA plans.

• Christian Scientists
• Users of Holistic or Naturopathic Medicine
• Healthy people who travel frequently or may stay long periods in other states
• Healthy Self-employed small business owners

Key Feartures of MSA Plans

• $0 Monthly Premium
• No network — access to any Medicare-participating provider
• Freedom to choose the best Part D plan
• Potential to grow account balance over time
• Investment opportunities for balances over $2,000
• Special tax advantages — balance and qualified expenditures not taxed
• Some plans also offer extra benefits.

Other important notes regarding MSA plans: 

• Funds contributed to MSA plans are not taxed as long as they are used for qualified medical expenses.
• You cannot personally deposit more money in your MSA bank account. Once you’ve used up all the money in the account, you pay out-of-pocket until the deductible is reached. 
• If you have any money leftover at the end of the year, it will remain in the account for the following year. 
• To be in a MSA plan you have to remain enrolled in Medicare Parts A and B.
• MSA plans are not allowed to include Part D prescription drug coverage. To get prescription drug coverage, you will have to join a standalone Part D plan. 
• If you choose to join a Part D plan, out-of-pocket costs associated with the prescription drug plan do not count toward your MSA plan’s deductible but copays for your prescriptions can be paid for from HSA or MSA funds.

For a list of Qualified Medical Expenses go here: https://www.mainemedicareoptions.com/qualified-medical-expenses

Some Examples of Medicare Medical Savings Account (MSA) plans

Remember, these are only examples. Plans vary and actual deposits and deductibles may be different from these examples.

Example #1

James and Mary are interested in joining Medicare MSA Plans. Plans ABC and XYZ are available in their area.

	PLAN ABC	PLAN XYZ
Yearly deposit	$2,500	$1,500
Yearly deductible	$4,000	$3,000
What you pay after the deductible	$0	$0
Out-of-pocket maximum	$4,000 (same as deductible)	$3,000 (same as deductible)

If James joins Plan ABC:

• Plan ABC deposits $2,500 into his account at the beginning of the year.
• If he uses the money in his account for Medicare-covered Part A and Part B services, he’ll have to spend $1,500 out-of-pocket before he meets his deductible and before the Medicare MSA Plan will begin paying for his health care.
• Once James has met his deductible, Plan ABC pays all of his Medicare-covered Part A and Part B health care, and he pays nothing.
• James must continue to pay the monthly Part B premium  

If Mary joins Plan XYZ:

• Plan XYZ deposits $1,500 into her account at the beginning of the year.
• If she uses the money in her account for Medicare-covered Part A and Part B services, she will have to spend $1,500 out-of-pocket before she meets her deductible and before the Medicare MSA Plan will begin paying for her health care.
• Once Mary has met her deductible, Plan XYZ pays all of her Medicare-covered Part A and Part B health care costs, and she pays nothing.
• Mary must continue to pay the monthly Part B premium.  

Example #2

Linda joins a Medicare MSA Plan with a $3,000 yearly deductible and deposits $1,500 into her account. The plan pays for all Medicare-covered services once Linda meets the deductible. Look below to see how Linda uses the money in her account.

Linda has a $500 doctor’s visit and uses her account to pay for this expense. Since the expense is a Medicare-covered service, the $500 is credited towards her deductible.

Account balance	Deductible
$1,500 − $500 = $1,000	$3,000 − $500 = $2,500

Linda gets an MRI that costs $1,000. She uses her account to pay for this expense. Since the expense is a Medicare-covered service, the $1,000 is credited towards her deductible.

Account balance	Deductible
$1,000 − $1,000 = $0	$2,500 − $1,000 = $1,500

Linda visits specialists and the total cost of the visits and additional tests is $1,500. She’s used all the money in her account, and must now pay out-of-pocket until she reaches her deductible. Since the expense is a Medicare-covered service, the $1,500 is credited towards her deductible.

Account balance	Linda’s out-of-pocket costs	Deductible
$0	$1,500	$1,500 − $1,500 = $0 (deductible is met)

Linda is admitted to a hospital for surgery. The cost for her hospital stay is $12,000. Since she has met her deductible, the plan pays all of her Medicare-covered Part A and Part B services for the remainder of the year.

Linda’s out-of-pocket costs	Plan pays
$0	$12,000

Example #3

David joins a Medicare MSA Plan. On January 1, the plan deposits $1,500 into his account. The plan’s yearly deductible is $3,000. The plan pays for all Medicare-covered services once David meets the deductible. Look at how David uses his account.

David has a $500 doctor’s visit and uses his account to pay for this expense. Since the expense is a Medicare-covered service, the $500 is credited towards his deductible.

Account balance	Deductible
$1,500 − $500 = $1,000	$3,000 − $500 = $2,500

David visits the dentist, who charges $600 for the service. He uses his account to pay for this expense. The dental service is a Qualified Medical Expense, but it’s not a Medicare-covered service. He may use his account for the dental service, but the expense isn’t credited toward his deductible.

Account balance	Deductible
$1,000 − $600 = $400	$2,500 − $0 = $2,500

David’s electric bill is due. He uses the money in his account to pay the $200 bill. He’s allowed to use the account to pay for this non-medical expense, but it isn’t credited towards his deductible. He’ll also pay income tax and a 50% tax penalty on this non-medical expense.

Account balance	Deductible
$400 − $200 = $200	$2,500 − $0 = $2,500

David falls and goes to the emergency room. The emergency room visit and other costs related to his fall total $3,500. He uses the remaining $200 in his account and must then pay $2,300 out-of-pocket until he meets his deductible. After he meets his deductible, the plan pays the remaining cost of his emergency room visit and for all of his Medicare-covered costs for the remainder of the year.

Account balance	David’s out-of-pocket costs	Deductible	Plan pays
$200 − $200 = $0	$2,300	$2,500 − $2,500 = $0 (deductible is met)	$1,000

How do you avoid tax withdrawals from your account for Qualified Medical Expenses?

File Form 1040, U.S. Individual Income Tax Return [PDF, 188 KB], and Form 8853 [PDF, 89.4 KB] each year to report your Qualified Medical Expenses.

Where can I get a list of Qualified Medical Expenses?

For a list of services and products that count as Qualified Medical Expenses and for other tax information, view IRS publication #969 [PDF, 2.13 MB] for the year that you’re filing.

Would you like my help?

If you would like help understanding your costs or need help finding a plan or if just want to ask a few questions, you can call 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 an independent insurance agent and I am paid by the insurance companies (not you) 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.”

Learn more about Medicare Advantage Plans (Part C)

Please send me a copy of the MSA Medicare Advantage plan(s) available in my area.

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Congratulations, you no longer need to obtain a degree in Medicare!

There are resources available in our great states of Maine & New Hampshire that can educate you on the Alphabet soup of Medicare, while personalizing the approach to suit your needs.  

If you are reading this, you or a loved one may be approaching age 65, retiring from the workforce, or possibly experiencing significant changes to your current Medicare plan and are interested in finding a better insurance plan.

The good news is, we are experts in Maine and New Hampshire’s Medicare health plan options, residing in the communities we serve.  

By contacting one of our local Medicare Advisors we can guide you through all the steps needed to identify the most appropriate plan for you. 

Steps For Finding The Right Medicare Advantage Plan:

• Utilize the Medicare Plan Finder tool to review prescription drug costs on each plan.
• Review plans to make sure they are accepted by your physicians and hospitals.
• Evaluate plans in total, comparing overall out-of-pocket costs, including monthly premiums.
• Identify additional value and cost savings through carrier-specific programs list Over-the-Counter Allowances, Member Rewards, Dental, Vision, Hearing, Gym memberships, and more. 
• Identify the need for coverage outside your service area, such as out of network scenarios or specific travel destinations.  

A local Medicare Advisor will not only dig into the details for a plan best suited for you, but assist with any service related needs you encounter after your plan becomes effective. If priorities or prescriptions change from year to year, we will conduct policy reviews to determine whether another plan is worth considering.  

There is no substitute for a qualified, local professional to navigate Medicare insurance with. Check out our map to find one of our 32 local agents endorsed by Plan Advisors.  

Would you like my help?

If you would like help understanding your costs or need help finding a plan or if just want to ask a few questions, you can  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 an independent insurance agent and I am paid by the insurance companies (not you) 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.”

There are many things to consider when it’s time to choose a Medicare Plan. 

For example:

1. How much are your premiums, deductibles, and other out-of-pocket costs? 
2. How much do you pay for services like hospital stays or doctor visits? 
3. Is there a yearly limit on what you could pay out-of-pocket for medical services? 
4. Which doctors and hospitals do you need access to?  
5. What prescriptions must be covered?  
6. Can you qualify for extra help?  

By working with a local Medicare Advisor you get unbiased access to all your available options. We also make sure you understand each of the options, and keep you informed of new plans or changes to existing plans occurring each year.

Here the important points we will review with you in order to help you find the Medicare plan best suited for you.  

Medicare Costs 💸

With Original Medicare there’s no limit on out-of-pocket cost per year, unless you have supplemental coverage or a Medicare Advantage Plan (Part C).

When comparing out-of-pocket costs, remember to also include what you pay each month for your plan’s premium.

This is often overlooked and can cost you thousands more if you’re not careful. Your agent can easily help you compare costs of each option, so you can feel confident the plan you choose fits your budget and risk tolerance. 

Since so many details surrounding your costs & benefits are not covered beyond the benefit summary we help you with a deeper look at the plan in order to gain a complete understanding of the costs associated with each benefit and to make sure you understand all your benefits and how to access them.

Medical Coverage ⚕️

Medicare Supplements and Medicare Advantage Plans all offer coverage beyond that of Original Medicare.

Medicare Supplements work in combination with Original Medicare (Parts A & B) by filling in the gaps of Original Medicare.

These plans do not have networks and offer flexibility to see any doctor or use any hospital in the country as long as the provider accepts Medicare payments. But these plans do not offer additional benefits, such as dental, vision or hearing aids.

Medicare Advantage Plans offer the actuarial equivalent of all the services Original Medicare covers. Most do far better than this minimum requirement.

Some plans offer extra benefits that Original Medicare doesn’t cover – like vision, hearing, or dental.

By helping you understand the pros and cons of each option, you’ll be confident in the selection you make each year.  

Prescription Drugs 💊

Prescription drug coverage is a vital component to your plan choice, not only for the coverage it provides, but in order to avoid penalties and fees according to the Medicare regulations.

Whether you take prescription medicines or not, Medicare requires you to have minimum drug coverage. This can be obtained by enrolling in a Part D stand alone plan, Medicare Advantage Plan that includes drug coverage, or what Medicare deems “creditable coverage” like larger employer group plans, retiree plans, or veteran coverage. 

When you meet with your Plan Advisor, we will run a calculation with the Medicare.gov Rx Tool, taking your specific medications into account, ensuring they are covered under the desired plan and with an affordable copay

We will also help you apply for extra help or other available subsidies to cover the costs of medicines, as there are several resources and programs we can apply for.

For prescriptions alone, it pays to schedule a consultation. 

Doctor and Hospital Choice 😷

We will always start with helping you find a plan that your desired Doctors and Hospitals accept and we will confirm that your primary care physician is able to refer to the specialists when necessary. 

Many plans offer some out-of-network coverage. For out-of-network physicians we will help confirm that those doctors will accept your chosen plan as an out of network benefit. This is yet another important feature that our local agent will provide for you.

Quality of Care ✅

The quality of care and services offered by plans and other health care providers can vary. 

Medicare Advantage plans are now graded on certain quality scores by Medicare, known as Star Ratings. A Star Rating is like the reviews you may read about with a local business or vendor.

It is important for you to know the star ratings as they also impact the funding of your selected plan, which may impact plan stability and costs.

Customer service is an important part of using your insurance. This is why having an agent is so important. If you cannot get the answers you need from your insurance company you can always rely on your agent to help.

With over 10 years of experience helping people with these Medicare plans in Maine I have gained a vast knowledge of how these plans work and help my clients resolve issues quickly and easily when the customer service rep on the phone cannot.

Travel Coverage ✈️

Original Medicare does not cover care outside the US so if coverage during travel is important to you, be sure to share this with your agent during our meeting.

Certain Medicare supplements do have travel features. Most Medicare Advantage plans cover emergencies or urgently needed care services outside the US as well.

Whatever your needs, we will review the plans and find one that travels with you.

Would you like my help? (it’s free!)

If you would like help understanding your costs or need help finding a plan or if just want to ask a few questions, you can  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 an independent insurance agent and I am paid by the insurance companies (not you) 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.”

Like all insurance plans, Original Medicare has deductibles for both Parts A and B. In addition, Medicare Part D plans usually have an annual deductible. And Medicare Part C plans, better known as Medicare Advantage plans, may also have yearly deductibles but some do not.

What Does Medicare Cost?

The Medicare program employs a cost-sharing model that includes monthly premiums, deductibles, and coinsurance or copayments. The Centers for Medicare and Medicaid Services (CMS) sets the rates, working within the budget they’re allotted by the White House each year.

Medicare premiums and deductibles vary for each “part” of Medicare.

Original Medicare includes two parts: A and B.

Medicare Part A is commonly referred to as hospital insurance, because it covers inpatient services received in a hospital or skilled nursing facility.

Medicare Part B is commonly referred to as medical insurance. Part B covers outpatient services, including doctor visits, mental health care, lab work, and durable medical equipment.

Medicare Advantage plans (Part C) are sold by private insurance companies. Every Advantage plan must provide the same benefits you get with Original Medicare, but most Part C plans also provide additional coverage, such as prescription drugs, routine vision and dental care, and hearing aids.

Medicare Part D provides prescription drug benefits. These plans are also sold by private insurance companies also. You may join either a standalone Part D prescription drug plan (PDP) or a Medicare Advantage Prescription Drug plan (MA-PD).

The Medicare Part A Deductible

Unlike most types of insurance plans, the Medicare Part A deductible is figured by benefit period, not annually. A benefit period begins the day you are admitted to the hospital as an inpatient and ends once you go 60 consecutive days without receiving inpatient care.

The Medicare Part A deductible is $1,484 per benefit period in 2021. You pay $0 copays for the first 60 days you receive inpatient hospital care. After that, your Part A copays are:

$371 per day for days 61 through 90
$742 per day for days 91 through your 60 lifetime reserve days
NOTE: If you have a Medicare Advantage plan or Medicare Supplement Insurance (more commonly known as Medigap), your plan may pay some or all of these costs.

Before Medicare Part A will pay for care received in a skilled nursing facility, you must first spend at least 3 consecutive days as a hospital inpatient. In addition, the Skilled Nursing Facility care must be related to your hospital stay and happen within the 60-day benefit period.

Part A coinsurance for skilled nursing facility care is $0 for the first 20 days and $185.50 per day through day 100. You are responsible for all costs from day 101 and beyond.

Additional Medicare Part A Costs

Although around 99 percent of Medicare beneficiaries qualify for premium-free Part A, that remaining 1 percent accounts for hundreds of thousands of people. If you or your spouse did not work and pay the Medicare payroll tax for 40 quarters (10 years), the standard Medicare Part A premium is $471 in 2021. If you paid Medicare taxes for at least 30 quarters but less than 40, the standard premium is $259 per month.

The Medicare Part A Late Enrollment Penalty

People who delayed Part A enrollment for a full 12 months and who do not qualify for a Special Enrollment Period (SEP) may also owe a late penalty. The Part A late enrollment penalty is 10 percent for twice the number of years you could have had Part A but did not.

1 year = 2 years paying the penalty
2 years = 4 years paying the penalty
And so on.

Please note that, when it comes to calculating Medicare late enrollment penalties, Medicare does not looks at calendar years but 12-month periods starting from when you could have enrolled but did not.

The Medicare Part B Deductible

The 2020 Medicare Part B deductible is $203. This is an annual amount that you must spend out-of-pocket before your Part B benefits kick in.

Additional Part B costs include:

Standard Part B premium is $148.50 per month in 2021. Most people pay the standard premium. However, if your yearly, modified adjusted gross income exceeds $87,000 (filing singly) or $174,000 (married filing jointly) you will also have to pay an additional Income Related Monthly Adjustment Amount known as IRMAA.

The Medicare Part B Late Enrollment Penalty

If you do not sign up for Medicare Part B during your Initial Enrollment Period (IEP) and do not qualify for a Special Enrollment Period, you may owe a late enrollment penalty.

The late penalty is 10 percent of your premium for every 12-month period in which you could have signed up but did not. So, one full year is 10 percent, two full years is 20 percent, and so on. However, unlike Part A, you will pay the late enrollment penalty for the entire time you have Medicare Part B.

This is why we strongly encourage people to talk to an agent or broker who knows the rules and can explain when you need to enroll in Part B. Delaying could cost you thousands of dollars over your lifetime.

The Medicare Advantage (Part C) Deductible

All of your Part C costs vary according to your Medicare plan. This includes the deductible, copays, premium, and coinsurance (if applicable).

The Medicare Part D Deductible

The standard Medicare Part D deductible is $445 in 2021. However, some prescription drug plans set a lower yearly deductible. In addition to the deductible, most Part D plans have monthly premiums and copays or coinsurance payable at the time of purchase. Please check with your plan to verify out-of-pocket costs for Part D.

As with Medicare Part B, high earners enrolled in Part D may owe the IRMAA surcharge.

If you have a Medicare Advantage Prescription Drug plan, you may have a separate deductible for your prescription drug coverage.

The Part D Late Enrollment Penalty

As with Parts A and B, there is a late enrollment penalty for Part D. Like Part B, you pay this penalty for the entire time you have Medicare prescription drug coverage.

Unlike Parts A and B, you begin accruing this late fee once you go 63 consecutive days without creditable prescription drug coverage. In this case, “creditable” means a prescription drug plan that provides comparable benefits to Part D at a similar price. (In other words, a prescription discount card is not the same thing as a prescription drug plan.)

The Part D late enrollment penalty calculation is based on a percentage of the national base beneficiary premium, which changes every year. In 2021, the base beneficiary premium is $33.06.

You pay 1 percent of this “base” premium for every month you go without creditable prescription drug coverage, then round that number to the nearest dime. If you go 6 months without coverage, the calculation looks like this:

$33.06 X 1% X 6 = $1.9833

Rounded to the nearest dime, your late penalty would be $2. This is then added to your monthly premium every month for the entire time you have Medicare prescription drug coverage.

Compare Your Medicare Plan Options

When comparing your Medicare plan options, look carefully at both benefits and the total out-of-pocket costs. I can help you compare Medigap, Part D, and Medicare Advantage plans in your area and explain the subtle differences between the plans and help you choose a plan that covers all your doctors and prescriptions at the lowest cost to you.

Good news! Some Medicare Advantage and Part D plans in 2021 will provide supplemental benefits for insulin, including during the coverage gap (or Donut hole) phase.

A new program in 2021 called, the Part D Senior Savings Model will weigh the effects of offering people who are enrolled in Medicare more choices of insurance plans that would lower your out-of-pocket costs of insulin to $35 for a one-month supply – and these costs will stay at $35, even when you hit the Donut hole!

High insulin costs, in the past, have been a huge burden on many of my clients, being detrimental to their health and their finances.

During Medicare’s Open Enrollment this year, if you are a diabetic, you should review which plans in Maine will participate in this new program and what that may mean to the cost of your insulin and other medications.

Who is Participating?

In 2021, there will be 1,635 prescription drug plans participating in the Part D Senior Savings Model, including both Medicare Advantage Plans and stand-alone Part D Prescription Drug Plans.

• For a full list of the drugs effected, click here.
• To see all the plans that are participating, click here.
• To talk to a local expert about this program, click here.

Why the New Model?

The new Part D Senior Savings Model was created in response to President Trump’s plan to lower the cost of insulin. For carriers with products participating in this model, a one-month supply of insulin would not cost any more than $35.

The model also intends to decrease Medicare expenses by offering a variety of supplemental benefits to cover costs such as copays and initial coverage.

The Part D Senior Savings Model’s goal is to provide beneficiaries with higher quality care and will benefit those who have either a Part D Prescription Drug plan or a Medicare Advantage Plan.

When Will These Changes Take Place?

Beginning with the Annual Enrollment Period for the 2021 plan year, which runs from October 15th to December 7th, participating insurance companies will offer Mainers on Medicare beneficiaries these supplemental benefits for insulin. The drug companies will pay the 70 percent discount for your insulin, if it is included in the program.

Under the new program, Medicare plans in Maine will offer Mainers more choices that will allow them access to more types of insulin. With the maximum copay being $35, the model projects members saving an average of over 66 percent in annual out-of-pocket costs on insulin.

Additional information on the 2021 Part D Senior Saving Model, including fact sheets and press releases, can be found linked at the bottom of the CMS report.

Would you like my help?

If you would like to talk about this program or schedule a meeting, 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 w not cost you anything 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, just like your car insurance agent.

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.

If you are diabetic and using insulin,
you may be able to save a lot of money.

Call me today and I will be happy to explain all your options and help you compare plans so you can choose the coverage you need for a price you can afford.

Schedule a phone call or meeting today.

I can answer all your questions over the phone or we can talk face-to-face and I can help you with everything you need to know. I have all the forms and applications you need and I can also help you complete them.

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Medicare Advantage plans are very popular in Maine, but since there is no one-size-fits-all plan, Medicare Supplements (Medigap) may still be the best option for you.

Supplements work in combination with Original Medicare (Parts A & B) to fill in the gaps of the traditional Medicare program, hence the name “Medi-gap”.

Generally Medicare covers 80% of your medical cost and the Medigap plan pays most or all of the balance of copayments, coinsurance and deductibles.

Medigap plans in Maine and New Hampshire are standardized, meaning every insurance company offers identical plans, with monthly premium costs and underwriting guidelines being the primary differences between them.

In Maine and New Hampshire plans are labeled with letters A, B, D, G, K, L, M, & N. In recent years, insurance companies have added extra benefits like discount dental and vision, and fitness programs, to try and differentiate beyond price.  

Medigap plans have their own set of enrollment periods and rules which vary from state to state. I can help you know when you qualify for one of these plans and go over the different options with you. There is no cost or obligation for my help.

Would you like my help?

If you would like help understanding your costs or need help finding a plan or if just want to ask a few questions, you can call  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 an independent insurance agent and I am paid by the insurance companies (not you) 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.”

Medicare Rate Increases in 2021: What You May Be Able to Expect

Medicare rate increases are typically announced in November each year, so any Medicare cost changes effective for 2021 won’t be announced until late in 2020.

In this guide, we take a look at Medicare rate increases from 2019 to 2020 to shed some light on what we might be able to expect for 2021 Medicare costs.

We also outline some 2021 Medicare cost projections based on the annual Medicare Trustees Report.

2021 Medicare Part B Cost Projections

Based on reporting from the Centers for Medicare & Medicaid Services (CMS), the projected 2021 Medicare Part B premium will be $148.50 per month.¹

It’s important to note that this figure only represents an estimate of 2021 Part B premiums. Actual 2021 premiums will be determined in the fall of 2020.

The standard Part B premium in 2020 is $144.60 per month. That’s an increase of $9.10 from $135.50 in 2019.

While most people pay the standard Part B premium, you may pay more if you had a higher reported income two years prior to enrolling in Medicare Part B..

The table below shows the additional amount you will pay in 2020 — called the Income-Related Monthly Adjustment Amount, or IRMAA – based on your Modified Adjusted Gross 2019 Income.

2018 Individual tax return	2018 Joint tax return	2018 Married and separate tax return	2020 Part B premium
$87,000 or less	$174,000 or less	$87,000 or less	$144.60
More than $87,000 and up to $109,000	More than $174,000 and up to $218,000	N/A	$202.40
More than $109,000 up to $136,000	More than $218,000 up to $272,000	N/A	$289.20
More than $136,000 up to $163,000	More than $272,000 up to $326,000	N/A	$376.00
More than $163,000 up to $500,000	More than $326,000 up to $750,000	More than $87,000 up to $413,000	$462.70
More $500,000	More than $750,000	More than $413,000	$491.60

Will My Medicare Supplement Insurance Premiums Go Up?

Medicare Supplement Insurance, or Medigap, provides coverage for certain Medicare Part A and Part B out-of-pocket expenses like deductibles, coinsurance and copayments.

The lowest cost Medigap plan premium in Maine currently is $198.60 per month.²

This cost figure is weighted, which means that some 2020 Medigap plan premiums in some areas may be higher.

Each type of Medigap plan offers a different combination of standardized benefits. Plans with fewer benefits may offer lower premiums.

Other factors such as age, gender, smoking status, health and where you live can also affect Medigap plan rates.

Medigap premiums can increase over time due to inflation and other factors, so you can typically expect Medigap plan premiums to be higher in 2021 than they are currently in 2020.

Compare 2020 Medicare Supplement Insurance Plan Costs

A licensed insurance agent can help you find Medigap plans that are available where you live. You can find out the types of benefits each available plan may offer, the insurance companies that sell them and the premium costs you can expect to pay.

You can request an online plan comparison for free, with no obligation to enroll.

A local Medicare Advisor will not only dig into the details for a plan best suited for you, but assist with any service related needs you encounter after your plan becomes effective. If priorities or prescriptions change from year to year, we will conduct policy reviews to determine whether another plan is worth considering.  

There is no substitute for a qualified, local professional to navigate Medicare insurance with. Check out our map to find one of our 32 local agents endorsed by Plan Advisors.  

Would you like my help?

If you would like help understanding your costs or need help finding a plan or if just want to ask a few questions, you can  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 an independent insurance agent and I am paid by the insurance companies (not you) 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.”

¹ Medicare: Part B Premiums. (Updated April 4, 2019). EveryCRSReport.com. Retrieved from www.everycrsreport.com/reports/R40082.html.

² TZ Insurance Solutions LLC internal sales data, 2019. This data is based on the Medicare Supplement Insurance policies TZ Insurance Solutions LLC has sold. It is not a comprehensive national average of all available Medicare Supplement Insurance plan premiums.

Not happy with your current Medicare Insurance Plan? Or just curious if there is a better plan?

Like the song says… “You better shop around!”

This is very good advice!

Whether it is groceries, heating oil, or anything else, everybody wants to get the best value for their money. And today’s options for health insurance can be pretty darn costly. That’s why it’s a good idea to shop around for the right Medicare Advantage or Prescription Drug Plan.

Cost is not the only thing to consider when comparing plans.

There are dozens of Medicare Supplemental plans available in Maine this year, all with different costs. 

Keep the following things in mind when you compare plans to make sure you get the best plan!

• What are the monthly premiums and deductible costs?
• What will you pay for the benefits and services you’re likely to use?
• Is there a limit on what you will have to pay out-of-pocket for the year? 
• Will you have to change pharmacies if you change plans?
• What benefits are most important to you? Such as Dental, Vision, Chiropractic

Comparing costs of prescription drug coverage is another part of the cost puzzle. 

• Do you know how much your prescriptions will cost?
• Does the plan cover the drugs you take? 
• What pharmacies will give you the best price?
• Will the Part D coverage gap (“donut hole”) effect you? If so, when?

Only you can determine what mix of benefits and costs will work best with your needs and budget, but I can help. 

I can help make it easy to compare plans so you can pick one that best meets your needs. 

I can explain everything you need to know and after you’ve narrowed your choices to a few really good plans, together we will review those plans to get more details about their benefits and services. 

I work with all the insurance companies and plans available and I have helped hundreds of people with this decision. I understand these plans and how they work and I can help you understand them too.

And the best part is – you pay nothing for my help!

That’s right. I help you review your plan options and answer all your questions and it won’t cost you a cent!

Why?

This is what agents do. Just like with your car insurance or home owners insurance, as your agent I work for you and I get paid by the insurance companies to help you. And not just now but throughout the year.

I am trained by each insurance company on how their plans work and what they offer plus I have clients who use these plans which gives me real experience helping them year after year.  So, I know which plans are the most popular and why.

Another great thing about having someone on your side is that I am available throughout the year if you have any questions or need help!  So, if you have a problem with the insurance company or if you don’t understand something you get in the mail, I will be here to help with that too!

No one plan is perfect for everyone.  Each plan is different, just like each person is different.  I will help you understand the differences so you can the right choice with confidence!

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 by calling 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message. 

Again, 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.”

Dual Eligible Special Needs Plans (DSNP) are health plans for people who have both Medicare and Medicaid (AKA MaineCare).

What’s the difference between Medicare and MaineCare?

If you’re not sure, we can help.

Medicare provides health benefits for people over age 65, as well as people younger than 65 who qualify due to a disability. Medicare is a federal program. Medicaid, on the other hand, is managed at the state level. Medicaid provides health benefits for people with lower incomes, but the rules to qualify vary from state to state.

Can you have both Medicare and MaineCare at the same time?

Yes, some people qualify for BOTH Medicare and MaineCare. These individuals are often called “dual eligible.” This is where dual special needs plans — or “dual” plans — come in.

Dual plans work together with MaineCare and Medicare. Dual health plans cover doctor visits, hospital stays and prescription drugs and often they will include extra benefits like Dental, Vision, transportation and over-the-counter items such as aspirin, toothpaste, band-aids, and more!

Medicare/MaineCare Dual plans offer these extra benefits and features at no extra cost to you

Dual plans go beyond either MaineCare or Original Medicare alone. You will have all the Medicare and MaineCare benefits you have now plus you will have additional benefits with the dual plan you choose. And best of all, with your dual plan, you get these many extra benefits and features than at no extra cost!

These extra benefits may include:

• Dental coverage of up to $3,000
• Eye exams, plus credit for eyewear up to $400
• Hearing exams, plus credit for hearing aids
• Rides to health care visits and the pharmacy at no cost to you.
• up to $100 in credits EACH MONTH to buy health-related products over the counter
• and many other benefits like food cards or pet food if you have a service animal.

Want to get these extra benefits?

The best new of all is that if you qualify for these plans, you do not have to wait for Open Enrollment in the fall. You can sign sign up for a plan today!

Need more information? I can help.

If you would like to ask a question or get more information about these plans, you can call me directly at 207-370-0143 or use the simple form below 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. And I’m always available during the year to help with questions on how to use the plan or to offer assistance if you have any trouble!

“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.”

Todd Reagin

In 2020, many Medicare Advantage plans will offer dental & vision coverage as an extra benefit. But for those who don’t have dental coverage, or don’t like their plan’s option, may want to find a plan on their own.

Choosing either dental insurance or a dental discount plan can save you money, but there are important differences to consider before deciding which route to choose.

Dental insurance versus dental discount plans

Before jumping into details, here’s a quick overview of the two types of dental plans:

Dental insurance

Most dental insurance plans operate pretty much the same way. Although benefits vary, plans generally fully cover preventative care, like two cleanings and one set of X-rays per year. They also tend to cover about half the cost of major procedures such as root canals, bridges, and crowns.

Most plans have annual deductibles of $50 to $100 and usually limit annual coverage amounts, with a median cap of $1,000. Some plans may or may not cover orthodontics or have lifetime limits on the amount covered for implants, so that’s also something to consider when shopping around.

Insurance companies often have a “network” of dentists and some plans will only cover work done by this network while other plans may offer flexibility to see dentists outside this network but often at a lesser amount of coverage.

With the high cost of dentistry, it’s easy to see how paying for a plan with a low annual max plus a monthly premium may not make sense. According to their annual survey, the American Dental Association Health Policy Institute says the average cost of a cleaning for an adult in the US is $73 to $130; fillings, $108 to $246; crowns, $959 to $1,650; implants, $1,200 to $2,500; and root canals, from $613 to $1,200.

Dental discount plans

With a discount plan, you pay a monthly or annual membership fee and will receive a discounted price on services. Monthly membership fees for an individual range from about $10-$15.

Dental discount plan networks may be more limited than insurance networks, and compared with insurance, the out-of-pocket costs are often higher for patients. You can get full coverage of preventive care with some discount plans, but it is much less common than it is with insurance.

Discounts range from about 20-50 percent, with routine procedures getting the highest discounts. But unlike dental insurance, with discount plans there are no caps. You keep getting the discount on all services for the entire year and the discounts do not end.

Factors to consider when choosing one option over another

At first glance, you may think the only difference between dental insurance and a dental discount plan is the cost and amount of coverage, but there’s more to consider.

When do you need coverage to start?

Some insurance plans may allow you to get a cleaning or X-ray right away, but there are often waiting periods.

It’s common to see six-month waits for for major services. These waiting periods prevent consumers from abusing the insurance plan — using the insurance for a procedure and then dropping it right away.

By contrast, dental discount plans don’t have any waiting periods. It may take a few business days for your membership to go through. If you have an immediate (non-emergency) need, you may be able to pay for a dental discount plan and get a discount on the procedure a few days later.

How many options do you want?

An important consideration is how many dentists you can choose from, and if there’s a well-rated in-network dentist nearby. If you already have a dentist you like, check with the office to see if it will accept the insurance or discount plans you’re considering.

Which option is best for you?

Compared with having no coverage at all, you can save money with either a dental insurance plan or a dental discount plan.

If you already have a dentist whom you like to visit and are looking to save money, your best bet may be to ask which options your dentist accepts and compare the costs for your general needs. When you don’t have a dentist, it can be a bit easier because you can choose the plan that offers the best coverage and then look at the list of dentists that accept the plan you chose.

For those who regularly get cleanings and don’t have a history of dental problems, a dental discount plan could provide adequate coverage for a low monthly fee. Although you may only break even or save a little money on your twice-a-year cleanings and annual X-ray, you’ll have some added security in knowing you can save money on other procedures. However, since the discount plan isn’t likely to cover the entire cost for major work, you may want to have some savings set aside for an emergency.

More ways to Save On Dental Care

With or without dental insurance, there are many ways to make dental care more affordable. Check out these strategies.

Get covered if you can.

For seniors over 65, Medicare doesn’t cover dental services, but you can buy a Medicare Advantage plan with dental coverage. Some Medicare Advantage plans charge additional premiums for dental and some offer dental coverage at no additional costs.

If you’re a veteran and have a service-connected disability, you may be eligible for free comprehensive dental care from the Department of Veterans Affairs. Other veterans can buy dental insurance at a reduced rate and some Medicare Advantage plans offer plans specifically tailored to compliment your VA benefits.

Click here to find out how Veterans are winning with Medicare Advantage!

Time your treatments.

If you need an expensive procedure, ask your dentist whether you can space out the treatments so that you can apply the cost against two annual limits instead of one by starting near the end of one year and finishing in January.

Create a dental emergency fund.

Put aside money you might have used for premiums. Instead of paying an insurance company $50 per month for a plan, transfer that money to a savings account each month and use that money when you need it.

Check out medical expense accounts.

Ask whether your employer offers tax-advantaged accounts to help save and pay for dental expenses not covered by its insurance, such as a health flexible-spending account (FSA) or a health reimbursement account (HRA).

And if you have a high deductible health plan (HDHP), you can fund a Health Savings Account (HSA) with pre-tax money and use it on a range of healthcare costs including dental.

For most dental expenses the IRS will allow HSA payments for “diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.” As long as the expenses are not eligible for reimbursement through insurance or other sources.

Go to a dental school.

You could pay 30 percent to 40 percent less on dental services at university dental schools compared to a private practice. You’ll get care from students supervised by dentists but the downside is that it’s very time consuming.

It’s much slower because the student is doing work under the supervision of an instructor. Visits are longer and care that could be done in a few sessions in a dental office could take a few months to complete.

Check a community health center.

Some community health centers offer dental care and charge on a sliding scale based on your income. But they may have limited services and, possibly, waiting lists. Call your local health department or state dental association, or go to Tooth Wisdom to find clinics near you.

Do some haggling.

Whether or not you have insurance, you pay a lot for expensive procedures so you should compare prices for big ticket items. Use FAIR Health to research prices where you live.

Dentists are often open to negotiating prices and may offer a discount if you pay for a procedure when you get the service. Some dentists also offer in-office dental plans for people without benefits.

Spread out services.

Many employer plans provide 100 percent coverage for getting a checkup twice a year. But if you’re paying on your own and in good dental health, once a year may be enough according to American Dental Association guidelines.

The ADA also says that adults with generally healthy teeth only need bitewing x-rays every 18 to 36 months. There’s no one-size-fits-all dental treatment though. You can go to the ADA’s MouthHealthy.org site for more information on paying for dental care, preventive care and recommended frequency of visits.