- How to Review Your Medicare Plan for Maximum Benefits
- Medicare Advantage vs Medicare Supplement Plans (Updated Review and Important Tips)
- The Difference Between Medicare and Medicare Advantage
- Medicare Advantage vs Medicare Supplement Plans in 2023! What’s best for you? ????
- Medicare Basics: Parts A, B, C & D
- Medicare Explained (2023 and 2022 Updates!)
- Why I Would Never Choose Medicare Advantage
How to Review Your Medicare Plan for Maximum Benefits
and welcome back to the morning blend,with our continuing series insurance 101,with sovereign select,well there are many things that come,around once a year you know your,birthdays,holidays and medicare open enrollment so,julie lucy is an independent medicare,broker,with sovereign select and shes here to,discuss this very important,time of year which will sneak up on us,sooner than we think good morning to you,julie,hi tiffany how are you im doing well,thanks for joining us so tell us what,this open enrollment is and exactly what,we need to do now,well open enrollment comes about you,know once a year,um youre going to hear it youre going,to see it youre going to,theres a lot of advertising around this,time of year,but first theres a lot of things that,we do on a yearly basis,um we pay taxes we,should review our retirement plan um,we should get a health or we should get,a checkup or a physical,as well as we should get a flu shot im,going to give you one more thing to do,on an annual basis,and that is to review your medicare plan,on a yearly basis medicare can change,their basically their,health care plan as well as their,prescription drug plan,so costs can change coverage,your network of physicians can change,you want to make sure that your price,the price of prescription drugs hasnt,gone up too much,and you want to make sure that your,physician is still in network,so these are all changes that can take,place,and um you want to know about them,so the annual enrollment period is a,period from,october 15 through december 7th,in which almost everyone can change,their,medicare plan and for some that includes,a prescription drug,plan um its a period that happens for,most people once a year,so if you have some questions or,if you want to save some money um,its a good time to review your plan,keep in mind that our services are free,and were really not,not biased at all so you can make it an,appointment with us,and we can talk about changes,well yeah and as you say when you review,your plan theres so many reasons as you,just mentioned to do that you know,um the monthly premiums can go up youve,learned your doctor wont be in network,just as you said your medications have,changed,all of those but but what can people do,during the annual enrollment period than,if they find those things happening okay,so everyone on a medicare advantage plan,or prescription drug plan is going to,get a packet of information from their,medicare provider,by september 30th and this,packet is going to include evidence of,coverage,and an annual notice of change its,going to let you know,what changes are taking place in your,medicare policy,for the next year some people are happy,and dont need to do anything,but if youre not happy with those,changes,[Music],give me a call um maybe we can find a,better plan,that fits your healthcare needs and your,budgetary needs,um if peoples premiums keep going up,and they can no longer,afford their medicare there are,different type you know we can always,find a plan,that suits your needs possibly at a,better budget as well,your doctor can change and maybe you,want to change,your medicare provider to one that,includes your doctor,also prescription drug coverage can,change,if your prescription drug if youre on,some new drugs in your prescription drug,prices keep going up,please give me a call and we can,evaluate and look for some different,prescription drug plans,thats great were running our time a,little bit so i want to kind of make,sure that we go through some of these,things that people can do,so what can they do during the opening,the annual open enrollment period,so they can go from a medicare,supplement to a medicare,advantage plan this is what most people,did last year,with me because the medicare supplements,get expensive,also people can go from a supplement to,i should say they can go from an,advantage plan to a supplement,they do need to take into account they,could be underwritten,and ask some health care questions,people,can add drop or even change their,prescription drug,coverage keep in mind that,these changes will not take effect until,january 1st of 2021,thats great and i know that its so,confusing for people they can contact,you,during this period to really lay it out,and get some more information,and youve got these great road to,medicare educational meetings,im going to give all that information,now so that people can join you and,learn more,during this open enrollment period,thanks so much julie okay take care,tiffany have a great day,you too and here are those road to,medicare um educational appearances its,friday,september 11th friday october 2nd friday,october 16th,and then friday october 30th they are,all at 10 a.m,you can do them virtually or over the,phone and this is educational only you,can contact julie lucy,at sovereign select directly at,414-253-3554 or email her at julie,jlmedicare.com
Medicare Advantage vs Medicare Supplement Plans (Updated Review and Important Tips)
this is one of the most if not the most,commonly asked question i get so today,im doing an,updated simple explanation on the,difference between,medicare supplement plans and medicare,advantage plans,so stay tuned,[Music],hi everyone im stephanie apt im a,licensed,medicare insurance broker and welcome to,my channel this is where i answer my,most,commonly asked medicare questions and,offer,educational medicare videos so that we,can hopefully,help you simplify the confusing world of,medicare,my team and i are licensed in almost,every state,so we help seniors all over the country,with their medicare insurance,and one of the most common confusions i,see,is people not always understanding the,difference between medicare supplement,plans,and medicare advantage plans there are,also lots of advertisements that youll,see on tv that make this,even more confusing to people and there,are a few videos out there that talk a,little bit about the difference between,these two options but today i really,wanted to do,an updated video about this topic so,thats what well dive into,traditional medicare has two main parts,to,it medicare part a and medicare part b,part a is your hospital insurance and,for most people,thats free medicare part b is your,medical insurance,and for most people you have to pay for,that,the standard premium for part b in 2021,is 148 and 50 cents per month,it may be higher if youre a high income,earner and that part b,premium can increase over time and once,you,have or once you enroll in medicare,parts a,and b you essentially have two main,options on how to receive your medicare,benefits,its kind of like theres a fork in the,road you choose one path or the other,and thats how youll receive your,coverage so id like to use a little,flow chart to explain this,and its important to know that no,matter which,path you choose you generally still have,to pay your medicare part b,premium that 148.50 per month premium,you still have to pay it no matter which,path you choose,the first path is where you keep,traditional medicare,parts a and b as your primary insurance,coverage,and this means that you can maintain the,freedom to visit,any medicare doctor anywhere in the,country and,most any medically necessary service is,going to be covered,by parts a and b your doctor your,hospital,will bill medicare as your primary,insurance,and from here youll likely add on a,standalone,medicare part d prescription drug plan,to cover your prescription medications,additionally many people like to add on,a,medicare supplement or a medigap plan,to cover all of the deductibles and,co-insurance and out-of-pocket costs,that traditional medicare part a and b,doesnt pay medicare supplement plans,are offered by,many different insurance companies but,the benefits are,standardized so if you pick,lets say a medicare supplement plan,g with one company thats the same exact,plan as if you were to purchase it,through any other company,so whats good about medicare supplement,plans whats good about this path,first off there are no doctor networks,that you have to worry about,so you can always visit any medicare,provider,wherever you are wherever you live,wherever you travel,you can choose your own doctors secondly,on this path,you have peace of mind in knowing that,you wont really be hit with any huge,medical bills right because your,medicare supplement plan,is going to cover almost all or all,of your potential out of pocket costs,under parts a,and b these plans give you very,comprehensive coverage,so usually you have little to no,deductibles and co-pays,so what is the downside to this path,well medicare supplement plans do have,an additional monthly premium,that you have to pay on top of the part,b,premium that youre already paying in,most parts of the country,medicare supplement insurance for a 65,year old,will range from 80 a month to 150,a month but that depends on where you,live additionally these plans,dont include dental and vision benefits,so,medicare supplement plans are designed,to cover,all of the services that traditional,medicare parts a,and b covers and since traditional,medicare parts a,and b doesnt usually cover dental and,vision services,then your medicare supplement plan,typically would not either,now lets talk about the other option,the other path you can take,which is medicare advantage medicare,advantage plans are also,known as part c of medicare but really,these,are plans that are alternatives to,your traditional medicare benefits so,private insurance companies contract,with medicare,to offer these managed care medicare,advantage plans,and medicare advantage plans cover all,of the services covered by,traditional medicare parts a and b and,they usually,include your part d prescription drug,benefits rolled right into the plan,when you enroll in a medicare advantage,plan like an hmo,or a ppo plan you are choosing to,receive your benefits,through this insurance companys managed,care plan,so when you go to the doctor or the,hospital they dont bill,traditional medicare any longer they,bill your,medicare advantage plan insurance,company medicare advantage plans can,establish,their own cost shares their own,co-pays their own deductibles for,your medical and hospital services,additionally these plans often include,some coverage for things that are not,covered under,traditional medicare things like dental,or vision,or hearing services keep in mind like i,said before,in most cases you must continue to pay,your part b,premium even if you enroll in a medicare,advantage plan so whats good about,medicare advantage plans,well these plans are usually very,affordable,in most parts of the country medicare,advantage plans start at,zero dollars a month so they can be a,really great alternative,for people that cant afford a medicare,supplement plan,also these plans roll your medical,your prescription drug coverage and,sometimes your dental and vision,coverage all,into one plan so you have one card that,youre carrying around in your wallet,and a lot of people like that,convenience so what are the downside to,these plans,well these plans do use provider,networks,which can change over time so you dont,have as much provider freedom,typically youre more limited to a set,network of doctors and hospitals,some plans do offer coverage out of the,network but its usually at a much,higher,cost share to you also medicare,advantage plans,have out-of-pocket maximums that are put,in place,to help cap your out-of-pocket spending,in the case of a catastrophic medical,event but many medicare advantage plans,do have out-of-pocket maximum limits,that are on the higher end,in 2021 the standard out-of-pocket,maximum limit on medicare advantage,is seven thousand five hundred and fifty,dollars per year,so if you had a major medical event,illness etc you may be responsible for,up to that out-of-pocket limit each,calendar year,additionally these plans may require,referrals to see a specialist,or prior authorizations for certain,medical,services whereas traditional medicare,has historically rarely required,prior authorizations for medical,services so there are many different,factors to consider,when you are debating medicare,supplement plans,versus medicare advantage plans your,budget,your medical history as well as what,types of plans and pricing are available,in your area,are just a few of the things that youll,want to take into account and of course,this is,exactly what we help people do every day,as an independent broker,our service is free of charge and,because we work with both,medicare advantage plans and medicare,supplement plans,we are able to offer you an unbiased,review,of the plans in your area to help you,determine,which type of coverage will best meet,your needs,something thats important to remember,is that in most states,medicare supplement plans are typically,medically underwritten when you are,not new to medicare so in other words,when youre new to medicare you have,this one time,open enrollment window
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The Difference Between Medicare and Medicare Advantage
back in the 90s medicare beneficiaries,had far fewer choices than they do today,for example there were no medicare,advantage plans in the form that we had,them now,the only choice for people with no,retiree coverage from a former employer,was to enroll in original medicare and,add a medigap plan to help them cover,their deductibles co-pays and,coinsurance,fortunately medicare beneficiaries today,have more choices,they can opt to get their medicare part,a and b health care services through a,medicare advantage plan,and many of them do with approximately,42 percent of them choosing medicare,advantage plans today,but which one is right for you original,medicare or medicare advantage,in this video ill discuss both options,and share a few tips to help you choose,the right plan,[Music],under original medicare you get your,benefits directly from the federal,government,original medicare benefits include two,parts,part a and part b,that provide your hospital and medical,insurance,if you have a qualifying work history,your part a benefits are premium free,medicare part b premiums are set each,year by the federal government and most,people pay the same standard rate which,is 170 and 10 cents in 2022.,some high earners pay an income related,adjustment in addition to the standard,premium,because original medicare is managed by,the federal government the benefits are,exactly the same for every person who,enrolls there are no pre-existing,condition limitations and no waiting,periods,part a covers inpatient care while you,are admitted to a hospital or a skilled,nursing home,it also covers hospice care and certain,kinds of home health care,part b pays for outpatient expenses like,doctor visits x-rays and lab tests,it also covers durable medical equipment,like wheelchairs and home oxygen,supplies,under original medicare benefits you can,use any healthcare provider who accepts,original medicare,this includes over 1 million providers,nationwide there are no networks you pay,the same amount for covered services,from any of these providers no matter,which one you visit for your medical,care,original medicare does not cover,outpatient prescription drugs though,you can enroll in a standalone part d,drug plan for that coverage,think of part d as an insurance card,that you use only at the pharmacy,part d drug plans are offered by private,insurance companies but they are,regulated by medicare to ensure that all,plans meet certain minimum requirements,with their drug formularies,if you choose to stay with original,medicare you need to know that there is,no limit to how much you might pay out,of pocket each year for example if you,need chemotherapy,your 20,co-insurance responsibility could be an,awful lot of money for this reason most,people who choose original medicare will,also buy a medigap plan,medigap plans pick up where medicare,leaves off,they step in to pay the deductibles,co-pays and coinsurance that you would,otherwise have to pay yourself,most people who choose original medicare,plus a medigap plan value freedom of,access to medicares entire list of,providers,medicare offers the ultimate flexibility,for you to treat with any provider that,accepts medicare since theres no need,to choose a primary care provider you do,not have to get a referral to see a,specialist,this kind of flexibility is appealing to,many people who travel frequently or,live a snowbird lifestyle because they,can see doctors anywhere they go,other people choose original medicare,and medigap because they want very,predictable back end costs,they want the peace of mind that comes,from knowing exactly how much they will,spend on a hospital stay or a chronic,illness they buy for convenience and,dont mind spending a bit more to gain,peace of mind,sometimes people also choose original,medicare if their doctors do not,participate in any of the medicare,advantage plans doctors have their own,reasons for choosing not to participate,in medicare advantage network sometimes,if yours doesnt youll have to decide,whether you want to keep original,medicare and pick up a medigap plan so,you can keep seeing that doctor or,whether you are willing to change to a,new doctor who does participate in the,medicare advantage coverage,medicare advantage plans are very,similar to group health insurance that,youve had during your working years,these plans have networks and you pay,for medical services as you go along,you must be enrolled in both medicare,part a and part b to enroll in a,medicare advantage plan,medicare advantage is also known as,medicare part c so its technically,still a part of medicare but plans are,not offered directly by the federal,government the government sets rules and,guidelines for medicare advantage but,private insurance companies sell and,administer these plans,medicare pays the insurance company to,administer your part a and b benefits,through the medicare advantage plan,while all plans must cover the same,health care services as parts a and b,different medicare advantage plans will,have different networks co-pays and drug,formularies,medicare advantage plans also do not,require any underwriting since there are,no health questions its very easy to,obtain a medicare advantage plan if you,live in the planned service area and are,enrolled in medicare parts a and b,there are several different types of,medicare advantage plans,the two most popular medicare advantage,plan networks are hmo and ppo hmo plans,have closed provider networks and you,generally must get all but emergency,care within your plans network,you choose a primary care doctor who,oversees all of your medical care,your plan may require you to get a,referral for a specialist care and,obtain prior authorizations for certain,tests and procedures,hmo plans often include part d,prescription drug coverage rolled right,into the plan,ppo plans also have provider networks,but you can still use any provider that,accepts medicare and is willing to build,a plan,however treating with providers who are,outside the network will generally cost,you more out of pocket,with the ppo plan you usually dont have,to choose a primary care doctor,or need a specialist referral many of,these plans also include part d coverage,now all medicare advantage plans have to,offer the same health care services that,you would get under original medicare,however many go beyond and offer other,coverage like routine vision and dental,care to their memberships,some even have wellness programs gym,membership discounts and 24-hour nurse,hotlines,its difficult to give a snapshot of,your costs with a medicare advantage,plan because each one is different,each company that offers a plan can,choose what to charge you,for premiums deductibles and copay,amounts,you may have heard of a zero premium,medicare advantage plan,a zero premium plan simply means that,the plan doesnt add any additional,premium above what you are already,paying for part b,for 2022,the average medicare advantage plan,premium is about 19 a month but in many,urban areas you can find plans with zero,premiums for you to consider,some medicare advantage plans have,deductibles and others dont deductibles,may apply to inpatient services,outpatient services or to medicare part,d,about half of all medicare advantage,plans with part d benefits dont have a,part d deductible so if drug spending is,anticipated you can try looking for a,plan in your area that has no drug,deductible for you to satisfy up front,this is a good thing since the part d,standard benefit has a 480 dollar,maximum allowable deductible in 2022,however you may find that plans with the,lowest monthly premiums may have drug,deductibles build in there is a,trade-off here which is why its so,important for you to work with an,experienced broker like boomer benefits,to help you choose a plan that has the,right balance of cost versus benefits,medicare advantage enrollees usually pay,a co-payment when they access healthcare,services,this is usually between 10 and 50
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Medicare Advantage vs Medicare Supplement Plans in 2023! What’s best for you? ????
in this episode of retirement Real Talk,were going to be looking at the,differences between Medicare Advantage,plans and supplemental plans so that,youll be able to decide which is best,for you,welcome to retirement Real Talk where we,cut through the advertisements sales,pitches and all the confusion,surrounding Medicare Social Security and,retirement finances introducing the,internets leading Medicare educator and,co-founder of medicareschool.com Marvin,music,and his son certified financial planner,and the co-founder of medicareschool.com,Joshua music,time for some retirement real talk,[Music],so weve broken this episode down into,four different parts first were going,to cover what is a supplemental plan how,do they work were going to talk about,what is an advantage plan how do those,work what are the differences between,these two options and then the last,which I think the most important is how,to decide which one is best for you so,lets go ahead and get started if you,wouldnt mind why dont you explain to,our listeners what is a supplemental,plan well when people decide to go on,Medicare one of their options is to stay,in what we call the original Medicare A,and B system which means that anytime,they go to a hospital or go to the,doctor Medicare is going to be the first,payer but other than preventive Services,Medicare never pays anything a hundred,percent so theres always a balance of,the bill and that balance of the bill,could be a deductible it could be a,copay it could be coinsurance theres a,variety of ways but the balance is the,insurance responsibility and because,theres such a risk there most people,dont want to be liable for those we,call those gaps and so when someone buys,a Medigap policy also call the Medicare,supplemental plan there buying that to,to fill in to cover those gaps that,Medicare did not pay for so Medicare,pays first the balances of the insured,responsibility but they can pass that,liability onto an insurance company so,when they buy that policy theyre going,to pay a premium and then the insurance,company will be responsible for that Gap,instead and theres 10 different,policies we find that about probably 97,to 98 of all people buy one of three but,they buy them for the purpose of having,the insurance company pay those gaps for,them instead of being out of pocket,themselves okay so lets talk about the,gaps real quick what are and there I,think there are six or seven total but,what are the maybe top two or three that,they need to be aware of that could,really impact them financially meaning,Medicare is going to pay for part part,of it but theres this big gap that you,would be responsible for to pay out of,your own pocket unless you add a,supplemental plan that would then step,in and pick that up thats right yeah,there are six gaps theres three gaps on,the A and three gaps on the B and really,the your your big responsibility be on,the on the egg side is youre gonna have,to pay a deductible its not a high,deductible just clarify for people the a,side is the hospital the inpatient,hospitalization the B when we talk about,Medicare Part B were talking about,outpatient things so doctors visits you,know test Labs x-rays outpatient,surgeries anything that would be,outpatient its going to fall under the,B side thats right so on the a side you,said theres the day side which is the,you know the inpatient side of Medicare,theres a deductible its not real high,but it has the possibility of occurring,more than once in a year so theres,risks there its 1556 dollars right now,so if anyone goes to hospital whether,theyre in one day or two days 10 or 60,days up to 60 theyre going to pay that,1556 deductible and if theyre,re-hospitalized anytime you know two,three four months later then theyre,gonna pay it again so its not just an,annual deductible they could pay it two,three four times a year so it could be,you know up five six seven thousand,dollars out of pockets right yeah its,tied to whats called a benefit period,And so that there is a possibility that,those could happen four five times in a,year and then on top of that there would,be if they have an extended Hospital,stay theres a daily hospital copay and,what are those numbers yes well right,now what that means is after being in,the hospital 60 continuous days the next,month every day during that third month,would be 389 dollars a day so when you,do the math someones in that third,month its going to cost them twelve,thousand dollars and then month four and,five if theyre still in of course,theyre really very sick most people in,that situation are in a coma but it does,happen and so month four month five it,doubles to 788 a day right now and,thats what basically twenty five,thousand dollars each month that theyre,going to be in the hospital and then,what happens is theres no coverage,after that and so thats why people get,supplemental plans to fill in the gaps,for those extended hospital stays the,deductible as well as giving people one,full year in the hospital at no cost,after the Medicare coverage Runs Out if,youre finding this video helpful I want,to invite you to go right up here and,actually click on a link that will allow,you to watch what I call the Medicare,Essentials Workshop theres a workshop,that I did that really is going to show,you everything you need to know about,Medicare from A to Z how to enroll wind,and roll and the plan options for you so,so go that link and check it out okay so,lets talk about the Medicare Part B,side which is outpatient what are the,costs associated with that well Medicare,B also has three gaps it has a very,small deductible this year thats 233,dollars but the big gap on the B side is,20 co-insurance so anything that,Medicare is going to cover on the,outpatient side or the doctor Services,they only pay 80 percent and so the,insurer is responsible for 20 and the,problem that 20 is it never stops its,unlimited and so that really is the I,think the overall largest financial,exposure that people have on Medicare,today especially if they get ill if they,have a surgery and theres going to be a,surge in anesthesiologist multiple,doctors are going to see in every one of,those Physicians theyre to be,responsible pay that 20 co-insurance and,then on top of that theres also this,thing called an excess charge which,means that any doctor out there can,charge an extra 15 percent above,whatever that Medicare approved amount,is and in that instance thats probably,on you unless you have a supplemental,plan that covers that exactly right so,to kind of summarize this the Supplement,Plan covers all this stuff that A and B,does not cover and the most popular plan,for years was the F plan and it,basically paid everything that Medicare,didnt pay so Medicare paid their,portion F plan paid everything else the,G plan has been popular for probably,five years now or so and its almost,identical to the F plan except that you,have to pay the Medicare Part B,deductible which is this year 233,dollars after you pay that deductible,its 100 coverage after that and the,other plan thats worth mentioning here,that a lot of people are getting is,called an in-plan so the implants a,little less benefit can you explain how,the implant Works sure well the end plan,is of course lower in premium any were,from yeah I averaged about thirty,dollars youll save versus the g plan,but you are going to take on a couple,more items the end plan like the GE plan,will not pay the B deductible not a big,expense but it most importantly it will,not pay excess charges if and when they,occur and theres still 42 states that,allow doctors to charge excess now the,majority doctors dont for sure but that,could change and if Medicare will,continue to keep their a reimbursement,rate stagnant then we can see more and,more doctors possibly adding excess,charge and thats 15 percent anyone that,goes to Mayo Clinic and some of these,specialty hospitals and Cancer Centers,they will be billed that extra 15,percent and so
Medicare Basics: Parts A, B, C & D
(upbeat music),- Hi, my name is Carol Carstensen.,Im part of the Medicare Made Clear team.,And I know from trying to learn about it myself,,just how much there is to know about Medicare.,It can be kind of overwhelming at times,,even if youve been at it for years.,So today, Im gonna go over the basics of Medicare,because a strong foundation in the basics,is gonna help you understand your choices,and make better Medicare decisions for yourself.,Well start at the beginning and talk a little bit about,what Medicare is and who can get it.,Then, well talk about the parts of Medicare,,what they cover, what they cost,,and then well go into how to put those parts together,to come up with coverage that works for you.,So, lets get started.,Medicare is a federal health insurance program,for people 65 and older,and others who have qualifying disabilities.,You also need to be a United States citizen,or a legal resident.,If youre a legal resident,,you need to have lived in this country,for at least five years in a row,,including the five years just before you enroll in Medicare.,Another important thing about Medicare,is its individual insurance.,Meaning every individual person,needs to qualify for it themselves, enroll in it,and choose coverage for themselves.,This can be different from what youre used to,if youve had a family health plan through an employer,,for example.,Government-sponsored Medicare is made up of two parts,,Part A and Part B.,Each part covers certain health care services.,The two together are often called Original Medicare,or sometimes traditional Medicare.,Theres also a Part C and a Part D,,and Medicare supplement insurance.,And well get to those in a little bit.,So, lets start with Part A.,Part A is hospital insurance.,It covers inpatient care when youre in the hospital,or a skilled nursing facility.,It covers your room, your meals,,your nursing services when youre in the hospital,,any equipment or supplies that are used in your care,,operating room, whatever the needs are that you have,while youre in the hospital,or in a skilled nursing facility.,Medicare Part B is medical insurance.,It covers your doctor visits or your doctor services,,even when youre in the hospital.,Other things covered by Part B include,care when youre in an outpatient facility,like the clinic or the emergency room, for example,,ambulance services if you need to go to the emergency room,,preventive care services like flu shots,,medical devices that you might use at home,,such as a wheelchair.,Original Medicare, again, has Part A and Part B,,and it does come with some costs.,Those costs can include premiums, deductibles, copays,,and coinsurance.,Now, lets start with Part A.,Part A, in fact, is premium free for most people.,If youve worked and pay taxes or your spouse has,for at least 10 years, then you get Part A premium free,,otherwise you would have to pay a premium.,Other costs for Part A include a deductible,and some copays and coinsurance.,But importantly, you only pay for Part A,when youre actually receiving Part A services,,such as when you go in the hospital.,So, Medicare Part B does come with a premium.,And that will be deducted out of your Social Security check,if you receive Social Security.,Otherwise youll need to pay it directly to Medicare.,Other costs with Part B include some copays, a deductible,and some coinsurance.,For most services, you pay 20% coinsurance,,and that means you pay 20% of the Medicare-approved amount,for that service and Medicare pays 80%.,So, weve talked about Original Medicare,Part A and Part B, what they cover and what they cost,,but they dont cover everything.,Neither Part A nor Part B covers prescription drugs,,for example, dental, or vision, or hearing care.,This is where Part C, Part D,and Medicare supplement insurance come in.,They offer you more coverage options.,Lets start with Part C.,Part C is Medicare Advantage.,Medicare Advantage plans are offered,by private insurance companies.,They cover everything that Original Medicare covers,,all of your Part A benefits and Part B benefits.,In addition, most plans will include,prescription drug coverage and additional benefits,like dental and vision coverage.,The costs for a Medicare Advantage plan,might include a premium or it might not.,There are some plans that have $0 premiums.,Other costs would include copays for services you receive,and sometimes the coinsurance.,Another important thing to know,about Medicare Advantage plans,is that they are required by Medicare,to set an annual out-of-pocket limit.,This out-of-pocket limit is like,built-in financial protection,,because if you reach that limit,,the plan would pay all of your costs,for the rest of that year.,There may be many Medicare Advantage plans offered,in a region, or a state, or a county,,and each one will have its own coverage and cost terms.,Now, lets talk about Medicare Part D.,Medicare Part D is prescription drug coverage.,You can get prescription drug coverage in two ways,,either through in the Medicare Advantage plan,,like we just talked about,,or through a stand-alone Part D plan.,You can always remember prescription drug plans and Part D,by thinking D is for drugs.,Medicare requires that Part D plans cover all the types,or classes of drugs that are normally used,by Medicare beneficiaries.,Every plan has a formulary or a list of covered drugs.,So, when youre choosing a Medicare Part D plan,,its really important to look at those formularies,and make sure that the drugs that you take,are on those lists.,Costs for a Medicare Part D plan vary from plan to plan.,But it usually includes a premium,,and youll probably pay a copay,when you fill a prescription.,What you pay in copays, again, depends on the plan,and also the formulary.,Every plan places certain drugs on what they call tiers,,or levels, of a formulary,and the level determines what you pay,at the pharmacy counter.,Usually, the higher the level or tier, the more youll pay.,Costs for Medicare Part D will vary from plan to plan,,but most plans have a pharmacy network.,And if you fill your prescriptions within that network,,youre going to get the best price for that prescription.,Medicare supplement insurance is also called Medigap,,and its just what it sounds like.,It supplements Medicare.,Medicare supplement plans help pay,some of the out-of-pocket costs,that come with the Original Medicare Part A and Part B.,Medicare supplement plans are standardized,,theyre labeled from A through N.,Theres 10 different plans with varying levels of coverage.,So, each Medicare supplement plan that has the same letter,offers exactly the same coverage.,However, plans may differ in what they charge.,So, a Plan G, for example,,in one state may be a different price,from Plan G in another state.,The main purpose of a Medicare supplement plan,is to cover the costs that come with Original Medicare,Part A and Part B.,However, some Medicare supplement plan providers,do offer additional programs,that can provide discounted services for dental,,or hearing, or other health care services.,Medicare parts and plans can work together,in different combinations to offer you,the coverage you need.,It really comes down to two scenarios.,You can keep Original Medicare Part A and Part B,and decide to add prescription drug coverage,and/or a Medicare supplement plan,Or you can choose a Medicare Advantage plan instead,,which encompasses all of the coverage in one plan.,People often ask, how do I know whats right for me?,What Medicare plan should I choose?,Well, that choice is personal,because your health needs are personal,and each person needs to make a decision for themselves.,There are a few things to think about as you look at,Medicare plans and coverage in general.,One, would you like to have additional benefits,like dental or vision?,If so, then a Medicare Advantage plan,might be a better choice because they offer these options,whereas Original Medicare doesnt.,Two, would you prefer to have lower month
Medicare Explained (2023 and 2022 Updates!)
hi everyone stephanie apt here today i,am diving into the basics of medicare in,2022 so whether you are new to medicare,this year or maybe youve been on,medicare but you just need a little,refresher course,thats what were going to be jumping,into today,so stick around for medicare explained,in 2022,so lets go ahead and get started,when we talk about medicare explained,there are a few different things that we,really want to cover,were going to today go over all of the,different parts of medicare were going,to talk about when to enroll in medicare,how to enroll in medicare well also get,into depth on the medicare costs for,2022 that you need to be aware of and,then well review medicare supplements,or medigap plans theyre also called as,well as medicare advantage plans so some,of the different choices that youre,going to have,when youre on medicare thats what,well talk about today to go ahead and,dive in there are four main parts to,medicare that you want to be aware of,medicare part a is your hospital,insurance thats going to cover,inpatient hospital services,medicare part b is your medical,insurance coverage,medicare part c,is an optional part of medicare theyre,also known as medicare advantage plans,and well talk more about those in a,little bit,and then theres medicare part d which,is your prescription drug coverage so,when should you enroll in medicare,well most people are going to enroll in,medicare during their initial enrollment,period also called their iep,and this is a seven month window that,starts,up to three months before the month that,you turn 65 and it goes up to three,months after your 65th,birth month,now as long as you sign up for medicare,before your 65th birth month then,generally your medicare part a and b,coverage is going to start on the first,day of the month that you turn 65,now theres a little catch here if you,turn 65 on the first of the month,then your medicare eligibility date is,actually one month prior so if i turn 65,on july 1st then im actually eligible,for medicare starting,june 1st right,if you are collecting social security,benefits prior to turning 65,then medicare will automatically enroll,you in medicare parts a and b you dont,have to do anything youre going to get,your medicare card in the mail youll be,automatically enrolled however,if youre not collecting social security,benefits then you do have to actively,enroll in medicare and there are a,couple different ways you can do that,what most people do is they go online to,ssa.gov,medicare and i have a video that ill,put up here that also shows you exactly,how to enroll in medicare online,you also have the option of calling,social security or you can go down to,your social security office if they are,allowing in-person appointments in your,area once you go ahead and enroll in,medicare youll be enrolling in original,medicare which is parts a and b thats,what we call original medicare,or traditional medicare so lets talk a,little bit more about how those work,part a is your hospital insurance like i,mentioned before and this part of,medicare is usually free as long as,youve been living working in the u.s,for 40 quarters this part of medicare,covers inpatient hospital care so,skilled nursing care inpatient care,some home health care services are going,to be covered by medicare part a,medicare part b is your medical,insurance and this part of medicare is,not free so many people are surprised to,find out that they do have to pay to be,enrolled in medicare part b and the,premium currently in 2022 the standard,premium is 170.10,per month medicare part b covers all of,your outpatient hospital services it,also covers doctors office visit,testing,durable medical equipment ambulance,pretty much everything medical thats,outside of the inpatient hospital,setting is typically covered by medicare,part b and most people will go ahead and,sign up for medicare parts a and b,during their initial enrollment period,when theyre turning 65,however if you are working,and youre actively employed past age 65,you may be able to delay medicare,without penalty so im going to link a,couple videos in the description below,that talk about exactly when,and how to delay medicare part b if that,situation sounds like you so be sure to,watch those videos now most people pay,the standard part b premium once they,enroll in part b however some people,will pay more than that so if you are,considered a high income earner then you,may be subject to irma which is the,income related monthly adjusted amount,now irma impacts both your part b,premium,and your part d premium if youre,enrolled in a part d drug plan which,well talk about in a second but this,chart shows you know how they determine,irma medicare will let you know in,advance with a written notice if youre,going to be subject to irma and what,your expected premiums will be if youve,had a life change in the past two years,maybe you used to be a high income,earner but now youve retired and you,wont be any longer,there is an appeal form which im gonna,link below where you can appeal irma if,you think that situation applies to you,so you can potentially appeal these,charges but just something i wanted to,mention so that youre aware that some,people will have to pay more for their,medicare premiums so once youre on,traditional medicare parts a and b once,youre enrolled,what are,your out-of-pocket costs medicare parts,a and b helps to cover inpatient,hospital stay and all of your medical,services,but it doesnt cover everything at 100,necessarily so if you just have medicare,part a and b and you dont have any,other type of supplemental insurance,coverage,here are what your expected,out-of-pocket costs would be in 2022.,for medicare part a,you have an inpatient hospital,deductible of,1556 dollars,now this is not an annual deductible,this is a 60-day benefit period,deductible so you could potentially have,to meet this deductible,more than once in a year if you have,more than one hospital stay,after that the first 60 days of the,hospital are covered at 100,by part a,days 61 through 90 youll have to start,paying a coinsurance of 389,per day days 90 to 150 you will have to,start paying a coinsurance amount of 778,dollars per day for a skilled nursing,facility stay medicare covers your first,20 days in a skilled nursing facility,and then after that you have to start,paying 194.00,per day for days 21 through 100. when it,comes to medicare part b there is an,annual deductible of 233 dollars per,year so you have to pay the first 233,dollars of your medical expenses,doctors office visits etc before,medicare part b kicks in and after,youve met that deductible medicare part,b will pay eighty percent of your part b,medical services,and you have to pay the other 20,and its important to know that theres,no cap on that theres no out-of-pocket,limit or anything like that you do have,to pay the full 20,of all of your part b medical services,so because that is quite a bit of,out-of-pocket exposure for medical,spending with just traditional medicare,parts a and b,most people look into doing some type of,supplemental coverage to help cap those,potential out-of-pocket costs,and theres really two main options that,you have here so i have been using this,flow chart for years and referencing it,for a long time so ill use it again,today i think its just an easy way to,understand,what your options are,when youre on medicare parts a and b,when youre on medicare you can decide,how you want to get your coverage the,first option or the first path that im,going to talk about here is to you know,keep original medicare traditional,medicare parts a and b as your primary,insurance coverage so you have your,hospital insurance you have your medical,insurance,just like we just reviewed from there,you can decide if you want to add on,prescription drug coverage via medicare,part d,so most people will add on a medicare,part d prescription drug plan there are,penalties associated with part d if yo
Why I Would Never Choose Medicare Advantage
when you come into medicare your first decision is which way youre going to go are you going to stay ,with original medicare are you going to choose a medicare advantage plan and its a huge decision ,one you absolutely need to understand im going to tell you right now why i would never choose a ,medicare advantage plan ill show you exactly why and the difference between the two and im keith ,armbruck im founder of medicare on video and i help people across the country make the right ,medicare choices i can absolutely help you as well if youve watched any of my other videos you know ,i am not a fan of medicare advantage im going to tell you exactly why i personally would never ,choose a medicare advantage plan so first we need to understand what is a medicare advantage plan ,and it really should be called medicare managed care because thats exactly what it is so if you ,choose a medicare advantage plan and these are all the tv commercials that you see especially ,at the end of the year during medicares open enrollment plan primarily all medicare advantage ,plans so what a medicare advantage plan is is if you choose to go on to a medicare advantage plan ,it takes you off of original medicare and put you into a private insurance carriers managed care ,plan now how does that work and why does the cost not reflect that to you medicare actually pays a ,managed care plan to take responsibility of all your medical claims so they pay ,its generally upwards of about a thousand dollars a month per member to the medicare advantage ,company to take your claim responsibility away from medicare so good for medicare ,and good for the medicare advantage company because they want as many as possible thats why ,you see so many commercials and why they sell so hard because for each member that they get ,they get a significant monthly premium that goes along with it so when you go into a medicare ,advantage plan again it ought to be called managed care used to be called in the old days an hmo ,health maintenance organization which you dont hear that term that much anymore ,but that is essentially what most of these plans are and it takes the decision making away ,from medicare to the medicare advantage company so my experience with managed care plans in my ,younger days i actually worked for four different managed care companies i was an account executive ,and i did manage care sales primarily to large employers so if you work for a large employer your ,group health plan was typically an hmo and you may have had some other options but that was typically ,what your primary choice was at a large employer and i was the one that would go in every year and ,explain the benefits and tell them how much their costs have increased and their benefits decreased ,it really was a miserable job it was not enjoyable i happen to be good at it which worked out okay ,but it just was not something that was in a place of feel good so i have made the transition ,since then about 10 years ago into medicare medicare is absolutely a feel-good position ,and its very enjoyable when you do it correctly because it does exactly what its supposed to do ,medicare is probably possibly the only government program that does exactly what its supposed to ,do and does it very well and thats why its confusing to me why anyone would want to choose ,to leave medicare and go to a medicare advantage plan unless its kind of a sales situation where ,somebodys selling you into that scenario so im going to tell you exactly why i would never choose ,that and theres a couple of main reasons lets first talk about the cost differences between a ,medicare advantage plan and staying on original medicare so if you stay on original medicare a ,and b youd likely have a medicare supplement plan that covers the pieces that a and b do not a has a ,deductible thats kind of big b has a deductible thats pretty small and then theres some 20 ,co-insurance also that you wouldnt want to be responsible for so you get a medicare supplement ,plan that covers most of all of that and a medicare supplement plan generally for the ,folks that we deal with runs pretty close to about a hundred bucks a month so its not by any means ,prohibitive in a cost standpoint now something to understand whether youre on original medicare or ,on a medicare advantage plan youre always going to have your medicare part b premium so your part ,b premium which is also a couple hundred bucks a month is going to be paid regardless of which ,avenue you choose so that really negates the difference between the choice because thats ,always there the difference after that is the medicare supplement plan and then on original ,medicare youd also probably get a medicare drug plan so your medicare drug plan can run ,as low as 10 a month up to about 20 25 a month depends on how complicated of prescription drug ,regimen that you have now a medicare advantage plan can have zero additional premium or it can ,have 50 a month or it could be higher than that it also generally will include medicare drug plan ,as part of the medicare advantage part of it now something to understand if you are looking ,at medicare advantage plans the lower that cost is generally the more restrictive it will be or ,the smaller network of doctors and hospitals so kind of get what you pay for without a doubt so ,when you go to use either original medicare with a supplement or medicare advantage plan ,significantly less expensive with original medicare and a supplement when you have ,a supplement lets say you have plan g with your a and b youre out of pocket for the year ,is a couple hundred bucks and thats it for the entire year once youre out of pocket a couple ,hundred bucks which is generally just the medicare part b deductible it pays a hundred percent the ,rest of the year without any out-of-pocket expense on medicare advantage its kind of a pay-as-you-go ,and your out-of-pocket maximum for the year if you had a really significant year medically can ,be as high as 7 500 for the year so absolutely something to keep in mind can be a little bit ,less expensive on the front medicare advantage but can be significantly more expensive as you ,use it so if you never use it its terrific and thats generally where you hear the good things ,about medicare advantage is people that havent had a lot of experience using them ,if you go on to google and you pick a medicare advantage company and you look for reviews ,on that company i mean youll find books and books of reviews on medicare advantage ,medicare supplement theres really no interaction with an insurance company you go to the doctor ,you give them your medicare card you give them your supplement card the doctor bills medicare ,medicare pays their part and sends it then to the medicare supplement company the medicare ,supplement company has no decision to make on whether they cover or whether they dont ,cover if medicare covers it they have to cover it so theres literally no interaction between ,you and the insurance company or any pre-authorizations or any referrals ,or anything of that nature with original medicare thats the primary reason ,that i would absolutely choose original medicare would never choose medicare advantage is because i ,want control over what i do and medicare original gives you that control its absolutely terrific ,its basically autonomous if its medically necessary and your doctor says you need it ,medicare covers it and then your supplement has to cover it because they have to cover whatever ,medicare covers so theres literally no decision made on a medicare advantage plan different story ,theres pre-authorizations where if youre going to have something significant generally they have ,to get it pre-approved before you can do it and that can cause wait times of weeks