Medicare

Are you or someone in your family becoming Medicare Eligible?

* Turning age 65?
* Retiring?
* Social Security Disabled?

Medicare Facts

  • Medicare is for people who are age 65 or older. You can qualify for it at a younger age if you are Social Security Disabled.
  • There are four different parts of Medicare that help cover specific services:
  • Medicare Part A – (Hospital Insurance) Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care
  • Medicare Part B – (Medical Insurance) Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services
  • Medicare Part C (Medicare Advantage) – Part C is a Medicare Advantage plan that is provided by an insurance company and is an alternative to Original Medicare
  • Medicare Part D (Prescription Drug Coverage)
    Helps cover the cost of prescription drugs (including many recommended shots or vaccines)

If you are still employed and your employer provides group insurance, you only need to sign up for Medicare Part A. 

Medicare Part A in most cases is free and you should sign up within 2-3 months before you turn 65. 

You can enroll online via the following link:  https://www.ssa.gov/benefits/medicare/

  • You do not have to sign up for Medicare Part B if you are covered by your employer’s group medical plan or your spouse’s employer plan. You can decline Part B, and you should as it has a premium. If you plan to continue working, are satisfied with your employer provided coverage, or are covered by your spouse’s medical plan, you can decline Medicare Part B.
     
  • See Medicare Part B Premium outline – Income Related Monthly Adjusted Amount (IRMAA)

  • Please note that there can be a Late Enrollment Penalty (LEP) for not having “other creditable coverage” and not being enrolled in Part B. The penalty is 10% for each year you were eligible for Part B but did not have creditable coverage. Please note that continuation plans (COBRA or State Continuation), Christian Share Plans, and Veterans Plans are not creditable coverage.

Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage.

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare.

Most Medicare Advantage Plans include drug coverage (Part D).

  • If you have group medical coverage and are covered by a Creditable Health Plan, you do not need to enroll in Medicare Part D. If your Employer’s Health Plan is not creditable you will want to consider enrolling in a Part D Prescription Plan to avoid the Part D late penalty. Make sure you keep a copy of your Annual Creditable Coverage Notification your employer provides you each year.

  • Please note that there can be a Late Enrollment Penalty (LEP) for not having “other creditable coverage” and not being enrolled in Part D. The penalty is 1% for each month you were eligible for Part D but did not have creditable coverage.
  • You will qualify for an “Initial Enrollment Period” (IEP) that will let you sign up for Part B when you turn age 65. This is a 7 – month period when someone is first eligible for Medicare.

  • This enrollment period begins 3 months before a beneficiary turns age 65.

  • It includes the month of turning age 65.

  • And, it ends 3 months after turning age 65.
  • You may qualify for a “Special Enrollment Period” (SEP) that will let you sign up for Part B:

  • During any month you remain covered under the group health plan and your, or your spouse’s, current employment continues; or 

  • In the eight-month period that begins with the month after your group health plan coverage or the current employment it is based on ends, whichever comes first.
  • Part A – You can sign up any time after you turn age 65. Part A coverage starts 6 months back from when you sign up. No penalty for signing up late.
     
  • Part B – After your Initial Enrollment Period ends, you can only sign up for Part B with a Special Enrollment Period (SEP). If you do not elect Part B timely you can only elect Part B between January 1 thru March 31st each year. This is the General Enrollment Period.  Coverage will start July 1st and you will have a late enrollment penalty of 10% for each 12-month period you could’ve had Part B.
  • IRMAA stands for Income Related Monthly Adjustment Amount

  • Social Security has a sliding scale for incomes and the more money someone makes the more they pay for Part B and Part D. 
  • IRMAA is calculated by your income tax return from two years prior (i.e., 2020 income tax return is used to calculate your 2022 Medicare premiums).

  • The Social Security Administration will inform you of your IRMAA assessment.

Part B – 2022 IRMAA

Individual

Joint

Monthly Premium

$91,000 or less

$182,000 or less

$170.10

> $91,000 – $114,000

> $182,000 – $228,000

$238.10

> $114,000 – $142,000

> $228,000 -$284,000

$340.20

> $142,000 – $170,000

> $284,000 – $340,000

$442.30

> $170,000 – $500,000

> $340,000 – $750,000

$544.30

Greater than $500,000

Greater than $750,000

$578.30

Part D – 2022 IRMAA

Individual

Joint

Monthly Premium

$91,000 or less

$182,000 or less

$0

> $91,000 – $114,000

> $182,000 – $228,000

$12.40

> $114,000 – $142,000

> $228,000 – $284,000

$32.10

> $142,000 – $170,000

> $284,000 – $340,000

$51.70

> $170,000 – $500,000

> $340,000 – $750,000

$71.30

Greater than $500,000

Greater than $750,000

$77.90

  • 20+ Employees
  • For those eligible for Medicare (age 65+), work at least 30 hours/week, and participate in the employer medical plan, your medical plan will be primary for you and your covered dependent(s) and Medicare will be secondary.
  • Medicare may be primary for some Medicare-eligible active employees with certain medical conditions such as end-stage renal disease (ESRD). Consult with your local Social Security administration office prior to turning age 65 to learn what illnesses qualify for primary Medicare coverage.
  • Less than 20 Employees
  • For those eligible for Medicare (age 65+), work at least 30 hours/week, and participate in the employer medical plan, your medical plan will be secondary for you and your covered dependent(s) and Medicare will be primary.

High Deductible Health Plans (HDHP) and Health Savings Accounts (H.S.A.)

HDHP and H.S.A.’s may or may not be creditable for Part D.  Make sure that you receive a Creditable Coverage letter from your employer. 

You may not contribute to an H.S.A. if you are enrolled in any part of Medicare.  You must stop contributing to the H.S.A. six months prior to getting Part A.   Part A is always retroactive six months.

COBRA and Medicare

  • COBRA coverage is not creditable coverage
  • When COBRA ends it is not a Special Enrollment Period (SEP). If COBRA is elected, when it terminates the next Medicare Part B enrollment may occur during the General Enrollment Period (GEP). GEP is from January through March and coverage begins on July 1st.
  • Now that I am Medicare Eligible or need to choose a Medicare plan what is the best plan for me?

  • Stay on the Group Health Plan?
  • Change to a Medicare Supplement?
  • Change to a Medicare Advantage plan?

  • There are benefits to all three options but ultimately it comes down to the following considerations:

  • Physician and facility acceptance
  • Prescription drug utilization
  • Out of pocket cost from utilizing the benefits
  • Premium cost
  • A Medicare Supplement (Medigap) insurance is sold by private companies and can help pay some of the health care costs that Original Medicare doesn’t cover, like co-payments, coinsurance, and deductibles.

  • If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Your Medigap policy pays its share.

  • You will need to purchase a Stand-Alone Prescription Drug Plan (PDP) for prescription drug coverage.

  • A Medigap policy is different from a Medicare Advantage Plan. Medicare Advantage is another way to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

Types of Managed Care Plans

  • Health Maintenance Organization (HMOs)
  • Preferred Provider Organizations (PPO)
  • Private Fee-for-Service Plans
  • Medicare Special Needs Plans

In most of these plans, there generally are extra benefits and lower co-payments than in the Original Medicare Plan

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B.
You will have to pay your monthly Medicare Part B premium to Medicare.

  • When can I enroll?
  • Keep in mind that Medicare limits when you can join, switch, or drop a Medicare Advantage Plan. You can join a plan when you first become eligible for Medicare. This is anytime beginning three months before the month you turn 65 and ends three months after the month you turned 65.
  • For example, if you turn 65 on May 5, your eligibility period starts on February 1 and ends on August 31.
  • If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after twenty-five months of your disability.
  • You can switch or drop your Medicare Advantage during an enrollment period between October 15 and December 7 of each year.

This information was obtained from www.medicare.gov

Plans are written by private insurance companies. If you purchase a Medicare Supplement Plan you should also purchase a stand-alone prescription drug plan. Medicare Advantage Plans may or may not include a prescription drug plan.  If purchasing a stand-alone plan there are many options for premiums, deductibles, and copays.

True Out of Pocket (TROOP) – This is a combination of your premiums, deductibles, and copays for the calendar year.

 

           

 

Stages of Coverage:

        

 

 

Stage 1: Annual Prescription (Part D) Deductible

    

 

 

Stage 2: Initial Coverage Stage – Copays or Co-Insurance until total drug cost reach $4,430

 

Stage 3: Coverage Gap, (also called “Donut Hole” you pay 25% for your prescriptions until they reach $7,050

 

 

Stage 4: Catastrophic Coverage – After your out-of-pocket costs reach $7,050 you will pay the greater of 5% co-insurance, or $3.70 for generic and $9.20 for name brands

 

  • Medicare Beneficiaries complete a questionnaire
  • Determine if a Medicare Supplement or Medicare Advantage is best
  • We use the questionnaire to narrow down the best plans by looking up doctors to see if they are in certain networks and we review the prescription plans so we can illustrate how prescriptions are covered
  • When we get finished reviewing plans a member not only knows which plan is best for them but also what it will cost to use the plan they choose

If you are interested in reviewing Medicare plans to determine if it is better for you or a dependent to be enrolled in a Medicare plan vs. the group insurance we can assist. Our process is the following:

•Medicare Beneficiaries complete a questionnaire
•Determine if a Medicare Supplement or Medicare Advantage is best
•We use the questionnaire to narrow down the best plans by looking up doctors to see if they are in certain networks and we review the prescription plans so we can illustrate how prescriptions are covered
•When we get finished reviewing plans a member not only knows which plan is best for them but also what it will cost to use the plan they choose

If you have any questions regarding Original Medicare, Medicare Supplements, Medicare Advantage and Prescription Part D coverages please feel free to contact Individual Insurance Solutions, LLC at 713-322-0040.

Make one call to us for a proposal from all carriers.

IIS Educational Videos

Title One

Title Two

Request a Detailed Medicare Proposal

View the most recent "Medicare & You" Publication from Centers for Medicare and Medicaid Services (CMS)