Pam Powers & Kara Bramley – Fogle Insurance Group’s Medicare Team
The Medicare Basics: Important Facts About Starting and Being On Medicare
- Who is eligible for Medicare? Most members are age 65 and over or are on Medicare if they have a certain illness or if they have been on disability for over 24 months. The best time to start applying for those aging into Medicare is 3-4 months prior to your birthday month.
- What is Medicare? Medicare is made up of two parts; Part A, which covers your hospital and inpatient needs and Part B, which covers outpatient needs like office visits, medical testing, and procedures. Part A and Part B are commonly known as “Original Medicare”
- Most beneficiaries get premium-free Part A coverage
- Part B monthly premiums in 2022 start at $171.10 and increase depending on your income threshold
- Can I delay Medicare? Maybe! Those over 65 who continue working and are enrolled in employer sponsored health insurance have the option to delay coverage. If you have “credible coverage”, you can delay enrollment in Part B. Get with your employer to see if your plan is considered credible, if not, you could pay a penalty.
- Does Original Medicare Cover Everything? No! Medicare Part B will only cover about 80% of medical claims – as the beneficiary, you would be responsible to pay the leftover 20%
- Can I get more coverage? Yes! There are two main paths you can take. One, a Medicare Supplement AKA “Medigap” plan that works along with your Original Medicare. Or two, you can enroll in a Medicare Advantage plan that contract with Original Medicare and provide the Part A and Part B coverages and typically prescription drug coverage – many offer more benefits like dental, vision, and hearing!
- What about prescriptions? If you are not enrolled in a plan that includes prescription drug coverage like a Medicare Advantage plan, there are separate policies you can enroll in called Stand Alone Part D plans. This will also help you avoid penalties for not enrolling in a plan that offers prescription drug coverage
- Am I stuck with my choice? No! You can make changes to most plans during the Open Enrollment period, October 15 – December 7 every year. This time is when those on Medicare Advantage or Part D plans can explore options and make changes. You can also change your Medicare Supplement plan during this time, but there may be additional eligibility questions required.
How to Decide What Plan is Right for You?
- This is where Laura Finan, Benefits Consultant, and Pam Powers, Benefits Consultant Assistant at Fogle Insurance Group come in! We sit down with every client to assess their needs, budget, and eligibility.
- Laura and Pam ask clients for a list of their doctors and medications, so they can give each client an individualized recommendation and experience. Medicare is not a system where one plan fits all. Some clients have a need for lower specialist copays where another client may want to maximize their dental care benefits – we have options for both!
