Medicare

How do I know if I need a Medicare Advantage Plan or a Supplement?

Posted on by McGriff Williams in Medicare |


Medicare can be confusing. We can all agree on that. But it doesn’t have to be. What it really boils down to is that your options are limited, which makes things quite simple. You can go one of two routes. The first is an Advantage Plan and the second is a Supplement, or what some people may refer to as Medigap. Let us break these down to hopefully help you decide which is the best fit for you and your health care needs.
Keep in mind that this is after you’ve already enrolled in “original†Medicare Parts A and B, which provides the basic hospital and physician coverage. See our video here for instructions on enrolling in Parts A and B: How to enroll in Medicare parts A and B. That must be done first, and then you can essentially “buy up†whichever other coverage you’d like.

•    Route 1: Medicare Advantage Plan
Think of this option as a replacement policy for A and B. It essentially takes the place of your original coverage and is used just like an individual under 65 health plan would be. Most times, there are copays or coinsurance for services, a deductible to meet and an out of pocket maximum. This plan will have out of pocket expenses but the monthly premium is typically very low, considering. With this plan, you would use this card at the doctor in place of the original Medicare ID card. Advantage Plans and their provider networks can vary by county so it’s always safe to confirm that your physicians are part of the network.

Example of coverage: The current Florida Blue Medicare Advantage Plan for 2020 has a monthly premium of $47.90. Pretty inexpensive, right? There is coverage such as a $10 copay for an in-network family physician, $45 copay for a specialist, $50 copay for urgent care, $90 copay for ER visit, $295/day for inpatient hospital care, and a $6,500 out of pocket maximum. This plan also has prescription drug coverage built in at different tiers depending on the medication.

Ideal client for this plan: Someone that may not visit the doctor often, has no major health concerns or current struggles, has the financial ability to pay the out of pocket maximum in the event something big happens unexpectedly.

•    Route 2: Medicare Supplement (“Medigapâ€)
A supplement is in addition to original parts A and B. It fills in the blanks of what A and B don’t cover. Now because of that, it will only cover things that Medicare does because it basically follows suit with Medicare and then supplements the gaps afterwards. This plan does not have copays or coinsurance or out of pocket expenses. It has a higher monthly premium so that it covers almost everything at the time of service. At a Doctor visit, you would use your original Medicare ID card first along with this one.

Example of coverage: There are several different levels of supplements but the most popular one that is available now is the plan G. There is an annual deductible for the part B coverage that the supplement will have, which is $198. Once that is met, essentially everything is covered at 100%. The current plan G monthly premium in Gainesville, FL is $180.60. It’s important to note that the supplement does not cover prescription drugs and those must be purchased in a separate Part D plan. I know this sounds like alphabet soup but stay with us!

Ideal client for this plan: Someone that frequents the doctor, has some health issues or is prone to illness, can afford the higher monthly premium for peace of mind, or someone that just doesn’t want to have to worry about health care costs.

That’s it! Congrats! You made it through the treacherous trenches of Medicare. There are only two routes and you get to pick! We always like to get a better feel for clients’ individual situations and health care needs to better advise the best fit but it’s pretty simple. And as we mentioned, there’s a separate Part D drug plan for prescription coverage with the supplement route… you can get more information on that here: Part D drug coverage. If we can ever be of assistance and help simplify this process or guide you to a decision you’re comfortable with, please contact us at 352-371-7977 or [email protected].

No more Medicare Plan F supplement in 2020?

Posted on by McGriff Williams in Health Insurance, Medicare |


Believe it or not, Open Enrollment season is upon us! There’s been a lot of talk lately about the Medicare Plan F supplement going away in 2020. Here are some helpful facts to clarify what our new reality looks like.

For decades now, the Medigap Plan F has been by far the most popular supplement purchased for Medicare eligible individuals. The fact that it covers all deductibles, coinsurance and copays easily justify that. For many, this has been the first time they’ve ever had no out of pocket expense when receiving medical care such as a doctor visit, lab work, or even a surgery or hospital stay. This is what some may refer to as “first dollar coverage†since whichever company you got the supplement from pays immediately. Sound too good to be true? Well, if you weren’t eligible for it by the end of 2019, it is no longer available.

Along with Plan F, the Plan C supplement is, although less popular, also no longer available starting January 1, 2020. The common denominator between the two is that they both cover the Medicare Part B deductible. Based on the Medicare Access and CHIP Reauthorization Act, Congress has decided that they no longer wish to have plans available that pay the first dollar, without any deductible to meet, because patients may access care more often or unnecessarily.

For those already on Plan F (or even eligible but not yet enrolled), the good news is that you can keep it! You are “grandfathered†in on that supplement, at least for the time being. Rates may increase over the years but that’s always a possibility. For others moving forward, the Plan G will be the next best option for a Medigap supplement. G covers everything that F does except for that Part B deductible… but often times, the difference in premium comes out to be almost the same in the end.

Medicare can seem like a very overwhelming, stressful transition in health insurance, especially when there are heavily regulated guidelines and changes like this. We are happy to discuss how this affects you or your loved ones and help guide you to the best protection for your needs.

Please email [email protected] or call (352) 371-7977.

When do I need to sign up for Medicare if I’m still working?

Posted on by McGriff Williams in Health Insurance, Medicare |


TRUE OR FALSE: “I don’t need to think about Medicare until I’m 65 or retired since that’s when I become eligible.â€

FALSE. Please tell us you answered FALSE.

Medicare is a federal health care program that is regulated by CMS (Centers for Medicare & Medicaid Services) and with that, comes a lot of important guidelines to follow. And breaking these rules can result in much more than a slap on the wrist. We’re talking financial penalties that can stick with you indefinitely. Forever. Or worse, make you ineligible for coverage.

Medicare is typically available to people at age 65 or retired, but is also offered to those under 65 if disabled or suffering from End-Stage Renal Disease/permanent kidney failure.

Here are a few scenarios that could get you a not-so-nice penalty:

  • Your group employer does not provide sufficiently credible coverage OR you enroll in Medicare but don’t think you need Part D because you aren’t currently taking any medications.
    • Result: Part D penalty that gets tacked on to your premium when you do obtain the correct coverage & will stay on forever. As of now, this is 1% of the base beneficiary premium for every month after age 65 that you didn’t have it.
    • How to avoid: Enroll in even a low premium Part D plan, regardless if you need it at the moment or not.
  • Your employer has fewer than 20 employees & you didn’t sign up for Part B since you’re still working.
    • Result: You could have major coverage gaps you aren’t even aware of.
    • How to avoid: Enroll in Parts A&B at age 65 if still working with 20 or fewer colleagues.
  • You’re still working & contributing to your HSA account.
    • Result: You are at risk for being assessed a tax penalty.
    • How to avoid: Stop contributing to your HSA 6 months prior to Medicare eligibility. You can still use the funds in that account for deductibles, copays or coinsurance but you cannot add any more money to it.
  • You elected COBRA coverage at the time of retirement but didn’t enroll in Part B.
    • Result: COBRA is now secondary to Part B so you must enroll in Part B in order to not have a coverage gap.
    • How to avoid: If you already have Medicare, you can get COBRA…. But if you become Medicare eligible while on COBRA, you cannot keep it.  Most importantly, losing COBRA does NOT qualify as a Special Enrollment to get Part B.

So much of this is situational and really depends on your personal circumstance. We are happy to discuss this individually and help determine exactly what you need to do and when.

What if I’m eligible for Medicare but still working?

Posted on by McGriff Williams in Health Insurance, Medicare |


How does Medicare work if I’m eligible but still working? What if I’m also drawing social security? How does my spouse fit into all of this?

Medicare can seem like an overwhelming and intimidating time but it doesn’t have to be. A big part of the confusion and nervousness is regarding when you’re eligible but still working and how social security and your spouse can be affected. Here are a few of the most common questions surrounding this:

  • What if I’m turning 65 but still working? If you’re still working full time for a company with twenty or more employees, you are not required to enroll in Medicare Part B upon turning 65. You can wait until you retire. However, if the company you work for has less than twenty employees, you may be required to go ahead and enroll in Part B. Keep in mind, Part A is automatic and has no premium, but Part B almost always does have a premium associated with the coverage, depending on your income. You can still remain on the employer-provided group plan if you prefer.
  • What do I need to do if I’m still working and also drawing social security? If you turn 65, are working, and already drawing from your social security, you will be automatically enrolled in both Parts A and B, and the premium for Part B will be deducted from your social security. If you decide to come off of your employer’s group plan to go on a Medicare supplement, you can elect whether or not you’d like the Part D prescription coverage to be deducted from your social security as well.
  • What if I’m retiring but my spouse isn’t 65 yet? Your employer may offer a group retirement plan that your spouse can remain on but most times, they will need to get an individual health plan in place for themselves when you go on Medicare.

A lot of this is very situational and handled case by case. We are always happy to discuss those specific circumstances with you or you’re welcome to join one of our quarterly Medicare seminars as well. Please contact us at [email protected] or (352)371-7977 if we can be of assistance.

What you need to know about Medicare Part D prescription drug coverage

Posted on by McGriff Williams in Blog, Health Insurance, Medicare |


Approaching 65 or retirement can be a time of celebration, but also a time of confusion and overwhelm when it comes the transition from health insurance to Medicare. There are Parts A and B original Medicare, then what’s referred to as Part C for Advantage Plans, but also Supplements and Part D Prescription Drug Plans. It’s a lot, right? Although it sounds like an alphabet soup puzzle, it doesn’t have to be over complicated. Let’s focus on the Part D Prescription Drug coverage for now. This is sold by private companies, in addition to the medical coverage on a Supplement, that goes with original Parts A and B.

 

How do I choose a Part D Plan?

  • You can visit medicare.gov and select the tab titled “Drug Coverage (Part D)â€. If you are going the route of an Advantage Plan, there will be Part D coverage built into that plan. But if you’re opting for a Supplement, such as the ever-so-popular Plan F with Florida Blue, you’ll need a separate Part D Plan.
  • This Part D section of medicare.gov is a great tool to compare plans that are specifically offered in your zip code. You can also look up actual medications in their formulary to see what your cost would be, based on what plan and pharmacy you prefer.
  • As you compare coverage, you may see things like copays and coinsurance that apply to certain drugs. There is also a coverage gap referred to as the “donut holeâ€. In 2019, the guideline is that once you and your drug plan have spent $3,820 on covered medications, you enter the “donut holeâ€. Once in that coverage gap, you’ll pay no more than 25% of the plan’s cost for covered brand-name drugs. In 2019, Medicare will pay 63% of generic drugs during this time as well.

 

When can I enroll?

  • Time frames to consider: You can choose and enroll in a Part D plan within the same 7 month window as regular Medicare…. 3 months before your 65th birthday month until 3 months after. Outside of that period, the late enrollment penalty will apply. And if your health status or prescribed medications happen to change throughout the year, you can switch Part D Plans during open enrollment, which begins October 15th, 2019.

 

What if I don’t enroll on time or choose not to have a Part D Plan?

  • It is advised that even if you don’t currently take any regular medications, still enroll in some sort of Part D coverage to avoid the late enrollment penalty. The current penalty fee in 2019 is 1% of the “national base beneficiary premium†of $33.19 times the number of full, uncovered months you didn’t have Part D or creditable coverage once becoming eligible. The monthly penalty is then rounded to the nearest $.10 and added to your monthly Part D premium…. Forever.
  • Keep in mind that your health can change or decline quickly and the cost of prescription medications are at an all-time high. It’s more important than ever to have Part D coverage and it’s worth every penny to avoid astronomical out of pocket expenses and the forever-haunting penalty that comes from going without.

 

This can all seem very complicated so it’s really best and most accurate if you look up your specific medications and compare plans based on your actual needs. We are always happy to help guide you through this process and make recommendations or answer questions anytime.