If you are looking for Medicare options in Horn Lake, Mississippi, you’ve come to the right place! If you are new to Medicare, our expert advisors can teach you the ropes and find the Medicare options that are a good fit for you. If you’re a seasoned Medicare beneficiary, we are happy to review your current coverage and see what else might be available to you. Either way, we’d like to run through a quick course on what your options are and how a Medicare advisor can help. Let’s dive in!
Medicare Parts A – D
First things first. Medicare has several components that work together to provide you with comprehensive medical coverage. While you may not need to enroll in every aspect, you do need to know what coverage each one offers so that you can choose how to get the most of your benefits.
Medicare Parts A and B
Parts A and B make up what we call “Original Medicare.” Part A is your hospital insurance. It will help pay for your room and board costs during a hospital stay. Many beneficiaries enjoy premium-free Part A. As long as you paid Medicare taxes for ten years, you will not pay a monthly premium. However, there is a deductible. The current deductible is $1556 per benefit period. A benefit period begins on the first day of your inpatient hospital stay and ends when you have been out of the hospital for 60 consecutive days. Your coinsurance costs with Part A will depend on how many days you stay in the hospital. For the first 60 days, you have no coinsurance costs.
Part B of Medicare is your outpatient insurance. As the name implies, it covers many outpatient services such as visits to your doctor, surgeries, diagnostic tests and images, durable medical equipment (DME), and many preventive services. Part B does have a monthly premium of $170.10. This is the current rate for 2022, but it is subject to change each year. While most beneficiaries pay this amount, some pay an adjusted amount called the Income-Related Monthly Adjustment Amount or IRMAA. You will pay IRMAA if your income is above a certain threshold. The Part D deductible is currently $233. Unlike the Part A deductible, this is only applied annually. Once the deductible is met, most of your outpatient expenses will be covered at approximately 80%.
You are eligible to enroll in Medicare Parts A and B three months prior to your 65th birthday. Individuals who are younger than 65 but have been on disability for 24 months are also eligible for Medicare, as well as those who have been diagnosed with End-Stage Renal Disease (ESRD). If you do not enroll in one or both of these when you are eligible, you will face penalties. However, if you have other creditable coverage (like insurance through an employer), you may delay enrollment without penalty.
Medicare Part C
Medicare Part C is more often referred to as Medicare Advantage. Medicare Advantage (MA) plans are offered by private insurance companies as a way to bundle all of your medical coverage into one policy. If you enroll in an MA plan, your benefits from Parts A and B will be covered by the insurance company, not the government.
MA plans have many benefits. They often come with a low monthly premium and usually offer more benefits than the ones found in Original Medicare. (They can offer a low premium for several reasons, the most important being that they are paid by the Medicare program to offer the plans.) Medicare Advantage plans often have benefits for dental, vision, and hearing services, and most offer prescription drug coverage.
Since Part C plans are offered by private insurance companies, the benefits vary based on the plan, as does the monthly premium. There are several types of MA plans, and you’ll need to understand the differences between each one. Typically, you must receive care from providers who participate in the plan’s network.
You can enroll in a Part C plan as soon as you have enrolled in both Parts A and B. There is no penalty if you choose not to enroll in a Part C plan.
Medicare Part D
We mentioned that some Medicare Advantage plans offer prescription drug coverage. If it doesn’t, or if you choose not to enroll in an MA plan, you’ll need to purchase a stand-alone Part D plan. The only thing these plans cover is prescription medications. Part D plans are also offered by private insurance companies, so there are many to choose from, and your coverage and premiums will depend on the plan. Most Part D plans use the standard annual deductible of $480.
All Part D plans (including the ones included in Medicare Advantage plans) utilize a drug formulary. A drug formulary is a list of prescriptions covered by the plan and how those prescriptions are categorized. The drug formulary will have anywhere between 3-5 tiers. Prescriptions placed into lower tiers will have a lower out-of-pocket cost for the beneficiary.
You are eligible to enroll in a Part D plan three months prior to your 65th birthday. Like Parts A and B, you will be penalized if you do not enroll in a Part D plan as soon as you are eligible. If you have other creditable coverage, you can delay enrollment without penalty.
After enrolling in Original Medicare, most beneficiaries choose to enroll in either a Medicare Advantage plan or a Medicare supplement plan. Both provide more coverage than Original Medicare, but the two work quite differently.
A Medicare supplement is designed to help pay for the costs not paid for by Original Medicare. There are ten supplements to choose from, all with varying levels of coverage. Several of the plans offer comprehensive coverage, leaving the beneficiary with almost no out-of-pocket medical expenses. Your premium will depend on which plan you choose and which insurance company you purchase it from.
However, a supplement does not pay for anything that is not also covered by Parts A and B. (Compare this to Medicare Advantage plans, which usually offer extra benefits.) You will need to enroll in a stand-alone Part D plan and may want to consider other options for additional coverage needs. The advantage of these plans is that they do not require you to see certain doctors. As long as your provider accepts Medicare (which most do), they will also accept your Medicare supplement.
You can enroll in a Medicare supplement as soon as you have enrolled in Original Medicare.
How a Medicare Advisor Helps You
If you didn’t know by now, you can see that there is a lot to understand when it comes to Medicare. It can be quite confusing and overwhelming. The good news is, you don’t have to go through the enrollment process alone!
A Medicare advisor in Horn Lake, MS, can help you decide which coverage types you are eligible for, which ones fit your needs, and which ones will provide the best benefits for you. We will be able to look at every plan across many carriers and find competitive rates. Give us a call, and we would be happy to schedule you for a complimentary consultation!