Medicare Solutions

We will help you answer the following questions to help you decide:

Medicare Supplement insurance, commonly referred to as Medigap insurance, is used to supplement Original Medicare to fill in some, if not all, of the “gaps” not covered by Original Medicare. Medigap insurance is standardized by each state, which means that all of the companies offer IDENTICAL coverage- the only difference between companies is company rating and price. This is one of the many reasons why having an independent Medicare expert is crucial in your deciding process. You don’t want to pay too much for the same product! Medicare Supplement insurance is divided into different lettered plans A-N, each having a different monthly premium and amount of coverage provided.
Medigap or Medicare Supplement insurance plans cover some, if not ALL, of the deductibles and remaining 20% of your doctor and hospital bills. As you can see above, there are 10 different, standardized plans for you to choose from. Each of these lettered plans covers different services and each of them has a different monthly premium for you to pay. The high-deductible F Plan offers the lowest monthly premium with the lowest amount of coverage, while the standard Plan F covers EVERYTHING left behind by Original Medicare so that you’re only out-of-pocket cost is your monthly premium! Julia will go over each one of these plans to ensure that you find the plan that fits your needs and budget best!
Medigap/Medicare Supplement policies do not require referrals so you are able to go to ANY doctor or hospital in the nation that accepts Medicare! You read correctly- there are NO network stipulations when you use Medigap/Medicare Supplement insurance! As long as the doctor or hospital you choose accepts Medicare, they will accept your Medigap/Medicare Supplement policy. It’s that simple!
Whew! The amount of mail and paperwork Julia has seen on clients’ dining room tables is frightening! That being said, there IS an easy way to choose a company for your Medigap/Medicare Supplement policy. As stated previously, Medigap policies are standardized by the state of Florida, so all Plans offer the same coverage. Simply put, the ONLY difference between companies is company rating and price! Julia works with all of the top companies in South Florida so that she can offer you any company you choose. Julia works with United Health Care/AARP, United American Insurance Company, Mutual of Omaha Insurance Company, Blue Cross and Blue Shield of Florida, Gerber Life Insurance Company, Forethought Insurance Company, etc. She has her clients’ favorite companies and her recommendations, but ultimately, the choice is yours! Julia makes it easy to choose. Remember: Medigap/Medicare Supplements only cover your doctor and hospital bills, NOT your prescription drugs. When you have a Medigap/Medicare Supplement policy, you must take out a Part D Plan to cover your prescriptions. Medicare Part D So how do you cover your prescription drugs when you have a Medigap plan? Your answer is right here- Medicare Part D. Medicare Part D is your prescription drug coverage that is taken out in conjunction with your Medigap plan. Drug coverage is ALWAYS separate from your Medigap plan, meaning there is no Medigap plan that includes drug coverage. If you work with Julia, you will have the lowest-cost drug plan in your area, year after year.
In Palm Beach and Martin County alone, there are 29 different plans to choose from. Luckily for you, Julia makes it very simple for her clients. You simply provide her with a list of your prescriptions and the pharmacy of your choice, and she does the research to find the least-expensive drug plan in your area based on your prescriptions! The cost varies by plan and by drug, so each person will have a different result, unless two people are on the exact same drugs.
Julia will print-out your best plan that will break down your cost month by month. Every Part D plan has a monthly premium, and they range from $15.00 per month all the way to $100 per month. Again, your result will depend on your prescriptions. Some Part D plans also have an annual deductible that you will be responsible to satisfy before your plan will begin coverage. Every Part D Plan separates prescriptions into 4 distinct tiers, or genres- preferred generics, non-preferred generics, brand names, and high-end brand names, and each of these tiers has a corresponding copayment.
Most Part D plans offer a prescription drug mailing program and all plans give you the option to pick up at any pharmacy nationwide, including independent pharmacies. Depending on which plan is best for your particular prescriptions, there may be a pharmacy in your area where your copayments are the lowest.
Last, but not least, the dreaded donut hole. YES, we’ve all heard of the donut hole. Unfortunately, in Julia’s best effort to not confuse you, we cannot discuss it here. You will need to call Julia to set up an appointment so that she can let you know if you personally will be affected by the donut hole. Not everybody is, so again, an in-home appointment is necessary to discuss the donut hole. Medicare Advantage Plans Medicare Advantage Plans are typically offered through HMOs and PPOs, which most of you are familiar with through your current private or employer coverage. If you elect a Medicare Advantage plan, you are electing to have “private insurance”, rather than coverage through Original Medicare. Thus, you exclusively use the network of doctors and hospitals that your plan contracts with. The “O” stands for “organization” and applies to the network of doctors and hospitals by which you must abide. Medicare Advantage Plans are considered “pay as you go” plans because you pay the contracted copayments and deductibles when you visit the doctor, hospital, lab, etc. Monthly premiums for Medicare Advantage plans are very low and in some cases, free. Medicare Advantage plans have annual caps or maximum out-of-pocket amounts for both in-network and out-of-network services, ranging from $5,000 to $10,000 per year. There are several companies that offer Medicare Advantage plans, such as Humana, United Health Care, and Blue Cross and Blue Shield of Florida. Julia works with all of these companies and more so that you have your choice to find the company that suits your needs and network of doctors and hospitals best! Below are two of the most common choices when it comes to Medicare Advantage Plans: HMO Plans HMO’s represent the lowest form of coverage available through Medicare. In an HMO, you must exclusively use a county-wide network of doctors and hospitals. Except in an emergency, if you go outside of the network, you must pay 100% of your doctor or hospital bill. You elect a Primary Care Physician in-network from which you will be required to get referrals from to see any specialist in the network. You pay the contracted copayments and coinsurances for doctor and hospital services. Annual maximums for out of pocket are usually $5,000/year. Most HMOs include drug coverage at no extra premiums and only require you to pay copays at the pharmacy. PPO Plans PPOs were created because of a great lack of coverage and flexibility through HMOs. PPOs allow you to travel outside of the county-wide network for care, usually anywhere in your state and through some companies, out-of-state coverage is permitted. On a PPO plan, you do NOT need referrals to see specialists and you do NOT need to elect one primary care physician. You are required to pay the contracted copays and deductibles when visiting the doctor or hospital. The annual maximums for out-of-pocket are usually $5,000 in-network and $10,000 out of network. The large majority of PPOs include drug coverage at no extra premium and only require that you pay copays at the pharmacy.

Medicare 101

Are you overwhelmed by all of the paperwork, brochures, and phone calls you’ve been receiving in regards to your 65th birthday? Does the word ‘Medicare’ make you cringe with anxiety? You’re not alone! Fortunately for you, you’ve come to the right place at the right time.

I provide my clients and prospects with free in-home Medicare education sessions, and will include a brief description on my website for you as well!

Let’s start with the basics. There are four parts of Medicare. I emphasize the word “Parts” because later on we’ll discuss “Plans”, and I don’t want you to confuse the two. Again, there are 4 PARTS to Medicare, labeled A, B, C, and D. Simply put, Medicare Part A covers your hospital bills, Medicare Part B covers your doctor and inpatient bills, Medicare Part C is the ‘Medicare Advantage Program’ and Medicare Part D is your prescription coverage. Let’s go over all four parts in more detail- starting with Part A.

Medicare Part A

Part A is your hospital coverage with Medicare. Part A is your entitlement, which means that there is no monthly premium for this coverage. If you or your spouse has worked 40 quarters in the United States, Part A is yours on the first of the month of your 65th birthday. For example, if I’m turning 65 July 19th, 2014, my Medicare coverage will start on July 1st, 2014. Part A covers 80% of all semi-private rooms, meals, general nursing, and hospital services and supplies. An easy analogy I use to explain Medicare is in terms of taking a vacation. If you were on vacation with Medicare, Part A would cover your hotel bill. Medicare Part A covers the cost of your room and board at a hospital.

There is a deductible with Part A of $1184 upon entering any hospital that you, or your insurance, must pay before Medicare Part A will cover 80% of your hospital bill. We will learn how to cover this deductible and the remaining 20% below.

Medicare Part B

Medicare Part B is Medicare’s form of doctor and inpatient coverage. Part B covers 80% of all medical expenses for physician services, inpatient and outpatient medical services and supplies at a hospital, physical and speech therapy, ambulance, and outpatient psychiatric care. If you were on vacation with Medicare, Part B would cover all of your activities and excursions- everything EXCEPT your hotel bill.

Because Medicare Part B covers the large majority of your healthcare costs, you must pay a monthly premium that bases at $104.90 per month in 2014. Your Medicare Part B premium will vary based on the amount of income marked on your tax returns. Medicare looks back two years for this information, so if you turn 65 in 2014, Medicare will look at your income from 2012. Next year, they’ll look at 2012.

There is an annual deductible with Medicare Part B of $147 to your doctor’s office before Medicare Part B will cover 80% of your doctor bills. As stated above, in the Medicare Supplements and Medicare Advantage Plans sections, you will learn how to cover these Part A and Part B deductibles and the remaining 20% not covered by Original Medicare.

How do I sign up with Part A and Part B?

The next step is finding out how you can sign up for Medicare Parts A and B. Above is an example of a Medicare card. As you can see, Part A and Part B are listed with the effective dates of coverage. These dates are usually the 1st of your birth month and the year you turn 65.

If you are already receiving Social Security monthly benefits, you will automatically be signed up with both Part A and Part B. You will receive your Medicare card in the mail roughly three months before your 65th birthday. After you receive your card, you are then ready to sign up with the secondary insurance of your choice. ( i.e. a Medicare Supplement Plan or a Medicare Advantage Plan)

If you are not yet receiving Social Security monthly benefits or are still working and have health insurance through your employer, you will only be automatically signed up with Medicare Part A, NOT Part B. This means you will have to manually sign up for Part B through Social Security via phone, online, or by visiting the Social Security office. If you decide to use Julia as your Medicare agent, she will take care of all of this for you at no charge!

Remember, you must be signed up with both Medicare Part A AND Part B to enroll in a Medicare Supplement plan or a Medicare Advantage plan.

Medicare Part C- Medicare Advantage Plans

Part C is referred to as Medicare Advantage plans. Medicare Advantage plans combine hospital, doctor, and prescription drug coverage. Medicare Advantage plans are offered through private insurance companies and are normally in the form of an HMO, PPO, POS, or PFFS plans. Each company has a network of doctors and hospitals that you must abide by. Part C plans often offer services not covered by traditional Medicare, such as dental, vision, and hearing. To learn more, please click here for more information about how a Medicare Advantage Plan can work for you!

Medicare Part D

Medicare Part D is Medicare’s form of prescription drug coverage. Part D can be offered on its own to be used with a Medigap policy, or it can be included in a Part C, or Medicare Advantage plans. Prescriptions are divided into different tiers, or subcategories, which require corresponding copayments. Julia works very closely with her clients to ensure that they make the best and most affordable choice for their Part D coverage. There are 29 different plans in Martin and Palm Beach County alone, so proper guidance is key!

Medigap Plans

Medicare follows the 80%/20% rule. Medicare covers 80% of all doctor and hospital bills leaving you, or your insurance company, with the remaining 20% of your doctor and hospital bills. You, as a Medicare beneficiary, have two options for covering that remaining 20%.

Option # 1: Take out a Medicare Supplement policy, otherwise known as a Medigap policy, to cover some, if not all, of the remaining 20%. Medicare Part D will be taken out in addition to cover your prescription drug costs.