simpsontruckdriver
Guest
I thought I would write a "Cliffs Notes" of the book all Medicare recipients (and those turning 65) should have received called "Medicare And You". One big question is, can you wait to sign up for Medicare? The answer is YES! For instance, if your birthday is not in January and you have Medicare-compliant Group (company) Insurance. When you sign up for Medicare Part-A, you can select in the application that you'll delay signing up for Part-B. That way, you can finish your term with your Group Insurance and sign up for January 1st the following year. You will not be penalized. You can also select whether or not you want to take Social Security, and if not, you can have the Part-B premiums billed directly.
Medicare Part-A is $0 for anyone who has worked 40 quarters, you will be charged a copay of $1800 or so for the first 90 days in the hospital, less than 1% of people go past that. If you go into a nursing home (prescribed by a doctor), your first 20 days are $0.
Part-B covers out-patient, like doctor/specialist visits and procedures/tests. "Basic" Medicare has 20% coinsurance, meaning if your doctor/procedure is $100, you're charged $20. Part-B also covers drugs administered by a doctor in their office, also at 20%.
Part-D is for prescription drugs, the basic plans have a $300 (or less) deductible, then in the "Initial Coverage Period" the drugs are divided by cost. You have Generic, Brand-Name, special Generic, special Brand Name, and Specialty. Once you hit $3820 out-of-pocket amount, you enter the Coverage Gap (Donut Hole), where drugs are cut down to two (Generic and Brand Name). Once you hit $5100 out of pocket, you hit the Catastrophic Phase, where drugs are 5%. Average cost of a Part-D plan is $30/month. The more you pay in premiums, the less you pay in copays.
With those, you have a choice between a Medicare Supplement or a Medicare Advantage with Prescription Drugs (MAPD). MAPDs are either Health Maintenance Organizations (HMO - specialists require referrals, can't go out of network, low copays) or Preferred Provider Organizations (PPO - no referrals required, out-of-network more expensive). Medicare Supplements have an additional premium, but unlike MAPDs, they do not include drugs (additional premium). Their only network is any doctor who accepts Medicare. Plan-F covers every single medical (not drugs) copay, so your premium will be under $200/month. This will not be offered past November 30th, you can sign up now for 2019 effective date, but it will not be available January 1. Plan-G has a deductible, then 100% of copays paid (you pay $0), usually under $75/month. Premiums, copays, etc vary by city/county/state, so if you have a friend with an almost zero plan in one state, what is available in your area may be slightly more expensive.
Todd S
Licensed Health Insurance Agent in FL and NC (others by request)
Medicare Part-A is $0 for anyone who has worked 40 quarters, you will be charged a copay of $1800 or so for the first 90 days in the hospital, less than 1% of people go past that. If you go into a nursing home (prescribed by a doctor), your first 20 days are $0.
Part-B covers out-patient, like doctor/specialist visits and procedures/tests. "Basic" Medicare has 20% coinsurance, meaning if your doctor/procedure is $100, you're charged $20. Part-B also covers drugs administered by a doctor in their office, also at 20%.
Part-D is for prescription drugs, the basic plans have a $300 (or less) deductible, then in the "Initial Coverage Period" the drugs are divided by cost. You have Generic, Brand-Name, special Generic, special Brand Name, and Specialty. Once you hit $3820 out-of-pocket amount, you enter the Coverage Gap (Donut Hole), where drugs are cut down to two (Generic and Brand Name). Once you hit $5100 out of pocket, you hit the Catastrophic Phase, where drugs are 5%. Average cost of a Part-D plan is $30/month. The more you pay in premiums, the less you pay in copays.
With those, you have a choice between a Medicare Supplement or a Medicare Advantage with Prescription Drugs (MAPD). MAPDs are either Health Maintenance Organizations (HMO - specialists require referrals, can't go out of network, low copays) or Preferred Provider Organizations (PPO - no referrals required, out-of-network more expensive). Medicare Supplements have an additional premium, but unlike MAPDs, they do not include drugs (additional premium). Their only network is any doctor who accepts Medicare. Plan-F covers every single medical (not drugs) copay, so your premium will be under $200/month. This will not be offered past November 30th, you can sign up now for 2019 effective date, but it will not be available January 1. Plan-G has a deductible, then 100% of copays paid (you pay $0), usually under $75/month. Premiums, copays, etc vary by city/county/state, so if you have a friend with an almost zero plan in one state, what is available in your area may be slightly more expensive.
Todd S
Licensed Health Insurance Agent in FL and NC (others by request)
