Getting Started With Medicare
Getting started with Medicare is not a complicated process. Anyone turning 65 or enrolling in Medicare for the first time for any reason can use our guide to understand the process. You will also find guidance on the choices you have to make. We will cover the process from start to finish. Learn if you need to enroll in Medicare Part B or not. Should you enroll in a Medicare Advantage plan (MAPD), Medicare Supplement or a Part D prescription drug plan (PDP). Read below to find out. While we feel our Medicare guide is much easier to understand, than the information Medicare has on how to get your Medicare benefits. You can review that by clicking here if you would like a different opinion.
Getting Started With Medicare “quick guide” for those that do not want to read everything below –Click here for Medicare Quick Start Guide
Outline of the process and steps to take:
- When you are eligible for Original Medicare and costs
- Should you enroll in Part B of Original Medicare?
- Medicare Part A Benefits
- Medicare part B Benefits
- Explaining Medicare parts C and D
- Understanding a Medicare Supplement and Part D drug/Rx plan (Medicare part D)
- Understanding a Medicare Advantage plan (Called Medicare part C)
- Comparing Advantage plans vs. Medicare Supplements and stand alone Medicare part D drug plans
- The process to enroll in a plan and when to do so.
- Working with an independent broker/agent
- When can you change plans?
- Medicare Part D coverage gap
- Medicare Part B and D penalties
- Coverage when you have VA benefits
- Getting started with Medicare other resources and Medicare Supplement benefit description
When you are eligible for Original Medicare and costs
The first step to getting started with medicare is to learn about Medicare A and B. You are eligible for Medicare the first of the month you turn 65. If someone has a birthday on June 20th, they will be eligible for Medicare A and B on June 1st. Some people may be eligible for Medicare prior to turning age 65 due to disability. Keep in mind Medicare benefits and Social Security payments are two different things. You do not need to take Social Security payments in order to enroll in Medicare benefits. If you are drawing Social Security payments at the time you turn 65, you will automatically be enrolled in Medicare A and B.
If you are not taking Social Security payments at the time you turn 65 you will be enrolled in Medicare Part A only.
You must elect part B to be enrolled. You can enroll in Part B at your local social security office or online through the Medicare.Gov website. The online enrollment is very easy to use. CLICK HERE FOR SITE TO ENROLL IN MEDICARE PART B Note: This is the Social Security site but you can enroll in Medicare only on this site.
Most people will pay nothing for Medicare Part A. (There is no cost for part A as long as someone worked at least 10 years on the books paying FICA tax. You can also qualify through a working spouse that put in at least 10 years) Just about everyone will pay for Medicare part B however. The standard Medicare part B premium for 2018 is $134 a month per person.
If you are receiving Social Security payments, your part B premium will be taken out of your check every month automatically.
If you are not taking Social Security payments, you will be billed for Part B quarterly. Some people pay more for part B if they make over certain amounts of income. We will review that later in this post. Some individuals receive extra help and do not pay part B at all. If they are enrolled in a Medicare Saving Program. Again, more on that later.
Should you enroll in Part B of Original Medicare?
The quick answer to this question is, it depends. Anyone that wants to enroll in a Medicare Advantage plan or a Medicare Supplement must also be enrolled in Medicare part B. (You don’t need to have B to enroll in a stand alone part D drug plan only.) There are times when you may not want to take Medicare part B however. This usually comes up when someone is 65 or older but they get coverage through their employer or through the employer of a spouse. If you are getting coverage from an employer, you may keep that coverage and may not be required to purchase part B (saving you $134 a month).
If at any time down the road you lose access to that employer plan, you can then sign up for Medicare part B through a special election to do so.
You have 3 months to enroll in part B once you lose coverage. (the month you are notified and two months after that) Be careful, if you don’t sign up when eligible for a special election you will need to wait and sign up during the general Medicare Part B enrollment period. You many need to pay a penalty for the rest of your life. The part B general enrollment period runs from Jan 1 through March 31 for a July 1 start date.
One other special rule to consider when getting started with Medicare.
If you have coverage through your work or your spouses work, one of you must be actively working. Part B is not needed if actively working but if the spouse getting the coverage through work retires, you must sign up for Part B within two months, even if your employer is still offering coverage. Failure to do so can lead to a life long penalty. CLICK HERE TO LEARN MORE ABOUT THIS TOPIC
Medicare Part A benefits
Part A provides Inpatient hospital benefits, Skilled nursing and home health care benefits. Medicare part A has an inpatient deductible fo $1340 per benefit period for 2018. Means you pay the first $1,340 out of your pocket. You are then covered in full for the next 60 days and have a cost share per day after that. Most people do not pay a premium for Medicare part A. If you do pay a premium is will be $422 a month. A benefit period is 60 days and ends when you have not had a skilled nursing or inpatient hospital services for 60 days.
CLICK HERE TO SEE MEDICARE PART A BENEFITS 2022
Medicare Part B benefits
The cost for Medicare part B is usually $134 a month for 2018. Medicare part B covers outpatient services and part B drugs. Outpatient services are things like doctors visits, lab work, scans, testing, specialist visits and outpatient surgeries. There is an annual deducible of $183 for 2018 which means you pay the first $183 of cost and then you are covered at 80%. Keep in mind, it is 80% of what Medicare allows and not what the doctor charges. This means the 20% you pay will be a lot less than 20% of what is initially charges. Our getting started with Medicare guide is not going to cover all the details on Medicare A and B. A link has been provided below with more detail.
CLICK HERE TO SEE MEDICARE PART B BENEFITS
Explaining Medicare parts C and D
Ok…it is easier to start with Medicare part D. Medicare part D is the drug coverage portion of Medicare. Medicare A and B do not provide drug coverage. If you want to have drug coverage, you must buy a stand alone part D drug plan from a private insurance company or you can get it built-in with a Medicare Advantage plan. Medicare does not provide you with a plan. You can purchase them through a private insurance company. You are able to have Medicare A and B for your Medical and then buy a stand alone part D drug plan.
Medicare Part C is a Medicare Advantage plan.
They are private plans insurance companies offer and they usually include drug coverage. This means they include the Medicare Part D benefit. If you enroll in a Medicare Advantage plan (MAPD) you are using that plan instead of your Medicare A and B. Medicare Advantage is an alternative to using Medicare A and B as your medical benefits.
The Advantage plan becomes your primary and secondary Medical and drug coverage. (assuming you get an MAPD that includes Medicare part D coverage) When you are enrolled in an MAPD plan, your Medicare A and B benefits are not used. The MAPD and its benefits are your coverage. You cannot buy a stand alone Medicare part D drug plan and also have the advantage plan. More on this later.
Understanding a Medicare Supplement and Part D drug/Rx plan (Medicare part D)
So, original Medicare A and B provides medical coverage. It does not cover all costs however. Medicare Part A has a deductible and cost shares and Medicare part B covers at 80% leaving you paying at 20%. There is no out-of-pocket cap on your costs with Medicare A and B. One of the ways to cover what Medicare does not is to buy a Medicare supplement plan. They are also called Medigap plans. Same plans but different names.
A Medicare supplement covers after Original Medicare pays.
When you go to any medical provider, they will bill Original Medicare. Medicare pays their portion and a bill for the remainder of the charges is sent to your Medicare supplement plan provider. The supplement you choose will determine how much of the remainder will be covered. Some plans such as plan F cover all approved Medicare costs.
You will need to pay a monthly premium for the Medicare supplement plan.
Medicare supplements are secondary to Original Medicare so you are able to see any medical provider that accepts Original Medicare. Medicare supplement plans are standardized in most states. What is a standardized Medicare supplement?
Medicare Supplements do not cover prescription drugs so you could choose to buy a stand alone part D drug plan (PDP) from a private company.
The stand alone plan will also have a monthly premium. You will use the PDP id card at the pharmacy for your drug coverage. Please note that stand alone PDP plans are not all the same. Time should be taken to find the one that covers your specific medications the best.
This set up will have you using 3 cards, Original Medicare A and B card and Medicare supplement card for Medical services and a stand alone Part D card for drug coverage. You will also pay 3 monthly premiums. Your part B premium, Medicare supplement plan premium and the stand alone part D (PDP) plan premium.
Understanding a Medicare Advantage plan (Called Medicare part C)
Medicare Advantage plans are completely different from Original Medicare A and B and a supplement. A MAPD plan looks and works similar to an employer group plan. The plan has copays for services such as primary and specialist visits, lab work, scans and other services. There are larger copays for major services such as inpatient hospital stays. Most Advantage plans include drug coverage so you do not buy a stand alone drug plan.
When you use an MAPD plan:
The plan is both your primary and secondary insurance. You do not use Medicare A and B as your primary insurance. As a result, medical providers will bill your MAPD plan. An MAPD plan can be very low-cost with plans as low as $0 per month. The trade-off is you have copays, medical management and networks you must stay in with MAPD plans.
You cannot have an MAPD plan and a Medicare supplement at the same time and you cannot have an MAPD plan and purchase a stand alone PDP plan. This is the case even if you buy an Medicare Advantage plan without prescription drug coverage. Our getting started with Medicare guide is a brief description of MAPD plans. Use the links below to learn more.
Comparing Advantage plans vs. Medicare Supplements and stand alone Medicare part D drug plans
Click here to watch a recorded webinar on the difference between a Medicare Advantage plan and a Medicare supplement plan and drug plan.
Click here for a blog on the differences between Medicare Advantage and Medicare supplements
The process to enroll in a plan and when it can be done
- You will automatically be enrolled in Medicare part A when you turn 65. If you are already taking Social Security payments, you will automatically be enroll in part B as well. Regardless of which day of the month you turn 65, you’re Medicare A and B start date will be the first of that month. If you are not taking Social Security payments, you will need to enroll in Part B through the local Social Security office or online at https://www.ssa.gov/benefits/medicare/
- Keep in mind that most people pay $134 a month for Medicare Part B. If you draw Social Security (SS payments) Medicare will take your payments out of your check every month. If you do not take SS payments, you will be billed quarterly.
- Some people pay more for Medicare part B based on their income from 2 years previous to the current year. A chart has been provided for your reference Click here to learn about Part B Medicare costs.
- Once you have Medicare A and B, you can determine which type of plan you want to provide drug coverage and how you want to cover the Medical portion not covered by Original Medicare.
- You could enroll in a Medicare Advantage plan up to 3 months prior to the month you’re Medicare A and B starts. If you do not want to go with a Medicare Advantage plan, you can enroll in a Medicare Supplement and PDP plan. Watch this webinar on the differences between Medicare Advantage and a Supplement and drug plan Click here for webinar recording.
- Once you determine the plan type you want, you should speak with an independent agent to find the best price or fit for your specific situation. Any application that goes in the first 3 months before you turn 65 will start on the first of the month you turn 65 to coincide with your Medicare A and B start dates. If you put in an application during the month you turn 65 it will start the first of the next month. You have 3 months after you turn 65 to put an application in. When you turn 65, you are guaranteed to be accepted into Medicare. They cannot block you due to health conditions.
- There is an opportunity to change the plan you are in every year during the Medicare Open Enrollment Period. This runs from October 15th through December 7th every year. Any change you make will take effect on January 1st
Working with an Independent agent or broker
An Independent Medicare Insurance Broker does not work for any insurance company.
They often run their own insurance agency. They have contracts with the major insurance companies or at least those with the most competitively priced products in your area. Because the independent Medicare insurance agent or broker can work with any of the companies available, they can show you all the plans that are available to you, the prices from multiple companies and the prices from each of these companies.
A good independent agent will work in your best interest, finding the right plan and best price for your situation.
It doesn’t matter which plan or company choose, because the independent Medicare insurance broker can help you with any option you choose. Note that some agents may only work with one or two companies. Make sure you ask your independent agent which insurance companies they represent. You want to be sure they can offer a good selection.
You will not need to pay the independent Medicare insurance agent or broker.
They receive a commission from whichever company you choose to get your Medicare supplement through as long as the broker helps you with the application process.
Rates do not change when you worth with an independent agent or broker. You pay the same price whether you go directly to an insurance company, use one of their internal agents or have an independent broker help you. The independent Medicare insurance broker receives a commission to introduce your business to the insurance company.
When can you change plans?
Each year, you have a chance to make changes to your Medicare Advantage or Medicare prescription drug coverage for the following year. There are 2 separate enrollment periods each year you can utilize to make a plan change.
Medicare Open Enrollment Period runs from October 15th to December 7th every year. Any change you make will take place for a January 1st start date.
- Change from Original Medicare to a Medicare Advantage Plan.
- Change from a Medicare Advantage Plan back to Original Medicare. You can also apply for a Medicare Supplement and/or Part D Rx plan at this time.
- Move from one Medicare Advantage Plan to another Medicare Advantage Plan.
- Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
- Change from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
- Join a Medicare Prescription Drug Plan.
- Switch from one Medicare drug plan to another Medicare drug plan.
- Drop your Medicare prescription drug coverage completely.
Medicare Advantage Disenrollment Period (MADP) runs from January 1 through February 14th. During this time you can….
- If you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare.
- If you switch to Original Medicare during this period, you’ll have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. You can also apply for a Medicare supplement at this time. Your coverage will begin the first day of the month after the plan gets your enrollment application.
Here is what you can’t do during the MADP
- Switch from Original Medicare to a Medicare Advantage Plan.
- Change from one Medicare Advantage Plan to another.
- Switch from one Medicare Prescription Drug Plan to another.
- Join, switch, or drop a Medicare Medical Savings Account (MSA) Plan.
Special Election Periods
Special Election Periods (SEP’s) are times you can make plan changes during the year outside of the OEP and MADP time frames. There are numerous SEP’s but the more common ones are.
- Moving out of the current plans service area
- Losing drug help or Medicare Savings Program in your state
- Losing group coverage or retiring from work and losing coverage
- Medicare Advantage Trial Right CLICK FOR TRIAL RIGHT INFO (Topic number 6 starting on page 8)
Note: The Medicare guide hit on some of the SEP’s, but there are others. Please use the link above to view all available special election periods.
Medicare Part D coverage Gap
When you get PDP coverage from a stand alone Medicare Rx plan or from the drug coverage in a Medicare Advantage plan, you will need to be aware of the Rx coverage gap. Another name for the coverage gap is the donut hole. The coverage gap runs from January to January and reset every year. It is based on the amount of money you and the insurance company pay for prescriptions. Once you and the insurance company spend a combined $3,750 on Rx costs, you will go in the coverage gap.
In the gap you will pay 35% of the brand drug costs and 44% of generic drug costs. Once you meet the out-of-pocket threshold of $5,000, you reach the catastrophic level and pay $3.35 for generic drugs. The cost for brand drugs is either $8.35 or 5% whichever is greater.
The coverage gap, details from the Medicare website click here
Medicare part B and D penalties
Medicare part B has a late enrollment penalty for those that did not enroll in Medicare part B when eligible to do so. If they have a valid waiver for part B they would not pay a penalty. The penalty is 10% of the annual premium. The penalty applies to your Part B for as long as you have Medicare Part B.
If you or a spouse are working and getting coverage through work, you may not need to sign up for part B.
Once the spouse that is primary with the coverage retires, both the spouse and dependent must sigh up for Part B even if the group is still offering coverage.
If you did not sign up for Medicare Part D Rx coverage when you first became eligible:
You will receive a penalty when you do decide to sign up for a plan. The penalty is 1% of the monthly benchmark premium.
Benchmark premium vary by state and range from $25 to $50 a month. 1% of $50 is $.50 so a person that went 10 months without coverage will pay a penalty of $2.50 in additional to their drug plan premium every month for as long as they have a plan. FOR BENCHMARK PREMIUM BY STATE CLICK HERE
Medicare Part B late Enrollment Penalty click here
Click for Medicare part D (PDP) Late Enrollment Penalty
Coverage when you have VA coverage
VA coverage is completely separate from Medicare. Usually members can use VA benefits for Medical services and Rx coverage. It may make sense to enroll in a $0 premium Medicare Advantage plan for situations when you want to get coverage outside of the VA. The Medicare Advantage plan will cost nothing and will have no interaction or negative effect on the VA coverage.
VA docs are not part of the Medicare program so they do not need to be in the network of the advantage plan.
Please note that VA benefits will not coordinate with either Medicare A and B, Medicare Supplements or Medicare Advantage plans.
Click to learn more about VA coverage and Medicare
Getting started with Medicare: Next Steps are to call your independent sales agent
At this point you should contact your Independent Medicare agent to talk about the specific plans and companies that can provide the best plan for you.
Other resources to help you with Medicare and a Medicare supplement benefit description
Getting started with Medicare: Medicare supplement benefits flow chart: Click for Medicare supplement benefits by plan chart
The National Council on Aging also has good resources and information for new recipients of Medicare. Click for the site
The CMS website has info on the basics of starting Medicare A and B. Click for Site
HSA plan contributions:
Be sure not to contribute to an HSA if you have Medicare A and/or B Click to read more
More about how to enroll in Medicare by WebMD
Medicare Part B Premium and Benefits 2018
Under the Hold Harmless provision:
Medicare savings program CT 2018
There have been major changes made to the Medicare Savings Program CT 2018. The changes have substantially lowered the income guidelines for those receiving help with their Medicare Part B premium, drug co-pay costs and Medical cost shares. Prior to 1-1-18 anyone that was under the monthly income levels below qualified for help. There is not an asset test on the programs.
Those who no longer qualify for programs based on the new income limits will notice changes for 2018. If you no longer qualify, you will start to again pay your Medicare part B premium which is $134 a month for most people. If you are taking Social Security payments, they will start to take it out of your payment every month. Those not taking Social Security will be billed quarterly for it.
Anyone receiving drug help with co-pays will continue to receive that help throughout 2018 even if they no longer qualify for the program. Those receiving cost share help with co-pays and Medicare deductibles and coinsurance will cease getting that help as of 1-1-18. (assuming you no longer qualify based on the new income amount) Anyone qualifying at any of the below levels does not pay the monthly part B premium, has help on drug costs and is not subject to the drug plan coverage gap. Those that qualify at QMB level also have help with medical costs.
Medicare Savings Program CT 2018 – Update
NOTE: UPDATE: It has recently been decided the program will be extended under the 2017 income levels through the month of February 2018
**Please note: The chart below gives income levels for 2017 and the new income levels for 2018. Allowable income levels for all program have dropped.
| MEDICARE SAVINGS PROGRAM BENEFIT SUMMARY/SERVICES | INCOME- ELIGIBILITY LIMIT BEFORE JAN. 1, 2018 | INCOME- ELIGIBILITY LIMIT
JAN. 1, 2018 |
RELATED INFORMATION | |||
| Qualified Medicare Beneficiary
(QMB) |
Medicaid pays the Medicare Part A premiums, Medicare Part B premiums, and Medicare deductibles and coinsurance for Medicare services provided by Medicare-enrolled providers. | single | couple | single | couple | Entitled to Medicare Part A.
No asset test.
May have both QMB and full Medicaid, if eligible.
|
| $2,120
per month |
$2,854
per month |
$1,025
per month |
$1,374
per month |
|||
| Specified
Low-Income Medicare Beneficiary
(SLMB) |
Medicaid pays Medicare Part B premiums only. | single | couple | single | couple | Entitled to Medicare Part A.
No asset test.
May have both SLMB and full Medicaid, if eligible.
|
| $2,321
per month |
$3,125
per month |
$1,225
per month |
$1,644
per month |
|||
| Additional
Low-Income Medicare Beneficiary, also known as Qualifying Individual
(ALMB)* |
Medicaid pays Medicare Part B premiums only. | single | couple | single | couple | Entitled to Medicare Part A.
No asset test.
May not have ALMB and any other Medicaid at the same time.
|
| $2,472
per month |
$3,328
per month |
$1,377
per month |
$1,847
per month |
|||
| *There is an annual cap on funding for the ALMB benefit level, which could limit the number of individuals accepted into the benefit.
At all three levels, there is an income ‘disregard’ for beneficiaries who have income through employment, meaning that the actual eligibility levels for the Medicare Savings Programs will be somewhat higher for working people. |
||||||
Health Insurance Open Enrollment 2018
Health Insurance Open Enrollment 2018 runs from November 1, 2017 through December 15, 2017. This is an opportunity to make any desired changes to your existing health insurance plan. This could be changing plan options with the same company or looking a plans from other companies. Those with an Exchange plan (obamacare) plan may want to look at other offerings in the exchange or possible outside of the exchange for 2018. For exchanged and non exchange based plans, the insurance companies can not block enrollment due to health issues. This is a guaranteed issue period on exchange and non-exchange type plans. All changes during this time will take place on 1-1-18.
Benefit Changes and Rate Increases
Benefit changes and the inevitable rate increases for the plans also take place on 1-1-18. The preliminary estimate shows that most companies will have increases of over 20% for 1-1-18. It is not yet know how the subsidy for those on Obamacare plans will be effected. Usually, those receiving an income based subsidy are best staying on an exchange plan given they are getting help with the premium. The monthly subsidy can be substantial if the insured persons income falls within the guidelines. Although the plans will be increasing their premiums, it is hard to tell how much of that will be offset by the subsidy.
Health Insurance Open Enrollment 2018: Other options
Those that are not planning on being able to get a subsidy for 2018 may want to explore other options. Non subsidized plan premiums are very expensive for someone age 50+ and the 20+ percent increase will only make that worse. A non subsidized silver level plan for a 50 year old is currently about $640 a month. After the increase that number will be around $768 a month.
Crowe and Associates has access to other non-exchange and non-subsidized plans for 2018 that have substantially lower premiums. Call our office to learn more at 203-796-5403 or email Edward@croweandassociates.com
Our plan is a full major medical plan that waives the penalty for being uninsured. There are copays for services prior to paying any type of deductible. Rates are the same for all ages and are as follows…
- Single -$548 month
- Parent and Children- $898 month
- Couple- $1,022 month
- Family- $1,298.00 month
What is an annuity
This is a more complicated question than one might realize. So what is an annuity? The standard definition from the dictionary is listed below but it does not really help to answer the question.
-
a fixed sum of money paid to someone each year. In most cases, payments are for the rest of their life.“he left her an annuity of $1,000 in his will”
-
a form of insurance or investment entitling the investor to a series of annual sums.“an annuity plan”
-
Answer:
Annuities are a type of investment account clients typically use either for retirement savings, conservative account growth or to generate regular income payments in retirement. Annuities are insurance contracts, the issuing insurance company provides basic guarantees in the contract, this depends on the type of annuity.
There are many types of annuities, and the right one for each person depends on their situation and goals.
Looking for guaranteed income in retirement
Consider income annuities or annuities with guaranteed income riders:
Income annuities can provide a stable and predictable source of retirement income. With these types of annuities, you surrender access to a lump sum of money in exchange for a stream of income that’s guaranteed for life. Payments from income annuities can start as early as 30 days from the day you sign the contract. Although, the more competitive income annuities require a much longer gestation period ranging all the way up to age 85.
Fixed or Variable Annuities with guaranteed income rider:
The majority of annuities on the market today offer a guaranteed income riders. Riders will provide a set amount of income at a future date determined by the insured. Income riders are predictable and can be illustrated to show how much guaranteed income will be paid out for life at any given start date. Most income riders have an annual fee that is deducted from the overall account value of the annuity. Some income riders will increase the benefit base (number used to determine the income payout) on a guaranteed annual basis. You can find past income riders with 8% to 10% compound roll ups for 20, 30 or sometimes 40 years. The current interest rate environment has lowered the guarantees in most products income riders over the past few years.
Trying to conservatively grow your nest egg.
Consider either a Variable or fixed indexed annuity for safe growth.
Most growth oriented annuities will provide minimum growth guarantees and also have lock in features which set a new minimum value every year. Some Variable annuities can go below your initial value if the market based accounts they use have negative returns.
What is an annuity; what to consider when making a choice:
Understanding the basics of an annuity is one thing. The bigger step is knowing the details and understanding which annuity is best for your situation.
- What the fees and charges will be. Fees and charges vary greatly from company to company and also depends on the type of annuity.
- Who issues the annuity. Annuities are backed by the strength of the company that offers them. Take a look at the financial rating of the company you use.
- How do you want your annuity invested. You can go with a fixed annuity (called a MYGA), an indexed annuity or variable annuity. In general the fixed annuity is a set rate but will often have a lower yield. Fixed indexed annuities have potential for more growth but can also do little to nothing in bad years. A variable annuity can either grow substantially or have negative returns. This will depend on market performance.
- How much flexibility you need. Annuities have surrender periods. The surrender periods range from 3 years up to 15 years. This depends on the product as well as state. Choose one that fits your needs.
If you have more questions on the topic, either give us a call at 203-796-5403 or email Edward@croweandassociates.com to get answers.
For more information; you can visit our website croweandassociates.com.
Independent Medicare insurance agents
This post will help clients understand why it is important to work with independent medicare insurance agents. Here at Crowe and Associates, we want our clients to feel confident about their insurance choices. We are happy to meet with anyone either in our office or at your home, if necessary. Because every client is important to us, you can reach us by phone at (203)796-5403 or by email at edward@croweand associates.com anytime you have questions or concerns.
We DO NOT charge clients for our services.
Independent Medicare insurance agents work with multiple insurance companies on a general contractor basis. Independent agents do not work for any one specific company. This arrangement gives clients more choices when they shop for Medicare plans. This also helps to ensure that clients will receive the best offer available. Unfortunately, not all independent insurance agents work with all of the companies. It is important to ask your agent which companies they work with. In general, they should be contracted to offer Anthem/Empire BCBS, United Healthcare Medicare Advantage and Medicare Supplement plans, Aenta Medicare, Wellcare, Connecticare, Emblem, Mutual of Omaha and First United American. Crowe and Associates works with all of the mentioned carriers and a few others. There is never one insurance company with the best plan for everyone, therefore it is important to have access to all the major companies.
Crowe and Associates is an agency of Independent Medicare Insurance agents
Let the experienced professionals at Crowe & Associates help you understand the difference between Medicare Supplement and Medicare Advantage plans. We are here to make sure you get the coverage you need at a price you can afford. We don’t want you to make the wrong health plan choice and get yourself into a mess that you could have avoided. Let Crowe & Associates guide you through your Medicare enrollment and you can rest easy.
Our location is; 304 Federal Road, Suite 107, in Brookfield, CT. Crowe & Associates is a seasoned group of licensed sales professionals in both the insurance as well as the investment fields.
We are licensed to sell insurance in most of the 50 states and have partnerships with several mainstream insurance carriers. This allows us to guarantee the best insurance services in Connecticut and the Eastern United States.
Build your assets, share your questions, obtain benefit security, and start an outstanding relationship with one of our dedicated professionals. We will help you obtain the best coverage available. Contact us today to schedule a free consultation.
Medicare Advantage dis-enrollment period 2018
You are only eligible to enroll and dis-enroll in Medicare Advantage Plans at specific times of the year. Therefore, some of you may want to know when the Medicare Advantage dis-enrollment period 2018 is. The (MAPD) Medicare Advantage Dis-enrollment Period starts on January 1 and lasts until February 14 every year. During this time, you can leave your MA plan and go back to Original Medicare. You also have a chance to enroll in a Part D drug Plan, if you haven’t already done this.
During the Medicare Advantage Dis-enrollment Period 2018:
You can decide to leave a Medicare Advantage plan and go back to Original Medicare. The length of your enrollment does not matter. Even If you have just joined the Medicare Advantage plan during the AEP (Annual Election Period). You are able to change your mind and go back to original Medicare (Part A & Part B). If you do decide to dis-enroll from your MA Plan, that goes into effect on the first day of the following month after you make your request.
Example: if you dis-enroll from your plan on January 1, it won’t be in effect until February 1.
Be aware of the date your Medicare Advantage dis-enrollment goes into effect. Some kinds of Medicare Advantage plans require you to use in-network providers in order to be covered. If you’re in a SNP (Special Needs Plan) or an (HMO) Health Maintenance Organization, you must only use doctors that are in the plan’s provider network until you are dis-enrolled. If you use out of network providers, your plan may not pay for the services you receive.
If you decide to dis-enroll during this period, you will be eligible to join a Medicare Prescription Drug Plan(PDP). This is true whether or not the Medicare Advantage plan you leave included drug coverage. If you are enrolled in a Medicare Advantage Prescription Drug plan, you can just join a stand- alone Medicare prescription drug plan. If you do this, you will be automatically dis-enrolled from your Medicare Advantage plan. You could also just submit a dis-enrollment request to your plan. As we stated earlier, when you join a Medicare prescription drug plan, your coverage starts the first day of the following month.
It would be wise to enroll in a PDP very close to the time you decide to dis-enroll from a MA plan. This way you can avoid any lapse in drug coverage. Original Medicare doesn’t come with prescription drug benefits. Additionally, Medicare Part D has a penalty if you go without creditable prescription drug coverage for over 63 days in a row. If you have other prescription drug coverage, it must be the equivalent of standard Medicare Part D prescription drug coverage.
You CANNOT use The Medicare Advantage Dis-enrollment Period 2018 to either join or to change plans.
The only thing you can do during the MADP is to dis-enroll from Medicare Advantage to go back to Original Medicare. The Medicare Advantage Dis-enrollment Period is not the same thing as the Open Enrollment Period also known as the AEP. The Open Enrollment Period is only to enroll in a Medicare Advantage Plan or a prescription Drug Plan, make plan changes or dis-enroll from a Medicare Advantage plan and go back to Original Medicare plans.
There is also a difference between the MADP and the Initial coverage election period. The Initial coverage election period is the time that you are first eligible to enroll in a Medicare Advantage Plan. There is no other time that you can change your Medicare Advantage plan unless you qualify for a special election period. In certain circumstances you can dis-enroll from your Medicare Advantage plan and switch to a different plan. For example; if you move out of the plan’s service area or if someone used deceptive marketing practices on you when you signed up for your plan.
Please contact us with any questions about this information. You can reach us either at (203)796-5403 or at edward@croweandassociates.com.
Medicare Open Enrollment 2018
If you have questions about Medicare Open Enrollment 2018, you should read this. The Open Enrollment Period (OEP) starts on October 15 each year and runs through December 7. This time is also referred to as the Annual Election Period. This period of time is for Medicare clients to re-evaluate their coverage, check for changes and explore any new options that may meet their needs more efficiently. You should speak with your broker and at that time he/she can help you compare your current plan against others on the market. If you find a better health coverage option is available, you can make the desired changes. Your new coverage will begin on January 1 of the following year (Jan.1, 2018)
For example:
If you have Medicare Parts A or B, you can either join or drop a Part D prescription drug plan.
If you already have a Part D prescription drug plan, you can change to a different Part D prescription drug plan.
You can also drop your Medicare Advantage Plan (also called Part C) and change back to Parts A & B (Original Medicare)
If you have a Medicare Advantage Plan, you can change to a new Medicare Advantage Plan.
Learn more about the difference between a Medicare Advantage plan and a Medicare Supplement plan
Do I really need to re-evaluate my Medicare coverage during Open Enrollment?
There are changes made every year to health plans that can effect how much they cost you. Changes can include premiums, deductibles, drug costs as well as pharmacy and provider networks. This means that it is possible that your chosen provider may decide not to participate with your health plan anymore. Your health plan may also change it’s formulary (the list of covered drugs and how much they will cover for them). Because of all these variables, you really should review your options. Make sure the coverage you chose still meets your needs. If you do this, you may be able to:
Get yourself better prescription drug coverage or add it in for the first time. Your medication needs may have changed during the course of a year.
Keep your current doctors in-network. Just in case your provider has decided to change his network affiliation. Open enrollment can be a good time to lower your medical costs.
You might find a higher quality plan that is still in your budget.
These are all things you might want to consider when you are planning for the upcoming year.
Crowe and Associates works with numerous Medicare Advantage, Medicare Part D Rx and Medicare Supplement plans. If you have any questions about your coverage, please feel free to contact us. You can reach us either by phone at (203)796-5403, or by email at edward@croweandassociates.com.
Balance billing rules Medicaid
This blog Balance billing rules Medicaid will provide details on billing for those with Medicare and Medicaid. It is also useful for those with Medicaid only. This information may help to prevent future out of pocket costs associated with health care.
Balance billing rules Medicaid and Medicare Advantage plans
A number of Medicaid eligible members also have a Medicare advantage plan. Medicare advantage plans are co-pay based plans with a network of providers. Those enrolled in Medicaid will not need to pay the co-pays on the Medicare advantage plan if the provider they see is participating with Medicaid. If the provider is not participating with Medicaid, they will have a co-pay for the services. There are plans called Dual Eligible Medicare Advantage plans that work a bit differently. If the provider participates with the Dual Advantage plan, the insured will not be responsible for a co-pay. This is true even when you go to a doctor this not participating with Medicaid. This rule gives members access to doctors who are not currently participating with Medicaid without a cost share.
Balance billing rules with Original Medicare and Medicaid
Those with Original Medicare A and B and Medicaid can go to any provider that participates with A and B. If the provider does not participate with Medicaid, they are not allowed to bill the insured for the Medicare cost share. Providers not with Medicaid do have the ability to refuse to see that member if they choose however.
Overall
Non Medicaid providers not being able to bill Medicare and Medicaid dual eligible members can be a positive in some situations. This is because it allows members access to a wider range of providers. Some providers will simply not be willing to see dual members any longer and as a result, this trend is increasing. Dual eligible plans help to expand access to providers and may have extra benefits such as dental and vision. On the other hand, if the dual plan does not have a specific doctor in network, the member will not be able to see them. They would be able to see that same provider if on Original Medicare only.
If you would like more information about Crowe and Associates, please visit our website at here.
Medicare Savings Program CT
If you would like some information on Medicare Savings Program CT, you should read this post. The Medicare Savings Programs (MSP), has multiple levels called QMB (qualified Medicare beneficiary), SLMB (specified low income medicare beneficiary) as well as ALMB (additional low income Medicare beneficiary). As you can see, there can be many confusing terms used for the same program. We hope this will help you sort it out a little. All are programs that can help qualified individuals pay for both their Medicare premiums and drug costs. In fact, QMB will also help you by paying your Medicare coinsurance as well as your deductibles.
Who is eligible for the Medicare Savings Program CT
If you are eligible for Medicare Part A and your income is below the program limit, you could be eligible for one of CT’s Medicare assistance programs. Eligibility for the programs is determined by the amount of your annual adjusted gross income. The amount of your assets will not matter when determining your eligibility. However, any money being drawn out of a qualified retirement plan such as an IRA will count as income in the year it is taken. Individuals with income below $2,265 a month are eligible for MSP at the ALMB level. Couples under $3,064 are also eligible.
Benefits
MSP does more than pay the monthly part B Medicare premium. Depending on the level of help, the program can reduce drug copays, pay monthly part D drug premiums (up to the benchmark) create a special election period and pay medical copays. (QMB level and higher)
Single vs. Couple Medicare Savings Program CT
If a couple is married, the income of both spouses is considered. They are not able to qualify as an individual. Any Medicare Part B premium deductions you have will also count towards your income. Even though the part B premium is being pulled out of your Social Security check, it still counts as income.
Re-determination of Medicare Savings Program CT
Those on MSP will need to re-certify for the program on an annual basis. Failure to fill out the re-determination notice will result in removal from the program.
Click for MSP Application
Click for MSP Brochure and Income levels
Medicare vs work insurance as primary
Some people have insurance coverage through both their employer/group plan and through Medicare. When this is the case, the question comes up about which is the primary insurance which is what we will answer for you in our Medicare vs work insurance as primary blog.
If you are 65 or over, eligible for Medicare, and have insurance through your or your spouse’s current job, you should still enroll in Medicare Part A. For most people, Medicare part A is free.
In order to decide whether to take Part B (medical insurance), for which most people pay a monthly premium of $134 a month, you should ask your benefits manager or human resources department how your employer insurance interacts with Medicare and confirm this information with the Social Security Administration (SSA). Be aware that when you qualify for Medicare, your employer insurance may start to work differently for you. Your employer insurance may start to pay as the secondary insurance. This is usually the case for groups under 20 employees. When you are over 65 and working for a employer under 20 employees you usually need to purchase Part B of Medicare in order maintain coverage.
As a first step, assess whether your employer insurance will be primary or secondary to Medicare.
- Secondary insurance:
- pays all or some of the unpaid portion of covered health care expenses after the primary/main insurer has paid. If your employer insurance will be secondary to Original Medicare, you should generally take Medicare Parts A and B when you are first eligible to enroll.
- Primary insurers pay first:
- Normally, you do not need Medicare Part B if you have primary employer coverage. You may decide to take Part B if you are unhappy with that coverage. This is usually for an employer group of 20 or more employees. Before you decide to waive part B Medicare, you may want to evaluate which coverage is a better deal.
You qualify for a special election period when;
You are over 65 and getting coverage while working on your own or through a working spouses coverage.
If you drop the group health coverage or you or your spouse stops actively working.
IMPORTANT: You have an 8 month period to enroll in Medicare part B.
Part B enrollment special election rules
Before you sign up for your Part B Medicare coverage there are some Part B enrollment special election rules that you need to understand.
You are not required to take Medicare Part B during your Initial Enrollment Period (IEP) (the first of the month you turn age 65) if you are have insurance through work and either you and/or your spouse is still working. You should only delay Part B if the employer insurance (called group health insurance) is the primary payer on your health care expenses. This means that Medicare would pay secondary (after your group/employer plan pays). It is a good idea to talk with the employer or the HR department to see which is the primary payer. Usually the employer must have more than 20 employees in their plan in order for the plan to be considered the primary insurance . If you are eligible for Medicare because you get Social Security Disability Insurance, the employer must have more than 100 employees to be the primary payer.
When there are fewer than 20 employees at the company where you get your insurance, Medicare is likely your primary coverage. If this is the case, you should not delay your part B enrollment. If you do so, that can leave you without any insurance coverage at all.
In either case:
If you have insurance from a current employer, you remain eligible for a Special Enrollment Period (SEP). During this time, you can enroll in Part B without penalty at any time. This is true while you or your spouse is still working. This is also true for up to eight months after you lose employer coverage, switch to retiree coverage, or stop working. However, if you have a lapse in coverage more than eight months at any time after you become 65 and Medicare-eligible, you will lose your SEP. A lapse means any period of time where you were not covered by either Part B or insurance from a current employer.
Part B enrollment special election rules- Cobra and retiree insurance
Important: Medicare DOES NOT consider COBRA or any retiree insurance the same as current employer insurance. If you are on either of these, you will not have a Special Enrollment Period to enroll in Medicare beyond the eight months you have after you retired/stopped working. If you have COBRA or retiree insurance and delay enrollment in Part B, you will likely have a Medicare Part B late enrollment penalty when you do sign up for part B
It important to note:
If you had already taken Social Security before you turned 65, or if you become eligible for Medicare due to disability, you will be automatically enrolled in both Medicare Part A and Part B. It is not mandatory that you take Part B. If you decide not to take Part B, you will need to send back the Medicare card you received in the mail with the form you received stating that you do not want Part B. After you do this, you will receive a new Medicare card in the mail. The new card will have part A only on it and not part B. You will not need to pay your Medicare Part B premium as a result.
If you are thinking about turning down Part B—or enrolling in only Part A it is advised you call the Social Security Administration at 800-772-1213 and ask if you delay enrollment will you be subject to the Medicare Part B late enrollment penalty. Be sure to explain the type and source of your other insurance and other circumstances in as much detail as possible. When you call Social Security, make sure to write down whom you spoke to, when you spoke to them, and what they said. Remember you generally must be covered under a group health insurance plan which you have access to due to you or your spouse working in order to avoid the part B late enrollment penalty.