Do you need to enroll in Medicare?

Have you started receiving Social Security benefits?  If you have then you will automatically be enrolled into Original Medicare.  You will receive your red, white, and blue Medicare card in the mail around 3 months before you turn 65.

If you haven’t started receiving Social Security benefits then you need to learn if you need to enroll in Medicare.  If you are going to have coverage through your employer, your spouse’s employer, or some other form of health insurance then you may not need to enroll in Medicare yet.

Are you delaying Medicare?

If you are planning on delaying Medicare then this page will be helpful.  Otherwise let’s continue.

How to enroll in Medicare

There are 3 ways to enroll in Medicare.  There is no official Medicare office to enroll because Social Security helps you enroll in Medicare.

• Online with Social Security
• Phone with Social Security – 1-800-772-1213
• In person with Social Security – Contact your local Social Security office

If you are planning on starting your Social Security benefits AND Medicare at the same time then you should contact your local office in person.

You should plan on enrolling into Medicare when you are within 3 months of your 65^th birthday. For example, if your birthday is October 15^th then I would recommend contacting Social Security to enroll in Medicare July 16^th or shortly after.

This way you will receive your Medicare card in the mail in August.  Which gives you time to apply for additional Medicare coverage which requires your Medicare card information.

Original Medicare Costs and Coverage

Original Medicare is made up of 2 parts which are called Part A and Part B.  This is the coverage that is under your red, white, and blue Medicare card.

Part A

Medicare Part A is also known as hospital insurance.  It covers:

• Inpatient care in a hospital
• Skilled nursing facility care
• Impatient care in a skilled nursing facility
• Hospice care
• Home health care

PREMIUM

As long as you or your spouse have worked and paid into Medicare for 40 quarters (10 years) then Medicare part A does not have a premium.  So most people do not pay a monthly premium for Part A.

It is possible to buy Part A if you did not pay into Medicare for 40 quarters.

• If you buy Part A, you’ll pay up to $437 each month.
• If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $437.
• If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $240.

DEDUCTIBLE AND CO-INSURANCE

But Medicare Part A doesn’t cover everything at 100%.  You still have costs for treatment even though you may not pay a premium.

Medicare part A does have a deductible.  For 2019 it is $1,364 per period.  It’s unique because many deductibles are for the calendar year.  This deductible lasts for a period of 60 days.  So it’s possible you could have to pay that deductible multiple times per year.

After you meet your deductible you still have some additional costs associated with part A:

• $170.50 per day for days 21-100 in a skilled nursing facility
• $341 per day for days 61-90 in the hospital
• $682 per day for 60 days lifetime days before 90 in the hospital

PART B

Part B is known as Medical Insurance.  Part B covers things like:

• Doctor visits
• Outpatient services
• Physical therapy
• Chemotherapy
• Lab work

PREMIUM

The average person starting Medicare in 2019 will be $135.50 per month for part B.  This premium can vary based off your income so some people may pay different amounts.  If you are curious about different costs then you should read about IRMAA for higher incomes or here for assistance for lower income.

DEDUCTIBLE AND CO-INSURANCE

Part B has a calendar year deductible of $185 for 2019.  Once you meet this deductible Medicare pays 80% of your part B charges and you pay 20%.

But your 20% doesn’t have a limit on how much you can pay.

So if your medical bill is $100 then you owe $20.

But if it’s $10,000 then you owe $2,000.

And if it’s $50,000, you owe $10,000.

Obviously this is a concern for most people.  And it probably is for you too.  So here is one way people who are already on Medicare help limit their exposure.

Medicare Supplements

Medicare supplements fill in the gaps or supplement Original Medicare.  There are many different options on how to tailor your supplement coverage.  The most popular in Wisconsin is to get the supplement that covers all of your deductibles, copays, and co-insurance.  (This may not be available for people turning 65 in 2020)

Original Medicare allows you to use any doctor or hospital that accepts Original Medicare.  And supplements just fill in the gaps so they make is hassle free for you.  No bills, no paperwork, not restrictions on where you can go for your treatment.

They are guaranteed renewable so you can keep that plan as long as you keep paying the premiums.

Obviously costs vary but a rough estimate for the comprehensive supplement I mentioned is around $150 per month.

Females tend to be healthier than males.  Which means female supplement rates tend to be lower than males.

There are more than 30 Medicare supplement companies in Wisconsin.  And the only difference for you is the name of the company on your ID card and the price you pay for that plan.

There are no other differences as far as coverage, doctors you can see, or how fast claims will be paid.  They are forced to be standardized.  Which makes it easier for you to compare since it is truly apples to apples.

PRESCRIPTION DRUG COVERAGE

Medicare Part D is prescription drug coverage.  These types of plans are sold by insurance companies.  The average premium is around $35 per month.

These plans vary in:

• Premium
• Medications covered
• Pharmacies you can use
• Costs of medications

It sounds confusing but there is a tool that we can use together based off your current medications.  After entering that information into the tool we can see the estimated costs for you to cover your current medications so you can make an educated decision about which plan to apply for.

OPTION 1

This brings us to your first main choice. Deciding to stay with Original Medicare.  Choosing this option means you will likely want to apply for a Medicare supplement and prescription drug plan.

So you will have 3 different ID cards with 3 different premiums:

• Original Medicare (Part B) $135.50
• Medicare supplement $150
• Prescription Drug plan $35

This means your total monthly premiums will be around $320 per month.

But you are not limited on the doctors you can see.  And when you visit a doctor you will not have copays or deductibles.

Your monthly premium will cover everything Medicare approved except your copays for prescription medications.

Option 2

Medicare Advantage or Part C of Medicare

Medicare Advantage plans combine parts A and B plus usually Part D into 1 plan.  These plans are offered by insurance companies.  Choosing this option means you are going to receive your Medicare benefits from an insurance company instead of Original Medicare.

Insurance companies use a network of providers that you can use to get your treatment.  They may use an HMO or PPO type format.

HMO

HMO plans mean you may need a referral from your primary care doctor in order to see a specialist.  And you may need prior authorization from your insurance company before major procedures.

Also you may not have coverage if you see a doctor outside of the network. Which means you would be responsible for 100% of the costs unless it’s considered an emergency by the insurance company.

PPO

PPO plans have a network as well but it tends to have more providers compared with HMOs.  And if you see a provider out of network you still typically have coverage.  But the share the insurance company covers is smaller compared to using in network doctors.

So you will get the best value staying in network.

Medicare Advantage plans are locked in for a calendar year.  Unlike Medicare supplements they are not guaranteed renewable.  So that means every year the plan could potentially change.  Some of these changes include:

• Premium you pay
• Benefits like copay amounts
• Maximum out of pocket you are responsible for

Or the plan could cancel everyone in that area completely forcing you to move to a new plan.

PAY AS YOU GO

These plans often have lower premiums compared with Medicare supplements.  Some plans even have zero premium here.

But in exchange for lower premium is more of a pay as you go model.  So every time you visit the doctor you have additional costs.  These are normally set copays but could also be a percentage of the total cost depending on type of treatment.

And if you have a really poor year health wise then you have a maximum out of pocket.  Once you reach your maximum out of pocket then the insurance company covers 100% of the costs.

Choosing Medicare Advantage means you won’t use your red, white, and blue Medicare card anymore.  You will still need to pay your part B premium but you can keep your card at home.

You will use the 1 ID card from your insurance company for all of your medical coverage including prescriptions.

• Medicare Part B $135.50
• Medicare Advantage premium ? (varies from zero to $200+)

So your total monthly premium could be as low as $135.50.  But you will be restricted to using a network of providers.  And you will have additional costs as you use your plan benefits.

THINGS TO ASK YOURSELF

• Is there a doctor that is important for me to be able to see?
• Am I comfortable changing doctors to potentially save money?
• Do I prefer to pay a fixed monthly premium for something I may or may not use?
• Or would I prefer a lower monthly premium and potentially save money?
• How do I feel about having to pay a copay whenever I need treatment?
• How would I feel about being told I can’t see a certain doctor because I didn’t receive a referral from my primary doctor?
• Do I have specific prescriptions that I need covered?
• Do I travel out of the area often? (You may not want an HMO that covers you in southern Wisconsin if you travel to northern Wisconsin often)

THINGS NOT COVERED BY MEDICARE

Dental

Original Medicare doesn’t provide any routine dental benefits.  Even though it’s recommended to have your teeth cleaned twice a year you will have to pay those costs entirely on your own.   Here’s a look at some average dental costs:

• Cleaning and x-rays $198 just for a cleaning
• Fillings $100
• Extraction $150
• Crown $328
• Root Canal $150
• Dentures $1,500 per set ($3,000 for top and bottom)

Vision

Do you have glasses or wear contacts?  Medicare isn’t going to help you pay for the costs of getting a new pair when you need them.  Because Medicare doesn’t include any vision coverage.

Long Term Care/Nursing Home coverage

Long term care which many people know better as being in a nursing home is not covered by Medicare

Many people aren’t certain what long term care is.  It’s really not medical care but more like assistance with everyday tasks.  Things like eating, dressing, bathing, or moving from a bed to a chair.

Often times this kind of care occurs in nursing homes.  It can also by very expensive.  National averages are almost $7,000 a month for a shared room.  That’s over $80,000 a year!

Hearing Aids

Average price is $2,300 per unit.  So if you need 2 that’s $4,600 out of your own pocket.

HOW I CAN HELP YOU

I have been a licensed agent in Wisconsin since 2009.  I am paid by the insurance company so you get my experience and knowledge for free.  I represent many different companies including Dean, Humana, United Healthcare, and Aetna.

I also offer all of these types of products.  Medicare Advantage, Medicare supplements, and Prescription Drug Plans.  So you get my unbiased advice based off your unique situation.

There are over 30 Medicare supplement companies in Wisconsin. I can help you shop them all at once.  So you don’t need to call 30 different companies or agents.

My services are free to you.  Insurance companies set the prices for these products.  And they have to be the same regardless of how you enroll.  So you can’t save money by “cutting out the middleman” and buying directly from the insurance company.

You certainly can buy directly from an insurance company.  But then you will be on your own for all questions in the future.  Which means you will have to call into a 1-800 call center for all questions.  And if you have to call twice, what are the odds of getting the person you had talked to earlier about your issue?

Probably not good.  Which means you get to start over each time you call.

CONTACT ME

We can speak over the phone.  Or I can come see you in person.

Mike Lovell

Phone 608-571-4461
Email Mike@askMedicareMike.com