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Medicare 101

At Casanova Ins we offer Medicare expertise on everything having to do with Medicare:

Getting Started with Medicare: 

Will I get Part A and Part B Automatically? 

(On pg. 15 Medicare & You) 

  • Signing up for Medicare: If you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB) you’ll automatically get Part A and Part B starting the first day of the month you turn 65 (if your birthday is on the first day of the month, Part A and Part B starts the first day of the prior month.)
  • If you’re under 65 and have a disability, you’ll automatically get Part A and Part B after getting 24 months of disability benefits either from Social Security or certain disability benefits from the RRB. 
  • If  you have ALS (Amyotrophic lateral sclerosis, also called Lou Gehrig’s disease), you’ll get Part A and Part B automatically the month your Social Security disability benefits begin.

Will I have to sign up for Part A and/or Part B?

(On pg. 15 Medicare & You) 

  • If you’re close to 65, but NOT getting Social Security or RRB benefits, you’ll need to sign up for Medicare.  Visit SSA.gov/medicare to apply for Parts A and Part B. 
  • If you are still working past age 65 you DO NOT HAVE TO SIGN UP for Medicare (pg. 19 Medicare & You).  You can stay on your employer plan until you decide to retire.  However, if you want to compare what you’re paying for your benefits at work and what Medicare will cost you can click on the Employer Plan or Medicare Calculation Tool on the right side of this page.  This form will help you decide if it would be more advantageous for you to move to Medicare.  If you decide to stay on your employer plan you will need to sign up for Medicare Parts A and B at least two months before you leave.  This will create a what is known as a Special Enrollment Period (SEP).   
  • If you have a High Deductible Health Plan and contribute to an HSA (pg. 20 Medicare & You) DO NOT sign up for premium free Part A.  Medicare and HSA’s DO NOT work together.  You may end up paying a penalty if you do.  If you do decide you want Part A you will no longer be able to contribute to your HSA. 
  • COBRA (pg. 19 Medicare & You): If you retire before you are 65 and elect Cobra you must enroll in Medicare when you turn 65 even though you have Cobra because Cobra is not considered creditable coverage based on current employment, and it will not offer a Special Enrollment Period (SEP).  This means you will have to wait until the General Election Period which begins each year on January 1st and runs until March 31st to enroll in Medicare. 

What Does Medicare Cost:

(Pg. 22 & 23 Medicare & You)

  • You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working for 40 quarters or 10 years.  If you did not you can still get Part A, but you will pay a premium for it.  
  • Part B has a monthly cost and that cost is means tested.  What it cost depends on your income from the two years prior to you enrolling.  For example, if you enroll in 2024 Social Security in conjunction with the IRS will look at your 2022 tax return, and will look at your Modified Adjusted Gross Income (MAGI) to determine what your Part B premium will be.  Click on 2024 Medicare Costs on the right side of this page to see the income levels with corresponding rates for 2024.  For most people the rate will be $174.70 a month for 2024.  This rate is based on for an individual tax return of income below $103,000, for a joint return it’s income below $206,000.  These rates are adjusted every year in December for the next year.  In 2023 the rate was $164.90.    

Penalties (pg. 17, 22 & 23 Medicare & You):

  • This will only occur if you did not sign up for Medicare when you were first eligible and did not for whatever reason enroll.  For example, if you retire before age 65 and DO NOT enroll in Medicare during your Initial Enrollment Period (IEP) that begins 3 months before your birthday month, and continues through your birthday month and goes 3 months after your birthday month for a total of 7 months you may have to pay a penalty.  The penalty is 10% for every 12 months you did not have Medicare.  If you are still working past age 65 and have group insurance with your employer this is considered creditable coverage, you do not have to enroll in Medicare until you decide to retire.  In this scenario you will not incur a penalty unless you decide not to enroll in Medicare after you retire which is not likely to happen ever.    

After You’ve Been Enrolled What’s Next: 

After you’ve been enrolled into Medicare Parts A&B you will have three options to choose from:

  1.  You can stay with only Parts A&B and then buy a prescription drug card (Part D) from the carriers we represent AetnaSilverScript or UnitedHealthcare or Blue Cross Blue Shield.  You can look up their plan options from the Rx Plans Tab above.  If you DO NOT enroll in a prescription drug plan when you are first eligible you may pay a penalty when you decide later in life that you may need one (pgs. 64, 79, 81-85 Medicare & You).  For example, if you are not taking any prescription drugs and decide you do not want to pay a premium for it and later in life your doctor tells you you need a medication that you’ll need to take for the rest of your life the penalty will be 1% for each month you did not have a prescription drug plan.  
  2. You can choose to buy a Medicare Supplement also referred to as a MediGap policy (pg. 75 Medicare & You) insurance policy from AARP UnitedHealthcare or from Blue Cross Blue Shield the two Medicare Supplement carriers we represent.  Medicare Supplement policies are insurance policies you buy you own it.  You will pay a monthly premium and that premium will increase annually as you age.  Why do people choose this option?  Because a Medicare Supplement Plan G (the most purchased plan today) will pay the Part A Hospital Deductible which is $1,632 for 2024 in full at 100% each time you are hospitalized.  It will also pay the Part B 20% coinsurance you are responsible for at 100% after the calendar year deductible of only $240.  This deductible will be the only medical expense you will have each year with this policy in place.  Moreover, you will have total freedom to choose any doctor or any hospital you want in the country as long as they accept Medicare.  There are no networks to worry about.  If you choose this option you’ll also need or want to purchase a dental, vision, and hearing policy if you want to have those benefits.  This policy is totally up to you as a consumer.   
  3. The third option is a Medicare Advantage plan.  We represent Aetna, UnitedHealthcare, Blue Cross Blue Shield, KelseyCare, Memorial Hermann, and Cigna.  All of these plans use networks of hospitals, physicians, Durable Medical equipment companies, Labs and other providers.  You’ll need to stay within the network to receive the highest level of benefit from your plan.  Moreover, if you choose an HMO you’ll be required to choose a Primary Care Physician (PCP) for all your care.  Should you need to see a specialist you will need a referral from your PCP.  It’s very important to note if you go out of the HMO network you will be responsible for all of the costs.  The other choice available to you is a PPO, with a PPO you can self refer to a specialist without having to get a referral from your PCP.  Out of pocket costs are higher for a PPO plan than an HMO.        

What are the major differences between a Medicare Supplement and Medicare Advantage Plan?   

  • Medicare Supplements have a monthly premium that will increase as you age.  Medicare Advantage plans are $0 premium plans.    
  • Why do Medicare Advantage plans come with no monthly premium?  Because you have already paid for it.  When we work throughout our lives we all pay into the system via Medicare taxes.  It is estimated we all pay in around $80,000 during our working lives into the Medicare system.  Once we are eligible to enroll in a Medicare Advantage plan the insurance company will receive around $12,000 a year from the Centers of Medicare and Medicaid Services (CMS) to insure you.  That money is the money we paid into the system.  To be eligible to enroll in a Medicare Advantage plan you must have Parts A&B in place and continue to pay your Part B premium, and you must reside in the service area which is determined by your home zip code.  If you choose this type of plan and you start to need health services that is when you will start to pay out of your pocket in the form of copays or coinsurance for each service.  Medicare Advantage plans also provide benefits for dental, vision, hearing, a prescription drug card, Over the Counter benefits, gym memberships at no cost, and more.  Every plan in the marketplace is by law required to have a maximum out of pocket limit for medical care.  It can range from a low of $3,900 for an HMO plan to as high as $7,900 for a PPO.  
How to check your Medicare enrollment status on your MySocialSecurity account:
 * You can check you enrollment status daily on your mysocialsecurity account.  Once you log on to your account click on Your Benefit Verification Letter on the next window you’ll see a PDF Your Benefit Verification Letter (example of these on the right) this letter will show your effective date of Parts A&B and will include your Medicare number.  You need this number before you can enroll in Part D, a Medicare Supplement or a Medicare Advantage plan.
 
* I recently enrolled in Medicare on July 1, 2024 and was approved on July 3rd.     

Medicare & You 2024

UnitedHealthcare Medicare Supplement Plans 2024

Employer Plan or Medicare Calculation

2024 Medicare Costs

UnitedHealthcare 2024

Aetna Medicare 2024

Blue Cross Blue Shield Medicare Plans 2024

Cigna 2024

KelseyCare Advantage 2024

Memorial Hermann 2024

my Social Security Account

Benefit Letter

RC Acceptance Medicare Letter