Medicare is government-funded healthcare for people over the age of 65 who paid Federal Insurance Contributions Act (FICA) for 40 quarters, the equivalent of 10 years. You have the option to enroll for Medicare Part A and Part B within three months of your 65th birthday: three months before you turn 65 and three months after you turn 65.
Part A is premium-free coverage for hospitalization, short term nursing care and hospice care. If you have not contributed to FICA for at least 40 quarters, you can still buy Part A for a premium. Part A Coverage
Part B covers medically necessary services including doctor’s visits, surgeries, laboratory tests, a one-time welcome to Medicare visit and annual “wellness visits,” which are actually annual Medicare information sessions with your physician and not preventive physical exams. You can go to any doctor in all 50 states without a referral. However Part B does not cover routine preventive physical examinations. The cost for part B is $134.00 for a single filing up to $85,000 or a joint filing up to $170,000. Above these amounts, costs are indexed based on your income. Part B Coverage
Part C allows you to opt out from Part A and B and choose health coverage through a private insurance company, which is called an “Advantage Plan” (opting for Part C is actually the greatest disadvantage to you - FIND OUT WHY). Advantage plans are usually premium free. You will simply continue paying the part B premium of $134.00 for Medicare. They also include a prescription plan and perhaps dental services, eye care, hearing aids - even a membership to a spa! Advantage Plans come with these enticing benefits because Medicare pays the insurance companies to get you off their liability.
The tradeoff is that you can only go to your primary care doctor. You’ll also need referrals from your doctor to go to an “in network” specialist, so you are giving up the freedom to choose your doctors that you would have had with original Medicare Parts A & B. Furthermore, you cannot make any changes to your elected plan – you won’t be able to go back to your original Medicare or switch to a different advantage plan until the open enrollment period, which occurs only once per year from October 15th through December 7th. Changes in your plan will take effect on Jan 1st so if you need to make changes before that, you are handcuffed for a full year. .
You may be tempted to get a Medicare Advantage Plan – Part C – to substitute Medicare. Medicare Advantage promises $0 premium for managed care, but be sure you know what you’re getting before you buy.
Managed care means that you agree to visit only certain doctors and hospitals that are “in-network” and the treatment is managed by a large insurance company. The insurance company employs a team of doctors who have the final word on what treatments and care the company will cover. When your doctor determines a care plan, the insurance company (even without seeing you, the patient) has the ability to override the doctor and deny coverage, deeming the care unnecessary. Unfortunately, there is a clear conflict of interest when that decision is made by the very body that has to pay for the care.
You have the right to appeal this decision by sending a letter asking your insurance company to have a second team of doctor’s review the decision internally. However, these doctors are also employed by the insurance company and are no less biased than the first set of doctors who reviewed the request. They have up to 90 days to respond to the appeal, during which time you may have to put your medical care on hold. .
Part D is a Medicare program administrated by a third party, usually an insurance company, that offers coverage for prescription drugs. The cost is based on what plan you choose and how much medication you take. In addition, if you do not take any prescriptions you can choose not to enroll. However, if and when you need it, you will only be able to enroll once a year during the yearly open enrollment period between Oct 15th and Dec 7th, effective Jan 1st. Moreover, you will be penalized with a penalty of 1% of the national premium rate per month for each month you delay enrollment for the rest of your life. Part D is not a one size fit all; it needs to be customized for each one based on the medications you take.
Beware! Parts A and B cover limited hospital and medical care, leaving many big gaps. In order to have complete coverage and still have freedom of choice, you need to choose Parts A, B & D along with a supplement.
|Admission||First 60 Days||61-90 Days||Over 90 Days (not covered; 60 day once-in-a-lifetime reserve you can use)|
|$1316 deductible per benefit period*||Fully covered||$329 deductible per day x 30 days = $9,870||$658 deductible per day x 60 days = $39,480|
The Risk A benefit period begins upon admission to a facility and ends 60 days after the last service you received there. If you are readmitted after 60 days, you begin a new benefit period and all costs apply. (Rather than a calendar year deductible like part B or private insurance plans)Your hospitalization coverage under Part A is exhausted after a hospital stay of 150 days. The hospital will put a lien on your assets to cover your extended stay, which is in addition to the over $50,000 of copayments you accumulated during the first 150 days of your stay.
Hospitalization coverage is the biggest gap with Medicare and the most urgent reason that you need to supplement Medicare to fill this dangerous gap.
|10-20 Days||21-100 Days||Over 100 Days|
|Fully covered||$164.50 deductible per day x 80 days = $13,160||No coverage|
The supplement will pick up the $13,160 gap up to 100 days. After 100 days, you are no longer covered – even if you (a) have a supplemental policy (b) are at home receiving home care. You will need to buy a long-term care policy to ensure you’re covered. Don’t assume Medicare covers you for long term care! This is the biggest mistake people make and when they finally realize their mistake, it’s usually too late to buy a long-term care policy.
Please note that the Medicare supplement policy is only supplementing Medicare, meaning that it fills the gap only when Medicare covers part of the costs. If Medicare does not cover a particular expense, the supplement won’t cover it either. One exception to this is international emergencies, which are covered up to $50,000 by most Medicare supplement plans.
After a $183 deductible, Medicare will cover 80% of approved charges for physician’s services, inpatient and outpatient care, medical and surgical services and supplies, physical and speech therapy, diagnostic tests, and durable medical equipment. A supplement will help cover the remaining 20% of costs.
There are many serious gaps in Medicare so make sure you’re covered → You’ll need supplemental insurance – also known as Medigap policies – to ensure maximum coverage. Supplemental insurance will pick up the remaining 20% of costs after Medicare Part B has paid 80% of the approved charges if the doctor accepts assignment,* and up to the current charges if the doctor does not accept assignment.
*Assignment means that your doctor, provider, or supplier agrees to accept the Medicare-approved amount as full payment for covered services. Legally, if a doctor does not accept assignment, he can only charge a patient up to 150% of the Medicare approved charges.
Choose your plan wisely. It is important to choose the original Medicare and the right supplemental insurance from the start:
If you’re paying more than $71/month* for a Medicare supplement, you’re wasting your money.
*price subject to change based on policy owner’s zip code
Eli has done the research for you. Contact Eli to select the right supplemental plan for you.
Plan F covers all the gaps, deductibles and copayments.
Plan F also covers the difference between what your doctor bills and what Medicare pays, and covers you even when you’re traveling outside the US (up to $50,000). Plan F also covers Medicare Part A’s gap, covering hospitalization beyond 150 days up to 365 days. Plan F’s monthly premium is $279. Check to see the cost in your area.
High Deductible Plan F gives you the same great benefits with a lower monthly premium and lower annual cost.
See for yourself:
|Monthly Premium||Annual Premium Cost||Deductible||Annual TOTAL Cost|
|High Deductible Plan F||$71||$852||$2,200||$3,052
Consider this scenario: You visit the doctor ten times in a year and the doctor charges $200 for each visit.
|Medicare Pays||Patient Responsibility|
|Visit 1||$13.60 (80%) after deductible||$183 Medicare deductible and $3.40 for the 20% left.
Your toal responsibilty to pay will be $186.40
|Visits 2-9||$160||$40 towards High Deductible Plan F deductible|
For visit number 1, you’ve paid $183 to satisfy the Medicare deductible and an additional $3.40 for the 20% copayment, all of this is accountable towards the HD Plan F deductible, totaling $186.40.
For the other 9 visits, you paid 20% copayments = $40 each, also counting towards HD Plan F deductible for a total of $360. totaling $546.40, in addition you’ve also paid an $852 annual premium. At the end of the year, your total comes to $1,398.40.
Compare $1,398.40 to the $3,348 cost of the regular Plan F without the high deductible and you’ll see that you’re way ahead of the game!
Therefore, by choosing the HD Plan F, you save $1,949.60 for the identical coverage. Instead of paying up front for the coverage, choose the HD Plan F and pay only if you use it.
Most people will not maximize their deductible under the HD Plan F. The savings quickly add up! Five years in the above scenario = $9,748 in savings. Ten years is $19,496 in your pocket.