SPECIAL BIRTHDAY EDITION Medicare Options

SPECIAL BIRTHDAY EDITION Medicare Options

If you are turning 65, Happy Birthday!

This Special Edition will take you through the process and explain simply what you need to do.  You are not alone if you’ve received stacks of advertising and official looking documents and not sure where to start.  A little Overwhelmed?


Be wary of misleading mailers that suggest you fill out a form and mail it in, or indicate that they are your new Medicare agent….This is a sales lead generator that will place you on a call list that is almost impossible to get off of!
OK, Here are the basics ~

Original Medicare (Parts A and B)

Medicare was started in July of 1965. It is provided by the government and pays fees for your care directly to the doctors and hospitals you visit. Part A helps with hospital cost and Part B helps with doctor and outpatient care. In 2005, the government added part D and this helps pay for prescription drug costs.

Medicare Part A (Hospital Coverage)

Part A helps with the cost of your inpatient hospital stays and skilled nursing care after a hospital stay. Medicare Part A is free to you so long as you have worked 40 Quarters/10 years in this country. Although the monthly premium is free, the deductibles and copays are not. This can leave you with a big financial exposure. The deductible is $1316 this year. If you are in the hospital longer than 60 days, the you will have a share in the financial responsibility. This is why you would choose to have a supplemental insurance plan in place.

Medicare Part B (Doctor Visits)

Part B helps with the cost of doctor visits including outpatient care, clinics, labs, etc. There is a monthly cost by activating Part B. Most people this year will pay $134 per month, but if you’re single making more than $85,000, or married and making over $170,000, you will pay a higher monthly premium.

You will have a deductible of $183 for Part B services, then Part B picks up 80% of your doctors fees, and you are responsible for the remaining 20%…There is NOT a ceiling on your 20% financial responsibility. This is why a supplemental insurance policy is important to protect you.

Medicare Part D (Prescription Drugs)

Part D helps with the cost of prescription drugs. This is not a part of Original Medicare and must be purchased. Part D plans are sold by private companies and can range in costs from $15/month to beyond $100/month. This is optional, but you will incur a penalty if this is not satisfied by enrollment into a plan or have a Medicare plan that includes “creditable” drug coverage. This penalty stays with you for life. Even if you do not currently take medications, you must satisfy this requirement.

As you have read above, Original Medicare Does NOT cover everything.

Original Medicare helps, but leaves holes in your Medical coverage, leaving you with a potential financial burden. Most people enroll in additional coverage to help them pay for the cost and benefits that aren’t covered by Original Medicare Parts A & B. And you must have Prescription drug coverage in place so as not to incur the penalties.

How do you fill in the HOLES of Original Medicare? With all the mailings you’ve received, likely you are seeing a new language called Medicare Supplemental Plans, or Medicare Advantage Plans…

Medicare Advantage Plans (Medicare Part C- Think of C for Combination)

Medicare Advantage plans are run by private companies. Here in Orange County, you’ve probably heard of companies like ~ Aetna, Anthem, Blue Shield, Humana, Scan, or AARP/United Healthcare, and there are more. These are all companies that offer Medicare Advantage plans you can choose from.

They combine coverage for certain hospital costs, doctor visits, and most include the required Part D (drug) coverage at no additional cost. In most plans you choose a primary doctor and your doctor has access to specialists within their group. Most plans offer additional benefits not offered by Original Medicare for example, Dental, Vision, Hearing, and Gym Memberships. Many Advantage plans here is Orange County have $0 monthly costs. The Advantage plans offer Out-of-pocket limits which is your financial protection.

YOU MUST CONTINUE TO PAY YOUR ORIGINAL PART B MONTHLY PREMIUMS.

Medicare Supplement Plans (Medi-Gap)

Medi-Gap plans do what the name implies, they fill in the Gaps of Medical Coverage that are not covered by Original Medicare A & B. This type of plan works along with your Original Medicare A & B. This can protect you against big financial exposure.

Medi-Gap plans are like a PPO, but more choices. You can see any doctor throughout the U.S. as long as the doctor participates with Original Medicare A & B. This solution does not require a referral from a doctor. There is a monthly cost for a supplemental plan and YOU MUST CONTINUE TO PAY YOUR ORIGINAL PART B MONTHLY PREMIUMS. Unlike the Advantage plans, on a Medi-Gap plan, you are required to enroll with a separate Part D (Prescription drug) plan. Medi-Gap plans offer greater Freedom, but it comes with a monthly cost.


HAVE YOU HEARD OF THE BIRTHDAY RULE?

For those of you that already understand all the basics above, here is something you may not already know…If you currently have a Medi-Gap Supplemental plan in place, during your birthday month, you can change from one company to another.

It must be “like" plans or lesser. Example from a Supplemental Plan F to another (equal plan F), or a Supplemental Plan F down to a Plan G (a slightly lower premium plan that just has a yearly deductible of $183).

Why would you do this? Well, did you get a Birthday card that wasn’t so nice indicating your new monthly costs will be higher because you are now a year older?

The great news is that you're able to make a move and not stuck with a higher payment. You do not lose ANY of your same doctors. You do not have to answer health questions. Its a simple process and worth a quick phone call during your bday month. If you wait until after your birthday, it will be too late.

Here is an example ~ If you are age 70, living in Orange County

Using the Birthday Rule, if these are lower than you are paying, you can make a change and save money.

Plan F current rate $206/month
Plan G current rate $175.91/month
Plan N current rate $136/month

Hope this was helpful.

I love helping Seniors understand and enroll with Medicare and in the plan that fits their needs. Feel free to contact me directly, or attend one of my Medicare 101 Educational meetings at Mission Hospital offered every month.

PS. Be sure to work with a local Medicare Insurance “Broker” to get a comparison on more than one company, and more than one plan in just one visit. Find someone that is familiar with doctors in your area. We get paid by the insurance companies so there is No Cost to you. We still make House calls!

Denice Merrill

Merrill Insurance Services, Inc.
Specializing in Medicare Plan Choices with over
12 Years Experience.
She can reached by calling
949-388-7332
CA LIC# 0D99790

Latest News

Unique Boutique: Doheny Clothing Exchange

Business Showcase Sorbet Mag

Unique Boutique: Doheny Clothing Exchange

Certain things in life I am very grateful for. These things include chocolate, wine, soul music ...

THE ART OF FALSETTO

Entertainment Sorbet Mag

THE ART  OF FALSETTO

“The gypsy cri-i-i-ied…” Lou Christie – The Gypsy Cried Was the voice you heard a high pitched female alto, a ...

Segerstrom Center for the Arts and Attila Glatz Concert Productions Proudly Announce Salute to Vi…

Entertainment Sorbet Mag

Segerstrom Center for the Arts  and Attila Glatz Concert Productions  Proudly Announce  Salute to Vienna New Year’s Concert

Celebrate the arrival of 2018 in spectacular style with Salute to Vienna New Year’s Concert at Segerstrom Cente...

Sanctuary Home Furnishings byRenaissance

Business Showcase Sorbet Mag

Sanctuary  Home Furnishings  byRenaissance

Last spring, with the “immense assistance of my design and sales team,” Owner Dennis Penman completely redesign...

Paris in a Cup: French Flair, Lunch Fare, Great Gifts and Holiday “SpecialTeas!”

Business Showcase Sorbet Mag

Paris in a Cup:   French Flair, Lunch Fare, Great Gifts and Holiday “SpecialTeas!”

Paris in a Cup is a transporting experience. That is to say, once inside, you’re in Paris. Segmented into two u...

Mobile Dental USA. Bringing the Dentist to You!

Health & Wellness Jody Robinson

Mobile Dental USA. Bringing the Dentist to You!

Serving private residences/homesNursing homesCorporate buildingsVeterans’ communities There are countless thin...

The “Mindful Mover’s” Wish List

Health & Wellness The ALIGN Pilates & Yoga Team

The  “Mindful Mover’s” Wish List

The holiday season has arrived! But what to do about that perfect gift? Well, if there’s a special someone in y...

Living with Lymphedema. Benefits of Quality Medical Compression Garments

Health & Wellness Livia De Los Rios

Living with Lymphedema. Benefits of Quality Medical Compression Garments

The word “lymphedema” means swelling (edema) that results from the pooling of too much lymph fluid in areas of ...

Finding Body Harmony with Health Works Juice Bistro

Business Showcase Sorbet Mag

Finding Body Harmony with Health Works Juice Bistro

A symphony orchestra is typically comprised of seventy to one hundred musicians. Depending on the work being pl...

Less Bluster, More Bustle. Finding Your Way in the Windy City

Travel Jody Robinson

Less Bluster, More Bustle. Finding Your Way in the Windy  City

My first introduction to the city of Chicago was the 1995 film While You Were Sleeping. B-roll of the city’s sk...

Chicago Eats. Distinctive Dining Destinations

Dining Out Sorbet Mag

Chicago Eats.    Distinctive Dining Destinations

312 Chicago136 N. La Salle Street Old World charm and authentic Italian cuisine is at its finest in the heart ...

Addressing Depression - Naturally

Health & Wellness Mary McPherson

Addressing Depression - Naturally

Depression does not discriminate based on your social standing, how much money you have in your bank account, y...

Battling the Isolation Crisis with ALYCEMates

Health & Wellness Jody Robinson

Battling the Isolation Crisis with ALYCEMates

When one contemplates the term “health crisis,” images from the 1995 medical disaster movie Outbreak come to mi...

A Mission for Michael: Setting a New Standard for Recovery

Health & Wellness Sorbet Mag

A Mission for Michael:  Setting a New Standard  for Recovery

Historically, great change has been associated with fire. A great crucible, reforming lives beneath the purifyi...

Pets of the Month

Home Life Jody Robinson

Pets of the Month

This scruffy little guy is King, a four year old cutie who is hoping to meet his match. While King enjoys playi...

Sad Songs, Heartaches and Tragedies

Entertainment Joe D

Sad Songs, Heartaches and Tragedies

“What in the world’s come over you…?” Jack Scott, “What in the World’s Come Over You” The lyrics of the 1950’s...

The Towers at Laguna Wood Willage

Home Life Sorbet Mag

The Towers at Laguna Wood Willage

Ask any resident of The Towers why he or she moved there and you’ll get a similar response: “I was ready to giv...

SOKA Performing Arts Center presents TenPints New Music Series - John Welsh Band - Latin Reggae

Entertainment Sorbet Mag

SOKA Performing Arts Center presents TenPints New Music Series - John Welsh Band - Latin Reggae

Friday, October 20, 2017 @8:00 PM John Welsh Band creates a sound that blends high energy Latin, West African...

Business Showcase: Shamrock Windows and Doors. Insulating Your Investment and Installing a View of t…

Business Showcase Sorbet Mag

Business Showcase: Shamrock Windows and Doors. Insulating Your Investment and Installing a View of the Future

Average temperatures in White Bear Lake, Minnesota range from -6 degrees Fahrenheit to 106. It isn’t difficult ...

Platinum Pacific. Your Retirement Community Leader in Quality Remodels

Business Showcase Jody Robinson

Platinum  Pacific. Your Retirement Community Leader  in Quality Remodels

There has been a surge in popularity over the past decade in the field of home renovation. At first, it was sim...

Prev Next