Medicare has two parts – Part A and Part B. Part A covers hospitalization (‘inpatient’) and Part B covers medical services (doctor visits, ‘outpatient’, etc.) Medicare does not cover prescription drugs, dental care, vision care or hearing aids. Medicare Prescription Drug Plans (sometimes referred as Part D) are offered through private insurance companies and plans approved by Medicare.

Medicare Supplement policies require you to be enrolled in Medicare Parts A & B. You can enroll in a Medicare Supplement during your initial enrollment period which is the six month period that begins the first day of the month in which you are 65 or older and enrolled in Medicare Part B. If you enroll in a Medicare Supplement during this period, your enrollment is guaranteed and you are not subject to underwriting criteria that is otherwise applicable to Medicare Supplement applicants. There are also Special Enrollment Periods for such things as if your employer coverage is ending or you are now enrolling in Part B after deferring enrollment. In other circumstances, you may enroll or change your Medicare Supplement coverage but it will be subject to underwriting and can be denied.

Most doctors are assigned with Medicare and will see any Medicare patients. Some doctors are not assigned with Medicare but will accept Medicare pricing and standards. Doctors may also opt-out of Medicare . These opt-out doctors do not accept Medicare patients or pricing and file no claims with Medicare. If you are treated by a doctor who has opted out of Medicare, you do so at your own cost. In this circumstance, a Medicare Supplement will not reimburse you for your medical expenses.

Thanks for asking!!! As a licensed independent insurance agency, Feder Insurance is paid commission by the insurance companies with whom we place your insurance coverage. Because most commissions are within a similar range, it makes us indifferent as to with whom we place your coverage. More important, we are guided by one simple rule – we do what is best for you. We know the market extremely well and will suggest companies that best match your needs with the best product, coverage and customer service. We must be doing something right and continue to earn your trust – our business has grown largely as a result of your referrals. We thank you for that!!!

Medicare Part A (hospitalization) usually costs $0 (if you or a spouse has worked 14 quarters and paid into FICA). Part B (medical services) has a premium cost of $135.50 per month charged by Medicare. Individuals who are considered high wage earners by Medicare will pay an increased amount (IRMA – ‘Income-related monthly adjustment’).

Medicare uses your US Federal Tax Returns (with a two year look back) to determine if you will be charged an additional amount for your Medicare Part B. In 2019, individuals with a modified adjusted gross income of $85,000 (single) or $170,000 (joint) reported on your 2017 tax return will pay an IRMA (income-related monthly adjustment). See the IRMA information published by Medicare on our web site.

Medicare has very precise rules as to when you must have Part B and when you can defer enrollment in Part B without penalty. At age 65, you must have Medicare Part B if you are retired, or if you or your spouse are working and your employer has less than 20 employees even if you are covered by a group health plan. If you or your spouse are working and your employer has 20 or more employees your employer group health plan will be your primary coverage and you may defer Medicare Part B. For more information see ‘Who Pays First’ brochure published by Medicare.

A Medicare Supplement (also known as Medigap) works as secondary coverage to original Medicare and provides reimbursement for medical expenses not fully paid by Medicare. There are different levels of coverage in standard Medicare Supplement Plans offered by private insurance companies. The key feature of Medicare Supplement plans is that you may seek medical care from any doctor or facility anywhere which accepts Medicare patients. There is no Network of providers that you must follow.

Medicare Advantage plans (sometimes known as Medicare Part C) are Medicare-approved health plans offered by private insurance companies that provide healthcare coverage at least as broad as Medicare and often include Prescription Drug coverage. With a Medicare Advantage plan, your healthcare is no longer provided by original Medicare but now with a private insurance company who stands in place of Medicare (you must however continue to be enrolled in Medicare Parts A & B). The Medicare Advantage policy defines your healthcare coverage and benefits and may require you to seek medical care from a network of providers. Healthcare claims are filed directly with the Medicare Advantage insurer, not with Medicare.

Medicare Advantage plans also require you be enrolled in Medicare Part A & B. There are very definite times when Medicare Advantage enrollment is available. You may enroll in a MA plan 3 months before or after your 65th birthday or Part B enrollment. You can also enroll in a new MA plan every year during the Medicare Annual Enrollment Period (October 15 to December 7). MA plans have a calendar term of January 1 through December 31 of each year. Except for end stage renal disease, there are no underwriting restrictions for MA plans.

The requirement for Prescription Drug Plans (‘PDP’) is that you must be enrolled in Medicare Part A and/or Part B to be eligible. Medicare PDP (also called Part D plans) are standalone drug plans offered by private insurance companies approved by Medicare. You may enroll in a PDP plan 3 months before or after your 65th birthday or Part A enrollment. You can also enroll in a new PDP plan every year during the Medicare Annual Enrollment Period (October 15 to December 7). PDP plans have a calendar term of January 1 through December 31 of each year.

Be aware that you could face a late enrollment penalty if you do not enroll in a Medicare prescription drug plan when you’re initially eligible for Medicare, or if you go without prescription drug coverage that covers as much or more than a Medicare drug plan for more than 63 continuous days after you’re eligible.

You can change your Medicare Supplement plan at any time, however you may be subject to underwriting restrictions and be denied coverage. You cannot be dropped by a Medicare Supplement plan in any circumstances except for non-payment of premium.

You can change a Medicare Advantage plan annually during the Annual Enrollment Period (October 15 through December 7).

This is the single-most source of much confusion – so pay attention: If you or your spouse are working and you are covered under an employer group health insurance policy the size of your employer determines if you must have Medicare Part B. If your employer has less than 20 employees, Medicare is primary and you must have your Part B coverage. After you turn age 65, when you incur medical costs, Medicare will be your insurance, not your employer health insurance plan.

If you or your spouse work for an employer of 20 employees or more and are covered under the employer’s group health insurance plan, you may defer enrollment in Medicare Part B. In this circumstance, if after age 65 you incur medical costs, the claim will be filed with your employer group health insurance company and not Medicare.

Thanks for asking!!! As a licensed independent insurance agency, Feder Insurance is paid commission by the insurance companies with whom we place your insurance coverage. Because most commissions are within a similar range, it makes us indifferent as to with whom we place your coverage. More important, we are guided by one simple rule – we do what is best for you. We know the market extremely well and will suggest companies that best match your needs with the best product, coverage and customer service. We must be doing something right and continue to earn your trust – our business has grown largely as a result of your referrals. We thank you for that!!!