Medicare 1 2 3
As seniors age into Medicare, many are confused because they are inundated with US mail, phone calls, emails, and friends recommending what they have.
This blog will try to clear up some misunderstandings and provide clear, concise information about Medicare.
1. What is Medicare, and why does it have so many parts?
a. Medicare is senior health insurance for those over 65 and those disabled for 24 months regardless of their age.
b. Medicare has four (4) parts. Parts A, B, D and C. Part A is hospitalization. Parts A & B are considered Original Medicare and include Parts A & B. Under Part A you can go to any hospital, anywhere in the US, that takes Medicare. Hospitalization services, as stated above, fall under Part A. You have been paying for Part A under your social security payment thus there is no additional charge for Part A unless you don’t have the 40 quarters to qualify for no charge Part A. There are provisions based on quarters worked so you can buy into Part A. Part B is any service done as an outpatient, meaning doctor, lab, X-Ray, and urgent care that is done outside the hospital. You pay for Part B either directly to social security or if you are collecting social security, it automatically comes out of your social security payment. Part D is for drug plans. Even if you do not take any medications you are required by law to have a drug plan. They are either standalone plans or come with the Medicare Advantage Plans.
Part C includes Parts A, B & D under private insurance and are called Medicare Advantage Prescription Drug plans or MAPD plans for short. These plans are offered by insurance companies directly to you and often have additional benefits like transportation, gym membership, Chiropractic or Podiatrists services do not offer under Original Medicare.
Enrollment periods are very confusing for seniors. You can enroll in Medicare, three months before, the month of and three months after your birthday month. That is your option because to enroll, you must have Parts A & B. Many seniors, if
they are still working, opt to take only Part A. That is very confusing and I will explain below.
If you decide to take only Part A because you are still working, I’d suggest you follow the information because it is very confusing.
If you work for a company with more than 20 employees. You can stay on your group health plan if the HR department tells you the group plans are considered creditable under Medicare regulations. Simply put the drug plan must have copays for various drug tiers. If you have a high-deductible plan or HSA plan that is not considered creditable coverage under Medicare rules. You should get annually a letter from your employer stating you have creditable insurance and creditable drug coverage. (Medicare is only Parts A & B and doesn’t realize all other plans offer drug coverage. Avoid any confusion and get that letter stating it as suggested above.
If you work for a company with less than 20 employees. You must go onto Medicare when you turn 65 or be subject to lifetime fines for not having Part B. (10% of the Part B premium includes any income surcharges). I must either go to the supplement and drug plan or MAPD route. Once all of that is sorted out you still must decide if you want any additional plans to add to Parts A & B.
Original Medicare and standalone drug plan. I do not recommend this option because Original Medicare has no maximum out-of-pocket. Meaning if the bill is $300,000 you owe 20% or $60,000. If the facility or doctor does not take Medicare Assignment of benefits you owe the 15% that Medicare disallowed. Not a good option.
Medicare supplements and standalone drug plan. The supplement is an addition to Original Medicare and picks up 20% that Medicare doesn’t pay and any other charges. There is a small Part B deductible but everything else is covered. You must have a drug plan. You can buy that separately. Many people chose this route because you can see any doctor,
go to any hospital in the United States that takes Medicare. There is a cost associated with the supplemental plan and drug plans so consider this the Cadillac option.
Medicare Advantage Plans or MAPD plans. This is a very popular option for seniors because the plans usually do not have a monthly premium and offer significant ancillary benefits as discussed previously. Over 150,000 seniors in Clark County use these plans and they are very popular. You must be careful to confirm your doctors and medications are covered in the plan and that the cost of the drugs is reasonable.
2. How do I choose a plan that’s right for me?
It makes sense to have an independent broker assist you in choosing the best plan for you. Their services are free because they are paid for by the insurance company. All MAPD plans pay the same amount, so impartiality is given. With the supplements, all carriers pay differently so ask the broker why they chose that specific plan for you. Listen to what they say so you can decide which plans work best for you. I personally want to insure all their doctors and all their medications covered by the plan with the best pricing as well. That is the only way to choose a plan for your prospect. In Clark County there are 84 different MAPD plans available and it is a daunting task for the average senior to figure it out. Use a broker and it will be worth your while.
3. Can I Add a Supplement to Original Medicare? Yes, and getting a standalone drug plan is another option. You now can see any doctor, go to any hospital and have almost the entire bill paid between Medicare and your supplement. You should know that the price of the supplement rises annually. I personally have a supplement due to Rheumatoid Arthritis which requires medications administered in the doctor’s office, so the supplement is the least expensive approach. Between Original Medicare and my supplement, I pay nothing for the medication. If you want the freedom to see any doctor, then the supplement plans are your best option.
I hope this clears up any concerns or issues relating to choosing the best Medicare option for you but like most things, there will be questions. Please feel free to either call me, email me or set up an appointment to meet and get answers to your questions. There is no obligation on your part to buy from me. Of course, I would like your business, but you are free to choose another broker or agent to help you.
My credentials are 23 years as a Medicare broker here in Las Vegas and not having one complaint or issue against me on that time. I carry Errors and Omission insurance in the event there is an issue but to-date, no issues or complaints, or claims. Member of NAIFA (National Association of Independent Financial Advisors) and NABIP (National Association of Benefits and Insurance Professionals).
Also, you may want to take a look at 2026 Medicare Information.
The Barend Agency Inc. Len Barend, broker 702-250-2200
