Who Needs Medicare Insurance?

When you near 65, you need to begin considering Medicare. You need to sign up about three months before your 65th birthday, but you can plan ahead for which options you will choose. Medicare is a set of insurance plans designed specifically for older Americans, but many people with disabilities and some people who have experienced kidney failure qualify. 

The options bit refers to the parts of Medicare. The original plan includes Part A and Part B, but the updated Medicare also has Part C and Part D and Medigap (supplemental insurance). The latter comes from private insurance companies like Family Insurance Associates of Ruidoso, NM.

Through Social Security, you enroll in the original Medicare to obtain hospital and medical coverage. Part A covers hospital stays or short stays at a nursing home after a hospital stay. It also provides limited coverage for hospice or home health care. This comes free if you worked and paid Medicare taxes during your time as an employee. Part B covers doctor visits, outpatient and home health care, selected preventative services and some durable medical equipment. This you pay a premium to obtain.

Part C, also called Medicare Advantage, includes Part A and Part B coverages as well as dental, hearing, and vision insurance. It also provides prescription drug coverage. Everything comes in one bundle.
Part D provides prescription drug coverage. You might want to add D to A and B, but if you choose C, you do not also need A, B, and D because they are all in C.

The supplemental plans sold by private insurance companies still have to follow Medicare rules. The supplemental plans aka Medigap pay coinsurance, copays, and deductibles.
You only get a six-month window to apply. It begins three months before your 65th birthday and expires three months after it. If you do not jump on your registration for the coverage then, you must wait for a special enrollment period.

You can just accept the free Part A or apply for Parts A and B, but B comes with a premium. You can turn down B, then change your mind later, but you will pay more in premiums. For every 12-month period that you do not enroll in Part B, your premiums increase 10 percent. Each year, there is a general enrollment period from January 1 through March 31. Coverage does not start immediately but on July 1 of the same year. You can use Medicare with your employer’s insurance and your Health Savings Account (HSA).

So, Medicare is for those who have reached the age of 65 or have a disability. Part A comes free. All other parts cost money. Those who can afford Part C coverage obtain full medical coverage plus prescription medication coverage. You also add just Part B to get help with doctor visits or Part D to cover just prescription drugs. Your choices depend on your income.

Let Family Insurance Associates of Ruidoso, NM help you choose the Medicare plan that best suits your needs. While Medicare is eventually for everyone, the parts you need differ from those your neighbors might. Contact us today to make the right choice for your financial and medical future.

What is Medicare Supplemental Insurance?

As the baby boomers get older now, many people are reaching the age of 65, which is when they qualify for Medicare. There are four categories of Medicare coverage that are called “Parts,” and with a letter, as in Part A, B, C, and D. The decisions about Medicare are complicated. It is best to work with your agent at Family Insurance Associates, serving Ruidoso, NM, and the surrounding area to understand your choices better.

Here are the usage areas of the categories:

  • Part A — Hospital Costs
  • Part B — Medical Costs
  • Part C — Medicare Advantage
  • Part D — Medicare Prescription Drug Coverage

Americans, who paid enough payroll taxes (for more than 30 quarters) during their lifetime, qualify for the free Medicare — Part A. This is also called “premium-free Part A.” All you need do is apply for Medicare when you turn 65 to get these benefits.

If you are admitted to a hospital, you will pay a $1,408 deductible (as of February 2020) for each insured period of a year. There are no co-insurance payments (co-pays) for the first 60 days of your hospital stay.

From day 61, you will pay a co-pay of $352 per day up to 90 days. From day 91, you will pay a co-pay of $704 per day for up to the maximum lifetime reserve days of a total of 60 days. Lifetime reserve days are those days that exceed the period limits reserved for your entire lifetime. After you use up your 60 lifetime reserve days, you have to pay for all hospital costs.

Medicare Supplemental Insurance

The other Medicare coverage offered under Medicare Part B, C, and D requires that you pay a monthly premium to get the benefits. The premium for Part B, which allows you to see a doctor, who will accept the Medicare-approved amount for certain services, starts at $144.60 (as of February 2020) and goes up according to your income. The deductible is $198. The co-pays are usually 20% of the cost of medical services.

The monthly premiums and coverage for Part C and D vary by the plan. There are many programs to choose from for Part C and Part D. These are all called Medicare supplemental insurance. Contact your agent at Family Insurance Associates in Ruidoso, NM to discuss Medicare and Medicare supplemental insurance and to get a quote.

Qualifying for Medicare in Ruidoso, NM

You may wonder if you’re eligible for Medicare, especially when an insurance policy is so expensive. According to the American Association of Retired Persons (AARP), it’s expected that 79 million people will have Medicare by 2030. This rise may be attributed to the high number of individuals who are turning the age to collect these benefit. Family Insurance Associates, serving Ruidoso, NM and the surrounding area, helps individuals understand when they’re eligible as well as other specifics regarding Medicare. 

Age Plays a Role

Generally, you can’t receive Medicare unless you’re 65 or older. At this age, you’re eligible for part A, which is hospital insurance. Additionally, you qualify for part B, which is your standard medical insurance. Moreover, if you’re eligible for these two plans, you also can receive a prescription plan, more commonly known as a Part D plan. A spouse who isn’t working may collect at age 62. 

How Long You Worked

You have to work at least 10 years to qualify for Medicare benefits. You have to earn at least 40 credits. You earn each credit by working for a quarter. You can still qualify for Medicare if you don’t have enough credits; however, it’ll affect how much you have to pay for your premium. 

Certain Disabilities

If you have certain disabilities, you may qualify for Medicare, even if you’re not 65 or don’t have a spouse who’s 65 or over. You must qualify for Social Security Disability to also qualify for Medicare. Before you can apply for Medicare, you have to collect either certain Railroad Retirement Board benefits or Social Security Disability benefits for at least two years. 

Certain Diseases

You may qualify for Medicare based on your medical conditions, such as end-stage renal disease or amyotrophic lateral sclerosis (ALS). You may even utilize your Medicare benefits at the same time as your disability benefits. 

Discuss Medicare benefits with an insurance professional from Family Insurance Associates, serving Ruidoso, NM and the surrounding region, by contacting us at 575-257-6146. 

 

What Factors Do You Need to Consider When Selecting a Medicare Insurance Plan?

Selecting the right Medicare insurance plan or supplemental plan is not always easy. Many people get confused about the differences between policies, what is covered, and what coverage they need. Here at Family Insurance Associates, serving the Ruidoso, NM area, we want to help make the process as easy as possible. Here are a few of the factors you should consider when you are looking to purchase a Medicare insurance plan or supplemental plan. 

Coverage

One of the first things you need to do when considering a Medicare insurance plan is to understand the coverage. Different parts and supplemental plans have different types of coverage. One part may cover prescriptions, while another may cover hospital stays. Think about what coverage you already have or do not have with a private medical plan and then look for a policy that fills in the gaps that you need. 

Out-Of-Pocket Expenses

Next, look at any out-of-pocket expenses you may have with a plan, including co-pays and deductibles. You need to ensure you can afford the out-of-pocket costs that go along with the plan you are selecting. 

The Star Rating

Lastly, look at the star rating of the plan. The star rating is a rating from both providers and customers related to the plan. The rating is based on customer service, coverage, the plan’s quality, and how well people feel the plan performs for them. This is sort of like a review, allowing you to see how other people rate this specific plan. 

At Family Insurance Associates, serving the greater Ruidoso, NM area, we can sit down with you and discuss your medical insurance needs and help you select the right Medicare insurance plan for you. Give us a call now to schedule your appointment. 

Making Sense of Medigap Plans and MACRA

Medicare Supplement Plans C & F are not going to be available to new enrollees from 2020. December 31st, 2019 will be the last day when anybody eligible will be able to buy Medigap policies C & F. Many Medicare recipients among who chose to buy Medigap Policies chose Plan F in past as it has been the most comprehensive Medigap Plan. The reason for these plans going away is Medicare Access & CHIP Reauthorization Act of 2015 (MACRA). Starting 2020, Section 401 of MACRA will prohibit sale of Medigap Policies that cover Part B deductibles to newly eligible Medicare beneficiaries.
Some people who know Plan F, they think it is a big deal. Medicare Plan F is well-liked because it pays for all the gaps in Original Medicare Part A and Part B, including both your hospital and outpatient deductible as well as the co-insurance. It even pays the 20% that Medicare Part B does not cover. This means zero out-of-pocket for you at the doctor’s office.
People who buy Plan F on or before December 31st, 2019 can renew Plan F every year lifelong, provided there are no further law changes.
Some Insurance carriers also offer Plan F high deductible – that means you must pay the deductible before Plan F pays. Plan F High deductible serves a different financial purpose for some enrollees and because of the deductible it is clearly not the most comprehensive plan.
From 2020 the most comprehensive plan available will be Plan G, which at this time second most comprehensive plan after Plan F, Plan G does not cover part B deductible. Plan C is in the middle tier when you talk about comprehensiveness of the plan. Plan D has almost similar coverage to Plan C except for Part B (Doctors Office and Outpatient services) deductible. Do not get confused between Medigap Plan D vs Medicare Part D – which is Prescription Drug Coverage Plan. None of the Medigap plans give you Prescription drug coverage.


As you can see in above graphic Medicare supplement Plan F has been the most comprehensive Plan as well as simplest to learn about as it has the most checks in all the Medigap plan tabulations you see. As 2020 nears you will see scare tactics from people who might tell you to switch out of Plan F as it is going away, simultaneously you will see scare tactics from other people who will try you to switch to Plan F before it goes away.
Everybody’s financial situation is different, we advise you to choose a plan that makes most financial sense to you.
Feel free to use our Quoting platform below and find out what makes sense. For calculations, 2018 Part B deductible is $183/- per year. As a reminder – Part F & G also covers 100% of Part B excess charges, which is the difference between what a doctor charges and the amount Medicare Part B will approve.

Medicare Supplement Plan Quotes
Medicare Supplement Plan Quotes

Guide to Medicare Supplement Plans

Why Medicare Supplement?

Medicare Part A & B (referred here as Original Medicare) do not cover everything, though these pay for many healthcare services & supplies. Medicare supplement Plans, offered through private insurers, help cover certain costs that Original Medicare does not cover. These might include coinsurance, yearly deductibles & copayments. Certain Medicare supplement plans also help with coverage for a few services that Original Medicare does not pay for, such as emergency overseas travel or Part B excess charges.

Can I get Medicare supplement plan without having Original Medicare?

Medicare Supplement Plans supplement Original Medicare, you can not get Medicare Supplement Plans unless you are enrolled in Original Medicare. Original Medicare will pay first, and your Medigap policy fills in the cost gap. For example, for a Hospital visit if you are charged $10,000/- Original Medicare will pay 80% or $8000/- and Medicare Supplement Plan or Medigap plan might pay remaining 20% or $2000/-, depending on the plan coverage as you have the option of multiple different types of Medicare Supplement Plans. As these plans help cover the gaps in Original Medicare these plans are also commonly called as Medigap Plans.

What are different Medicare Supplement Plans and what do these plans cover?

Medicare Supplement (Medigap) Plans are standardized. The chart below explains the plan coverage. A check mark means the Medigap Plan covers 100% of the described benefit, a percentage denotes the percentage coverage and blank means the plan does not cover that benefit.

What is not covered by Medigap Plans?

Medigap plans generally do not cover Long-term care (care in a nursing home), Routine vision or dental care, Hearing aids, Eyeglasses, Private-duty nursing & Prescription drugs. Also, Medicare Supplement Plans are not Medicare Advantage Plans, you may want talk to our knowledgeable agents if you need information about Medicare Advantage plans.
We can assist you in getting Long Term Care Plans, Vision & Dental Plans, Hearing Plans & Prescription drug plans. Talk to our knowledgeable Agents if you need assistance with any of the above.

What else do I need to know about Medicare Supplement Plans?

To recap you must have Medicare Part A and Part B to get a Medicare Supplement plan.
A Medicare Supplement plan can only cover one person, so if you are married, you and your spouse would need to buy separate policies.
You can usually use your Medicare Supplement plan with any provider that accepts Medicare. However, some types of Medigap plans known as Medicare SELECT plans require you to only use doctors and hospitals in provider network.
Not all types of Medicare Supplement plans may be available in your zip code.
Premium amounts may vary by plan and location, even for the same standardized benefits.
In general, Medicare Supplement plans are guaranteed renewable as long as you continue to pay your premium.

This is not an all inclusive guide, however can help you in deciding what medicare supplement plan to choose. If you are wondering how much these plans cost please feel free to use our Quoting platform below. The link will open in a new window.
Medicare Supplement Plan Quotes
Medicare Supplement Plan Quotes

Guide to Medicare Plans

 

Eligibility for Medicare Plans

You should be 65  years  of  age  and  older  OR under 65 years and receiving disability benefits from Social Security Administration (SSA) or Railroad Retirement Board (RRB).  For people with ALS (Lou Gehrig’s Disease) – Must  receive  these  benefits  for  24  months before eligibility for Medicare OR Under 65 years and diagnosed with End Stage Renal Disease.

Medicare Eligibility

Enrollment into Medicare

Enrollment  into  Medicare ie either Automatic or By Application.

AUTOMATIC  ENROLLMENT: If  already  receiving: Social  Security  Benefits , Social  Security  Disability or Railroad  Retirement  Benefits. Beneficiary  will  receive  Medicare  card  3  months  BEFORE  benefits  are  to  begin.

ENROLLMENT  BY  APPLICATION: If  not  already  receiving  benefits  – beneficiary  applies  through  Social  Security Administration either 3  months  before  turning  65 or in the month  beneficiary  turns  65  or 3  months  after  turning  65. This  is  called  the  Initial Enrollment Period.

Medicare Enrollment

You may delay enrolling  into  Medicare  if you or your  spouse is actively employed AND is covered under group health insurance policy based on active employment. This  is  called  Delayed Enrollment. You may later enroll in medicare when: Employer Group Health Insurance ends. You have 8 Months to enroll.  This Eight Month period is called the Special Enrollment Period.

If you do not enroll during the Initial or Delayed Enrollment periods that is if  you miss your Initial Enrollment Period or your Special Enrollment Period, you get another chance to enroll between January 1st to March 31st of each year. Your coverage begins July 1st.  This is called General Enrollment and in this case you may have to pay a higher premium for late enrollment in Part A and/or a higher premium for late enrollment in Part B.

Original Medicare

Medicare Part A helps pay for Hospital or inpatient stay. Medicare Part B helps pay for Doctor Visits & outpatient services.

Medicare Part A & B

 

Medicare Plans are Available through Private Insurers. In New Mexico we can help you find the best plan for your needs through Aetna, BCBS of NM, Cigna, Humana, UnitedHealthcare (AARP) and Presbyterian Insurance.

Medicare Plan Explanation Source: UnitedHealthcare

Please click below for Medicare Supplement Plan Quotes

Medicare Supplement Plan Quotes
Medicare Supplement Plan Quotes

 

For Medicare Advantage Plan Quotes & Medicare Prescription Plan Quotes Please call our agents at NM Insure Phone: 575.257.6146