UPDATED Mar. 3, 2019. The new video Turning 65? Critical Medicare Decisions you Need to Make has been released on our YouTube channel. It is a Part II of our series “Turning 65? 2019 Guide to Medicare.”
Here is the script of video “Turning 65? 2019 Guide to Medicare Part II: Critical Medicare Decisions you Need to Make.” Find more on which Medicare plan is right for you from Compare Medicare Plans.
The Script for the video “Turning 65? 2019 Guide to Medicare: Critical Medicare Decisions You Need to Make.”
This program is for people turning 65 who are ready to enroll in Medicare. Here is Part II of your 2019 Guide to MEDICARE – EXPLAINED SIMPLY!
There are several Critical Medicare Decisions you need to make before enrollment. This presentation will help you to address these decisions.
My name is Gregory Lazarev, and I am the President of Liberty Medicare. Liberty Medicare is a licensed independent insurance agency specializing in various Medicare plans for people above age 65 or on disability. For many years we are helping people in many US states compare, select and enroll in the BEST Medicare plans.
You’ll find in this video not only the traditional Medicare information but also plenty of important details and tips rarely available elsewhere.
Closed Captions are available, please use it at your convenience.
Take a look at this picture – it shows the complex nature of Medicare. As you may imagine, it is NOT EASY to deal with it!
In this presentation, we’ll describe the steps to help you make the most important Medicare decisions. This framework provides an excellent starting point if you are turning 65 and are new to Medicare.
Let’s get started!
Here are your decision-making steps
Step 1: Do you need Medicare Part B? This is the critical step; it has a substantial impact on your subsequent decisions.
Step 2: Which Medicare plan meets your needs? You may select Original Medicare and add to it a Prescription Drug Plan and (optionally) a Medicare Supplement Plan.
Alternatively, you may select a Medicare Advantage Plan which typically includes a Prescription Drug Plan.
Step 3: Do you want or need Medicare prescription drug coverage?
Step 4: Do you want or need a Medicare Supplement (Medigap) policy?
Let’s review each of these steps.
Your first and probably most important Medicare choice will be whether or not you need Medicare Part B coverage.
If you elect to keep Part B coverage, you will be entitled to all Medicare Part B services.
Medicare Part B is not mandatory.
In deciding whether to keep Part B, the following factors should be considered:
- Can you justify paying the Part B premium ($135.50 in 2019)?
- Are you or your spouse currently working? Are you now covered by an employer or union group health plan based on your current employment status?
If you are currently working and covered by an employer health plan, you may want to consider delaying Part B enrollment. You will NOT be penalized for a delay under these special circumstances.
- Will you be ready to enroll in a Medicare Supplement (Medigap) within 6-months of enrolling in Medicare Part B? This consideration is very essential because of the Medigap Open Enrollment – time when you may enroll in a Medigap plan without Medical Underwriting.
If there is no particular reason why you should delay enrollment, you should keep Part B.
Delaying enrollment until the next General Enrollment Period will result in a penalty for as long as you have Part B.
The penalty is quite severe: 10% for each 12-month period in which you were entitled to Part B coverage, but did not enroll).
If you have made the decision to keep Medicare Part B, you now need to decide what Medicare plan type is the best for you.
In other words, you need to compare Original Medicare with Medicare Advantage.
This is a crucial Medicare choice – like the decision whether to keep Part B; a wrong decision may be difficult to reverse.
To help you decide between Original Medicare and Medicare Advantage, consider their advantages and disadvantages.
Benefits of Original Medicare
- Freedom to choose any doctor or hospital that accepts Medicare. There are no network constraints imposed by the provider (typical in an HMO plan) or by location.
- You are not required to obtain a referral.
- It is not a subject to annual contracts that may be changed or discontinued.
- It may be complemented with a Medicare Part D plan.
- It may be complemented with a Medicare Supplement Plan (Medigap Plan) to protect against catastrophic out-of-pocket expenses incurred while on Parts A and B of Original Medicare.
- Buying a Medigap policy limits your out-of-pocket expenses.
- It works with other insurances (such as your work insurance) and assistance programs.
Disadvantages of Original Medicare
- Out-of-pocket expenses (deductibles, copayments, or coinsurance) can be very high. For example, the Part A deductible is $1,364 per benefit period.
- It does not provide additional benefits, such as dental, vision and hearing services.
To avoid these disadvantages, here is the suggested SOLUTION:
- To enroll either in Medicare Advantage (Part C) or in a Medicare Supplement Plan
- Both of them are sold by private insurance vendors; to be eligible to enroll, you must have both Part A and Part B
Benefits of Medicare Advantage
- Medicare Advantage Plans must cover all of the services that Original Medicare covers. The plan can choose not to cover the costs of services that aren’t medically necessary under Medicare.
- Medicare Advantage provides comprehensive services for a premium that may be lower in comparison with the combination of Medicare Supplement and Prescription Drug plans. $0 premium plans may be available in your area.
- Beneficiaries with pre-existing conditions will not be denied enrollment or charged increased premiums. There are no health questions asked, and acceptance into Medicare Advantage is guaranteed (except for the beneficiaries with ESRD).
- Plans may include extra services not covered by Original Medicare, such as dental, vision and hearing coverage, fitness center membership, etc.
- Most of the plans include Prescription Drug Coverage (known as Part D) in addition to Hospital and Medical benefits.
Disadvantages of Medicare Advantage
- You are always responsible for copayments and coinsurances, and sometimes even for deductibles. Therefore, the cost could be quite high. There is an out-of-pocket limit of $6,700/year.
- Your choice of doctors/hospitals is limited by the provider network within a specific geographic area. Members are required to pay an increased cost, sometimes up to the full cost, for services outside the provider network.
- Medicare providers may not always accept Medicare Advantage plans so your choices may be limited. Some doctors and hospitals do not participate in any Medicare Advantage plans, and others participate only in a selected few.
- Many plans require referrals for specialists and other services.
- Medicare Advantage plans may change every year. Such changes may affect your premium, deductibles, copayments/coinsurances, and the scope of extra services.
Recommend Tips for Choosing Medicare Plans
- Consider enrolling in a Medicare Advantage Plan as long as you are healthy and willing to stay within the plan’s network. Remember that as you increase your use of the services (which typically happens the older we become), your out-of-pocket expenses will start to exceed any premium savings.
- Otherwise, select Original Medicare and complement it with a Medicare Supplement (Medigap) policy. In the case of serious illness, without Medigap stop-loss protection, you may incur very high medical bills.
This diagram illustrates our selection dilemma: Original Medicare vs. Medicare Advantage.
You may select either Original Medicare (Part A and B) or Medicare Advantage Plan with or without the Prescription Plan.
The choice of Original Medicare allows you to add stand-alone drug coverage, as well as a Medicare Supplement plan filling gaps in Original Medicare.
Do you need to enroll in Medicare Part D?
- Always enroll in Medicare Part D (Medicare Prescription Drug Plan or PDP) unless you have other Creditable Prescription Drug Coverage.
- If you do not enroll in Medicare Part D when you are first eligible and go without a creditable prescription drug coverage for 63 or more continuous days, you may have to pay the penalty if you decide to join later. The penalty is 1% of the average PDP monthly premium for every month of delay.
Two ways to enroll in Medicare Part D:
- If you are enrolled in Original Medicare, then you may enroll in the stand-alone Medicare Prescription Drug Plan (PDP)
- If you are enrolled in Medicare Advantage, be sure that prescription drug coverage is a part of the Medicare Advantage Plan (MAPD)
Should you enroll in a Medigap Policy?
- The prime purpose of Medicare Supplement Insurance (also known as Medigap) is to fill the gaps in Parts A and B of Original Medicare. Medicare Supplement Plans (Medigap Plans) provide protection against potential future (catastrophic) losses for Original Medicare out-of-pocket expenses such as:
- Deductibles (Part A and Part B)
- Copayments/ coinsurances (Part B: 20%)
- Excess charges
Medicare Supplement benefits are paid for by Medicare Supplement insurance after Medicare has paid its share of the bill.
- Medicare Supplement Plans are plans sold by private insurance companies who are licensed in your state.
- There is no network in the Medicare Supplement. As in Original Medicare, you may visit any doctor or hospital as long as your doctor accepts Medicare. Original Medicare is your PRIMARY coverage. The doctor must accept a Medicare Medigap plan. This is your SECONDARY coverage.
- All Medicare Supplement plans (Medigap plans) are guaranteed renewable even if you have health problems. In other words, the insurance company cannot cancel your policy as long as you pay the premium.
- Medicare Supplement provides some extra benefits that are not a part of Original Medicare, such as foreign travel emergency. Several companies provide additional benefits, such as pharmacy savings, vision discount, access to fitness facilities (such as Silver Sneakers), nurse health line, etc.
- Medicare Supplement plans DO NOT include prescription drug coverage – you must buy that separately.
The best time to enroll in a Medicare Supplement Plan is during the Open Enrollment Period. This is the six-month period after you’ve applied for Medicare Part B. During this time, the insurance company cannot deny you any insurance policy it sells, cannot delay your coverage, and cannot raise their rates based on your medical history.
If you apply for a Medigap policy after the Open Enrollment Period, insurance companies in most States may use medical underwriting. Medical Underwriting will determine whether to accept your application, raise your rate, and/or impose a pre-existing condition waiting period.
You should enroll in a Medigap policy (Medicare Supplement plan) because it gives you peace of mind from the financial exposure of Original Medicare out-of-pocket costs. They can be significant!.
Note, however, that you may not need a Medigap insurance policy if you have other coverage, such as employer group health insurance.
Now a couple words about LibertyMedicare and how it may help you in the selection of your Medicare Plans.
- Liberty Medicare is a full service, licensed independent insurance agency specializing in various Medicare plans (i.e., Medicare Supplement, Medicare Advantage and Medicare Prescription Drug Plans) for people above age 65 or on disability.
- Our services are offered in many states, including six Mid-Atlantic states (Pennsylvania, New Jersey, New York, Maryland, Virginia, and Delaware), and two Midwest states (Illinois and Ohio).
- There is NO CHARGE for our service – it is absolutely free for you Independent insurance agencies like ours are provided a commission from the insurance companies whenever we enroll an individual in one of their plans. Whether you apply to an insurance company directly on your own or if you apply through us, your premium will be EXACTLY the same – a commission charge is always part of the premium.
- We only represent well-established and nationally known providers doing business within the states we represent
- We provide a Lifetime Commitment as long as you have a policy with us, including Policy Maintenance and suggestions at Renewal Time, particularly at the Annual Enrollment Period at the end of the year when many seniors change their plan for the next year.
- We help you select and enroll into one or several Medicare Plans that are the BEST FIT FOR YOU. This is a rare opportunity for you, the consumer, to get all the benefits of an agency without any additional costs.
- Medicare is a complex and confusing subject. The experience of selecting and maintaining a Medicare plan on your own can be very frustrating. Rather than individually calling numerous health insurance companies – where you will often endlessly sit on hold only to tell your story multiple times to multiple people – you can instead dial one number: 877-657-7477. Our 8-years of business experience MAY save you time and money, and help you to avoid future surprises and disappointments.
- Contact us by visiting our website (www.libertymedicare.com), or by sending us the e-mail at firstname.lastname@example.org. You also may call us at 657.7477.
- Our Liberty Medicare channel in one stop shop for all your Medicare needs – Original Medicare, Medicare Supplement (Medigap) plans, Medicare Advantage plans and Prescription Drug plans.
- Which Medicare Plan is right for you? For more information on Critical Medicare Decisions and on how to Compare Medicare Plans visit our webpage: https://libertymedicare.com/medicare-plans/compare-medicare-plans/
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