expertise & RESOURCES when you need it the most

Three months prior to your Medicare eligibility date  is the time you want to consider what insurance plan is best for your situation in addition to prescription drug coverage.  If you are age 65, your Medicare begins the 1st day your birth month regardless of the day your birthday falls (or the 25th month from your disability).  This page will give you information on Medicare basics, but we recommend you talk to an agent in your service area.  Please contact us for a name of an agent in your service area. There is no cost to you to work with an agent.


There are several parts to Medicare.

Part A is the hospital plan that also pays for limited home health visits and hospice care. Part B is the partial payment of doctors' care, tests, and other services.  The Social Security Administration withholds a monthly fee for Part B which automatically comes out of your social security check. Depending on when you first applied for Part B and your current income, the fee for this part varies. If you are not collecting social security, but you are eligible for Part B, then you will be billed quarterly for Part B.  Low income individuals may be eligible for a subsidy that pays the cost of the Part B Premium. Please contact us to determine if you are eligible and learn how to apply.

If you do not enroll in Part B when you are first eligible, you will be assessed a 10% penalty for every year that you did not enroll in Part B. This is a permanent penalty, which can be costly. There is an exception to this rule. If you are enrolled in an employer-sponsored health insurance plan either through your employer or your spouse's employer which is considered creditable coverage.  Once you retire or your spouse retires, you will then have a Special Election Period in which to enroll in Part B without penalty. You always want to check with your employer's benefits department if your existing coverage will remain the same, or if you are required to enroll in Part B. This is very important to insure that you are not penalized later for a late enrollment.  If you a Veteran, please read our page on Veterans and Medicare to see how Part B applies to you.

Medicare Part A and Part B have deductibles and co-pays that can be expensive (see the Part A & B Deductibles below) .  Enrolling in either a supplemental insurance plan or Advantage Plan is typically a good idea to help fill in the financial gaps. Medicare Supplements (Medi-Gap)  works with original Medicare and typically pays the remaining 20% of Part B and 100% of the Part A deductibles. These plans are often referred to a Medigap Plans or Medicare Supplements. The advantage is you typically don't have any co-pays and typically don't have to be concerned about networks. Co-insurance and deductibles vary, depending your State and available plans. As of January 1, 2020, newly eligible beneficiaries will no longer be able to enroll in supplements that pay the annual Part B deductible. If you became eligible for Part A prior to January 1, 2020, you can still elect to choose a plan that covers the Part B annual deductible.


Medi-Gap policy disadvantages are higher premiums and full underwriting unless you enrolled during your initial open enrollment period (when you first became eligible for Medicare). This often makes it difficult for seniors to switch insurance carriers if they have had any health issues making them un-insurable.  Medicare Advantage Plans were designed to help with this situation.


Medicare Advantage Plans (also referred to as Part C or MA plans) no longer have health questions. Since January 1, 2021,  if you have end-stage renal disease (kidney failure requiring dialysis) you may now enroll in a Medicare Advantage plan. Prior to 2021, this was the only health question.  Medicare Advantage Plans are subsidized by the federal government which typically means your monthly premiums are lower (and sometimes $0) but you may have a co-pay or co-insurance. This is also called "cost sharing".


Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs (which original Medicare does not) . Most plans offer a drug plan with the health coverage but there are plans that offer only the health coverage without drug coverage. This is a great option for Veterans who utilize the VA Medical Center for their primary services. Our page Veterans and Medicare explains this.  Advantage plans come in a variety of plans like HMO, HMO-POS, PPO, and PFFS. It can be confusing of which plan is right for you. Please contact us to request a free consultation to help determine which plan is right for you.  With MA plans, you do not retain Original Medicare, the insurance company becomes the primary payor, not Medicare, like traditional supplemental plans.


There are also "Cost Plans" which are a "hybrid" plan. You retain Medicare and you have choice of higher co-pays and lower premiums or a higher premium without co-pays. Cost Plans also offer extra coverage, such as vision, hearing, and wellness programs that make it a great alternative for many. The Affordable Care Act put an end to these plans as of January 1, 2019 unless you reside in an area in which there are limited options of Medicare insurance plans. 

The main thing to remember is that plans and rules can change each year. It is especially important to be sure that your doctor accepts the plan and/or is in the "network".  We recommend speaking to a licensed agent that can help you sort through the plans and help you decide what is best for you. Contact us  to request a free, no-obligation consultation and/or quote.

Part D (Prescription Drug Plans)

Part D is the prescription drug plan which can either be a stand-alone drug plan (if enrolled in a Medicare Supplement, a Cost Plan, or PFFS plan), or integrated with your health plan. Medicare Advantage Plans (referred to as Part C), the drug coverage is  part of your health plan.  When you are first eligible for Medicare, you must enroll in a Part D plan or you will be penalized 1% for each month in which you were eligible for one, but did not enroll. This is a permanent penalty and could be very costly. The one exception to this rule, is if you are a Veteran utilizing the VA Medical Center...this is considered "creditable coverage" and you do not need to enroll in a prescription drug plan. Veterans, we have a special Medicare page which may be helpful to read.  Again, if you are enrolled in an employer's plan, this rule would not apply if the coverage is creditable or comparable.


In 2025, there will be a Maximum Out of Pocket on prescriptions of $2000 and the coverage gap will cease.


If you are low-income, you may qualify for Extra Help.  Follow this link to learn more:  https://secure.ssa.gov/i1020/start

Enrollment Periods

Annually:
The Annual Election Period to select a different health and prescription drug plan is between October 15th and December 7th of each year. Your new plan then begins Jan 1st of the next year.


Are there other time periods to enroll?

Yes. You may be eligible to enroll during a Special Enrollment Period due to special circumstances. Circumstances like moving outside of your current service area, employment, a plan being dropped,losing Medical Assistance or a low-income drug subsidy, etc.

In addition, each year from January 1 to March 31 (Open Enrollment Period), beneficiaries enrolled in Medicare Advantage Plans with prescription drug coverage (MAPD plans) can switch to a different MAPD plan. This is a ONE time enrollment into a different advantage plan. However, you cannot enroll in a stand-alone prescription drug plan unless you disenrolled from an advantage plan to return to Original Medicare.  You can disenroll from your advantage plan and return to Original Medicare during AEP (October 15-Dec 7th) or during OEP (January 1 to March 31). 


Eligibility Before Age 65

If you have received either Social Security Disability Income or Supplemental Security Income for the past two years, you will first be eligible for Medicare Part B on the 25th month of collecting disability benefits. You then choose either a Medicare Advantage Plan or a Medicare Supplement insurance plan. Some states only allow you to enroll in a Medicare Advantage plan. States that allows you to apply for Medicare and purchase a supplemental (Medigap) policy include:

California*, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts,  Michigan, Minnesota, Mississippi, Missouri, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Vermont*, Wisconsin


*In California, and Vermont, a Medigap policy is not available to those under the age of 65 with  End-State Renal Disease (ESRD).

Also, if you qualify to collect disability income from the Railroad Retirement Board you qualify for Medicare early.

#1 Question we receive from people on disability is "Can I keep my Affordable Care Act plan that I'm currently enrolled in and not accept Medicare?"
Answer: No, you cannot. When you are eligible for Medicare, you must accept Medicare (A, B, and enroll in a drug plan). The only exception is if you are on a spouse's employer-sponsored plan and can remain on that plan. Always check with your spouse's benefit department as rules are different if it's a small business employer or an over 100 employee-company. Read more about penalties on Part B and Part D on this web page, or contact us for assistance with your specific situation.


Premiums and Deductibles for Part A & B for 2024:

If you are new to Medicare in 2024 most people will pay a rate of $174.70 per month

2024 Income-Related Monthly Adjustment Amounts (IRMAA) forPart B Premium:

This is based on your modified adjusted gross income reported on last year's tax return. These figures are adjusted yearly and you will receive a noticed from Social Security Administration each November of your monthly premium for the following year.


Part B Monthly Premium; Individual Filers Yearly Income:
Individuals greater than $103,000 and less than or equal to $129,000; Part B premium is $244.60
Individuals greater than $129,000 and less than or equal to $161,000; Part B premium is $349.40
Individuals greater than $161,000 and less than or equal to $193,000; Part B premium is $454.20
Individuals greater than $193,000 and less than $500,000; Part B premium is $559.00
Individuals greater than or equal to $500,000; Part B premium is $594.00 per month

Part B Monthly Premium;  Yearly Income for Married and Filing Jointly:
Couples greater than $206,000 and less than or equal to $258,000; Part B premium is $244.60
Couples greater than $258,000 and less than $322,000; Part B premium is $349.40
Couples greater than $322,000 and less than $386,000; Part B premium is $454.20
Couples greater than $386,000 and less than $750,000; Part B premium is $559.00
Couples greater than or equal to $750,000 income; Part B premium is $594.00 per month

Part B Premium; Married and Live with Spouse at any time during year but file Separate Tax Returns:
Greater than $103,000 and less than $397,000; Part B premium is $559.00
Greater than or equal to $397,000; Part B premium is $594.00



2024  Part A & B Deductibles  & Co-Pays:


Part A Inpatient Hospital Deductible:
Hospital Coinsurance (per stay in a 60 day benefit period): $1632
61-90 days: $408 per day
91-150 days: $816 per day

 Skilled Nursing Facility Care Coinsurance (days 1-20) $0; Days 21-100 $204 per day

Part B Physician’s Deductible (per year) $240


NOTE: Medicare Supplements (prior to 01/01/2020) and Medicare Advantage plans may pay a portion or all of these deductibles. Please see your Summary of Benefits or Evidence of Coverage for plan specific details.


2024 Part D Premium Increases:

Medicare uses your modified adjusted gross income from the previous tax return to determine if you pay more for your prescription drug coverage.


If your filing status and yearly income is...

Individual Filer $103,000 or less - you pay only your drug premium per month

above $103,000 up to $129,000 - you pay $12.90 + your plan premium per month

above $129,000 up to $161,000 you pay $33.30 + your plan premium per month

above $161,000 up to $193,000 you pay $53.80 + your plan premium per month

above $193,000 and less than $500,000 you pay $74.20 + your plan premium per month

$500,000 or above you pay $81.00 + your plan premium per month


Married Filer $206,000 or less - you pay only your drug premium per month
above $206,000 up to $258,000 - you pay $12.90 + your plan premium per month
above $258,000 up to $322,000 you pay $33.30 + your plan premium per month
above $322,000 up to $386,000 you pay $53.80 + your plan premium per month
above $386,000 and less than $750,000 you pay $74.20 + your plan premium per month
$750,000 or above you pay $81.00 + your plan premium per month


Married & Separate Tax Returns above $103,000 and less than $397,000, you pay $74.20 + your plan premium per month.  $397,000 and above, you pay $81.00 + your plan premium per month.


Part B Coverage for Immunosuppresive drugs:

Since 2023, certain Medicare enrollees who are 36 months post kidney transplant, and therefore are no longer eligible for full Medicare coverage, can elect to continue Part B coverage of immunosuppressive drugs by paying a premium. For 2023, the immunosuppressive drug premium is $103.00. High income earners will pay more. Contact us for the chart.


QUESTIONS OR NEED ADVICE?

Please contact us  to speak or email a licensed agent in your region. There is no cost or obligation.





We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE or your local State Health Insurance Program (SHIP) to get information on all of your options.

UNDERSTANDING MEDICARE


Medicare (not to be confused with Medicaid) is the health-insurance plan that is available to people 65 years of age and older and for people with a long-term disability. Medicaid is the medical assistance program available for low-income individuals.

2024 BRINGS HIGHER PREMIUMS!


Part B Premium for 2024 will be $174.70/mo


High Income Earners will pay more as well

-- check it out below.