Medicare Made Easy

How Can Your Current Medicare Plan Change Next Year?

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 20:57:55 GMT

Many people are reluctant to change their Medicare Part D or Medicare Advantage plan coverage year-to-year.

However, millions of Medicare beneficiaries will see significant changes in their Medicare costs and coverage.

If you are staying with your current Medicare plan into next year, please be sure to review your plan’s Annual Notice of Change (ANOC) letter and use this list to help you look for important coverage changes that might impact your coverage next year.

And remember, there are no health-related questions should you decide to change your Medicare Advantage plan or Medicare prescription drug plan (however, Medicare Advantage Special Needs Plans require that you meet the plan’s specific “need”).

Your Medicare Plan May No Longer Be Offered Next Year

Many folks are currently enrolled in a Medicare Advantage plan (MA or MAPD) that will no longer be available next year. We can help you determine what will be happening with the plans you are looking at, or the ones you are currently enrolled in.

You May Be Automatically Reassigned to a Different Medicare Plan Next Year

Every year, many people enrolled in Medicare Advantage and/or Part D Standalone plans are automatically "crosswalked" into another plan for next year. Normally, you will be notified if you are in this group but we are more than happy to help you know for sure.

Your Medicare Plan May Change It's Name

Sometimes, your Medicare plan (no matter what type it is) may be changing its name. Along with a name change, it could also have different features.

Your Monthly Medicare Part D Premium May Be Increasing

Many Medicare beneficiaries will see their monthly Medicare Part D premium increase 20% or more. Some people currently enrolled in a Part D plan will see their plan premium double next year. The good news is that there is a group of people that will see a premium decrease of 10% to 63% next year.

Please keep in mind that in addition to lower-premium Part D plans, there may be low- or $0 premium Medicare Advantage plans (MAPDs) available in your area.

Your Plan’s Initial Deductible May Increase

Typically, the Medicare Part D deductible increases year-over-year. The exact amount can also depend on your situation.

Your Medicare plan’s Initial Coverage Limit (ICL) may change

Almost all stand-alone 2022 Medicare Part D plans use the standard Initial Coverage Limit (ICL), though some 2022 Medicare Advantage plans offer an ICL other than the standard, ranging higher and lower.

Your drug plan’s ICL sets the boundary between your Medicare Part D plan’s Initial Coverage Phase and the Donut Hole or Coverage Gap. The ICL is measured by the total retail value of your prescription drug purchases. You can contact American Senior Benefits for detailed information on the Medicare Advantage plans that have an increased or decreased Initial Coverage Limit.

Your Medicare Plan’s Cost-Sharing Can Vary Significantly Between “Preferred” and “Standard” Network Pharmacies

Year-over-year, certain stand-alone Medicare prescription drug plans (PDPs) will use different cost-sharing for preferred vs. standard network pharmacies. As an example, your plan might have a co-payment of $0 for a Tier 1 medication at preferred network pharmacies and, for the same Tier 1 drug, a $5 co-pay when purchased at a standard network pharmacy.

Your Medicare Advantage plan's Maximum Out-of-Pocket (MOOP) Limit May Change

The Medicare Advantage plan MOOP threshold limits how much you will spend on co-payments and co-insurance for in-network, eligible Medicare Part A and Part B coverage. It can often change year-over-year for plans and it is important to be aware of these changes.

The Bottom Line for Medicare Enrollees

If you decide to stay with your current Medicare Part D or Medicare Advantage plan into next year– AND you understand how your Medicare plan is changing – you do not need to do anything – you will be automatically re-enrolled into your Medicare plan along with any changes your plan is making for the coming year.

If your Medicare plan is being terminated in coming year and you are not merged or “crosswalked” to another Medicare plan, you may be without Medicare plan coverage on January 1st.

We are always happy to clear up any confusion when it comes to these Medicare changes that you should be aware of, so please feel free to reach out whichever way is most preferable for you.

How to Compare Medicare Advantage Plans

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 20:49:27 GMT

When it comes to Medicare Advantage plans, there are several factors to consider. Comparing these plans and knowing what to look at are crucial steps. Keep reading to learn more about Medicare Advantage plans, along with how they work, and what you should consider when comparing the different plan options.

A variety of benefits is offered by Medicare Advantage, which is also called Medicare Part C. Some people prefer the convenience offered by having all their drug and health benefits covered under one plan rather than enrolling in the stand-alone Medicare Part D coverage. Someone may also be looking for additional benefits that the original Medicare plan does not cover, like routine dental and vision coverage.

Keep reading to learn more about Medicare Advantage plans, along with how they work, along with what should be considered when comparing the different plan options.

What is a Medicare Advantage Plan?

A Medicare Advantage plan is an alternative to Original Medicare, which includes Part A and Part B. Rather than having Medicare benefits provided through a government-run program, people who receive the coverage can obtain it through a Medicare Advantage plan, which is provided by private insurance companies that have been contracted with Medicare.

For someone to be eligible to receive Medicare Part C, they must:

Currently have Part A and Part B Medicare coverage
Reside in the service area for the Medicare Advantage plan being considered
Not be end-stage renal disease patients (there are a few exceptions)

According to the law, all the Medicare Advantage plans are required to offer, at a minimum, the same amount of coverage as the original Medicare Part A and Part B Plans. However, some plans will cover other benefits, too, like dental, vision, hearing, prescription drugs, or specific health wellness programs.

Unlike the original Medicare plans, if someone wants prescription drug benefits, which is provided by Medicare Part D, they should not enroll in a separate Medicare Prescription Drug Plan. A better option is to get the benefit from one of the Medicare Advantage Prescription Drug plans. Not all Medicare Advantage plans will include coverage for prescription drugs, so it is a good idea to double-check with the particular plan being considered.

Tips for Comparing Medicare Advantage Plans

Since Medicare Advantage plans are provided through any Medicare-approved private insurance company, the cost and the benefits may vary from one plan to another. Also, not all plans will be available in every location. When someone is comparing the Medicare Advantage plan options, there are several things they need to consider.

Does the Monthly Premium Provide a Good Value?

Some of the Medicare Advantage plans will have premiums that are $0; however, the individual must continue to pay their Medicare Part B premium, along with deductibles, coinsurance, and copayments, that the plan requires.

What is the Annual Deductible for you?

Are Any Additional Benefits Included?

It is also important to consider if additional benefits are offered. This would include things like routine hearing, dental, vision, and other health or wellness plans.

Also, find out if a prescription drug is included. Are the existing medications a person takes included with the plan’s formulary or the list of drugs that are covered?

Is There a Provider Network Included

If it does have a network, it is essential to find out if a person’s current doctors and their health care providers are included.

What Is the Plan’s Star Rating?

A star rating is one way to determine the performance of the Medicare Advantage plan. Every plan receives a rating of one to five stars. Five stars is the highest rating that a plan can receive. Medicare evaluates all plans based on the five-star rating system, and these scores are calculated yearly.

Choosing the Right Medicare Plan for you

Each person is unique. This means it is necessary to research each of the Medicare Advantage plan options available and how it works with a person’s budget and health needs. Remember, plan costs, provider networks, services areas, and benefits can all change from one year to another, so it is smart to review a person’s coverage regularly to ensure the plan still works. Take some time to shop around and choose a plan that will help you save the most money.

I hope that you learned some valuable information from this article. Choosing a Medicare Advantage plan is a big deal, as you usually won’t be able to change it for up to a year. So you will have whatever coverage you choose for that period. If you find the plan doesn’t cover what you need, you will be stuck paying for it out of pocket.

If you think you know someone who might benefit from this article, please share button it. If you'd like to talk about these things or anything else you might have questions about, please contact us whichever way is most comfortable for you.

What Are the Original Medicare Coverage Gaps?

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 20:42:26 GMT

Original Medicare includes Part A and Part B coverage. It provides many medical and hospital services. While this is true, a person will also have to pay the cost-sharing amounts based on Medicare standards. There are some medical costs that Original Medicare will not cover.

Coverage Gaps in Original Medicare

One of the primary coverage gaps that occur in Original Medicare is coverage for prescription drugs. Some people do not realize that Medicare Part A and Part B coverage will not cover most of the prescription medications that are taken home.

Usually, Medicare Part A will cover medications a person receives when they are an inpatient at a skilled nursing facility or a hospital. Sometimes, Medicare Part B will provide limited outpatient coverage for some of the prescriptions a person takes that they receive from the doctor’s office, such as chemotherapy or intravenous drugs.

Keep reading below to see the costs that, in most cases, are not covered by Original Medicare.

Usually, Original Medicare will not cover the following costs:

Health coverage for individuals outside the country
Routine vision services like contacts, glasses, or eye exams
Nursing home care
Routine hearing care services, including hearing aids
Routine dental services like fillings, dentures, cleanings, or oral exams
Routine foot care

Cost Sharing with Original Medicare

Even if you are receiving services covered by Medicare, there are limits to the coverage provided. It will be necessary for a person to pay out of their own pocket for these “gaps” in coverage.

For example, with Medicare Part A, a person may receive full coverage for treatment from a skilled nursing facility for the initial 20 days of every benefit period. After that point, an individual must pay the daily coinsurance rate if the stay at the nursing facility extends from 21 up to 100 days. Past day 101, a person’s Medicare coverage is used, and a person must pay all related costs unless they have another type of coverage.

Cost-sharing will usually include expenses such as:

Part A deductible
Part A coinsurance costs
Part B copayment and coinsurance costs
Part B deductible

Medicare Supplement insurance plans may help offset some of these costs, but it is dependent on the plan that is purchased. It is also necessary to be aware that Original Medicare does not have any out-of-pocket limit during the year. There is no limit to the medical costs each year, even if the expenses result in hundreds of thousands of dollars in fees.

What Are the Solutions to Medicare Coverage Gaps?

There are a few options when someone is trying to avoid the coverage gaps seen with Medicare plans. For example, if a person wants to remain with their Original Medicare coverage by receive assistance with cost shaving along with coverage gaps, then Medicare Supplement insurance is a smart investment. Private insurance companies sell this, and the plans will work with Original Medicare plans to cover some out-of-pocket costs, such as deductibles and copayments.

If you need assistance covering prescription drug costs, I can help you look into Medicare Part D coverage. This is a stand-alone plan that will help with medication costs. It is a good idea to enroll when someone is initially eligible for Part D, or someone may owe a late-enrollment penalty when a person signs up.

Another viable option is to have Part A or Part B services provided through Medicare Advantage plans. This is an alternative method to receive the Original Medicare benefits, as these plans deliver both Part A and B benefits through a private insurance company that is Medicare-approved. Even if someone enrolls in a Medicare Advantage plan, they are still in the Medicare program.

Some Medicare Advantage plans will also cover additional benefits, such as hearing services, dental care, vision care, prescription drugs, and specific wellness programs. An added benefit of Medicare Advantage plans is that they have a maximum out-of-pocket limit, which means there is a cap on the out-of-pocket costs. The limit could vary from one plan to the next.

In many cases, Medicare will work with other insurance types, such as retiree insurance, employer-based coverage, and veteran benefits. The types of coverage may help and fill in some of the gaps present in Medicare insurance. Take time to consider all the factors mentioned here to find the right plan for a your needs and budget, as this is going to pay off in the long run.

Don't leave your Medicare to Chance

Coverage gaps can be a scary thing, since they tend to surprise people who chose coverage without being fully informed. When you choose to work with my team, we take your needs and concerns as the first consideration. We show you plans that avoid coverage gaps and give you options based on what you need.

If you feel this article helped you, please share it! And if you have any questions, you can contact me and I will personally answer any question you have.

Overview of Your Medicare Costs (Part 1)

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 20:36:17 GMT

If you’ve done a little bit of research, you probably have realized that Medicare isn’t going to be free. You will still have expenses related to the level of coverage you have, as well as the type of plans you choose. Choosing Original Medicare or Medicare Advantage is one of these choices for example.

In this article, we will provide an overview of your Medicare costs. This will be Part 1 of 2, so keep your eyes out for Part 2 soon! We will start with the Part A Premium. If you aren’t familiar with Part A includes, you can read about it here.

Part A Premium

The majority of Medicare patients don’t pay monthly premiums for their Part A plans as long as they have been paying Medicare taxes for over 40 quarters. Patients who have paid Medicare taxes for fewer than 30 quarters over their working lives will pay $458 per month. Those who have paid into Medicare for 30 to 39 quarters will pay $252.

Medicare-eligible patients may also face 10% higher premiums if they do not enroll in the program as soon as they are eligible. They will continue to pay this higher premium for twice as many years as they have had access to Part A insurance but failed to sign up.

Part A Deductible and Coinsurance

Before reading on, note that all the information below pertains to original Medicare. Policyholders with Medicare Advantage Plans will also have all of these services covered by insurance, but the costs vary by plan. The deductible and coinsurance, as dictated by Medicare, also tend to increase every year.

There is a total deductible cost for Part A during each per benefit period. It will typically increase year-over-year. There are no coinsurance costs for days 1-60 of care in each period.

On days 61-90, there is a set coinsurance per day.

On days 91 and beyond, the coinsurance cost increases from the rate for days 61-90. Beyond that, patients should expect to pay all costs for coinsurance.

Exceptions to the Rule

There are some exceptions to this rule. They include alternate provisions for home health care, hospice care, hospital inpatient stays, and mental health inpatient stays.

Home Health Care/ Hospice Care

Policyholders who require home health care will pay out-of-pocket for 20% off their durable medical equipment (DME). Medicare will cover the full cost of services.

Hospice patients are also held to slightly different standards under Medicare Part A. They should expect to make copayments of $5 or less for prescription drugs while in the home and 5% of the cost of inpatient respite care. Medicare doesn’t cover room and board in non-hospital facilities for hospice patients. Non-hospital facilities include private homes, nursing homes, and long-term care facilities.

Not all prescription drugs are covered under Part A. If a prescription drug intended to provide relief for pain or symptoms is not covered by hospice benefits, providers should contact the patient’s Medicare Part D insurance provider to investigate other options for coverage.

Hospital and Mental Health Inpatient Stays

While in the hospital, Medicare policyholders should expect to pay for optional services. These can include private-duty nursing, television or phone access, and private rooms that are not deemed medically necessary.

Otherwise, Medicare costs will be the same as those associated with outpatient care. Patients will have $0 coinsurance for days 1-60 in each benefit period.

For days 61-90, the co-insurance will increase.

And then from days 91 and beyond, the coinsurance will typically increase again until lifetime reserve limits have been met. Once this happens, you'll be responsible for all costs.

Those in the hospital for mental health care will need to pay for 20% of the services provided by doctors and others in this setting. Otherwise, the deductible and coinsurance costs remain the same as those for inpatient hospital stays.

There is no limit to benefit periods for mental health coverage in general hospitals. Patients treated in psychiatric hospitals can also have multiple benefit periods. There is, however, a lifetime limit of 190 days.

Skilled Nursing Facilities

Medicare Part A will pay for 100% of the cost of skilled nursing services for the first 1-20 days for each benefit period. Patients will be charged a coinsurance payment for days 21-100 and will be responsible for paying all costs if the stay is over 100 days.

Stay tuned for Part 2, which will go over the Part B cost overview. While not all of this information may apply to you in this moment, needs can change over time and it is important to be aware of what your expenses may look like if/when that day comes. As always, I am here to help address any concerns or questions you have.

I hope this article helped you – and if it did, please share it with someone who may also benefit.

Overview of Your Medicare Costs (Part 2)

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 20:28:48 GMT

When it comes to healthcare, being prepared is always a great idea. Birthday surprises are good! Medical surprises are not so good. By learning about what your costs may look like ahead of time, you will be ahead of the curve and ready when the time comes to be enrolled.

Monthly Part B Premiums

Policyholders should expert their Part B premiums to vary depending on the family’s income.

The cost of the Income Related Monthly Adjustment Amount (IRMAA) will be based on the policyholder’s modified adjusted gross income (AGI) from the tax year two years prior to enrollment.

Those who make less than $87,000 as individuals or $174,000 as part of a married couple that files jointly will not have to pay the IRMAA. Other this limit, the cost of the IRMAA continues to rise according to the policyholder’s income bracket.

Patients who fail to enroll in Part B when they become eligible can also expect to pay a 10% higher premium for each full 12-month period that the policyholder went without Part B coverage. Those who want to enroll in Part B may also have to wait until the General Enrollment Period to sign up for coverage.

Thing to know about Part B Deductibles and Coinsurance

Before reading on, please note that the costs described below apply only to policyholders who have original Medicare. Medicare Advantage Plans cover all the same services, but the costs vary by plan. Some policyholders will pay more for services and others will pay less. Deductibles also vary by plan.

The Part B deductible is a yearly deductible that usually increases every year. Once patients have met this yearly deductible, they should expect to pay 20% of the cost of covered services. The coinsurance applies to inpatient and outpatient services, DME, and therapy costs. Medicare will cover 100% of clinical laboratory services and home healthcare services.

The cost of the Income Related Monthly Adjustment Amount (IRMAA) will be based on the policyholder’s modified adjusted gross income (AGI) from the tax year two years prior to enrollment. Typically, most individuals or couples (filing jointly) people will fall into a bracket that results in them not having to pay the IRMAA adjustment amount. Please contact me and I can help you determine which bracket you are in, and if you'll have to pay the adjustment.

Home Health, Medical, and Other Services

Medicare will cover 100% of the cost of approved home healthcare services. However, patients will be responsible for paying 20% of the cost of approved durable medical equipment.

Expect to pay 20% of the cost of Medicare-approved doctor services, including most inpatient services. Policyholders will also be responsible for 20% of outpatient therapy costs and 20% of durable medical equipment costs.

Outpatient Mental Health Services

Medicare Part B policyholders will pay nothing out-of-pocket for yearly depression screenings. They will, however, have to pay 20% of the cost of all visits to doctors or other care providers for diagnosis or treatment of depression or other mental health conditions should they choose to pursue it. Patients who receive services in hospital outpatient settings should also expect to make additional copayments or provide comparable coinsurance.

Partial Hospitalization for Mental Health Services

Part B policyholders should expect to pay for 20% off the care they receive from doctors and other providers in outpatient hospital settings. They may have to pay more for care received in a hospital that could have been provided in a doctor’s office. Policyholders who receive outpatient services in hospitals should note that the copayments for these services are capped at the inpatient deductible amount.

It’s also important to note that most patients will have to pay not just the doctor’s copayment but also the hospital’s copayment. Some preventative services don’t have copayments, in which case this is not applicable. When there is a copayment, it cannot be more than the hospital stay deductible for the same service as covered by Part A.

The Part B deductible also applies to all hospital outpatient services, with the exception of non-qualifying preventative services. Those who receive care in a critical access hospital should expect their copayments to be higher. They should also note that the cost is not capped and can exceed the cost of receiving comparable services during an inpatient hospital stay as covered by Part A.

Your Part C/ Part D Costs

There is a lot of variation in Part C premiums, deductibles, copayments, and coinsurance rates. Those interested in switching to a new Medicare Part C plan should compare the costs for each plan individually.

Medicare Part D covers prescription drugs, in particular. As with Part C, costs vary substantially depending on the plan. Higher-income policyholders should expect to pay income-related monthly adjustments to their plan premiums.

If Medicare-eligible patients go without prescription drug coverage for more than 62 consecutive days after the initial enrollment period without coverage, they may be subject to a late enrollment penalty. Expect to pay this penalty for the duration of the plan. The penalty will be based on the length of time patients went without either Part D or other credible prescription drug coverage. Those with Medicare Advantage Plans or other credible prescription drug coverage will not be charged a late enrollment penalty to enroll in Part D.

Each Part D plan has different deductibles, copayments, and coinsurance costs. Before enrolling in Part D, it is important to get help in comparing your best options. The consequence of trying to do it all on your own is ending up on the right plan at best. At worst, you could end up on a plan that doesn’t give you the coverage you need.

I hope this article helped you. This was just an overview of Medicare costs and should not be taken as a rule – your costs will likely be different. The goal is for you to be informed of what your expenses may look like, so you can prevent any surprises when it comes to Medicare.

If you have any questions about your costs that you would like me to answer, please get in contact with me through whichever means you prefer (phone call, text message, or email.)

When You Should Join Medicare

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 20:23:13 GMT

"When Should I Join Medicare to Avoid Penalties?"

What is the most common question when it comes to people approaching Medicare? “When Should I Join Medicare to Avoid Penalties?”

Most people are aware that there are penalties for not enrolling in time, but are not necessarily sure how these penalties are applied and the causes for being penalized. Like most things, sometimes Medicare gets pushed to the back burner. Last minute enrollments and plan changes potentially lead to some issues, and more often than not the penalties you may have heard of.

According to Medicare, folks must be enrolled in Medicare or another accepted insurance plan at the time of their 65th birthday. When you follow this rule, you can safely avoid facing the penalties that can cost you for years down the road. We find that most people are easily able to join Medicare when they turn 65, as they are aware that it is something they must do.

Enrolling in Medicare, for many people we help, involves signing up for Part A and Part B of Medicare. But, there are some special cases in which folks will already have been enrolled in these Parts of Medicare (A and B.)

The majority of people who will be enrolled in Medicare before their 65th birthday are the folks who have been using their Social Security for 4 months before they turn 65.

So, to answer the main question: Everyone has a seven month window in order to be enrolled in Medicare on time to avoid penalties. This window includes 3 months before your 65th birthday, the month of your birthday, and 3 months after your 65th birthday. As long as you enroll within this time frame, you will be able to avoid any sort of penalties that come with enrolling at the wrong time.

Avoiding Coverage Gaps

However, it is important to avoid coverage gaps. How do you avoid them? For example, most people who wait to enroll during, or after, their 65th birthday will experience a coverage gap. This happens because there is often a delay between enrolling in Medicare and actually having the coverage.

You can avoid these gaps by ensuring you begin the enrollment process about 3 months before your 65th birthday. When we work with folks, we take the time to find the exact plans that you will benefit most from. And then when you see these plans, it is best to not rush into the first plan you see. When you begin the process early, you can take time and make the most informed decisions for yourself.

Getting Help With Medicare

There are a few ways we can help you enroll in Medicare, or at least get started on the road to enrollment.

Fill out the Help Form

Simply fill out the contact form , and we will get back to you! We are happy to answer any questions and address any concerns folks have.

Contact us for 1-on-1 Help

Some folks just want to get answers quickly, and we are here to help. For those who don’t mind talking on the phone, we welcome you to call us. In a short 15-min conversation, you can learn what you need to know and get on the right track. We never force you to buy or enroll. We are here to inform you , so you can make the best decisions for yourself. (717) 609-9315 .

Getting Help With Medicare Costs

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 20:17:42 GMT

Enrolling in Medicare is process in itself. Most people will learn A LOT in the 1-3 month enrollment process. Before enrollment, most people are just aware that Medicare is something you get when you turn 65.

As you go through the enrollment process, you learn about the coverage types, plans, and your options. Probably the most important thing you will figure out is how much the coverage you want/need will cost you.

An unfortunate misconception that some people have is that Medicare is free. While some people will pay less (and others more), for most people Medicare will be an expense they will have to budget for. Depending on the coverage you have, you may have to pay for premiums, deductibles, and copayments among other things.

Again, it is important to know that what you will pay depends on your own situation. Just because your friend may be paying a certain amount for coverage, your costs aren’t necessarily going to be the same.

The good news is, that there are options for you to get help with your costs. Continue reading below to learn about ways to help with Medicare Costs.

How Medicaid Works in Pennsylvania

Medicaid is another word people approaching Medicare may have heard, but are not familiar with. Medicaid is actually a government program. For people who qualify, Medicaid helps with healthcare and medical costs for people. Sometimes, extra benefits can be included as well. Usually, people who qualify for Medicaid have a lower income.

So how can Medicare help with your costs? First, you must actually learn if you qualify. If you do qualify, then you can apply for Medicaid. We are happy to help you figure out if Medicaid is something you qualify for – please don’t hesitate to fill out the form above to let us know you need help.

If your income is higher, that doesn’t mean you don’t qualify for Medicaid. It is always important to check, as you could be missing out on savings by not looking into to Medicaid for yourself. Basically, this process mainly involves subtracting your medical expenses from your income. Once your income reaches a certain level, you can become eligible for Medicaid. Again, we are happy to help determine if you can apply for Medicaid.

What is the Medicare Savings Program?

In some situations, people can get help with their Medicare premiums. There are a handful of Medicare Savings Programs. KEYWAVE DIGITAL can help you determine which ones you qualify for and how to access them.

Each of these programs has their own conditions for qualifying. These conditions depend on your income levels, whether or not you are married, and even where you live.

Another important thing to know is that these programs differ in what they pay for. Some pay for both Part A and Part B Premiums, while others may only pay for Part A or Part B only.

The key takeaway is that even if you think you do not qualify for help, it is always worth looking in to. Finding out you could have been saving an extra $150 every month is not pleasant! If you need help determining what programs you qualify for, simply fill out the form above and we will personally reach out to learn about you and your needs.

Programs for All-Inclusive Care for the Elderly (PACE)

PACE is a government program, like Medicare and Medicaid, that helps people with their coverage and healthcare requirements. However, PACE helps people without the need for them to go to a care facility.

PACE programs provide you with healthcare services in your home, and also at local centers. Usually, the PACE organization will have it’s own network of providers that take care of the people enrolled in the program.

In order to qualify for PACE, you first need to be 55 years of age or older. Importantly, you must also live in the area of coverage for the particular program.

These programs are mainly for people who would otherwise need to be in a nursing home. As a result, another requirement for PACE is that you would need a level of care on par with a assisted living facility. The final requirement is that you would be able to live safely outside of a care facility with the help of the PACE program.

PACE covers nearly all of your potential healthcare requirements. These include, but are not limited to, dentistry, home care, lab services, physical therapy, and prescription drugs. This is not a comprehensive list.

To see if you are eligible for PACE, we can sit down and search for PACE programs available in your area. After that, we can determine if you are eligible or if there may be better options for you.

So how much does PACE cost? There is no one-size-fits-all answer. The cost depends on whether you are enrolled in Medicare or Medicaid (or both), as well as a few other factors. If you aren’t sure, never hesitate to reach out to us to get your questions answered.

You Have Options for Medicare Help

All in all, these are just a handful of the ways you can get help with your Medicare costs. The common thread for any program that helps with Medicare costs is that these programs depend on mainly your income, as well as a few other factors.

However, that isn’t to say that just because you have a decent income, you don’t qualify for help. If you are unsure, it is always a great idea to ask someone familiar with the ins-and-outs of Medicare. That way, you can be sure you are getting the most out your coverage and not paying any extra.

As always, I hope that this article helped you. And if you think it could help someone you know, please share this article. I am always here to answer questions you have about Medicare.

Using Your Drug Plan for the First Time

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 19:59:00 GMT

For many people, getting enrolled in Medicare seems to be the hard part. But, it isn’t completely smooth sailing after enrollment. There are some things you need to know before using your coverage. It isn’t complicated, but you should be aware of these things.

What Do You Need To Take With You?

Your Medicare Card
A Photo ID
Your Plan Membership Card

Automatic Refill Plans (for mail-order service)

Many people who have Medicare benefits receive their prescriptions with an automatic refill option. This allowance delivers prescriptions to be refilled before they run out. In the past, some drug plans weren’t checking to make sure that customers wanted or needed the offered prescriptions, so they created waste and unnecessary additional costs for those with Medicare and its drug coverage (Part D).

Today, plans must receive a recipient’s approval to deliver a prescription, whether it is a new one or a refill, unless the request is made when the prescription is created. Some plans request this every year, others ask for this before delivery.

This policy doesn’t affect refill programs that the recipient picks up, and it doesn’t apply to long-term care pharmacies that give out and deliver prescription drugs. This new policy might be a change for anyone who has received their prescriptions via mail order and have not had the opportunity to confirm that they still need prescriptions.

Medicare recipients should always check if they receive any prescriptions that are unwanted via an automated delivery program. If you were, in fact, charged for a prescription that you did not request, you might be eligible for a refund. If you can’t resolve an issue with the plan or you wish to file a complaint, you are always welcome to call us for help.

When you apply to use your drug plan for the first time, you will need to provide your plan with certain documentation. These documents can include:

A purple notice from Medicare that states you automatically qualify for Extra Help
A green or yellow automatic enrollment notice from Medicare
An Extra Help “Notice of Award” from Social Security
An orange notice from Medicare that says your copayment amount will change next year
If you have Supplemental Security Income (SSI), you can use your award letter from Social Security to confirm that you are receiving Social Security benefits.
Proof of Medicaid coverage, living in an institution, or proof that you receive home- and community-based services:
A bill from an institution such as a nursing home or a state document showing that Medicaid has paid for your stay for at least one month
A printout from your state’s Medicaid system showing you have lived in an institution for at least one month
A document from your state that shows you have Medicaid and are receiving home- and community-based services

Once you provide your plan with this information, your plan must:

Make sure you pay no more than the LIS drug coverage cost limit. For example, in 2022, prescription costs cannot exceed $3.95 for each generic or $9.85 for each brand-name drug covered for the enrollment in the program
Contact Medicare for confirmation if it’s available. Processing takes up to two weeks after application, depending on the circumstances.

Privacy and security of the health information of any applicant should be the primary concern of patients and their family members, health care providers, professionals, and the government. Federal law requires anyone who handles health information to protect such data regardless of its storage method. This is required by the Health Insurance Portability and Accountability Act of 1996 (HIPPA). You may have additional protections and rights under your state’s laws.

Using Network Pharmacies

Medicare prescription plans have contracts with other pharmacies that operate within their networks. These operate to provide you with better service. Medicare drug plans also work with these “network pharmacies” to offer lower prices to their enrollees.

Your plan’s network, along with retail pharmacies, might offer a mail order program or an option for retail pharmacies to supply an additional two- or three-month supply of your prescriptions.

Preferred pharmacies : If your plan has preferred pharmacies, you could save money on out-of-pocket expenses
Mail order programs : Some plans may offer mail order programs that will provide you with a three-month supply of your prescriptions. These will be sent directly to your home.
Retail pharmacy programs: Some retail pharmacies offer a two- or three-month supply of any covered prescriptions.

KEYWAVE DIGITAL is Here to Help You

When you let us help you enroll, we are always here for you. Anytime you have questions about coverage, or are concerned about changes in your needs we are only a phone call away.

When it comes time to use your plan for the first time, don’t be embarrassed to call and clarify how to do so the right way. At the end of the day, we are here to help you.

Please share this article if you found it helpful, or fill out the the contact form on my contact page to request assistance. You can also feel free to call or text me to get your questions answered.

What is the Medicare Annual Election Period (AEP)

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 19:52:01 GMT

It is not uncommon for people to confuse the Annual Election Period (AEP) with the Medigap Open Enrollment Period in the Medicare insurance industry. However, these Medicare Election Periods occur at different times. Keep reading to learn more about AEP Medicare.

Medigap Open Enrollment vs. AEP Medicare

Each year, the Medicare Annual Election Period occurs between October 15th and December 7th. During this time, individuals can change their Part D drug plan or their Medicare Advantage plan.

It is possible to make a switch from original Medicare plans to a Medicare Advantage plan during this period too, and chance from one Medicare Advantage plan to a different Advantage plan, or even revert back to original Medicare.

Now it is time to learn what AEP is not. This is not a time when a person can apply for Medigap with no underwriting. The election period applies to all Medicare Advantage plans and Medicare Part D plans for prescription drugs. It does not apply to Medicare supplements. I will explain more of the differences below.

The Open Enrollment Period for Medicare

It is possible to find a good description of what the open enrollment period is by looking at the “Choosing a Medigap Policy” resource provided by Medicare. The period starts on the first day of the month that a person turns 65 or when they opt to enroll in Medicare Part B—whichever happens at the latest date. The “open” period for an individual lasts for just six months.

The idea behind the Medigap open enrollment period is for a person who is new to Medicare Part B to enroll in the Medigap plan without having to deal with medical underwriting. This means the insurance carrier does not have the option to decline coverage because of a preexisting condition or another health concern. It is not possible for this issuer to refuse a policy to a person or to make them pay a higher rate because of an individual’s health issues. In fact, within this period, a person does not even have to answer health questions that are included in the application.

Something that is important to understand about this period of time is that, after the six-month window is over, it is gone forever. Most people will not receive any type of election period where they will be guaranteed to receive a Medigap policy.

Changing Requires Medical Underwriting

Consider if a person has a Medigap policy, and it increases within a year. This is common for most Medigap plans, and most of them will have yearly rate increases. In this situation, it is necessary to shop around for a different insurance company to figure out if better pricing is possible.

In most states, a person must answer specific health questions or submit a copy of their medical records. The underwriter may also call someone to ask health questions. Eventually, the company will likely decline some people for specific health conditions.

This is essential because some people opt for the most affordable price during their open enrollment period. They fail to research the potential rate increases that may occur.

AEP or Annual Election Period

Everything AEP Is Not

The AEP does not offer the opportunity for individuals to enroll in a Medigap policy without undergoing underwriting. It is possible to use the AEP for leaving the Medicare Advantage plan and to go back to original Medicare. However, if someone applies for a new Medigap policy to help supplement their Medicare, they should be ready to answer specific health questions. A person is not guaranteed to be approved for the new Medigap plan they have applied to.

There are a few exceptions when the insurance carrier for the Medigap policy may provide a guaranteed issue enrollment in a Medigap policy. This is typically something that is beyond a person’s control. If the Medicare Advantage plan is taken off the market and it is no longer available, a person has a time period to choose a new policy with no underwriting necessary.

Election periods and enrollment periods are the most confusing elements of Medicare, so people should not become too overwhelmed. The best thing you can do, besides research on your own, is to contact me. I will personally answer any questions you have and set your mind at ease.

I hope this article helped you.

I will personally respond to you and answer any question you have. If you feel this article helped you – please share it!

What You Need to Know About Medicare Supplements

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 19:46:42 GMT

Medicare is a program available to eligible individuals to help cover healthcare costs. However, basic Medicare coverage is not comprehensive. This means there may be gaps in the coverage. This is where Medicare Supplement Insurance or Medigap comes in. Keep reading to learn more about Medigap coverage and what it offers.

What is Medigap?

Medigap is a type of Medicare Supplement Insurance that is designed to help to fill in the “gaps” found in Original Medicare. It is a policy that is sold by different private insurance companies. As mentioned above, original Medicare will pay for a lot; however, it is not comprehensive. This is when Medigap comes in and can help cover things like deductibles, coinsurance, copayments, and more.

There are some Medigap policies that can be purchased to cover services Original Medicare will not cover, such as medical care for individuals who travel outside of the United States. If someone has Original Medicare and they purchase a Medigap policy, there are a few things that will happen.

What is Provided by Medigap

When someone receives healthcare services, Medicare will pay the set share of the bill for the services that are listed as being covered. Anything that is not covered will be paid by the Medigap share.

There are a few things everyone should know about Medigap policies that are available for purchase today. To purchase Medigap policies, a person must have both Part A and Part B Medicare services. It is also important to note that Medicare Advantage Plans and a Medigap policy are not the same time. These plans are a way to receive Medicare benefits, but Medigap policies will supplement the original Medicare benefits offered.

With Medigap, a person may have to pay a private insurance company a set monthly premium. This is paid in addition to the monthly fee paid for Part B coverage. Also, Medigap policies will only cover a single person. If an individual and their spouse both want Medigap coverage, they must purchase separate policies. It is possible to purchase Medigap policies from almost any insurance company that has proper licensing in the state.

The standard Medigap policy will be guaranteed as renewable, even for individuals who are dealing with certain health conditions. What this means is that an insurance company cannot cancel the Medigap policy, if the premium is paid.

Medigap and Prescription Drugs

In the past, some of the Medigap policies that were sold covered prescription drugs. However, any Medigap policy that was purchased after January 1st, 2006 is not allowed to include coverage for prescription drugs. If someone wants to receive this coverage, too, they can join the Part D Medicare Plan, which is the Prescription Drug Plan. If someone purchases Medigap and the Medicare drug plan from the same insurance company, it may be necessary to make two premium payments. It is best to contact the company that the policies are being purchased to cover the cost of the premiums.

It is important to note – it is illegal for an insurance company to sell you a Medigap policy if you already have a Medicare Advantage Plan. The only time this is possible is if a person is making a switch back to Original Medicare.

Will Medigap Policies Cover Everything?

Today’s Medigap policies will usually not provide coverage for dental care, vision care, long-term care, private duty nursing, eyeglasses, or hearing aids. There are insurance plans that are not Medigap, too. These include Medicare Advantage Plans, Medicaid, Medicare Prescription Drug Plans, union or employer plans, Indian Health Service, Long-term care policies, Veteran’s benefits, and TRICARE.

Understanding Your Medigap Coverage

Sometimes, a person wants to purchase a different Medigap policy – not just the old policy with no prescription drug coverage. They may also decide to make a move to a Medicare Advantage Plan, which provides prescription drug coverage.

If someone decides to drop their Medigap policy, they should be careful when it comes to the timing. If they join a new Medicare drug plan, they will have to pay a late enrollment penalty in some situations. One situation is if a person decides to drop their entire Medigap policy or if someone goes 63 days or more before their new coverage starts.

The information here provides a good overview of what Medigap coverage does and does not do. Be sure to keep this in mind when shopping for this policy to help ensure the right coverage is received. Being informed and knowing what to expect with Medigap insurance is the best way to get the desired coverage results.

Medicare Coverage and Doctors (Part 1)

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 19:37:24 GMT

Senior citizens depend on Social Security and Medicare to meet their financial and medical needs. But now, there is concern among seniors that their doctors and clinics are going to stop accepting Medicare patients. In reality, most doctors accept Medicare patients. Often, a doctor who is not accepting a patient is doing so not because of Medicare but because their practice is full. Why are medical practices filling up with patients?

There is a concerning trend of medical students choosing to go into higher-paying specialties rather than general practice. They can earn almost twice as much per year as specialists. Because of this, as few as 3% of medical students choose family practice. As family doctors retire and fewer medical students choose to become family practitioners, a shortage of primary care physicians happens.

At the same time, a large number of Baby Boomers are reaching retirement age and Medicare eligibility. So, there is a shortage of doctors just as a large group of people becomes eligible for Medicare. In addition, Medicare reimburses doctors less than insurance companies for younger patients. A doctor can only see so many patients per day, so they try to balance non-Medicare and Medicare patients. A medical practice can only serve a certain number of patients.

Finding A Medicare Doctor

When a medical practice has reached the limit of patients they can handle, they will tell prospective patients they can not take new patients. The office staff might even say they are not taking Medicare patients when they should be saying they are not taking any new Medicare patients.

Congress must make changes to the Medicare program to address these problems so older patients continue to get the medical care they need. Medical students must be enticed to go into general medicine or family practice so the shortage of doctors is addressed. Medicare must reimburse doctors at a level similar to non-Medicare patient’s insurance. Since Medicare is paying out more than it brings in right now, funding solutions must be found to keep Medicare viable into the future.

What is Medicare and the Medicare Network?

Medicare is a huge national health insurance network for senior citizens. This program is not limited to one area but covers all of the U.S. Many people are covered by some type of health insurance all of their lives. Many insurance programs are through a person’s employment, such as PPO plans. In addition to basic Medicare, many seniors opt to sign up for a Medicare Advantage plan with a secondary insurance company supplementing Medicare. Medicare plans have networks of doctors and hospitals their clients can use. Clients are required to contact the network before having medical treatment. Doctor’s offices often do this for patients.

The Kaiser Family Foundation, after studying recent surveys, has found that fewer than 3% of seniors had trouble finding a doctor when they needed one. This agency has found similar experiences when assisting clients in finding and getting appointments with their physicians. Most doctors accept some form of Medicare. We do research to find out which Medicare plans are accepted by most doctors. Most providers accept either Original Medicare or a Medicare Advantage plan network, or they accept both. Very few doctors fail to accept any form of Medicare.

Finding A Medicare Provider After You Move

Senior citizens often relocate after they retire. They might want to be closer to adult children, move to a warmer climate, or downsize to a senior community in a different part of the country. And, some seniors want to spend a few years on the road as RVers seeing America. After the couple is settled in their new mailing address, they must locate the medical professionals they need.

There may be a temporary problem accessing medical treatment until they call around and find new primary physicians and specialists in the Medicare network of providers. It is wise to look for medical providers before one is actually needed. Since there are record numbers of Baby Boomers joining Medicare every day, there is competition for primary care doctors to consider. Most doctors accept Medicare patients if they have room.

Since Medicare pays a lower rate of reimbursement than other insurance plans, medical practices might limit the percentage of Medicare patients they see. They must have non-Medicare patients as well as Medicare patients to keep their practices profitable. They will continue to see patients who reach retirement age and switch to a Medicare plan, but they must limit new patients on Medicare to make enough money to keep giving all their patients quality care.

Each Medicare patient will have a long list of Medicare providers in the form of a Medicare provider’s book or online. The senior citizen will need to find doctors accepting Medicare in their area and call them to see if they have Medicare patient openings. People who are working with good Medigap agents can ask them to help with locating a physician that accepts Medicare. Once a person has established themselves with the medical professionals in the new location, they are set.

I hope you enjoyed reading about Medicare Coverage and Medicare doctors. Please keep an eye out for Part 2 of this blog post, where I will go over finding doctors who accept Medicare.

Medicare Coverage and Doctors (Part 2)

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 19:18:46 GMT

There are Different Ways Doctors Accept Medicare

A person looking for a medical service provider must find the one who accepts their type of Medicare program. Doctors who accept Medicare, in general, might not accept Medicare assignments. This is because doctors who accept Medicare assignment can not charge patients balance bills after Medicare reimbursement. They must accept Medicare reimbursement as payment in full. Some of these doctors are labeled non-participating because they will see Medicare patients but reserve the right to send the patient a bill for excess charges of up to 15% more than Medicare pays.

For this reason, many Medicare Eligible People opt to sign up for Medicare with Medicare supplement policies that cover all or part of these excess charges. Adding supplemental health insurance eliminates the need to ask every physician if they accept Medicare assignments. There are different Medicare options to choose, including Plan F and Plan G, that cover excess charges, and Plan N, which does not.

If a person chooses Plan N, they will need to ask every doctor if they take assignment or if they will send a bill for excess charges after treatment. Some states do not allow doctors to charge excess fees and, in those states, a Plan N will work like a Plan F or a Plan G concerning excess charges. Then, it is important to ask in advance if doctors take Medicare assignments.

Medicare Advantage Plans Have Fewer Providers

Basic Medicare has a very large provider network, but the newer Medicare Advantage plans have smaller, more-focused local networks of doctors and hospitals. Good Medicare Advantage plans offer several thousand providers in each geographical area. Since some Medicare Advantage plans have fewer or more providers, enroll in the plan with at least a thousand providers.

Look at the whole plan before enrolling to be sure you get the best care options as well as an affordable plan. Do not limit your provider access to save a few dollars. Get the best Medicare Advantage plan you can afford and that meets your medical needs.

Are Medicare Advantage Plans Accepted By All Doctors?

Since Medicare Advantage plans have their own approved network of doctors, specialists, and hospitals, their members can not go to all doctors. A person must stay within the Medicare HMO network’s providers or end up paying up to 100% of their medical bill with that provider.

There are Medicare HMO-POS or Medicare PPO plans that give members more flexibility. With these plans, the patient can see doctors outside the designated network at a higher cost to them and if the doctor is willing to bill the Medicare Advantage plan.

What If You Decide to Opt For the Newer Boutique or Concierge Medicine?

Here is a growing trend throughout the U.S. to use fee-based care with no insurance coverage. A person agrees to pay a monthly or yearly fee to a doctor or clinic. In exchange, the doctor agrees to see the patient whenever they need care. The idea is that, by patients paying cash for care, the doctors or clinics can see fewer patients in total but give better care to those they see.

Doctors like these arrangements because accepting insurance costs them money and they must wait to be reimbursed for care. Sometimes, claims are denied and the clinic must try to collect from the patient after the fact. It is easier to collect money directly from patients with less time and money spent on paperwork.

The downside of boutique care is that the client is signing away their right to use their Medicare with that doctor. If a serious condition develops and Medicare is needed, it may be hard to get established with a Medicare plan and a new primary medical provider.

Solve Medicare and Medical Service Problems With A Good Agent

By choosing KEYWAVE DIGITAL to help with your enrollment, you can avoid many problems with getting health care coverage and medical treatment. Agencies are not seeing large problems with Medicare yet. The continued success of the Medicare health insurance program depends on Congressional action to make the program more solvent. The fair compensation of doctors accepting Medicare must also be addressed.

One step in the right direction has been the Affordable Care Act bonus payments to doctors providing Medicare services. People approaching Medicare can help themselves more by enrolling in a Medigap policy through an insurance agency in addition to their Medicare. Our agency can help you find the right Medigap plan and the providers you need for medical care.

I hope that this article helped you out. Learning about how Medicare coverage works with doctors is very confusing. If you ever have any questions, please don’t hesitate to contact us.

What You Should Know About Your Medicare Part D Coverage

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 18:36:24 GMT

In their efforts to provide a standard level of prescription drug coverage, Medicare offers what is called Part D, which is a list of prescription drugs they cover. These drugs are called a formulary, and they are on different tiers of these formularies.

Medicare Prescription Drug Plans and Medicare Advantage Plans each have their own list of drugs that are covered. These plans include both brand-name prescription drugs and generic drug coverage. At least two drugs are included in the most prescribed categories and classes.

This ensures that people with medical conditions get the prescriptions they need. All Medicare plans must cover at least two drugs per category, but plans can opt for which drugs are covered by Part D.

The formulary might not include a specific drug but, in most cases, a similar drug should be available. An exception can be requested if a healthcare provider believes that none of the drugs on a plan’s formulary will work for a patient’s condition. In these cases, a specific drug can be allowed.

Read more below to learn about the changes that you should know about. It is important to be aware of these to avoid any surprises due to changes in coverage that you may not have been aware of.

Changes You Should Know About

Medicare drug plans can make changes to its drug list if it follows the guidelines set by Medicare. These changes are made since standards of care change, as new drugs are released, and when new medical information is made available.

If the Food and Drug Administration (FDA) removes a drug from their list of approved medications because they are unsafe or if the maker removes them from the market, the coverage may be deleted from the formularies. Brand-name drugs can also be replaced with generics for reasons such as a cost change. If a change is made, anyone with a prescription will receive notification of the change.

If a change involving a recipient’s prescription occurs, the plan must do one of the following:

Give written notice to a recipient at least 30 days before the change takes place OR
When a refill is requested, a written notice and a one-month supply must be provided under the same plan.

It should be noted that drug plans that offer Medicare prescription drug coverage (Part D) can remove a brand name drug from their formularies immediately and without prior notice. They may also replace them with generic drugs and change prices as well as coverage rules for all drugs. If a recipient is taking one of these drugs, they will receive a notice of these changes.

Changes may necessitate a change in the drug or the price you pay for it, although you may request an exception. Using the drugs on your plan’s formulary may save you considerable amounts of money instead of having to pay full price, unless you receive an exception.

Generic vs. Brand Name Prescriptions

The FDA considers generic drugs copies of brand-name drugs, and the same as those brand-name drugs in terms of:

Dosage
Strength
Safety
Route of Administration
Quality
Performance Characteristics
Intended U

The same active ingredients are used in generic drugs as are found in brand-name drugs. Before being approved for use by the FDA, generic drugs must be proven to work the same as brand-name prescription drugs. In some cases, however, there may be no generic drugs available for a brand name drug being prescribed. Interestingly, some generic drugs are better-known than the brand-name drug they serve as a substitute for. Fortunately, there may be another similar generic drug available that can serve as a substitute but works in the same way as the brand-name drug.

Regardless, anyone being prescribed a medication should discuss the possible use of generics with their physician.

Tiers

To lower costs, many plans offer prescription drug coverage that are on different tiers into their formularies. These tiers can be divided in different ways. These tiers cost different amounts. A drug in a lower tier will generally cost a patient less than a drug in a higher tier. Below is an example of a Medicare drug plan’s tiers, which might be different from yours.

Tier 1: Lowest copayment, most generic prescription drugs

Tier 2: Medium copayment, preferred, brand-name prescription drugs

Tier 3: Higher copayment, non-preferred, brand-name prescription drugs Specialty Tier. Highest copayment, high-cost prescription drugs

In some cases, a more expensive drug on a higher tier may be prescribed, and the prescriber believes that the recipient needs that drug instead of a drug on a lower tier, an exception can be requested, and a lower copayment can be requested.

Please note that your plan may be different and coverage levels can also change. The above is only an example.

Summing Up Medicare Part D

Because Medicare Part D deals with Prescription Drugs, it is an important part of Medicare for most people. It is complicated, but don’t let that alarm you. You don’t need to know the ins-and-outs of Medicare to get the best coverage. After all, that is our job. We stay on top of all the changes to the drugs and formularies, so you don’t have to. If there is a change that affects you in the pipeline, we always will let you know well before it happens. So you can be prepared.

We hope that when it is time for you to choose your Part D coverage, you will let us coach you through the process. After all, our goal is to help people get the coverage they need. Please share this article if you felt it was informative!

And if you need help, simply tap the button below to get in contact and I will personally answer your questions.

Top 5 Common Medicare Mistakes

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 18:18:17 GMT

There are a few birthdays that are important to people in the USA. Every birthday until the age of ten is significant for a kid and their family. Then, the next big one is usually sixteen, where you finally get your “freedom” and can drive a car. Eighteen is the next big one, where you can officially say you are an adult. After that, turning twenty-one is the last big birthday for most people.

But, after the twenty-first birthday, the rest of your birthdays won’t be the same in terms of gaining new legal privileges like driving a car, or being able to go to a bar. Sure, your car insurance cost will decrease at twenty-five – but most people won’t be celebrating that!

Turning 65 is when most people will have to make a few big decisions that will affect them for years down the road. These are your choices regarding Medicare. As with any big decisions, it is very important to be informed to avoid any mistakes. But getting informed isn’t always easy, especially with everyone's busy schedules these days. So we’ve laid out the top 5 mistakes people make when turning 65, so you can be ready when the time comes. Continue reading below to see them.

1. Waiting too long to learn about the Medicare basics

This is the first mistake you should watch out for. If you wait too long to learn about Medicare, you can find yourself in a bad place. There are quite a few things to learn about, but the big ones are:

Medicare Advantage Plans
Medicare Supplement Plans
Medicare Part D Prescription Drug Plan

When folks come to us with questions, we recommend they start learning about these things about 3 months before their 65th birthday. By doing this, you make sure you’ll have time to make informed decisions and not be pulling your hair out at the last minute. Or worse, by waiting to learn about your options, you could easily end up on the wrong plan. If you are on a plan that isn’t right for you, it can be expensive down the road while also not providing you with the coverage you need.

2. Not taking Medicare Part B when you are eligible for it

Not enrolling in Medicare Part B when you are eligible for it may make sense for a few reasons. Sure, it may save you some money by not having to pay the Part B premiums. But when the time comes and you actually need your Part B coverage, you will have to pay a penalty in addition to your monthly premium, for the rest of your life. It is easy to see how expensive that can be.

Without Part B coverage (or any other health insurance), hospital visits and stays will likely result in very high medical bills. This can be avoided by simply enrolling in Part B when you are eligible.

3. Buying the Most Expensive Plan

This may seem like not a real mistake, but it certainly is. When it comes to Medicare plans and coverage, buying the most expensive plan and calling it a day is more than likely one of the worst decisions you can make.

Some plans that cost $150 /month, say a Medicare Supplement Plan F, can cost you $75 /month for the same coverage. In this case, you would be throwing away that extra hundred dollars every month.

Or, there may be a Medicare Advantage plan that costs $100 /month. In some cases, you could have gotten the same coverage for $40 /month, or even free!

This is why it is important to do your research and be informed, so you can get the best plan for your needs! At KEYWAVE DIGITAL , we want to get you the plan that will make sure you have exactly the coverage you need. Everyone’s needs are different, and we always take into consideration what your needs are and what you feel is important.

4. Taking Plan Recommendations from Friends/Family

When it comes to Medicare, there is no one-size-fits-all. Sure, a certain plan may have worked out well for someone you know, but they may not have the same needs as you.

The best plan for is more than likely different than the best plan for your friend/ co-worker/ neighbor/husband. Whether your health needs are more important, or if you are looking for something cost-effective, it is important to make choices that suit you.

5. Choosing the Wrong Type of Agent to Help You Enroll

While some folks will feel comfortable doing the research themselves and enrolling on their own, most people will end up asking a professional for help.

When you are looking at agents to help you enroll, there are a few types to avoid. The first are lazy agents that only will seek to sign you up when you turn 65. After the helping you with the initial enrollment, they never reach out to contact you or see how things are going.

And then in the future, when your plan changes and you have questions, you will have a hard time getting in contact with them to help you again. At this point, you will probably have to get another agent to help you start over.

At KEYWAVE DIGITAL , we give you all the information and guidance needed to get through your enrollment successfully, with exactly the coverage you want. And if you choose us to help you with your enrollment: we have a dedicated team that ensures that you are satisfied with your coverage, even if your needs change. We are always here to help.

The other types of agents are the kind that can only represent one company. These types of agents are called “Captive Agents.” Because these agents can only represent one company, they won’t be able to help you switch to a different company that may have a better plan when the time comes.

Sure, when you enroll, they may have a plan that fits you. But when it comes time to change your plan because your needs changed, they won’t be able to get you the best plan because they can only represent one company that provides Medicare plans. In other words, you don’t get to “shop around” for the best price if you choose to work with a captive agent for your Medicare.

Why Choose John Ellis in Carlisle, PA for Medicare help?

At KEYWAVE DIGITAL , we are independent. This means we can shop around to multiple carriers and get you the best plan for your needs, at the best price. We represent all of the top plans, and by doing so all of the best plans are available to you.

This also means that when your needs have changed, we can help you shop around for plans and get you on to a new one that you will be happy with.

Or, if you want some questions answered, simply get in contact with us by using the "Contact Us" page and we will reach out to you for a personal Q&A session! You can also use the Chat Function on our website to send messages directly to me

And of course, please share this article with anyone that you think will benefit from it!

Medicare 101 Part 2

john@keywavedigital.com (John Ellis) — Mon, 19 Dec 2022 18:08:37 GMT

Just to pick up where we left off, we went over the Enrollment Periods so that you can have a good idea as to when you should start taking the steps you need to enroll. Please feel free to go back to that article in case you need a refresher. For this post, we are going to dive into explaining what Medicare actually pays for.

So What Does Medicare Actually Pay for?

We will start with Medicare Part A, and what it pays for. Medicare Part A is hospital coverage; it covers hospitalization, in-patient procedures, mental health care, skilled nursing, home/hospice care, and also some blood for in-patient care.

For Hospital visits in Part A, what you pay is based on the number of days of your stay.

For days 1 through 60, you will pay a 1,280 dollar deductible.

Then, for days 61 through 90, you will pay a 320 dollar co-pay for every day you spend in the hospital.

After that, for days 91 through 150, you will have to pay 640 dollars per day. The article continues below.

After 150 days in the hospital, you will have to pay for everything. Since skilled nursing is covered under Part A, you also have some coverage and it is based on the number of days you use the skilled nursing care.

For days 1 through 20, you don’t have to pay anything for skilled nursing case. It is covered by your Medicare Part A. Then, for days 21 through 100, you will pay 160 dollars per day. After day 100 however, you will be responsible for all costs.

Moving on, let’s talk about what is covered under Medicare Part B, and what you can expect to pay, and what will be covered. If you need a refresher on the things covered by Medicare Part A, B, C, and D, you can take a look at our articles here! We wrote them just for people who need some information about these things.

Medicare Part B

In case you weren’t sure, Medicare Part B is the medical part of Medicare. Part B covers things like doctor visits, some outpatient procedures, ambulance rides, x-rays, and quite a few other things. You can learn more about the specifics using the "Medicare Overview" button above.

What you pay under Medicare Part B is a bit more straightforward than Part A. You will pay 20% of any Medicare-approved amount for medical under Part B. There is also a deductible to pay every year. The Part B deductible usually increases, or otherwise changes, every year.

It is important to know that these costs are IN ADDITION to whatever costs you have for your Part B monthly premium. The Medicare Part B premium is the same for all people and also tends to change (usually increase slightly) every year.

Key Takeaways about Medicare Part B

Part B is where many folks make a common mistake. If you don’t enroll in Part B when you are supposed to, you will be penalized later when you actually do need it. If you aren’t sure when to enroll in Part B, we are happy to speak with you and figure out what your situation is. Some people can delay their enrollment in Part B, but it isn’t just as simple as doing nothing.

Especially when it comes to Part B, you should make sure you are 100% sure of your status. The best way to do this is to reach out to KEYWAVE DIGITAL and get a free consultation. Usually within a few minutes of us speaking, we can tell you what would be best for you. After that, we can help you do what you need to do, or simply give you the steps you can take to do it yourself!

Why work with KEYWAVE DIGITAL on your Medicare Enrollme nt

Another key takeaway is that Medicare is not the end-all, be-all, of health insurance. It doesn’t cover everything, and you will still be responsible for some costs. Sometimes this fact surprises folks, as they expected to be covered 100% by Medicare as they turned 65. If you’re reading this article and made it this far, you are already ahead of the game. Being informed as you approach Medicare will save you a lot of time, as well as preventing you from stressing out about health coverage at a time when you may need it.

If you feel you are ready to begin the process, you can reach out to me via phone, email, or text message and we will be happy to help you. Our goal at KEYWAVE DIGITAL is not to sell you anything – we want to inform you of your options, so that you can make the best choices for yourself. We use our years of experience to help people do just that.

Medicare 101: Part 1

john@keywavedigital.com (John Ellis) — Fri, 16 Dec 2022 00:47:43 GMT

In this article, which is Part 1 of 2, we will go over the basics of Medicare and what you need to know about Medicare.

You’ve probably heard of Medicare Part A, Part B, Part C, and Part D, but what do they mean? Don’t worry – we will go over it all!

One of the first things to know about is the “Medicare and You Handbook.” This is a free resource created by the government and is available to anyone, for free. It includes a summary of Medicare Benefits, your rights and protections, as well as available health and drug plans. Also, it has answers to frequently asked questions about Medicare. All in all, the “Medicare and You Handbook” is a great resource to have at hand as you approach Medicare and begin learning about it

There are a few ways to get your handbook:

It is sent to all Medicare households each fall (usually late September)
Log-on to mymedicare.gov and receive it via email.
Call Medicare at 1-800-MEDICARE and have them send it to your home address
Go to your local Social Security office and get one

One important thing to note, is that by being informed about your healthcare, you will be able to avoid any coverage gaps. A coverage gap is exactly what it sounds like – a period of time in which you don’t have any sort of insurance coverage. In the event of you needing to use medical services, or a hospital visit, you will be responsible for all costs.

For anyone that chooses to have KEYWAVE DIGITAL help them with their healthcare, we will always make sure you are aware well before any potential coverage gaps. We make sure you are covered at all times. No one likes surprises when it comes to their healthcare, and we take extra care to keep you informed and ready at all times.

You may have heard of Original Medicare before. Original Medicare? What is that?

Original Medicare is Medicare Part A and Part B. Part A is the hospital insurance part of Medicare. This covers the room and board in the hospital, as well as skilled nursing .

Part B of Original Medicare is the medical coverage of Medicare, and this pays up to 80% toward your bills of the Medicare approved amount.

One important thing to note is that Original Medicare Parts A and B do not cover the prescription drugs you might need. Medicare Part D Prescription Drug plans exist to cover the medications that you would get prescribed and purchase from a pharmacy.

A good option to Original Medicare Part A and B is a Medicare Advantage plan (Also known as Part C.) Part C, Medicare Advantage Plans are plans that include Part A and Part B, and many times Part D as well. In the case that your Medicare Advantage plan doesn’t include a Part D Prescription Drug Plan, you can always add one to it to get that coverage.

When should I enroll in these plans?

It depends – there are a few Enrollment Periods you should know about. If you aren’t sure about what is included in Medicare Advantage or Supplements, you can reach about them here. Medicare Advantage and Medicare Supplements .

The most common answer to this question is that the best time to enroll is during the Initial Enrollment Period, which is based on when your 65th birthday is. The Initial Enrollment Period starts 3 months before your 65th birthday, includes your birth month, and extends to 3 months after your birthday.

If you choose not to enroll in a Medicare Advantage or Part D plan during the initial enrollment period, you can always change plans or get a new plan during the Annual Enrollment Period (AEP), which starts October 15th and lasts until December 7th each year.

During AEP, you can change or add a plan, but they won’t start coverage until January 1st. If you choose to disenroll from a Medicare Advantage plan and switch back to original Medicare, you can do so from January 1st to February 14th.

You may have heard of the Open Enrollment Period, which lasts six months. It begins on the first day of the month in which you turn 65, and enrolled in Part B. Some people choose to delay Part B enrollment, but you can always enroll later in it.

When your Part B coverage does start, you can apply for a Medicare Supplement plan from 3-6 months before you need the coverage to start. This will make sure you have the coverage you need, when you need it.

That is it for Part 1. In Part 2, we’ll go over what Medicare actually pays for, and what you will have to pay. In the meantime, we hope you enjoyed this article. And if you ever have any questions, please don’t hesitate to send them to us via email, phone call, or the contact us button above.