Hello neighbor! My name is Christina Ramus and I help Seniors transition from traditional health insurance to Medicare, Medicare Supplements, Medicare Advantage and Prescription Drug Plans. One of the biggest benefits of turning 65 is you qualify for Medicare, but many are not sure how it works and what they should do now. This 2021 Special Edition Newsletter will give you an overview of Medicare options. By now you have probably received tons of mail and trying to pick one company or agent over the others can be very challenging. I can help. I am a graduate of the University of Washington and a member of Phi Beta Kappa. Since 1990 I have helped thousands of clients all over Southern California with their small group and senior insurance.
I live in Dove Canyon with my husband Brett Regan. Our daughter Maddy, a graduate of Santa Margarita Catholic High School and the University of Alabama, is currently working at Applied Medical, and our son, Michael, is also a graduate of SMCHS and currently attends the University of San Diego. I am blessed with clients from Santa Barbara to San Diego and over 30 years of experience in the insurance industry. I’ve sent you this newsletter to introduce myself and to begin to help you navigate the Medicare maze. Here is some very important information to consider.
Medicare Supplement Plans
These are also called Medigap plans as they help you cover some or all of the costs that Medicare Parts A and B don’t cover. The nice part is you can see any doctor in the USA that participates in Medicare. For the freedom of seeing any participating doctor, the premium is higher. Remember you still keep paying your Part B premium and with a supplement plan, your Part D premium is separate and not built in like most Advantage plans are. When you turn 65, you have a guaranteed issue in a Supplement Plan and are ‘Guaranteed Renewable.’ That means the policy renews automatically from year to year as long as you pay the premium on time.
Original Medicare (Parts A and B)
Medicare was started in July of 1965. It is provided by the government and pays fees for your care directly to the doctors and hospitals you visit. Part A helps with hospital cost and Part B helps with doctor and out-patient care. In 2005, the government added part D and this helps pay for prescription drug costs.
Medicare Part A (Hospital Coverage) Part A helps with the cost of your inpatient hospital stays and skilled nursing care after a hospital stay. Medicare part A premium is free to you as long as you have worked at least 10 years in this country. Although the monthly premium is free, the deductibles and copays are not. To walk into a hospital will cost over $1,400 and if your stay is longer than 60 days, then a copay of over $300 per day is added on for days 61-90 and over $600 per day for days 91-150.
Medicare Part B (Doctor Visits)
Part B helps with doctor visits including outpatient care at hospitals and clinics, lab tests and some skilled nursing care. The nice part is you can see any qualified doctor who is eligible to participate in Medicare and who is accepting new patients. There is a monthly premium for Part B and most people pay $148.50 per month, but if you’re single and making more than $88,000 per year or married making over $176,000, you will pay a higher monthly premium. As far as copays, you’ll pay the first $203 then generally Part B pays 80% of your doctors’ fees and you are responsible for the remaining 20%. In our experience, the Part B 20% that you are responsible for puts you at unlimited financial risk. Purchasing a Medicare supplement reduces this risk.
Medicare Part D (Prescription Drugs)
Part D helps with the cost of prescription drugs. Part D plans are sold by private companies and range in price anywhere from $7.20 to over $100 per month. WORD OF WARNING: You will read that Part D is optional. The problem is if you don’t sign up when you first become eligible and decide to at a later date, you will be assessed a penalty and that penalty will stay with you the rest of your life. For example, a person turns 65 and doesn’t take medication and decides against enrolling in Part D. When they turn 70, their doctor prescribes an expensive medication and this individual decides to enroll into Medicare Part D. Shortly thereafter they receive a letter from Medicare stating their late enrollment penalty. In this example that person’s penalty would be about $25 per month for the rest of their life.
Original Medicare doesn’t cover everything. Original Medicare helps you get basic coverage, but you should expect to pay some of the costs. Many people enroll in additional insurance coverage to help them pay for the cost and benefits that aren’t covered by Original Medicare Parts A and B. That is why you need to know the difference between Medicare Supplement Plans and Medicare Advantage Plans.
Medicare Advantage Plans (Medicare Part C):
Medicare Advantage plans are run by private companies. You have probably heard of United Healthcare, Anthem Blue Cross, Blue Shield, SCAN, Humana, Kaiser, etc. These companies offer Advantage Plans. They combine coverage for certain hospital costs, doctor visits and most include Part D coverage at no additional cost. In most plans you choose a primary doctor and your doctor has access to specialists within their group. Many plans offer additional benefits not offered by Original Medicare such as Vision, Dental, Hearing, Chiropractic, Acupuncture and Gym Memberships. Although you continue to pay your Part B premium, many Advantage Plans offer $0 monthly cost. All plans also offer out-of-pocket limits on medical cost. (Remember the unlimited 20% you are responsible for on Part B costs?) Each year you have a chance to change your coverage during the Annual Enrollment Period (AEP), which starts Oct.15th and runs through Dec. 7th .
I can’t tell you the number of times I’ve sat at a kitchen table and the person turning 65 walks over with a stack of papers and says, “Am I really supposed to read all this?” I helped them, and I can help you too. I want to make sure you have the right insurance that is tailored around your needs. By the way, the person you sign up with becomes your Medicare agent, so choose wisely! I am a broker with many options to share, so I’m able to remain unbiased and focus on your best interests. I want to earn your business. Contact me today for a free, no-obligation discussion about your Medicare insurance. I look forward to serving you!