Medicare 101 on 10.03.2018

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Important things to know about Annual Enrollment

Annual Enrollment Period, (AEP) also know as Open Enrollment Period (OEP) is from October 15th through December 7th each year.

All Medicare Advantage Plans and all Prescription Drug plans will change annually.  Medicare supplements (Medigap) benefits will stay the same and automatically renew.

  • It is important to “shop” for a plan every year..  This can be done at www.Medicare.gov or by contacting a reputable insurance agent that represents numerous plans.
  • Your existing insurance plan is required to let you know by letter what changes will be made for the upcoming calendar year.
  • If you are satisfied with your existing coverage, it will automatically renew for the next year.
  • If you want to change plans, this OEP is the time to make the change.
  • Be an educated consumer.  Changing plans could save you thousands of dollars per year.

Medicare Costs to Beneficiaries for 2018

Every year the Centers for Medicare and Medicaid (CMS) may change the out of pocket costs to Medicare recipients (known as beneficiaries).  In 2018, the Part A premium will continue to be $0 for most beneficiaries.  The Part B Premium will be $134 per month depending on your household income.  Those with higher incomes will pay more.  This is called IRMAA  and it based on a sliding scale. Feel free to contact me for more detailed information.

The Part A Hospital Deductible is $1340 per benefit period.

The Part B Medical Deductible remains stable at $183 per calendar year.

A Rehab/Nursing home stay will cost an additional $167.50 per day for days 21-100.

Please know that a supplemental Medicare policy (Medigap) may help pay for these increased costs.  Those who have Medicare Advantage Plans need to read their Summary of Benefits document since each plan has different premiums, deductibles and copays.

Dental Insurance Info

I recently met with Shirley, a prospective client for Medicare Supplement Insurance. She was shocked to find out that Medicare did not cover any dental costs. She said, “I don’t understand, good dental health and overall health go hand in hand”. I agreed, research shows oral health is linked to diabetes, heart disease, cancer and more. Unfortunately, that was not widely known at that time Medicare was implemented in 1965. Now, Medicare can not afford to pay out more benefits. Medicare beneficiaries need to purchase a separate policy if they want that coverage.

As it turns out, I can help. If you think insurance is hard to understand, dental Insurance is even more complicated and there are lots of choices. I begin by asking questions such as do you presently have a dentist and if so, are you willing to change? I ask that because a lot of available plans offer benefits only if you use their network providers. How often do you get your teeth cleaned? Do you routinely use services other that just preventative ones?

Consumers usually see the most savings when using a network type plan. This is because the insurance company has negotiated a significant discount. These savings get passed on to you. But, a lot of dentists do not work with any dental insurance plans or limit the ones they participate with. In that case, I recommend an “indemnity” type plan. With this type of plan, you can go to any dentist and get reimbursed for a portion of the expenses. Usually, the longer you keep your plan, the better the benefits.

I explain that either type of dental insurance can save significant money but it is not going to cover all the expenses. There are waiting periods, deductibles, co-insurance costs and usually a limited amount of coverage to consider. Occasionally, self-insuring may be the best choice.

Personally, I have a combination dental, vision and hearing plan that lets me go to whatever dentist I want. I get my prescription glasses at the warehouse-type stores where I really save. I love it because it really helps me budget my expenses and encourages me to take care of myself on a regular basis.

In case you are wondering, Shirley chose a dental plan that also included a membership to her local YMCA. The cost of the plan was lower than a regular membership fee. The dental coverage was like a free added benefit.