Medicare Made Easy Articles

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.

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? The annual deductible is another essential factor to consider. Is this something that you are comfortable paying? 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, service 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.

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.

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. 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. 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.

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. 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. 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 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  .

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.

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.

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 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. 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!