Medicare Can Be Confusing,
But it doesn't need to be!

You have alot of decisions to make with your Medicare Options. Below we have listed a brief set of Frequently asked questions to help your understanding of Medicare, however there is still much to consider when thinking about the coverage that best fits your needs. Things such as possible employer benefits, networks, ancillary benefits, and formularies. A NO COST Consultation with one of use here at Wiley Insurance will help make those decisions that much easier!

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What is Medicare?

Medicare is a federal program that offers health insurance to American Citizens and other eligible individuals like bases on age, disability, or qualifying medical condition such as:

  • People age 65 and older

  • People under age 65 with certain disabilities

  • People of all ages with End-Stage Renal Disease

Medicare has two parts, Part A and Part B. 

You can enroll in medicare by talking to Social Security or Give us a call and we will help. 

What about Part D?

Part D reffers to Stand Alone Prescription Drug Plans. These plans are sold by private Insurance Companies for a premium to help you cover your prescriptions. All Plans can have varying deductibles and formularies.

In 2023 the Deductible Ranges  anywhere from $0-$505

 

Eachs Plan's Formulary consist of 5 Tiers. 

  1. Preffered Generic Drugs

  2. Generic Drugs

  3. Preffered Brand Name Drugs

  4. Brand Name Drugs

  5. Specialty Drugs

The Donut Hole will apply when your Full Cost in the year hits $4,660 Dollars and you will pay 25% of the cost at that point.

Once your True Out of Pocket hits $7500 You will hit catastrophic and pay 0-5% the rest of the year

What is Part A?

Part A of Medicare is known as Hospital Insurance, It covers various inpatient services such as inpatient hospital, the nursing home and more. If you have paid into 10 years of Social Security or can claim off someone who has you can get Part A for $0 a month. If you do not have 10 years you rpremium could be up to $499. 

 

Part A Coverage Includes:

  • Semi Private Room

  • Your Hospital Meals

  • Skilled Nursing Services

  • Care in special Unites

  • Inpatient Drugs

  • Equipment/Supplies

  • Operating Room

  • Labs/Tests

  • Ect..... 

**Deductibles and Copays Apply

Medicare Supplements vs Medicare Advantage?

Medicare Supplement Insurance also known as Medigap Policies, are offered to you through private insurance companies and work as a secondary to medicare and help pay the medicare coinsurance and copays you may incure. They are offered for an addition premium. Different plans cover different healthcare services and Items.

Medicare Advantage Plans, also known as Part C are plans offered by private insurance companies. You elect to recieve your benefits through these companies but will still have to pay Part A/B premiums. These plans may charge premiums, deductibles, copays/coinsurance. They also have a maximum out of pocket anywhere up to $7,550. They may also offer Part D coverage, Hearing, Dental, and Vision coverage and other various wellness benefits such as gym memberships.

What is Part B?

Part B is reffered to as Medical, it covers your outpatient services such as:

  • Doctor Visits

  • Annual Wellness Visit

  • Ambulance and ER

  • Clinical Labs ie blood and urine

  • X-RAYS, MRI, CT Scans, EKG's

  • Physical Therapy

  • Durable Medical Equipment

  • Diabetes screening

  • Mental health care

  • Preventative Services

Part B has a premium of $170.10 for most people but can range up to $578.30 depending on income, if you are recieving social security benefits the premium is deducted from your check. Part B benefits have a $233 Deductible and then you will pay 20% of the approved amount, Medicare will pay 80%   

When Can I Enroll?

There are many oportunities to enroll in Medicare,

  • If you are turning 65 you have 3 months before, the month of and 3 months after.

  • If you are working past 65 you can delay it until you retire, as long as your place of employment has coverage equivelent to medicare and 20+ employees, otherwise you may not delay coverage.

  • Every year from Jan 1 to March 31 you can apply for a July 1 effective date.

  • Lastly if you are on social security disability for 24 months you may apply for early medicare

Medicare Insurance Plans all have varying Initial, Annual, and Special enrollment periods so be sure to reach out and see if you qualify!