What is Medicare?

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. It is available for individuals 65 and older, individuals who are be under 65 but have been receiving Social Security Disability Insurance (SSDI) for 2 or more years or individuals who are under 65 and have End Stage Renal Disease (ESRD).

Part A (Hospital Coverage)

Part A, helps with the cost of your inpatient hospital stays and skilled nursing care after a hospital stay. There is no cost for the Medicare Part A premium as long as you have worked 10 years in this country. It is automatically given to you at age 65, you do not need to sign up for it. The 2020 deductible and copays are as follows. There is a $1,408 deductible you must pay when you enter the hospital. If you are confined more than 60 days there is a $352 per day fee. If you are confined for more than 90 days there is a $704.00 per day fee.

Part B (Doctors Visits)

Part B, helps with outpatient care with doctors, specialists, labs, X-rays, etc. The 2020 premium for Part B is typically $144. This can vary based on your adjusted gross income. See the Income Related Monthly Adjustment Amount, IRMAA here. There is a $198 deductible and you are responsible 20% of all services administered outside the hospital. You do not need to sign up for Part B if you have credible insurance. Evaluate the cost of your insurance Vs Medicare. Once you decide to leave that insurance you will need to sign up for Part B or incur a penalty for life.

Initial Enrollment Period

This period consists of a 7 month window. It starts 3 months before your birthday month, the month of your birthday and three months after your birthday month. Keep in mind that if you wait to enroll in the last 3 months it can delay the start date of your Part B Medicare.

Medicare Broker

Now that you’ve enrolled in Medicare you have a choice from a number of different commercial insurance companies to help protect you from the costs original Medicare does not cover. That is where the benefits of working with Merrill Insurance Services,(MIS), come in. MIS does not work for Medicare nor do we work for any specific insurance carrier. We are independent brokers representing the top plans in our area. We can take the guess work out of determining which plan is better suited for your needs, whether you are healthy, have a lot of expensive medications, chronic conditions such as diabetes or heart disease, or are struggling financially we can help and we do this at no cost to you. If you call an insurance carrier’s (800) number to sign up and have an issue months later the likelihood of you connecting with that same super, great agent you enrolled with is slim to none. The cost for your plan is the same whether you go direct or work with MIS, and we are here as your advocate to help with issues you may have. MIS is paid directly from the carrier of the plan we (Agent/Client), select and MIS, is paid the same for all the available plans in your area. This makes MIS an unbiased resource for any plan we agree meets your needs.

Part D (Prescription Drug Coverage)

Part D helps with the cost of medication. Caution, just because you are not taking any medications you still need a drug plan or once again you could incur a penalty that will stay with you forever. The premiums range anywhere between $15 to $100. The formularies or list of medications they cover vary from plan to plan, and with about 40 plans to chose from how do you know which one is right for you. We help take the guess work out of finding a plan that works for your needs at no cost to you.

Medicare Supplement Plan

These plans cover any doctor, any hospital, anywhere in the US that accept Federal Medicare. The premiums (2020), start out at age 65 about $160. The cost will vary based on the county you reside. You might consider this plan similar to a PPO because of the freedom to choose your own doctors. An analogy I like to use… if you compared a PPO (preferred provider organization, meaning there are a lot of non-preferred providers), to the Medicare supplement plan, the PPO is an ant, where the Medicare supplement plan is an elephant. Again, any doctor, any hospital, anywhere in the US that accept Federal Medicare. The services mirror the benefits of Federal Medicare. You basically pay a premium for the plan and continue to pay your Part B premium. Many plans have a minor deductible and all medically necessary services are covered. The plans vary so we need to talk. They also have international travel, $50,000, $250 deductable and you pay 20%.

Medicare Advantage Plans (Part C)

Medicare Advantage plans are run by private companies like UnitedHealthcare®, Anthem Blue Cross, Blue Shield, SCAN, Humana, Kaiser, etc. They combine both the medical and drug benefits in one plan. This is an HMO plan so you must reside in the county where you get your benefits. You will need to select a primary care physician (PCP) and he will refer you to specialists for you given need. If you are outside your county and you need medical attention you will always have Urgent Care (minor copay) and Hospital Care (copay eliminated if admitted). This is also world wide unlimited. So if you are on a cruise ship in Alaska and have a heart attack they will airlift you off the ship and take you to the nearest hospital, admit you and your cost will be the ambulance fee which is about $250. Again this varies by county. Contact us to get the details on what you must do. Your local doctors should all be in the same network example, for Orange County, Monarch, Memorial Care, St. Josephs, Hoag, Greater Newport Physicians, etc. These will vary in other counties we represent.

Get this! Many of these plans have a $0 monthly premium. You must continue to pay your Part B monthly premium. Again premiums and copays vary from county to county. Many have $0 copays for doctors, specialist, hospital care, out patient surgery, (yes that includes cataract surgery), labs, X-rays, home health care, etc. They also include additional benefits given by the carrier not medicare. Many plans include benefits like Vision, Hearing, Chiropractic, Acupuncture, Transportation, Nurse Hot Line, Teledoc, Over the Counter Benefits, and Preventive Dental at a $0 to minimal copay.

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