Medicare

While it’s not often we get to talk about rate decreases, Medicare beneficiaries will see a decrease in their Part B premium for 2023. Beneficiaries may remember the 2022 premium increase of 14.5% increase last year, primarily due to expected spending trends due to COVID-19 & a newly released Alzheimer’s medication, Aduhelm.

Questions on Medicare?
Contact the Medicare experts at Senior Health Solutions: info@srhealthsolutionsllc.com

Expected costs were lower and the 2023 Part B base premium will decrease from $170.10 to $164.90. In addition, the Part B outpatient deductible will decrease by $7, from $233 in 2022, to $226 in 2023.

For further details on the 2023 pricing for Income-Related Adjustments & other Part A out of pocket, please see 2023 Medicare Parts A & B Premiums and Deductibles.  

Low-Income Subsidy Plans Available to Help with Overall Health Available in New York State, New Jersey, Connecticut, and Pennsylvania!

Contact us today about the Low-Income Subsidy (LIS) plans designed for beneficiaries with limited resources who:

• DO qualify for the Low-Income Subsidy (also known as “Extra Help”), but
• DO NOT qualify for a zero-dollar, dual special needs plan (generally state Medicaid and/or Medicare Savings Program eligible)

Questions on Medicare?
Contact the Medicare experts at Senior Health Solutions: info@srhealthsolutionsllc.com

While those qualifying for “Extra Help” can choose any plan with Medicare Part D, including Part D standalone plans, these LIS plans work specifically with the government’s Low-Income Subsidy program. Because the subsidy addresses your prescription drug needs, the LIS plans can focus on providing more meaningful medical and supplemental benefits like dental, hearing, vision, fitness, and others to address your overall health.

Reach out to us today!

Medicare 101

If you’re nearing retirement age, or are over 65 and still working, you may have questions about Medicare. Read on for the information you need to know.

What Is Medicare?

Medicare is health insurance for people who are age 65 or older, under 65 with certain disabilities, or any age with End-stage Renal Disease (permanent kidney failure).

Types of Medicare

There are four types of Medicare. Medicare Part A helps cover inpatient care in hospitals, skilled nursing facilities, and hospice and home health care. Generally, there is no monthly premium if you qualify and paid Medicare taxes while working.

Medicare Part B helps cover medical services like doctors’ services, outpatient care and other medically necessary services that Part A doesn’t cover. You need to enroll in Medicare Part B and pay a monthly premium determined by your income, along with a deductible.

Many people also purchase a supplemental insurance policy, such as a Medigap plan, to handle any Part A and B coverage gaps.

Medicare Advantage Plans, also known as Medicare Part C, are combination plans managed by private insurance companies approved by Medicare. They typically are a combination of Part A, Part B and sometimes Part D coverage, but must cover medically necessary services. These plans have discretion to assign their own copays, deductibles and coinsurance.

Medicare Part D is prescription drug coverage and is available to everyone with Medicare. It is a separate plan provided by private Medicare-approved companies, and you must pay a monthly premium.

Questions on Medicare?
Contact the Medicare experts at Senior Health Solutions: info@srhealthsolutionsllc.com

Getting Started

Medicare sends you a questionnaire about three months before you’re entitled to Medicare coverage. Your answers to these questions, including whether you have group health insurance through an employer or family member, help Medicare set up your file and make sure your claims are paid correctly.

If your health insurance or coverage changes at any time after submitting the questionnaire, call the Medicare Coordination of Benefits Contractor at 855-798-2627 to update your file.

Once you start Medicare, you should schedule a free preventive visit within the first 12 months to assess your current health status and provide a health roadmap for the future.

Also, create an account on Medicare.gov to access your information and keep track of claims. If you want your family or friends to be able to call Medicare on your behalf, fill out an Authorization Form to allow them to do so.

Coordination of Coverage

If you have Medicare and another type of insurance, the question of who should pay or who should pay first can be tricky. For example, generally a group health plan would pay before Medicare, but there are several exceptions. Contact the number above for specific answers for your situation, or visit www.medicare.gov for additional information.

This Know Your Benefits article is provided by Senior Health Solutions, LLC and is to be used for informational purposes only and is not intended to replace the advice of an insurance professional. © 2013 Zywave, Inc. All rights reserved.

Medicare annually publishes their helpful Medicare & You handbook with a lot of helpful information whether you’re new to Medicare or already enrolled every Medicare beneficiary should have a copy and read over to better understand the programs.

You can read more here:

One very popular method for Medicare beneficiaries to plan for healthcare costs is to use “Original Medicare” Parts A & B as primary coverage for physicians and hospitalization. Original Medicare however can have significant out of pocket expenses. This is where Medicare Supplements (MediGap) plans come in to play. They can help cover the deductibles, co-pays, and co-insurance of Medicare Parts A & B.

Medicare Supplement Plans

If you are getting close to your 65th birthday, you are likely preparing to enroll in Medicare. Enrolling in Medicare and figuring out how to decrease your out-of-pocket health care expenses can be daunting. A Medicare supplement plan can save you money and provide peace of mind.

Original Medicare, which consists of Medicare Part A and Part B, typically does not cover all of an individual’s health care costs. In order to fill the gap, many individuals purchase a Medicare supplement plan. Medicare supplement plans, also known as Medigap policies, are policies that can be purchased to cover expenses that Medicare does not pay.

The most common supplemental plans provide coverage for your out-of-pocket expenses not paid by Medicare, such as copays, deductibles, coinsurance, as well as some services that may not be covered by Medicare, such as international travel emergencies. Plans vary, so look for a plan that provides the coverage you need.

Where to Purchase

Medicare supplement plans are sold by private insurance companies, and you will usually pay a monthly premium. Insurance companies selling Medicare supplement plans do not need to adhere to the requirements for standard Medicare policies. This means that the cost of Medicare supplement plans can vary due to a number of factors, including the plan’s service area, the age you were when enrolling in Medicare or the age you currently are when enrolling in a Medicare supplement plan. Because premiums and out-of-pocket costs can vary, it is a good idea to shop around to ensure you find the best rate and policy to suit your needs.

Questions on Medicare?
Contact the Medicare experts at Senior Health Solutions: info@srhealthsolutionsllc.com

Eligibility

In order to be eligible for Medicare supplement plans, you must be enrolled in Medicare Part A and Part B, and you must not be enrolled in a Medicare Advantage plan. If you are under age 65 and receive Medicare as part of your disability benefits, you may be eligible to purchase a Medicare supplement plan depending on the state in which you live. In addition, only one person can be covered by each Medicare supplement plan. You will need to purchase separate policies if both you and your spouse want this type of coverage.

When to Enroll

The ideal time to purchase a Medicare supplement plan is during your Medigap open enrollment period. This is a six-month period beginning on the first day of the month that you turn age 65 or older and enroll in Medicare Part B. During this period, you will not be denied coverage for any pre-existing health conditions. In other words, you can purchase a Medicare supplement plan of your choice for the same premium that a healthy person without pre-existing conditions would pay. If you do not enroll in a Medicare supplement plan during your Medigap open enrollment period, you will not be guaranteed coverage, and you may be denied coverage or charged a higher premium due to your medical history or pre-existing health conditions.

This Know Your Benefits article is provided by Senior Health Solutions, LLC and is to be used for informational purposes only and is not intended to replace the advice of an insurance professional. © 2015, 2020 Zywave, Inc. All rights reserved.

Health savings accounts (HSAs) are tax-advantaged savings accounts that individuals can use to save money for medical expenses. You own the account, not your employer, and any money in the account that you don’t spend carries over to the next year; there are no “use it or lose it” rules as with other types of health accounts.

You can only contribute to an HSA if you are covered with a high deductible health plan (HDHP). If you switch to any other health plan or have other health coverage, you will lose your eligibility to contribute to an HSA. However, you may spend the funds in your HSA even if you switch to non-HDHP coverage.

When you reach age 65, your HSA eligibility will change due to Medicare, as will the rules for withdrawing funds.

Effects of Medicare

At age 65, you become eligible for Medicare and may be automatically enrolled. Enrolling in Medicare ends your HSA eligibility in one of two ways:

• If Medicare is your only health insurance, you are no longer eligible to contribute to an HSA because Medicare is not an HDHP.
• If you have Medicare as secondary coverage in addition to an employer-sponsored HDHP, you will also lose HSA eligibility because you have “other coverage.”

When you turn 65 and begin Medicare coverage, you lose HSA eligibility on the first day of that month. For example, if your birthday is April 19, you are no longer eligible to contribute to an HSA as of April 1. For the months prior to your birthday, you are still eligible for an HSA (assuming you have an HDHP). Your maximum contribution is determined by adjusting the HSA maximum in accordance with how many months of the year that you were eligible. For example, if you turn 65 in April, you were eligible for the first three months of the year. You can then contribute 3/12 of the HSA annual contribution maximum.

If you file an application to receive Medicare benefits (or for Social Security benefits) more than six months after turning age 65, Medicare Part A coverage will be retroactive for six months. This means that if you delay applying for Medicare (or Social Security) and are later covered retroactively, you cannot contribute to your HSA for the entire period of retroactive coverage.

Although you are only eligible to contribute for the months preceding your 65th birthday and Medicare enrollment, you typically have until April 15 of the following year (the tax filing deadline) to put the money in the HSA.

If you reach age 65 and have an employer-sponsored HDHP, you must avoid Medicare enrollment if you would like to remain eligible for your HSA. This option is likely only feasible if your health plan is through an employer that has 20 or more employees; if you work for a small employer with fewer than 20 employees, your employer-sponsored plan will become secondary to Medicare once you turn 65. In addition, if you don’t enroll in Medicare Part A when you’re first eligible, you may have to pay a penalty in the form of a higher Medicare premium for a period of time, once you do enroll in Medicare.

Larger employers’ plans continue to pay primary whether or not you have Medicare. Therefore, if you work for an employer that has 20 or more employees, you can decline Medicare and continue your employer-sponsored HDHP as long as you are also not accepting Social Security benefits.

If you are receiving Social Security retirement benefits, you will be automatically enrolled in Medicare at age 65 and lose your eligibility to contribute to an HSA.

Questions on Medicare?
Contact the Medicare experts at Senior Health Solutions: info@srhealthsolutionsllc.com

Withdrawals after Age 65

Before age 65, the money in an HSA can only be used tax-free for qualified medical expenses. If you withdraw your HSA funds for anything else, the money will not only be taxed, but you will also pay a 20 percent penalty fee.

After age 65, the rules regarding use of your HSA funds change in the following ways:

• Health insurance premiums—You can use your HSA funds tax- and penalty-free to pay premiums for employer-sponsored health coverage or for Medicare.
• Nonmedical retirement expenses—Although money used for nonmedical expenses will be subject to federal—and usually state—income taxes, after age 65 you will not be subject to the 20 percent penalty fee.

After age 65, your eligibility will typically end for HSA contributions. However, your options expand for using the money that you have saved in the account.

This Know Your Benefits article is provided by Senior Health Solutions, LLC and is to be used for informational purposes only and is not intended to replace the advice of an insurance professional. © 2015, 2017, 2020 Zywave, Inc. All rights reserved.

The Medicare Part D “donut hole” or coverage gap is the phase of Part D coverage after your initial coverage period. You enter the donut hole when your total drug costs—including what you and your plan have paid for your drugs—reaches a certain limit. In 2022, that limit is $4,430. While in the coverage gap, you are responsible for a percentage of the cost of your drugs.

You can read more here:

A common question we get is “I am turning 65 soon and will be Medicare eligible but plan on still working and covered by my employer’s health plan, do I need to sign up for Medicare Part B?”

The answer: it depends. If your employer is under 20 employees and the health insurance carrier coordinates benefits with Medicare, like most health insurance carriers do, you should sign up for Medicare Part B since that would be primary coverage for Physician Care. If your employer is over 20 employees than it really comes down to a choice as Medicare would be secondary. Many times, beneficiaries can find more cost-effective coverage and better benefits in the Medicare insurance markets, especially if you contribute a high amount toward your employer sponsored coverage and/or have high deductibles. This chart is useful in understanding how Medicare works with other insurance.

You can access the chart here: