The only thing you need know about Medicare is our phone number
What is Medicare?
If you have ever tried to do your own research on Medicare you certainly know how confusing, intimidating, and frustrating it can be. Here at Lifestyle Life, we have done all the leg work for you, our goal is to make Medicare as clear as possible for you so you can make confident decisions and feel good about your healthcare.
Medicare can be difficult if you don't have an agent on your side, we can help you through your transition to Medicare as well as become your go to resource. As an independent agency, we shop the world of Medicare insurance carriers to help you find the plan that works best for your lifestyle. We shine in finding you the most competitive Medicare Supplement, Medicare Advantage, and Part D Prescription Drug plans for you, all at no cost to you. Have questions about your existing plan? Paying too much for your existing plan and want to see if you could do better? Finding yourself stumped and need some place to turn? Don't hesitate to give us a call or send us an email, we would be happy to help.
Click on the buttons below to learn more about each part
What does Part A cover?
Part A, often referred to as hospital insurance, covers inpatient hospital care, skilled nursing care, hospice, and some home health care. The premium for Part A varies on the taxes you have paid over your life time, for most there is no premium because you or a spouse has worked and paid taxes for 10 years or 40 quarters.
Part A has an inpatient hospital deductible of $1,408 per benefit period. Each benefit period has to be a minimum of 3 days separated by no longer than 60 days. So if you were to incur a 5 day hospital stay, be released and then readmitted in 3 weeks you would have no deductible since it has not been 60 days since your last stay. In addition to a deductible, Part A also comes with certain copays. Copays for an inpatient hospital stay are; days 1-60 are $0, days 61-90 come with a $352 copay per day, days 91-150 come with a $704 copay per day, and any day after that Medicare does not cover. Copays for skilled nursing facility stays are: $0 for days 1-20, and $176 per day for days 21-100.
Premium
$0For most people
Deductible
$1408Per benefit period
Up to 60 days
Copays
$352Per day for days 61-90 in one benefit period
$704Per lifetime reserve day
Maximum of 60 lifetime reserve days
What does Part B cover?
Part B, often referred to as doctors insurance, covers doctor visits, outpatient care, diagnostics, labs, durable medical equipment, preventative care, OT/PT and ambulance services. The premium for Part B is based on your Modified Adjusted Gross Income (MAGI), with the premium starting at $144.60 per month. Part B comes with an annual deductible of $198, after the deductible has been met you are responsible for 20% of all costs with no limit or maximum out of pocket cost. Part B does not cover dental, vision, hearing and custodial care.
What does Part C cover?
Part C, often known as Medicare Advantage plans, are coordinated care plans. Medicare advantage plans combine Part A and Part B benefits into one plan managed and administered by a private insurance company. These plans contract with a network of doctors and hospitals to provide care to plan members, each plan creates its own provider network. While certain plans may allow for more freedom in choosing providers, it typically comes a higher cost. Most of these plans include prescription drug coverage and could offer additional benefits.
- Medicare Advantage plans operate within defined geographic areas, called service areas. You must live in a plan's service area to become a member, because of this the price and availability of plans varies from region to region. Plans vary so much on location there are often states or regions that essentially do not have any Medicare Advantage plans. Contact us today to see if there are any Medicare Advantage plans available in your area!
- Premiums for these plans can vary greatly, with some premiums being as low as $0, however, these plans typically come with a range of copays and deductibles.
What does Part D cover?
Part D is Prescription Drug Coverage, this coverage is structured based on the prescription drugs you take. These plans are offered by independent Insurance companies with the plans structures being regulated by the Center for Medicare/Medicaid Services.
- CMS creates a list of medications that are designed to meet a certain list of ailments, this list of drugs is called a formulary.
- Drugs are placed into tiers based on their price. There are 5 tiers in every plan, with tier 1 being the least expensive and tier 5 being the most expensive.
- If you take any medications that fall in tiers 3-5, you could have a deductible.
Medicare Supplement Plans
As their name would suggest, Medicare Supplement Plans add additional coverage, or “supplement”, your Medicare coverage. Medicare Parts A & B are designed with many gaps in coverage; deductibles, copays, excess charges etc., Medicare Supplement Plans pick up these gaps in coverage, this is why they are often referred to as “Medigap” Plans.
There are 10 types of Medicare Supplement Plans offered, Plan A, B, C, D, F, G, K, L, M, and N. They each differentiate in structure and amount of coverage, the most popular plans are F, G, and N as they pick up most if not all of the gaps in Medicare. Contact us today to learn more about which plan could work best for you!
Things to know about Medicare Supplement Policies:
- Unlike Medicare Advantage Plans, Medicare Supplement Plans are can be used anywhere in the country as long as the provider accepts Medicare.
- To enroll in these plans you must first be 65 and enrolled in Parts A&B.
- These plans operate on the basis of a monthly premium that is determined by your age.
- They do not cover prescription drugs.
You can change your Medicare Supplement Plan at any time of the year. However, if you do so after your 6 – month Medicare Supplement open enrollment period or if your acceptance is not guaranteed, then an insurance company can deny you coverage or charge you a higher premium depending on your health history. Contact us to see your options in changing plans.
When can I enroll?
Frquently asked questions
Below are the answers to some of our most commonly asked questions.
- I'm still working, can I stay on my employer coverage?
- Does Social Security automatically enroll you into Medicare?
- Does Medicare include dental and vision coverage?
- How do I decide between a Medicare Advantage Plan and a Medicare Supplement Plan?
- How often can I change plans?
- I missed my Initial Enrollment Period, what now?
I'm still working, can I stay on my employer coverage?
Generally, as long as your employer's health plan has more than 20 participants you are able to stay on your employer's health plan until you retire.
Be sure to check with your Human Resources department or plan administrator that your employer health coverage is considered "Creditable Coverage" for Medicare. Having Creditable Coverage will allow you to remain on your employer's health plan until you retire.
If your employer's health plan has less than 20 employees, then the Center for Medicare & Medicaid services requires that Medicare becomes your primary health insurance. One thing to consider is that if you have already worked for 40 quarters or more, you could enroll in Part A with no premium for you to supplement your employer coverage.
When you retire and plan to transition to Medicare from your employer's plan, you will incur what is called a “Special Enrollment Period” in which you have 2 months to enroll in Part C and Part D, and 8 months to enroll into Part A and Part B. However, it is important that you submit your application with form CMS-L564E which states that you had creditable employer coverage. You can find this form on https://www.medicare.gov/ or simply contact us for more info.
Does Social Security automatically enroll you into Medicare?
If you are enrolled in, or taking social security benefits prior to age 65, then you will automatically be enrolled into Medicare Part A and B when you turn 65. Your Part A and B benefits will begin the first day of your birth month and you will automatically receive your Medicare Card in the mail. In addition, your premiums for Part A (if any) and Part B, will be automatically deducted from your Social Security benefits.
Does Medicare include dental and vision coverage?
Medicare does not cover any dental or vision expenses. To have dental and vision coverage, you would need to enroll in a separate stand-alone dental or vision plan outside of Medicare.
We also work work with these stand-alone dental and vision plans, and would be happy to show you your best options for dental and vision coverage.
How do I decide between a Medicare Advantage Plan and a Medicare Supplement Plan?
At Lifestyle Life we do not recommend or push anyone in the direction of one plan or another. This decision comes down to your personal preference, health situation, and location. For those who enjoy an HMO or PPO style of healthcare, want potential extra benefits and discounts, and want to bundle their Part A, Part B, and Part D coverage together might find that a Medicare Advantage Plan is the best fit for them. On the other hand, those who do not like the idea of being constricted to a network, enjoy having coverage when traveling in the US, do not like copayments and would rather have all the gaps taken care for, or simply do not have a Medicare Advantage Plan in their area might find that a Medicare Supplement Plan is best for them.
Still having trouble weighing your options? Contact us today!
How often can I change plans?
Medicare Supplement Plans: You may drop or switch Supplement plans at any time. However, if you drop/switch your plan past your Medicare Supplement Open Enrollment Period (6 months after the month of your 65th birthday) you could be denied coverage or charged a higher premium based on your health history.
Medicare Advantage Plans: You have a three month window every year to switch or drop your Medicare Advantage Plan. This three month period is known as Annual Enrollment Period and begins on October 15th and ends December 7th.
Part D Plans: You can change Part D Plans in the Annual Enrollment Period as well, which runs from October 15th to December 7th.
I missed my Initial Enrollment Period, what now?
If you missed your Initial Enrollment Period you must wait until General Enrollment Period, which occurs once a year from January 1st through March 31st, this allows you to enroll into Part A and B of Medicare. Once enrolled your coverage starts July 1st. To enroll into Part C and D of Medicare you must wait until the second General Enrollment Period which begins on April 1st and ends on June 30th, once enrolled your coverage would start on July 1st.
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