MEDICARE BASICS

Medicare Coverages

Medicare is our country's health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those with disabilities and those who have permanent kidney failure.

The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. You have choices for how you get Medicare coverage. If you choose to have Original Medicare (Part A and Part B) coverage, you can buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company.

Medicare Part A (Inpatient Benefits)

Medicare Part A generally covers inpatient care in either a hospital or skilled nursing facility.

  • Part A deductible: $1,484 (2021)

  • Part A coinsurance: $371 per day (days 61-90 in hospital, 2021)

  • Part A coinsurance: $742 per day (days 91-150 in hospital, 2021)

  • Part A coinsurance: $185.50 per day (days 21-100 in a skilled nursing facility, 2021)

Medicare Part B (Outpatient Benefits)

Medicare Part B generally covers outpatient care for services such as physician visits, lab services, radiology services, chemotherapy, outpatient surgery, etc.  One of the biggest gaps in Medicare is that Part B services have NO out-of-pocket maximum.

  • Part B deductible:  $203 per calendar year (2021)

  • Part B coinsurance:  Generally 20% of Medicare allowable charge

  • No out-of-pocket maximum

Medicare Part C (Medicare Advantage)

Medicare Part C, otherwise known as Medicare Advantage, is where Medicare benefits are offered by private insurance companies rather than Medicare directly.  Part C plans will always include benefits for both Part A and Part B and usually, Part D.  Medicare beneficiaries have the option to choose a Part C plan to replace their Original Medicare benefits. Part C plans usually have a different schedule of benefits than Original Medicare but are required to offer, at a minimum, a level of benefits that is equal or better than Medicare.  Part C plans are overseen by CMS and typically change each calendar year.  Part C plans can be HMO, POS, PPO, or PFFS which are simply terms that define the provider network and provider choice options.  Medicare Part C plans MUST be discussed with agents in-person as there are many restrictions that must be complied with as required by CMS.  You are not permitted to purchase a Medicare Supplement policy if enrolled in Part C.

Medicare Part D (Outpatient Prescription Drugs)

Medicare Part D covers outpatient prescription drugs.  Each state has as many as 25 or more plan offerings for Medicare beneficiaries to choose from.  Part D plans are overseen by CMS but administered by private insurance companies.  Plans vary by price, deductible, copay amounts, formularies for approved drugs, and preferred pharmacy choices.  The easiest way to navigate your Medicare Part D options when you are first enrolling in Medicare is to let the Medicare team at Creekside Insurance Advisors assist in your evaluation.  We will need a list of your current medications, your zip code of residence, and your preferred local pharmacy – That’s it!  Call our local Virginia office at (800) 467-5425.

Medicare Supplement (Coordinates with Original Medicare A + B)

Medicare Supplement plans (aka Medigap) are usually purchased in addition to Medicare Parts A, B and D, but they only supplement benefits for Parts A and B.  Medicare Supplement plans, while standardized, vary from company to company in a few areas.  Using a plan that automatically has claim rollover from Medicare is important in order to avoid having to submit paper claims.  Also, it is important to work with a local, Virginia agency in order to have someone in your corner if a claim is not paid correctly or if a claim was misfiled by a medical provider.  Rates also vary greatly from company to company.  The team at Creekside Insurance Advisors can instantly quote all company rates by zip code in a matter of seconds in order to find your best value.  Here are a few plans that we recommend for Medicare Supplement (aka Medigap):

Plan G:  Does is the most comprehensive plan for new retirees except that YOU must pay the Part B deductible first.

Plan N:  Does a very good job of limiting out-of-pocket, but requires you to pay Part B deductible, then $50 ER copay, and $20 physician copay.  There is also up to 15% coinsurance responsibility if you do not use a Medicare assigned providers (which is rare, but possible).

Importance of Local Service

It is important, especially as you get older and Medicare becomes even more complex, to have an agency with a team that can assist you when the occasion arises.  Whether a claim is not paid or there is a future rate increase, Creekside Insurance Advisors is ready and eager to help you now and into the future.  By shopping more than a dozen companies, you can rest assured that you are receiving the coverage you desire at a rate you can afford.

Welcome to - Creekside Insurance Advisors, Inc.
OFFICE HOURS
                 Winchester Home Office

Monday - Thursday:  9 a.m. - 5 p.m.

Friday: 9 a.m. - 3 p.m.

                 Richmond Office

By Appointment Only

( or phone / Zoom)

Testimonials

“In recent months, I made the decision to retire from Winchester Public Schools. After 35 years, I had multiple task at hand and some very daunting.

Melissa made the transition much easier than I expected as she left no stone unturned. THANK YOU!"

Beth H.

“It was great working with Tina. She is knowledgeable and professional to work with. Helping us navigate through uncommon waters. Thank you!

 

I will be referring many friends so you can work your magic”

Bill, Bunker Hill, WV.

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