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    Your Guide to Medicare Open Enrollment 2023

    Medicare Open Enrollment is happening NOW

    During this time, you can make changes to your prescription drug plan, enroll in a prescription drug plan, change your Medicare Advantage Plan, or enroll in a Medicare Advantage Plan.

    What is New for 2023

    *Part B premium will be reduced from $170.10 to $164.90.

    *Part B deductible will be reduced from $233 to $226.

    *There is now a Plan G Plus plan which includes dental and vision benefits along with your medical benefits.

    *Many carriers offering Medicare Advantage plans have decreased the maximum out of pocket.

    *Many carriers offering Medicare Advantage plans have increased dental benefits.

    *There is now a Medicare Advantage plan being offered for $187 per month with $0 out of pocket expenses.

    *Part D deductible will increase from $485 to $505.

    *The initial figure needed to enter the donut hole has increased from $4,430 to $4,600.  As a reminder, Medicare is keeping a running total of the full cost of your drugs.  When you reach this figure, your coverage level (i.e. co-pays) change.

    *Part D TROOP will increase from $7,050 to $7,400. This is the amount you are responsible for before exiting the donut hole and entering catastrophic coverage.

    Reminders

    Medicare Supplemental plan premiums increase each year as you age.

    You can change your Medicare Supplemental plan at ANY time; however many carriers will medically underwrite before accepting a new policy.  This means the policy can be denied or you can be charged a higher rate due to your medical history.

    What you need to know about the Basics of MEDICARE

    Part A is provided by Social Security and covers HOSPITALIZATION.  The deductible is $1,600 and most people do not pay a monthly premium.

    Part B is also provided by Social Security and covers DOCTOR VISITS at 80%.  In 2023 the Part B premium will be $164.90/month.  Most people have the premium deducted from their Social Security.  The deductible for Part B is $226.  As a side note, Part B premium is based on income.  If your income is greater than $85,000 for an individual or $170,000 for those that file a joint return, you will pay a higher premium. 

    WHAT DOES THIS MEAN???  If you only have original Medicare, you will pay 100% of your doctor visits and hospital visits until you reach your deductible.  Once you meet the deductible (i.e. $226 per year for doctor visits and $1,600 for each hospitalization outside of 60 days). Medicare will start paying 80% of the bill for doctors’ visits and 100% of the hospitalization for the first 60 days. 

    It is important to note that not all doctors accept Medicare.  You will need to confirm with your doctor that they accept Medicare before making your appointment.

    WHAT ABOUT PRESCRIPTION DRUGS???  For those that are Medicare eligible, you are REQUIRED to purchase a prescription drug plan if you do not have credible coverage.  Prescription drug plans are provided by private insurers (i.e. BCBS, Humana, United Healthcare/AARP, etc.), NOT Social Security. 

    Many people think prescription drugs are included in Part A and Part B…they are NOT.  If you choose not to purchase a plan, you will be penalized 1% of the average premium for each month that you do not have coverage.  Although this figure sounds low, it does add up over time.  The penalty is NEVER removed.  Once you are assessed a penalty it will be added to your monthly premium (i.e. $30/month premium + $20 penalty = $50 monthly premium). 

    Prescription Drug plans are subject to an enrollment period.  The enrollment period is NOW.  If you qualify for a special election period (i.e. aging in to Medicare or losing credible coverage) you will be eligible for enrollment based on the date of your eligibility.

    Prescription Drug plans have a monthly premium, co-pays are charged based on which Tier your drug falls in to, and some plans charge a deductible.  It is important to review your drug list before switching carriers.

    What’s Next??

    *Healthcare: Open Enrollment has been extended until January 15th.  Current policy holders can submit changes to their existing plan or submit a NEW plan.  Once the 15th has passed, you will not be able to make any plan changes.  NEW policies submitted during this time will take effect February 1st.

    *Medicare: Medicare Supplement policy holders ages 65-75 have the option to change to another Medicare Supplement plan without requiring underwriting approval.  To qualify for the Birthday Rule, you must enroll in a plan with the same or lesser benefits.  The change must be done within 45 days AFTER your birthday. 

    *Medicare: Medicare Advantage policy holders are currently in a second Open Enrollment period until March 31st.  During this time, you can change to another Medicare Advantage Plan.

    *Auto/Home Insurance: Many policies renew during the month of January.  When reviewing rates consider these tips:

    +Always review the total package (i.e. home and auto).  Often, some carriers will have a better rate on the home as opposed to the auto however, the total calculation needs to be reviewed when determining the best scenario. 

    +Make sure you are matching coverages.  Some carriers are notorious for removing full coverage to reduce the rate.  Sadly, some people do not realize that until they have an accident.  Full coverage means the carrier will fix your vehicle in the event of an at fault accident.  On the flip side, liability only means your vehicle is NOT getting fixed in the event of an at fault accident.

    *Life Insurance: With the start of the New Year, many will review their financial goals for the year and discuss any gaps.  Many people will not buy Life Insurance because they overestimate the cost of a policy. Costs depend on a number of factors, including your health, age, tobacco use, and gender.  As one example, a healthy 35-year-old male can expect to pay about $20 per month for $250,000 on a 30-year term.

    *Business Insurance: We’ve received LOTS of calls lately regarding employees injured on the job.  A workers compensation policy provides wage replacement and medical benefits to employees injured as a result of their job.  Premiums are based on the annual payroll and type of work performed.

    Tips to Reducing your Medicare/Health Insurance Premium

    REMINDER: Medicare Open Enrollment ends December 7th and Health Insurance Open Enrollment ends January 15th.

     

    TIPS to Reducing your Medicare Premium…

    *Consider a Medicare Advantage Plan.  If you are already in one, you may want to consider another carrier.  Be sure to pick a plan with a low maximum out of pocket and confirm that your doctors accept the plan before switching.

    *Consider switching the type of Supplemental Plan you are in currently (i.e. Plan N is less expensive than a Plan G).  I will caution, that changing your plan may require you to pay for services that you have not paid for in the past. 

    *Consider switching carriers for your Supplemental Plan.  Plan coverages are the same regardless of who the carrier is.   Please note, you may be medically underwritten which means the new carrier can charge a higher rate or deny you based on your medical history.

    *Review your drug lists with other carriers.  Medicare.gov is a great source for reviewing rates with other carriers.  Simply plug in your drug information, select your pharmacy, and review the different plans available (based on the drugs you have been prescribed).

    *Consider switching pharmacies.  First, make sure your pharmacy is still in the Preferred Network with your prescription drug plan.  Second, find out what the different pharmacies charge for your drugs.  You may see a difference that can save you some time in reaching the donut hole.

     

    TIPS to Reducing your Health Insurance Premium…

    *Be prepared to discuss your household, estimated adjusted gross income for 2022.  This will be used to determine if you qualify for assistance.   Thanks to the American Rescue Plan, the threshold has increased.  Some families making $250,000 per year can qualify for assistance!

    *Those without pre-existing conditions should consider a short-term medical plan.  These plans do not provide coverage for pre-existing conditions, maternity, and limited wellness visits. However, these plans are a fraction of the cost of plans offered through the Marketplace and they have a PPO network.

    *If you are going to opt to self-insure, protect yourself with an accident or critical illness plan.  The plan works separate from health insurance and pays you in the event of an accident (slip, fall, and break an ankle) as well as a diagnosis of a critical illness (cancer, heart attack, or stroke).  The purpose is to use the funds to pay towards the unexpected treatment.

    Consider splitting your household.  If one of you need to be on a plan that covers pre-existing conditions the other can look into the short term medical plan.  You can also split plans through the Marketplace. 

     

     

    Medicare Open Enrollment October 15th-December 7th

    Medicare Open Enrollment is happening NOW

    During this time, you can make changes to your prescription drug plan, enroll in a plan, change your Medicare Advantage Plan, or enroll in a Medicare Advantage Plan.

    If you have a Medicare Supplement Plan, you are not obligated to make changes at this time.  You can enroll in a Medicare Supplement at any time.  Please note, if you are interested in making a change outside of your initial enrollment period, Medicare Supplement plans are subject to underwriting.  This means you can be charged a higher rate or denied due to past medical history.

     

    TIPS to Reducing your Premium…

    *Consider a Medicare Advantage Plan.  If you are already in one, you may want to consider another carrier.  Be sure to pick a plan with a maximum out of pocket and confirm that your doctors accept the plan before switching.  This will protect you in the event of a “bad” year.  

    *Consider switching the type of Supplemental Plan you are in currently (i.e. Plan G is often less expensive than a Plan F).  I will caution, that changing your plan may require you to pay for services that you have not paid for in the past.  For example, a Plan N will charge the Part B deductible and $20 co-pay for doctors’ visits. 

    *Review your drug lists with other carriers.  Medicare.gov is a great source for reviewing rates with other carriers.  Simply plug in your drug information, select your pharmacy, and review the different plans available (based on the drugs you are taking).

    *Consider switching pharmacies.  First, watch to make sure your pharmacy is still in the Preferred Network with your prescription drug plan.  Second, find out what different pharmacies charge for your drugs.  You may see a difference that can save you some time in reaching the donut hole. 

     

    What you need to know about the Basics of MEDICARE

    Part A is provided by Social Security and covers HOSPITALIZATION.  The deductible is $1,484 and most people do not pay a monthly premium.

    Part B is also provided by Social Security and covers DOCTOR VISITS at 80%.  In 2021 the Part B premium increased to $148.50/month.  Most people have the premium deducted from their Social Security.  The deductible for Part B is $203  As a side note, Part B premium is based on income.  If your income is greater than $85,000 for an individual or $170,000 for those that file a joint return, you will pay a higher premium.  

    *These figures have not been updated for 2022 yet and may be subject to change.*

     

    WHAT DOES THIS MEAN???  If you have only original Medicare, you will pay 100% of your doctor visits and hospital visits until you reach your deductible.  Once you meet the deductible (i.e. $203 for doctor visits) Medicare will start paying 80% of the bill.  You are still responsible for the remaining 20%.

    It is important to note that not all doctors accept Medicare.  You will need to confirm with your doctor that they accept Medicare before making your appointment.

     

    HOW TO FILL THE GAPS???  Many people purchase a Medicare Supplement plan to fill the gaps.  The most common plan today is Plan G.  These plans cover the Part A deductible and the Part B co-insurance (20%).  Medicare Supplements are provided by private insurers (i.e. BCBS, United Healthcare/AARP, Mutual of Omaha, Aetna, etc.) and charge a monthly premium.  The premium will vary by age, carrier, and zip code.

     

    Another option is a Medicare Advantage Plan.  These plans have a lower monthly premium, include prescription drugs, and are subject to the enrollment period noted above.  Medicare Advantage Plans are set up as “pay as you go”.  Meaning the monthly premium is less than a supplement/prescription drug plan, however you pay a co-pay for each of your services (i.e. $5 co-pay to see the primary care physician, $10 co-pay to see a specialist, etc.).  These plans are offered by private insurers (i.e. Blue Cross Blue Shield, Human, United Healthcare/AARP, etc.)

     

    WHAT ABOUT PRESCRIPTION DRUGS???  For those that are Medicare eligible, you are REQUIRED to purchase a prescription drug plan if you do not have credible coverage.  Prescription drug plans are provided by private insurers (i.e. BCBS, Humana, United Healthcare/AARP, etc.), NOT Social Security.  Many people think prescription drugs are included in Part A and Part B…they are NOT.  If you choose not to purchase a plan, you will be penalized for each month that you do not have coverage.  Once a drug plan is selected, the penalty will be added to the premium.  Please note, the penalty is NEVER removed.  

    Prescription Drug plans are subject to an enrollment period.  The enrollment period is NOW.  If you qualify for a special election period (i.e. aging in to Medicare or losing credible coverage) you will be eligible for enrollment based on the date of your eligibility.

    Prescription Drug plans have a monthly premium, co-pays are charged based on which Tier your drug falls in to, and some plans charge a deductible.  It is important to review your drug list before switching carriers. 

     

    WHO IS ELIGIBLE FOR MEDICARE???  People that are 65 or older or those that have been disabled and collecting social security disability for 24 months. 

     

    Your Guide to Medicare 2020-Open Enrollment.

    It’s time for Medicare Fall Open Enrollment.  Knowing how to navigate coverage options and understanding what changes are in store for Medicare in 2020 will help you make the most informed decisions during Fall Open Enrollment.

    During this time, you can make changes to your prescription drug plan, enroll in a plan, change your Medicare Advantage Plan, or enroll in a Medicare Advantage Plan.

    WHO IS ELIGIBLE FOR MEDICARE?  People that are 65 or older or those that have been disabled and collecting social security disability for 24 months.


    What to Expect in 2020

    • Plan F will no longer be offered to newly eligible enrollees.  If you have a Plan F currently, your plan will remain the same.  If you became eligible for Medicare before January 1, 2020 you will still be able to enroll in Plan F.
       
    • Humana had made a change to their prescription drug plan.  Those on the Humana Walmart Plan have been re-mapped to the Humana Premier RX plan.  Humana is offering a less expensive option, but we MUST make sure your drugs are covered in the new plan.  If you want to discuss your options, please have your list of drugs available.
       
    • The Part D (prescription drug) deductible has increased to $435.  Many carriers offer plan with $0 deductible for drugs in Tier 1 or Tier 2.
       
    • Donut Hole: The initial limit has increased to $4,020. 
    • United Healthcare/AARP and Blue Cross Blue Shield have little to no changes to their plans for 2020.  If you are happy with your plan, the plan will automatically renew. 

    Tips to Reducing Your Medicare Premium

    • Consider a Medicare Advantage Plan.  If you are already in one, you may want to consider another carrier.  Be sure to pick a plan with a maximum out of pocket and confirm that your doctors accept the plan before switching.  This will protect you in the event of a “bad” year.
    • Consider switching the type of Supplemental Plan you are in currently (i.e. Plan G is often less expensive than a Plan F).  I will caution, changing your plan may require you to pay for services that you have not paid for in the past.  For example, a Plan N will charge the $185 deductible and $20 co-pay for doctors’ visits. 
    • Review your drug lists with other carriers.  Medicare.gov is a great source for reviewing rates with other carriers.  Simply plug in your drug information, select your pharmacy, and review the different plans available (based on the drugs you are taking).  
       
    • Consider switching pharmacies.  First, watch to make sure your pharmacy is still in the Preferred Network with your prescription drug plan.  Second, find out what the different pharmacies charge for your drugs.  You may see a difference that can save you some time in reaching the donut hole. 
       

    This is an extremely busy time for me. I suggest scheduling early as my schedule will fill up.  Contact me at 708-444-0050 or kelly@kellyburkeinsurance.com.

    Please include your availability (i.e. mornings, afternoons, or evenings) and the type of appointment you are requesting (face to face or conference call). 

    Questions
    Questions

    Feel free to email or call me with any questions or comments about my services or if you have any insurance related inquires.

    Contact
    Contact

    Phone: 708.444.0050
    Email: kelly@kellyburkeinsurance.com

    Availability
    Availability

    Monday - Friday: 10am - 5pm
    Evening and weekends
    available upon request