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What this site is about:
If you are researching Medicare-related topics, then this is the right site for you. Originally, we started to help people who were turning 65 get information quickly and easily, but then we also started assisting people who wanted to change plans. We then started helping people who were assisting their parents, spouses, or other friends with Medicare coverage. And because we have a lot of information, other insurance brokers, or people who wanted to become a broker, started visiting us as well. So we have some information for people interested in getting into the field as a line of work as well!
I’ll try to break everything about Medicare down, so you’ll know what to expect from this website.
First, a little about me, Kathe Kline. I retired from Financial Planning after a thirty-year career. So, I look at Medicare Insurance a little differently than most insurance brokers do. I look at how it will affect the whole person in their individual situation, not just whether I’m going to make a quick sale. You can check out some of our reviews at https://medicarequick.com/reviews/.
If you’d like to know why I left a very lucrative business as a financial advisor and started working with Medicare insurance, it’s because my husband was told by an agent that he didn’t need a drug plan because he didn’t take any medications when he signed up for Medicare. Well, spoiler alert, he now will pay a monthly penalty for the rest of his life because of that very bad Medicare advice, and I decided that shouldn’t happen to anyone else. If you’d like to learn more, go to https://medicarequick.com/about-us-medicarequick-san-diego-medicare-insurance-broker/
In case your wondering, I’m no longer in San Diego, but many of my clients and friends are. My small but mighty insurance practice is all over the United States now.
Also, we won’t try to steer you towards Medicare plans that won’t work for your situation. That’s why we work with both types of plans here. We don’t focus on one company or one plan. We represent YOU instead of the insurance companies.
That being said, our services are free to you. Why is that? It’s because the insurance company pays us once you sign up for a plan. We’re not selling your information to ten insurance agents so that they can spam you or make you miserable with tons of unwanted phone calls. We’re looking for a relationship with you, not with multiple insurance agents who are going to drive you insane with all of their phone calls while you are trying to eat dinner.
What is Medicare?
We have many extensive articles on Medicare itself. This includes Parts A, B, C, and D of Medicare. We talk about what is covered, and how much you’ll have to pay yourself. It’s very important that you understand that Medicare doesn’t cover everything, and there is no limit to your expenses on original Medicare. That’s why we assist people in getting either a Medicare Supplement Plan (Medigap) or a Medicare Advantage Plan (MA or MAPD) to limit their liability and future expenses.
Medicare has four parts: Part A, Part B, Part C, and Part D. Each part covers different services:
Part A, known as hospital insurance, covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. You don’t have to pay a monthly premium for Part A because if you have worked for 10 years (40 quarters) and have paid sufficient Medicare taxes, you’ll be eligible for premium-free Part A. If not, then you must pay monthly premiums for Part A.
Part B, covers certain doctors’ services, outpatient care, some medical supplies, preventive services, and a range of services such as x-rays, diagnostic tests, and renal dialysis. Unlike Part A, Part B requires a premium. And if you are a high-income earner, you might pay more than the standard amount due to IRMAA. The higher your income is, the higher your premium is. Social Security sets the standards on the cost of Part B and can change yearly.
If you are low income, you might qualify for Medicaid, which can cover the Part B premium along with other help, such as help paying for prescription medications.
Part C, also called Medicare Advantage, is a health plan offered by private health insurance companies. Although it technically doesn’t replace Parts A and B, it replaces how you use those benefits.
If you opt for Part C or Medicare Advantage, you won’t use original Medicare while you’re on the Medicare Advantage Program. You’ll be subject to the rules of the private insurance company while limiting your maximum out-of-pocket expenses for medical care, and potentially getting additional benefits that Original Medicare doesn’t offer. These additional benefits could include Dental, Vision, and Hearing Aids, among some other benefits.
The cost of Medicare Advantage plans varies. Different factors could include the insurance carrier, the plan selected, and the county of residence. As I mentioned before, Medicare Advantage is an alternative to Original Medicare (Parts A and B). But before you can get it, you must be enrolled in both Parts A and B. You must pay your Part B premium to keep the Medicare Advantage Plan in force, even if the Medicare Advantage Plan has no premium.
Some Medicare Advantage plans have low or even no monthly premiums, but again: you still have to pay for Part B.
The main advantage of Part C is that it limits your liability with the MOOP (Maximum Out of Pocket) for medical expenses, and it may include benefits that Original Medicare doesn’t cover, like routine vision care, hearing care, dental care, and also prescription drug expenses (Part D).
Part D covers prescription drugs. You can add it as a stand-alone plan to Medicare Supplements or it could come as part of some Medicare Advantage Plans. Keep in mind that you cannot have both a stand-alone drug plan and a Medicare Advantage Plan.
Original Medicare doesn’t come with Part D. You’ll need to enroll in a stand-alone Medicare Prescription Drug Plan to get coverage or obtain a Medicare Advantage Plan that includes it. Most states have dozens of drug plans to choose from, the best way to find out which plan suits you is by contacting your Medicare Insurance Agent (and you can schedule a time to talk with us at http://MedicareQuick.com/schedule).
How Do Medicare Supplement Plans work?
Medicare Supplement Plans also known as Medigap plans are insurance contracts that help cover the gaps of original Medicare. Each plan is standardized so that if you have a Plan G with company #1, it covers the exact same benefits as company #2. However, recently some companies have started offering additional benefits in their plans. These additional benefits are not usually part of the plan. For example, if your plan offers Silver Sneakers, they could remove that benefit at any time. Some plans, such as Innovative or Extra plans DO guarantee the benefits under those plans, but I recommend that instead of getting into the “weeds” of added benefits, stick to the MEDICAL benefits when comparing supplement plans.
Be aware that many people (including doctor’s offices) confuse the terminology when discussing Medicare Supplements. They might call a Medigap plan a PPO. They are not PPOs. Among other things, a PPO has a network. PPOs can still use Prior Authorization. These do not exist with Medigap plans. For more details go to Medicare Supplements vs PPOs.
h2>How Does Medicare Advantage work?
Medicare Advantage is a Privatized Medicare Plan. Although you still have your Medicare card, you won’t be able to use it to get insurance benefits. That’s because Medicare entered into a contract with the insurance company that you choose to provide your benefits. The insurance company gets paid whether you utilize benefits or not. But, if you need expensive care, such as heart surgery, then the insurance company is on the hook for paying for it. So it helps limit the government’s liability to care for you.
As a consumer, when you choose a Medicare Advantage Plan, you can get additional benefits that Original Medicare doesn’t offer. These benefits are often very attractive. For example, many include dental, vision, and hearing benefits. You could also receive transportation to and from the doctor’s office. You might be able to get meals sent to your home after surgery. And you might even be able to get your Skilled Nursing Home paid for, even without a three-day inpatient hospital stay.
But, you also must follow all of the insurance company’s rules. One of those rules is often “prior authorization.”
Prior Authorization means that there is a decision-maker between you and your doctor who determines whether or not you’ll be able to have a procedure. This is often done to limit the insurance company’s costs.
What is the difference between Medicare Advantage vs Medicare Supplement Plans or Medigap
There is a huge difference between Medicare Supplement Plans and Medicare Advantage Plans (MA or MAPD). To understand the difference, either take our Medicare Class (it’s only 15 minutes) or go to the article on Medicare Advantage vs Medigap. But in a nutshell:
MA Plans are not standardized. It’s more difficult to compare them than Medigap plans.
MA Plans usually offer additional benefits. Normally Medigap plans only fill the gaps of original Medicare.
MA Plans have networks. This means that even if your doctor accepts Medicare, he or she might not accept your plan.
MA Plans can change every year. That means that your plan may morph into something that doesn’t work for you.
Medicare Advantage Plans also control costs by using pre-authorization. This means that even if your doctor thinks you need a certain procedure, the insurance company can say “no”. Medigap plans don’t do this. If it’s an approved procedure, and Medicare covers it, so will your Medigap plan.
How Do Prescription Drug Plans work?
I’m glad you asked! Actually, I wrote a best-selling Amazon book on this very topic. But you don’t have to buy my book for me to give you information on Medicare Drug Plans. The answer is that Medicare Part D (PDP) drug plans work very differently than you are used to.
First of all, there is a penalty if you don’t enroll when you are first eligible. That is as long as you don’t have creditable coverage. Creditable is a fancy word that pretty much means “coverage as good as Medicare,” but it’s not really accurate, because COBRA is not considered to be creditable, and COBRA is just your work insurance (that you had before) that you have to pay 103% of the cost for.
Anyway, I digress.
These PDP plans have some things you are probably used to. Like a deductible. But many companies waive the deductible for generic drugs. Not all, but many.
They’ll have a copay or co-insurance amount after the deductible. Pretty easy so far. But then…
Prescription drug plans have something called the coverage gap. You might have heard it called the donut hole. This donut hole is not something delicious and fattening. It’s something that can SHRINK your wallet. That’s because when you hit the donut hole your costs go up. That’s right. Normally your costs will go up in the donut hole to 25% of the cost of the drug. That can be a whopping amount.
And there is no Maximum Out of Pocket amount for the drug plan. So your costs can be unlimited. However, there is something called Catastrophic Coverage. What that means, is when you have paid a pre-determined amount (it changes every year), then your costs will go down through the rest of the calendar year. They’ll go down to either 5% of the cost of the drug, or a nominal amount (it changes every year) whichever is less. But this is not something that you are likely used to on your company medical plan. Or even on your individual plan. So you need to watch out for that.
Oh, and guess what? The plans change every year. I’ve had several clients who wanted to stay on their old plan but after I checked, had they done that, they would have spent over $3,000 extra. That’s right. So just remember to check your plan every year during open enrollment. It’s easy to do and is actually a class inside my Medicare Class Site. It’s about 8 minutes long and could save you thousands on your drugs.
Where can I find Medicare Classes Near Me?
The easiest way to learn about Medicare is through our Medicare Class site. Something you should know is that most Medicare Classes near you are taught by someone who sells Medicare insurance, either Medicare Advantage Plans or Medicare Supplements. Even if they are Educational in nature, you might feel pressure to meet with that person.
Additionally, I’m writing this as we are still in the COVID-19 crisis. Even if there were no COVID-19, there is still the possibility of getting ill when you meet with crowds of people. Someone might cough or sneeze near you, and then BAM! You’re sick in a couple of days.
You obviously have access to the internet or you wouldn’t be reading this. Why not get your information at home, where you a cozy and comfortable, with no pressure or risk of getting sick? Just go to our Medicare Classes Near Me site. The very first class discusses the difference between original Medicare, Medicare Advantage, and Medicare Supplements. It’s a great place to start because that is where the majority of questions are.
There are additional classes on the site too, for more detailed questions. And best of all, it’s all free to you, the consumer. (We do ask that insurance brokers pay for our guidance, which is only fair since they are competing with us for your business).
Of course, we do local workshops as well, and we provide 1:1 counseling/discussions/advice to people who would like more assistance. After all, that’s how we get paid.
How can I speak with you?
I love talking with people who have questions about their Medicare! There are a couple of ways to reach me. The first is to send me an email through this site. To do that, just go to https://medicarequick.com/contact-medicare-quick/
After we talk via email, if it seems like we should speak in person, I’ll be happy to send you a link to my calendar app so you can schedule a time to speak with me at your convenience on the phone or via video conferencing, whichever you prefer.
I can’t wait to meet you and talk about the Medicare Insurance plans that will work best for your unique situation. I am licensed in the states of California, Florida, Michigan, Missouri, Nevada, New Mexico, North Carolina, South Carolina, Tennessee, Texas, Virginia, and Washington. So feel free to contact me via email if you think I can help!
When you choose MedicareQuick, you can be sure that you are working with someone who has significant experience and can offer you guidance on your chosen plan.
We are Insurance Licensed in the States of Arizona, California, Florida, Michigan, Missouri, Nevada, New Mexico, North Carolina, South Carolina, Tennessee, Texas, Virginia, and Washington.
MAPD and PDP service areas vary.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.