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Michael T. Braden, November 2, 2023 MEDICARE VS MEDICAID Chart Showing Medicare vs Medicaid MEDICARE IS NOT MEDICAID Medicare is not Medicaid, and Medicaid is not Medicare. I wanted to write this article for anyone, especially those turning 65 next year. You see, there is a big misunderstanding about Medicare and Medicaid, with many people thinking they are the same . In reality, they are not similar at all. Hopefully, this article will help to explain and educate everyone on the differences between Medicare and Medicaid. Most people are confused and believe that Medicare and Medicaid are the same thing. Similar to Medicare Supplements and Medigap being the same. However, there is a stark difference. Medicare is the National Health Insurance Program for Americans age 65 and over , as well as those with ALS or Renal Failure, or those who have been issued a Disability designation by the Social Security Administration. Medicaid operates at the state level and helps provide Health Care and other vital services to low-income individuals, seniors, single mothers, and children. Medicare and Medicaid are very different programs created by the U.S. government to cover the medical bills of two distinct groups of Americans. Medicare is the National Health Insurance Program for Americans age 65 and older , along with individuals diagnosed with a Disability, those with ALS, and anyone diagnosed with End Stage renal Disease. Medicaid is a Government Assistance Program for low-income individuals of any age. Although they receive subsidies and funding from the Federal Government, Medicaid is run by each state, so even though the programs are similar, each state has its own way of doing things. For example, in California, its Medicaid Program is referred to as Medi-Cal. To qualify for Medicaid benefits, an individual must fall below the income guidelines. Medicare is the National Health Insurance Program for individuals 65 and older in the US. Medicaid is for families, Children, and those with low incomes. The Federal Government and Medicaid manage Medicare, which is managed by each state. ELIGIBILITY GUIDELINE FOR MEDICARE & MEDICAID One of the most significant differences between Medicaid and Medicare is who qualifies for coverage. Here’s all you need to know about how Medicare and Medicaid eligibility differ. MEDICARE IS NOT MEDICAID Who qualifies for Medicare? People who are 65 or older qualify for Medicare as long as they’re both naturalized U.S. citizens and Resident Aliens who have Green Cards and have been granted Full-Time Citizenship Status, or lawful permanent residents. MEDICAID IS NOT MEDICARE As for who qualifies for Medicaid, that differs from state to state, but it always provides health coverage to individuals who:  Have extremely Low Incomes (with or without children).  Individuals who have been classified as having one or more disabilities.  Women who are Pregnant.  Seniors Many states extend Medicaid coverage beyond what federal law requires. For example, most have expanded their programs to cover nearly all low-income residents. Other state Medicaid programs cover people receiving home- and community-based services and children in foster care. Did you know that Medicare covers more than 60 million Americans, while Medicaid has nearly 73 million beneficiaries nationwide? DUAL ELIGIBLE DEFINITION Individuals referred to as Dual Eligible are those who meet the eligibility criteria for both Medicaid and Medicare. You might be surprised that , according to the United States Government, there are more than 12 million people in America who are "Dual Eligible Members". 12 Million! That is a lot of people. Dual Eligibility Chart For Individuals Who Qualify for Medicare and Medicaid. Typically, an individual meets the requirements for Dual eligibility by being classified as a low-income senior Citizen (Seniors are age 65 and older). Or anyone of any age who has received a person with a Full-Time Disability from the Social Security Administration. If you have Medicare and Medicaid coverage, Medicaid may help with your Medicare premiums and out-of-pocket expenses, such as deductibles and copayments. Additionally, there are benefits for Skilled Nursing Care that extend beyond Medicare's 100-Day Skilled Nursing Care Limit . For anyone who meets the definition of a Dual Eligible person, Medicare always pays first, and Medicaid is the secondary payer, at least until you reach any limits in each state. ENROLLMENT IS DIFFERENT FOR MEDICAID AND MEDICARE YOUR MEDICARE ENROLLMENT If you want Medicare coverage, you have to sign up during specific enrollment periods. Most people first become eligible for Original Medicare, which is another name for Medicare Part A and Part B, during the initial enrollment period (IEP). This seven-month window of time includes:  The three months before you turn 65  The month you turn 65  The three months after you turn 65 People who miss signing up for Medicare Parts A and B — or for a Medicare Advantage plan — during the IEP have to wait until the next general enrollment period rolls around to do so. The Medicare general enrollment period goes from Jan. 1 to March 31 every year. Another way to get Medicare after the IEP is to qualify for a special enrollment period. Will you start receiving Social Security or Railroad Retirement Board (RRB) benefits at least four months before your 65th birthday? If so, you don’t need to worry about the dates above. You'll automatically get Original Medicare. If you want Medicare but you don’t get Social Security or RRB benefits four months before you turn 65, you can apply online or at a local Social Security office. Most people enroll in Medicare prescription drug coverage during the enrollment periods detailed above, if they decide to enroll at all. You can choose not to enroll in a prescription drug plan when you first become eligible for it. If you do that, though, you’ll pay a late penalty for not enrolling in a Medicare Part D Prescription Drug Plan within 63 Days of your Part B Eligibility Date. And, to make matters worse, this penalty never goes away. On average , they add 38 cents per month for each month you did not have a Prescription Drug Plan in force, and that amount is added to each month's premium. So instead of $7.40 Premium each month, you went 3 years without credible coverage (36 x .38 = $13.68). You will now pay $13.68 in penalties forever, meaning your $7.40 Premium is now $21.28 each month! YOUR MEDICAID ENROLLMENT With Medicaid, there are NEVER any penalties to worry about, and you will never need to worry about any dates or deadlines. You do have to apply and qualify for this health coverage, though. And you are eligible for Medicaid based on your income. These income requirements vary slightly from state to state. You should contact your state's Medicaid Department for the exact eligibility requirements for your area. We recommend that you contact your state Medicaid agency to apply for this kind of coverage. Another way to apply for Medicaid is through the health insurance marketplace established by the Affordable Care Act (Obamacare) . BENEFITS AND COVERAGE ARE VASTLY DIFFERENT Both Medicare and Medicaid cover many medical procedures and costs. They do so in different ways and to various extents, though. YOUR BENEFITS UNDER MEDICARE Medicare coverage is a lot more complicated than Medicaid coverage. Medicare consists of four main parts: A, B, C, and D. MEDICARE PART A Medicare Part covers your inpatient costs and Benefits. Medicare Part A primarily covers hospital costs. MEDICARE PART B Medicare Part B covers your Outpatient Care and Services. MEDICARE PART C = MEDICARE ADVANTAGE Medicare Part C is also known as Medicare Advantage. You get Medicare Advantage (Part C) plans through private insurance companies. They provide the same coverage as Part A and Part B. Sometimes, they cover care that Original Medicare doesn’t, like dental work, hearing tests, and prescription drugs. MEDICARE PART D (PRESCRIPTION DRUG COVERAGE) Medicare Part D covers prescription drugs. Not all Part D plans cover all drugs, though. Some plans may cover the medications you take, while others won't. Because of this, it's essential to review a plan's list of covered drugs, or "formulary,” before you join it. YOUR COMMON BENEFITS WITH MEDICAID Medicaid coverage is more straightforward than Medicare coverage, but that doesn’t mean it’s always easy to understand. That’s because although all state Medicaid programs must provide certain benefits, they can choose whether to give others. Here are some of the Medicaid benefits every state must offer:  Inpatient and outpatient hospital services  Doctor visits  Lab tests  X-rays  Family planning services  Home health services  Nursing facility services And here are some of the optional Medicaid benefits states can offer:  Chiropractic care  Dental care  Eyeglasses  Prescription drugs  Physical therapy  Speech, hearing, and language disorder services  Other diagnostic, screening, preventive, and rehabilitative services TYPICALLY BENEFICIARIES SPEND LESS MONEY ON MEDICAID THAN THEY DO IN MEDICARE Another key difference between Medicare and Medicaid is how much they cost. The main difference between the two programs is that people with Medicare pay a larger share of the cost of covered procedures and services than Medicaid recipients do. In fact, people who get Medicaid usually pay no part of the costs for covered medical care. Sometimes they’re charged a small copay, but that’s about it. Medicare recipients, though, often have to pay premiums, deductibles, and other out-of-pocket costs for coverage. And not only that, but they usually pay them for multiple Medicare “parts.” For example:  Most Americans don't pay a premium for Part A; those who do pay up to $437 each month.   Most people pay a premium for Medicare Part B. The standard amount is $164.90 per month, though it could be higher depending on your income.   Medicare Part D recipients usually pay monthly premiums, too. How much they pay depends on the drug plan they choose. DISCLAIMER: At Braden Medicare, we are always doing our best to vet the information we present to the public in our Blog Articles. Be would never intentionally omit information that is critical for anyone. Our simple goal is to present information, facts, and ideas that might be of interest and value to the Senior population in the United States. Any content or services we provide on our Blog and on our website at www.bradenmedicare.com are intended to inform and educate the public. Braden Medicare is not employed by, or directly affiliated with, the Centers for Medicare & Medicaid Services or the United States Government, and Medicare does not use us in any way. Our passion and drive are centered around serving others in the best way we can. We are licensed to operate and conduct business in Arizona, California, Colorado, Indiana, Iowa, Florida, Michigan, Nevada, Ohio, Oregon, New Mexico, Pennsylvania, Texas, and Wisconsin.

Michael T. Braden, August 27, 2024 MEDICARE ENROLLMENT How To Enroll In Medicare   ENROLLING IN MEDICARE When you are new to Medicare and Enrolling in Medicare, your first chance to sign up for Medicare is during your Initial Enrollment Period, which we’ll discuss a bit further in the next section. The Medicare Initial Enrollment Period starts 3 Months Before Your Birth Month WHen You Turn 65, and continues 3 Months after your Birth Month. This period typically begins when you turn 65. For instance, if your birthday is on March 1st, your Initial Enrollment Period would run from December to June. It spans seven months, starting three months before your 65th birthday and ending three months after your 65th birthday. For example, if you enroll in December, January, or February, your coverage begins on March 1st. This period ensures you have ample time to enroll in Medicare and avoid any gaps in coverage as you transition into this critical phase of life.   ENROLLING IN MEDICARE ENROLLING IN MEDICARE IS EASY, AND THERE ARE SEVERAL WAYS TO DO IT: Automatic Enrollment:  If you start receiving Social Security retirement benefits anytime between the ages of 62 and up to four months before turning 65, you'll be enrolled automatically in Medicare Part A and Part B when you reach 65. Applying for Social Security:  If you apply for Social Security benefits three months before your 65th birthday or later, you can sign up for Medicare during the same process. Initial Enrollment Period:  This 7-month period begins three months before you turn 65 and ends three months after your 65th birthday. It's crucial to enroll during this time to avoid any penalties. Exceptional Circumstances:  If you're not ready to receive Social Security benefits at 65 because you're still working, you can apply online for Medicare only. Alternati vely, you may wait until retirement to enroll during a special enrollment period.   WHAT DOES MEDICARE COVER? While specifics can vary based on your plan, all Medicare plans must offer at least the same coverage as Original Medicare. However, certain services may have limitations, such as being available only in specific facilities or for patients with particular conditions. HOW TO APPLY FOR MEDICARE PART B ONLINE USING THE SOCIAL SECURITY WEBSITE. HOW TO APPLY FOR MEDICARE PART A ONLINE USING THE SOCIAL SECURITY WEBSITE.

Explaining the Medicare Supplement and Medigap Open Enrollment Period Rules and Options WHEN CAN YOU ENROLL IN A MEDICARE SUPPLEMENT/MEDIGAP PLAN? DETAILING PURCHASING INFORMATION, ENROLLMENT PERIODS, GUARANTEED ISSUE RIGHTS, AND MORE   It is essential to understand protected enrollment periods for Medigap so you can time your enrollment wisely. Here , we discuss federally protected periods to purchase a Medigap policy . Get familiar with the Medicare Supplement Open Enrollment Periods to avoid any mistakes or disappointments.   Be aware that this information only pertains to protections that apply nationwide.  Some states have additional protections that give their residents more opportunities to enroll in a Medigap plan . Be sure to call your State Health Insurance Assistance Program (SHIP) or State Department of Insurance to ask about state-specific Medigap rights. OPEN ENROLLMENT PERIOD Generally, the best time to enroll in a Medigap policy is during your open enrollment period. Under federal law, you have a six-month open enrollment period that begins the month you are 65 or older and enrolled in Medicare Part B.During your open enrollment period, Medigap companies must sell you a policy at the best available rate regardless of your health status, and they cannot deny you coverage. The best available rate may depend on factors such as your age, gender, smoking status, marital status, and location . To ensure that you are getting the best available rate, you may want to check with your SHIP. If you purchase a Medigap during your open enrollment period, policies are limited in their ability to exclude coverage for pre-existing conditions, meaning conditions you had before you enrolled. GUARANTEED ISSUE RIGHT If you miss your open enrollment period, you can also buy a Medigap policy during a guaranteed issue period. If you are age 65 or older, you have guaranteed issue rights within 63 days of losing or ending certain types of health coverage. When you have a guaranteed issue right, companies must sell you a Medigap policy at the best available rate, regardless of your health status, and cannot deny you coverage. The best available rate may depend on factors such as your age, gender, smoking status, marital status, and location . A guaranteed issue right also prevents companies from imposing a waiting period for coverage of pre-existing conditions. Check with your SHIP to help ensure that you are getting the best available rate for your Medicare Supplement Policy. You may have a guaranteed issue right if: You, through no fault of your own, lost a group health plan (GHP) that covered your Medicare cost-sharing (meaning it paid secondary to Medicare) You joined a Medicare Advantage Plan when you first became eligible for Medicare and disenrolled within 12 months. Or your previous Medigap policy, Medicare Advantage Plan, or PACE program ends coverage or is found to be fraudulent . Note: If you have a Medicare Advantage Plan, Medicare SELECT policy, or PACE program and you move out of the plan’s service area, you also have the right to buy a Medigap policy.  However, many Insurers have recently stopped offering Medigap Plan G as a Guaranteed-Issue plan for those who move or switch from a Medicare Advantage plan.  This is due to many people realizing they may have a Health Issue around the corner, and insurance companies want to do everything they can to limit their risk exposure.  If this happens to you , you can apply for just about any other Medicare Supplement plan and still have Guaranteed Issue rights, or you will need to submit a Plan F or Plan G application to underwriting. Be sure to keep a copy of any letters, notices, postmarked envelopes, and claim denials in case you need proof that you lost or ended health coverage. Medigap insurers may require these documents before they sell you a policy. BUYING A MEDIGAP POLICY OUTSIDE OF REGULAR ENROLLMENT PERIODS Unlike Medicare Advantage Plans, you can apply for a new Medicare Supplement Plan anytime during the year.  However, please remember that the only time you will EVER   have a Guaranteed Issue Medicare Supplement plan is the 7 months when you first become eligible for Medicare.  That time is also referred to as your IEP (Initial Enrollment Period). Anytime after that first selection, anyone applying for a new Medicare Supplement Plan, regardless of which plan you are applying for, will be subject to underwriting.  What does that mean exactly?  Good question . That means you will need to answer questions such as your Height, Weight, and Medical History, and the company can accept or decline you for any reason.  This is why it is so important , when you first join a Medicare Supplement plan, to envision the best plan for you now and over the next 10-20 years. CANCELLING A MEDIGAP POLICY You have the right to review a new Medigap policy for the first 30 days. You can cancel it within that time for a full refund if it does not meet your needs. After the first 30 days, you can cancel your policy at any time. However, be careful when cancelling. Depending on where you live, you may not be able to buy another policy, or companies may charge you more due to your health.

Medicare Advantage HMO Plans WHAT ARE MEDICARE ADVANTAGE HMO PLANS? ABOUT MEDICARE ADVANTAGE HMO PLANS Medicare Advantage HMO plans are a popular option in America. According to the Kaiser Family Foundation, approximately 48% of Medicare beneficiaries are enrolled in a Medicare Advantage plan. Medicare HMOs are common because of the lower premiums they often offer. In some plans, that premium may be as low as $0. However, you must remain enrolled in and pay for Medicare Part B. You usually must also use in-network providers, except in an emergency.  MEDICARE ADVANTAGE HMO PLANS = MEDICARE HEALTH MAINTENANCE ORGANIZATION PLANS In HMO Plans, you generally must get your care and services from providers in the plan's network, except: Emergency care Out-of-area urgent care Out-of-area dialysis In some plans, you may be able to go out-of-network for certain services. But it usually costs less if you get your care from a network provider. This is called an HMO with a point-of-service (POS) option.   DO ALL HMO PLANS HAVE PRESCRIPTION DRUG COVERAGE? In most cases, prescription drugs are covered in HMO Plans. Ask the plan. If you want Medicare Prescription Drug Coverage (Part D), you must join an HMO Plan that offers prescription drug coverage.   DO YOU NEED TO IDENTIFY A PRIMARY CARE PROVIDER (PCP) IF YOU CHOOSE ONE OF THE MEDICARE ADVANTAGE HMO PLANS? In most cases, yes, you need to choose a primary care doctor in HMO Plans.   WILL YOU NEED TO GET A REFERRAL TO SEE A SPECIALIST IF YOU CHOOSE A MEDICARE ADVANTAGE HMO? In most cases, you have to get a referral to see a specialist if you have a Medicare Advantage HMO Plan. Certain services, like yearly screening mammograms, don't require a referral.   OTHER THINGS YOU NEED TO UNDERSTAND IF YOU ARE CONSIDERING AN HMO PLAN If your doctor or other health care provider leaves the plan, your plan will notify you. You can choose another doctor in the plan. If you get health care outside the plan's network, you may have to pay the full cost. It's important that you follow the plan's rules, like getting prior approval for a certain service when needed.    MEDICARE ADVANTAGE HMO PLANS Medicare Health Maintenance Organization (HMO Plans) are private plans that the federal government pays to administer Medicare benefits. Like all Medicare Advantage Plans, HMOs must provide you with the same benefits, rights, and protections as Original Medicare, but they may do so with different rules, regulations, restrictions and costs. Some HMOs offer additional benefits, such as vision and hearing care. ARE MEDICARE ADVANTAGE HMO PLANS AFFORDABLE You must have both Parts A and B to join a Medicare HMO. Generally, you will continue paying your Medicare Part B premium, though some HMOs will pay part of this premium. Some HMOs may charge an additional premium, on top of your Part B premium. If you want Part D coverage, you will receive it through your HMO. Plans may charge a higher premium if you also have drug coverage. Note: If you join a Medicare Advantage Plan and you want Part D coverage, you must receive coverage from your plan. You cannot enroll in stand-alone Part D coverage unless you join a Medicare Savings Account (MSA) or a Private Fee-For-Service (PFFS) plan that does not offer prescription drug coverage.Typically, you cannot have an HMO if you have ESRD (End Stage Renal Disease), unless: You join a Special Needs Plan(SNP) which is an HMO plan that specifically takes beneficiaries with ESRD Or, you were enrolled in an HMO prior to developing ESRD and you choose to stay in that HMO Note: If you remain enrolled in a Medicare Advantage HMO plan after developing ESRD and the plan leaves your area, you have a Special Enrollment Period (SEP) to enroll in another HMO in your area. WHAT TYPE OF BENEFITS ARE INCLUDED WITH MEDICARE ADVANTAGE HMO PLANS Once you have joined an HMO, you should receive a benefit card from your plan. You will use your HMO benefit card instead of your Medicare card when you go to the doctor or hospital. In most HMOs, you must see in-network providers to receive coverage, unless you need emergency medical treatment. Some HMOs offer a point-of-service (POS) option, which allows you to go out of network for certain services. In these cases, you will be covered but usually at a higher cost.  WILL YOU NEED REFERRALS FROM MY PRIMARY CARE PROVIDER IN ORDER TO SEE A SPECIALIST IF YOU CHOOSE A MEDICARE ADVANTAGE HMO? In most cases you have to get a referral to see a specialist in HMO Plans. Certain services, like yearly screening mammograms, don't require a referral.     NOW THAT YOU KNOW MORE ABOUT MEDICARE ADVANTAGE HMO PLANS, PLEASE REMEMBER THESE IMPORTANT TIPS BEFORE YOU MAKE ANY DECISION TO JOIN A MEDICARE ADVANTAGE HMO PLAN One of the main reasons people join a Medicare Advantage Plan is that they are attracted to the advertising talking about the " Extra Benefits " not offered by Original Medicare.  But, what they do not understand that these benefits are not always how they are advertised.  For example: A $2,000 Dental Benefit is usually broken down into 4 - $500 Benefits each Quarter. And, the unused amounts do not roll-over to the next quarter,  Medicare Advantage plans are well known in the industry for these tactics.  Please, please, please read the FINE PRINT of any plan.  You can find out more details on every plan by reading the Summary of Benefits and the Explanation Of Coverage sections printed in every Medicare Advantage Plan. Every Medicare Advantage Plan has a mandatory MOOP or Maximum-Out-Of-Pocket limit.  This means that once you reach your limit, all of your health bills will be paid for by your plan for the remainder of the year.  That is great, but EVERY MOOP is at least $1,000 - $3,500 more that what it would cost to have better coverage with Original Medicare and a Medicare Supplement. No Medicare Advantage Agent will ever tell you that you will always have a 20% Co-Insurance that you have to pay for for Cancer Treatments.  Even if you hit your MOOP, you still have to pay 20%.  Average Rounds of Chemotherapy and Radiations treatments cost between 10K - 15K, that is a lot of potential Out Of Pocket expenses you are always on the hook for with a Medicare Advantage plan. Your plan may require you to get 2-3 or more 2nd opinions for treatments.  Remember, these plans are "For Profit", their job is to string you along until the plan year is over so they do not have to pay out large sums of money if they do not have to.  It is sad, it is not fair, but; its the truth. The US Government pays every Medicare Advantage Insurance company $1,000 each month for every Medicare Advantage Member they have.Ask yourself, if they get 12K per year from the Government, why are they " Nickel and Diming " their plan members to death? The last thing that is important for you to know is that if you join a Medicare Advantage PPO plan, there is no guarantee you can see any doctor you choose.  Yes, you have the right to see if they will see you, but remember, they do not have to.  And, why would they agree to taking less money from you when they do not have to accept your plans rates.  The honest cold hard truth is if they wanted to be a doctor in your plans network, they would.  The fact that they are not in your plans network should tell you all you need to know.

Michael T. Braden, August 28, 2024, Applying For Medicare How To Apply For Medicare Without Going To The Social Security Office. HOW TO APPLY FOR MEDICARE WITHOUT GOING TO THE SOCIAL SECURITY OFFICE Most Americans do not realize that you apply for your Medicare Card through the Social Security website. Once you receive your card, all your Medicare questions can be answered on the Medicare website at www.medicare.gov or by calling Medicare 24/7 at 1-800-MEDICARE . This is the easiest and best way to apply for Medicare. You can do it online at www.ssa.gov . It is easy and straightforward, and only takes about 10 minutes to complete. Look for the Blue Tab labeled "Apply for Medicare Only." You will want to apply for Medicare Part A and Medicare Part B. Plan : you will want to have completed a CMS Form 40B and, if you are still working, to have completed a CMS Form L564 from your Employer. There will be a point at which you can upload the completed forms from your computer to your Medicare Application on the www.ssa.gov website. HOW YOU CAN APPLY FOR MEDICARE ONLINE AND NEVER HAVE TO GO TO THE SSA OFFICE AFTER YOU HAVE COMPLETED ENROLLING IN MEDICARE Once you receive confirmation from the Social Security Administration website that your application was completed, you are done. Then, in about 3-4 weeks, you will receive a letter in the mail from the Social Security Administration informing you that your Medicare Enrollment has been approved and that you will be receiving your Red, White, and Blue Medicare Card in about two weeks. Once you receive your card, contact your Broker or Agent, who can help you apply for the Medicare plan that best fits your needs and lifestyle . Note: You cannot apply for any Medicare Plan unless you have your Medicare Card. Your Medicare Card includes your name, your Medicare Beneficiary Number, and the Effective Date for both Medicare Part A and Medicare Part B. HERE IS WHAT YOUR MEDICARE CARD WILL LOOK LIKE UNDERSTANDING YOUR MEDICARE CARD If you ever get stuck in the process, contact your Broker. You can still have them FAX your completed Application form to the Social Security Office. This process takes 1-2 weeks longer than doing it online using the SSA website. HOW TO GET SIGNED UP FOR MEDICARE

Michael T Braden, August 27, 202 MEDICARE PART D Everything You Need To Know About Medicare Part D Prescription Drug Plans WHAT IS COVERED UNDER MEDICARE PART D At Braden Medicare Insurance, we want to share with you this "Everything You Need To Know About Medicare Part D Drug Plans." Medicare Part D plans are Insurance plans for your Prescription Medications, including vaccinations.   Private insurance companies offer these plans . Each plan that offers prescription drug coverage under Medicare Part D must provide at least the standard level of coverage set by Medicare. Plans can vary the list of prescription drugs they cover (called a formulary) and how they place drugs into different "tiers" on their formularies. (A formulary is a listing of all of the drugs/medications that a particular plan has available to its members.  All Medicare Part D Plans must have two drugs available in each category.  Most Medicare drug plans (Medicare Prescription Drug Plans and Medicare Advantage Plans with prescription drug coverage) have their own list of covered drugs, called a formulary. Plans include both brand-name prescription drugs and generic drug coverage. The formulary consists of at least two drugs in the most commonly prescribed categories and classes. This helps make sure that people with different medical conditions can get the prescription drugs they need. All Medicare Part D drug plans must cover at least two drugs per drug category, but they can choose which drugs to cover . The formulary might not include your specific drug. However, in most cases, a similar drug should be available. If you or your prescriber (your doctor or other health care provider who’s legally allowed to write prescriptions) believes none of the drugs on your plan’s formulary will work for your condition, you can ask for an exception. NOTE: If you need assistance, please call your Medicare Broker. They will be happy to assist you. Also, make sure that any doctor who prescribes for you knows which Medicare Part D Drug Plan you are using. It makes it much easier for them to verify that the medications are already available in your plan's formulary. A Medicare drug plan may make changes to its drug list during the year if it follows Medicare guidelines . Your plan may change its drug list during the year due to evolving therapies, new drugs, or newly available medical information . Plans offering Medicare prescription drug coverage under Part D may immediately remove drugs from their formularies if the Food and Drug Administration (FDA) deems them unsafe or if their manufacturer withdraws them from the market. Plans that meet specific requirements can immediately remove brand-name drugs from their formularies and replace them with new generic drugs, or change the cost or coverage rules for brand-name drugs when adding new generic drugs. If you’re currently taking any of these drugs, you’ll get information about the specific changes made afterwards. For other changes involving a drug you’re currently taking that will affect you during the year, your plan must do one of these:   Give you written notice at least 30 days before the date the change becomes effective. At the time you request a refill, provide written notice of the change and at least a month’s supply under the same plan rules as before the change. GENERIC PRESCRIPTION MEDICATIONS The Food and Drug Administration (FDA) says generic drugs are copies of brand-name drugs and are the same as those brand-name drugs in:   Dosage Form Safety Strength Route of Administration Quality Performance Characteristics Intended Use Generic drugs use the same active ingredients as brand-name prescription drugs. Generic drug makers must demonstrate to the FDA that their product is bioequivalent to the brand-name prescription drug. In some cases, there may not be a generic drug the same as the brand-name drug you take, but there may be another generic drug that will work as well for you. Talk to your doctor or other prescriber about your generic drug coverage. To lower costs, many plans offering prescription drug coverage place drugs into five different “Tiers” on their formularies. Each plan can structure its tiers differently. Each tier costs a different amount. Generally, a drug in a lower tier will cost you less than a drug in a higher tier. Here's an example of a Medicare drug plan's tiers (your plan’s tiers may be different):   Tier 1—lowest co-payment: most generic prescription drugs Tier 2—medium co-payment: preferred, brand-name prescription drugs Tier 3—higher co-payment: non-preferred, brand-name prescription drugs Specialty Tiers—highest co-payment: very high cost prescription drugs   MEDICATION THERAPY MANAGEMENT PROGRAMS If you're in a Medicare drug plan and take medications for different medical conditions, you may be eligible for a free Medication Therapy Management (MTM) program. This program helps you and your doctor make sure that your medications are working to improve your health. THROUGH THE MTM, HERE IS WHAT YOU WILL GET A comprehensive review of your medications and the reasons why you take them. A written summary of your medication review with your doctor or pharmacist. An action plan to help you make the best use of your medications (there will be space for you to take notes or write down any follow-up questions).   A PHARMACIST OR OTHER HEALTH PROFESSIONAL WILL REVIEW YOUR MEDICATIONS AND DISCUSS THEM WITH YOU Whether your medications have side effects If there might be interactions between the drugs you're taking Whether your costs can be lowered Other problems you’re having It’s a good idea to schedule your medication review before your yearly wellness visit so you can discuss your action plan and medication list with your doctor . Bring your action plan and medication list to your visit, or whenever you speak with your doctors, pharmacists, and other healthcare providers. Also, take your medication list with you if you go to the hospital or emergency room. If you take many medications for more than one chronic health condition, contact your drug plan to see if you're eligible for a Medication Therapy Management program.       USING YOUR MEDICARE PART D DRUG PLAN FOR THE 1ST TIME BRING THESE WITH YOU TO THE PHARMACY Your Red, White, and Blue  Medicare Card. A photo ID (like a state driver’s license or passport). Your plan membership card. HOW TO FILL A PRESCRIPTION WITH YOUR NEW CARD If you go to the pharmacy before your drug plan card arrives, you can use any of these as proof of your drug plan enrollment: The acknowledgement, confirmation, or welcome letter you got from the plan. An enrollment confirmation number, the plan name, and the plan's phone number. A copy of your official Medicare card that you can print by logging in or by creating your own Account at www.medicare.gov If you don't have any of these items, your pharmacist may be able to get your drug plan information. You'll need to provide your Medicare number or the last four digits of your Social Security Number. If your pharmacist can't access your drug plan information, you may have to pay for your prescriptions. If you do, save your receipts and contact your plan to get a refund.   YOU CAN USE THE AUTOMATIC RE-FILL MAIL-ORDER SERVICE FOR YOUR PRESCRIPTION MEDICATIONS Some people with Medicare get their prescription drugs by using an “automatic refill” service that automatically delivers prescription drugs when you’re about to run out. In the past, some prescription drug plans didn’t ensure that customers still wanted or needed prescription drugs, creating waste and unnecessary costs for people with Medicare and Medicare Prescription Drug Coverage ( also referred to as Medicare Part D).  Now, plans must obtain your approval to deliver a prescription (new or refill) unless you request the refill or a new prescription. Some plans may request your authorization annually so they can send you new prescriptions without asking before each delivery. Other plans may ask you before each delivery. This policy won’t affect refill reminder programs where you go in person to pick up the prescription, and it won’t apply to long-term care pharmacies that give out and deliver prescription drugs. Giving your approval may be a change for you if you've always used mail-order and haven't had the opportunity to confirm that you still need refills. Note: Be sure to provide your pharmacy with the best way to reach you so you don't miss refill confirmation calls or other communications . Contact your plan if you get any unwanted prescription drugs through an automated delivery program. You may be eligible for a refund for the amount you were charged. If you aren’t able to resolve the issue with the plan or wish to file a complaint, call 1-800-MEDICARE (1-800-633-4227). If you have both Medicare and Medicaid or qualify for Extra Help, also bring with you any proof of your enrollment in Medicaid or proof that you do qualify for Extra Help.    UNDERSTANDING NETWORK PHARMACIES, PREFERRED PHARMACIES, AND NON-NETWORK (RETAIL) PHARMACIES Medicare drug plans have contracts with "Network Pharmacies." These pharmacies have agreed to provide members of specific Medicare plans with services and supplies at a discounted price. In some Medicare plans, your prescriptions are only covered if you get them filled at network pharmacies. In addition to retail pharmacies, your plan’s network might include preferred pharmacies, a mail-order program, or a retail pharmacy option that provides a 2- or 3-month supply. PREFERRED PHARMACIES Every Medicare Part D Plan has Preferred Pharmacies. These are the Pharmacies you always want to use, because they have the lowest prices for your Medications. Most Mail-Order Pharmacies are Preferred Pharmacies. If your plan has preferred pharmacies, you may save money on your out-of-pocket prescription drug costs (like a co-payment or coinsurance) at a preferred pharmacy because it has agreed with your plan to charge less. OUT-OF-NETWORK OR STANDARD PHARMACIES You do not want to use Standard or Out-of-Network Pharmacies at all, unless in an emergency. The reason is that you will typically pay 2-10 times more for your medications. Your Preferred Pharmacies are the ones that have contracts to give you the lowest prices, and the other pharmacies are just making as much money as they can at your expense. MAIL-ORDER PHARMACIES Almost every Medicare Part D Drug Plan offers a Mail-Order option. This can be very convenient. But be sure to check prices to see whether your Mail-Order Pharmacy is priced at the exact cost or lower than your plan's regular Preferred Pharmacies. Usually, they are close, but many Mail-Order plans, such as Cigna, charge substantially more if you use Mail Order. Be smart and do your research. But you can't beat the convenience of knowing your medications will be automatically delivered to your door every three months. CHECK THE AMAZON PHARMACY IF YOU TAKE MULTIPLE MEDICATIONS THROUGHOUT THE DAY If you are an AMAZON PRIME MEMBER, the Amazon Pharmacy has Preferred Pharmacy pricing with the majority of Medicare Part D Prescription Plans. And they will ship your medications in easy-to-see "Pill Packs" for each time of day, with your Medications already sorted for you. This is a Game Changer for many seniors. LOOK INTO SEEING IF YOUR DOCTOR WILL PRESCRIBE A 2, 3, OR 6 MONTH PRESCRIPTION FOR YOUR MEDICATIONS Some retail pharmacies may also offer 2-, 3-, or even 6-month supplies of medications. This is not only a time-saver but also a cost-saver .   CAN YOU FILL A PRESCRIPTION IF YOU DO NOT HAVE YOUR NEW MEDICARE PRESCRIPTION CARD YET? Yes, if you go to the pharmacy before your drug plan card arrives, you can use any of these as proof of your drug plan enrollment: The acknowledgement, confirmation, or welcome letter you got from the plan. An enrollment confirmation number, the plan name, and the plan's phone number. A temporary card you may be able to print from the  www.mymedicare.gov  website.  If you don't have any of these items, your pharmacist may be able to get your drug plan information. You'll need to provide your Medicare Number or the last four digits of your Social Security Number. If your pharmacist can't get your drug plan information, you may have to pay some out-of-pocket costs for your prescriptions. If you do, save your receipts and contact your plan to get a refund.   NOTE: If you call your Medicare Broker or your Medicare Part D Plan, they can usually email you a Temporary Prescription Card that you can use until either your new Card or a replacement card arrives.

EVERYTHING YOU NEED TO KNOW ABOUT MEDICARE MEDICARE INSURANCE OPTIONS Everything you need to know about Medicare starts here: there are three ways to receive Medicare coverage: Original Medicare, Medicare Advantage, and Medicare Part D. Each option has its own benefits and costs.     OPTION 1 IS ORIGINAL MEDICARE This is a traditional 80/20 Healthcare Plan, managed and overseen by the U.S. Government and the Centers for Medicare & Medicaid Services, which are part of the U.S. Department of Health and Human Services.  Under Original Medicare, Medicare pays for 80% of all Medicare Covered/medically necessary procedures. And you are responsible for the remaining 20%.  There are No Deductibles, No Minimum, No Maximum out-of-pocket expenses, and no limit to how much your 20% can add up to.   OPTION 2 IS JOINING A MEDICARE ADVANTAGE PLAN Medicare Advantage Plans are Health Plans for Medicare Beneficiaries.  Also known as Medicare Part C.  These plans were signed into Law by President William Jefferson Clinton. They are intended to serve as an alternative to Original Medicare.  There are several types of Medicare Advantage plans available.  Most of them are HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations). Many of these plans are popular with many Medicare Beneficiaries because of their generally low monthly premiums and the "additional" or "extra benefits" they offer that Medicare does not.  These plans are not as good as Original Medicare, and they are loaded with Co-Pays and Co-Insurance bills that add up in a hurry, especially if you are ever hospitalized.  These plans are primarily HMO (Health Maintenance Organizations) and PPO (Preferred Provider Organizations) .   Most MA (Medicare Advantage) plans have a network you must use to receive the lowest costs and ensure your services are covered.  Many Medicare Advantage Plans may allow you to see Doctors outside their networks; however, they will not pay for these services. Their networks are mostly limited to the County or Region where you live . Because private insurers offer Medicare Advantage plans , each insurer sets the rules for its plans and decides what it will and will not pay for .  You will always pay a copayment or meet a preset coinsurance for any procedure until you reach your plan's MOOP (Maximum Out-of-Pocket) for the year.   MOOP varies by plan and ranges from $2,800 to over $10,000 per year, depending on your plan and location .  This means you could be responsible for $5,000 to $12,000 or more in annual Out-Of-Pocket expenses. In the long run , when you look at the details and magnify the small print, you get plans that look nice but nickel-and-dime you to death; they are limiting, and their plans are often not accepted at the finest hospitals (Mayo and Barrow Neurological).  Medicare Advantage plans, and Medicare Advantage plans with Prescription Drug coverage are often referred to as All-In-One Plans. They limit you to a set number of Physical Therapy appointments and require you to obtain 2nd, 3rd, and sometimes even a 4th opinion.  You have no flexibility, and you are never really in charge of your own healthcare.  It is more about your plan and your Primary Care Doctor than it is about you. Each fall, you need to select a new plan for the following calendar year. Medicare Advantage Plans market their plans to Medicare Beneficiaries. And often try to incentivize their plans by including what they call Dental, Vision, and Hearing Benefits, or by offering a few plans that rebate a portion of your Monthly Part B Deductible each month.  These companies are very good at making things sound unbelievably good. More often than not, when you really break down the benefits of these added services, they typically are not the complete healthcare plans that most people believe them to be. Just be sure to read both the full Summary of Benefits Section on every Medicare Advantage plan that catches your eye, along with the Explanation of Benefits. This is where you will find that what is advertised as a $2000 Dental Benefit is : A) Limited, and B) only $500 per quarter, with none of your unused amounts rolling over to the next quarter.    OPTION 3 IS ORIGINAL MEDICARE WITH A MEDICARE SUPPLEMENT/MEDIGAP PLAN  Everything you need to know about Medicare when it comes to choosing Original Medicare and pairing it with a Medicare Supplement policy. In my humble and professional opinion, this is the way to go.  There are 11 Different Medicare Supplement plans nationwide.  The most popular Plans available to new Medicare Beneficiaries are Plan G and Plan N.  With Medicare Supplement Plan G, your Medicare Supplement will pay the entire share of your 20% with Original Medicare, with no deductibles.   The best way to compare Medicare Supplements is to recognize that your Premium is your Maximum Out-of-Pocket Expense (MOOP) . Plans G in Arizona, Nevada, and Texas will cost $95- $135 per month. If you use an average of $120 per month, you pay $1,440 in Annual Premiums, and your plan covers everything else.  Not only that, but many Medigap Policies also pay the Medicare Part A Deductible of $1,600 for each time you are admitted into the hospital. And you can see any Doctor you choose, anywhere in the US! This is the most predictable and comprehensive Healthcare plan you can choose, and it provides everyone with the convenience, flexibility, and peace of mind they deserve. If you want the best coverage and consistent billing with no surprises, it makes budgeting easier . With Original Medicare and A Medicare Supplement Plan F or Plan G, you will have the best and most comprehensive Health Plan available.  And, it is portable. There are no networks, and you can see any Doctor and go to any hospital in America that accepts Medicare.    MEDICARE AEP (ANNUAL ELECTION PERIOD) OCTOBER 15TH - DECEMBER 7TH   EVERYTHING YOU NEED TO KNOW ABOUT THE MEDICARE AEP When it comes to the Annual Election Period or “AEP,” being on schedule is very important. For the 2023 plan year, the Medicare AEP ran from October 15th through December 7th. For those interested in taking on Medicare Advantage coverage, the enrollment period is available from January 1st to March 31st, 2023. This is the Medicare Advantage Open Enrollment period, also known as “MA OEP.” It’s important to remember that this is available to those already enrolled in Medicare Advantage plans. This is also the timeframe during which one can switch from Medicare Advantage to Original Medicare . In addition, there is the option for those who are near the inception of their Medicare eligibility who can take advantage of the Initial Coverage Election Period, or “ICEP.” This time is designated for those newly eligible for Medicare to enroll in a Medicare Advantage Plan for the first time. This happens at a different time of year than the Medicare Advantage Open Enrollment (MA OEP). It’s essential to identify when the right time is for you to enroll, as there are very few exceptions that fall into the Special Election Period. These exceptions apply only to specific life events, such as marriage or loss of other health coverage elsewhere.  The principal criterion for determining Medicare eligibility is age.   To qualify, you must be 65 years of age.   If you are not yet 65 , certain conditions may make you eligible, such as Lou Gehrig’s disease or End-Stage Renal Disease (ESRD).   If you have one of these conditions or have additional questions about your eligibility, contact The Health Exchange Agency directly to discuss your specific options.   Specified conditions must be disclosed to properly qualify an individual for coverage during an ongoing health concern.  Qualifying for Medicare may be simpler than you think. Once you reach age 65, you should consider a few additional factors. It is crucial to have had at least 10 years of Medicare-covered Employment before enrolling, which equates to a minimum of 40 quarters of employment with Medicare tax contributions. Even if you or your spouse did not make these tax payments, you could still meet the eligibility requirements. Other criteria will ultimately determine your qualification. In addition to the aforementioned criteria, another vital qualifier is your current citizenship or permanent residency status .   You must have either U.S. citizenship or Permanent Residency for at least 5 years to proceed with your enrollment .   If this sounds like you, you’re ready to enroll.   Taking the next step and signing up for Medicare may raise new questions. Be sure to clarify any questions you have about the process. While Medicare has three primary criteria for enrolling beneficiaries, individual circumstances can affect eligibility.   If you’re unsure based on your current status, we have answers to your questions.   While you may still be working part-time or full-time , or carrying private insurance, Medicare may still be an essential option to consider.   The benefits of having a supplementary plan assist in ensuring that you don’t end up paying out of pocket for costs that could otherwise be covered.   The Health Exchange Agency specializes in assisting men and women like you with their Medicare enrollment each day. You don’t have to do this alone.   We’re here to help, and we know that with the correct personalization of the process, you’ll get the exact coverage you want and need. You are at or nearing the age of Retirement (65) , and your own Health Insurance may still cover you through your Employer or through the VA. You have heard about Medicare for years, but you also know Medicare has Part A, Part B, Part C, and Part D.  Family members and friends may have mentioned Medicare Supplement Plans and Medigap Plans, Medicare Advantage Plans, and probably Prescription Drug Plans. All of these questions and considerations may seem overwhelming, but we have tried to break them down to make them easier to understand .     EVERYTHING YOU NEED TO KNOW ABOUT MEDICARE & THE 4 PARTS THAT MAKE UP MEDICARE MEDICARE PART A -  Which takes care of your Inpatient/Hospital Coverage. MEDICARE Part B -  Covers any of your Outpatient/Medical Coverage. MEDICARE Part C -  Uses Independent Insurance Companies to provide for your Medicare Part A & Part B Benefits. MEDICARE Part   D allows you to enroll in a company that provides Prescription Drug Services. Original Medicare = Medicare Part A and Medicare Part B MEDIGAP AND MEDICARE SUPPLEMENTS Original Medicare covers much, but not all, of the cost of covered health care services and supplies. A Medicare Supplement or a Medigap Insurance policy helps pay for additional things such as: Medicare Co-Payments Physician Co-Insurance Plan Deductibles Many Medicare Supplements pay your entire 20% share of Original Medicare. It has no Networks and allows you the flexibility to see any Doctor and receive services from any Hospital in the United States.   NOTE: As of January 1, 2020, Medigap plans sold to new Medicare enrollees aren't allowed to cover the Part B deductible. As a result, Plans C and F are not available to new Medicare enrollees starting January 1, 2020. If you already have either of these two plans (or the high deductible version of Plan F) before January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans. Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care if/when you travel outside of the United States. If you have Original Medicare and you buy a Medigap policy, here's what happens: Medicare will pay its share of the Medicare-approved charges for covered healthcare costs. Then your Medigap policy pays your 20% share, leaving you with $0 out-of-pocket .   Medicare Supplement plans are the most desired Medicare plans and offer the most flexibility; you can see any Doctor Nationwide who accepts Medicare patients. There are well over 800,000 Doctors who accept Medicare, representing over 96% of all physicians.  All of these doctors will accept any Medigap Policy that you enroll in, regardless of the Insurance Company you choose to partner with. All Medicare Supplement Plans are identified by an alphabetical letter, such as A, B, C, D, F, G, K, L, M, and N.   MEDICARE ADVANTAGE PLANS ARE SUPPOSED TO COVER EVERYTHING THAT MEDICARE DOES Private insurance companies offer Medicare Advantage Plans .  Each of these companies receives substantial government payments for each Medicare beneficiary it enrolls.  And make no mistake about the fact that every Medicare Advantage insurer is a for-profit entity. They will do everything they can to manage/micro-manage your care while turning a profit. Medicare Advantage Plans must cover all of the services that Original Medicare covers. However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost of hospice care, some new Medicare benefits, and some costs for clinical research studies. In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care.  Most Medicare Advantage Plans offer coverage for services not covered by Original Medicare, such as vision, hearing, dental, and wellness programs (e.g., gym memberships). Plans can also cover more extra benefits than they have in the past, including services like transportation to doctor visits, over-the-counter drugs, adult day-care services, and other health-related services that promote your health and wellness. Plans can also tailor their benefit packages to offer these new benefits to certain chronically ill enrollees. These packages will provide benefits customized to treat those conditions. Check with the plan to see what benefits are offered and if you qualify. Most include Medicare Prescription Drug Coverage or Medicare Part D. In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan. In 2023, the standard Part B premium amount is $164.90 (or higher, depending on your income). If you need a service the plan deems not medically necessary, you may be responsible for all costs . But you have the right to appeal the decision. You (or a provider acting on your behalf) can request in advance whether the plan will cover an item or service . Sometimes you must do this for the service to be covered. This is called an “organization determination.” If your plan denies coverage, it must notify you in writing. You don’t have to pay more than the plan’s usual cost-sharing for a service or supply if a network provider didn’t get an organization determination and either of these is true: The provider gave you or referred you for services or supplies that you reasonably thought would be covered. The provider referred you to an out-of-network provider for plan-covered services.   MEDICARE ADVANTAGE PRESCRIPTION DRUG COVERAGE Medicare Part D is prescription drug coverage. Medicare Part D is optional, and it’s available only through private insurance companies that contract with Medicare.   WHAT IS MEDICARE PART D ALL ABOUT? Medicare Part D prescription drug coverage was created by the Medicare Modernization Act (MMA) of 2003 and implemented in 2006. The goal of Medicare Part D is to help make prescription drugs available and affordable for Medicare beneficiaries.   WHO IS ELIGIBLE FOR A MEDICARE PRESCRIPTION DRUG PLAN? Anyone with Medicare coverage—either Medicare Part A (hospital insurance) or Part B (medical insurance) or both parts—may be eligible for a stand-alone Medicare Part D prescription drug coverage. You can’t be turned down because of your health status or income.   THE TWO TYPES OF MEDICARE PART D PRESCRIPTION DRUG PLANS You can get your Medicare Part D coverage from either of these types of plans:   A Medicare Advantage prescription drug plan covers both medical services and prescription drugs. You may find a Medicare Advantage plan particularly attractive if you prefer to receive all your Medicare benefits from one plan, like a health maintenance organization (HMO) or a preferred provider organization (PPO). Not every Medicare Advantage plan includes prescription drug coverage, so make sure the plan includes it before you enroll. A stand-alone Medicare Part D prescription drug plan, which provides only prescription drug coverage. This kind of plan can work alongside your Medicare Part A and/or Part B coverage. If you enroll in a Medicare Advantage plan, note that you continue to pay your monthly Medicare Part B premium. You also pay any premium the plan might charge.

Michael T. Braden August 27, 2024 MEDICARE SUPPLEMENTS & MEDIGAP Picture Of A Man In Deep Thought With The Caption: "Which Medigap Plan Should I Choose? CHOOSING A MEDICARE SUPPLEMENT PLAN. WHAT IS THE BEST MEDIGAP PLAN FOR YOU? Medigap Insurance is often referred to as Medicare Supplemental Insurance.  These Medigap/Medicare Supplement Policies help individuals pay their share of Medicare expenses not covered by Medicare, providing clear cost visibility .   Medigap Policies are popular because they cover copayments for Doctor visits and allow members to access Medicare providers in every state. Braden Medicare Insurance' Poster "Which Medigap Plan Should I Choose?" WHAT ARE GUARANTEED ISSUE RIGHTS FOR MEDICARE SUPPLEMENT PLANS? WHICH MEDIGAP PLAN SHOULD I CHOOSE? When you reach age 65, you can sign up for Medicare.  Your Guaranteed Issue Period includes the three months before your birth month, your birth month, and the three months after your birth month.  During this time, you can sign up for Social Security Benefits and Medicare.  You can choose to participate in Original Medicare, enroll in a Medigap Plan , which is commonly referred to as a Medicare Supplement Policy, or choose a Medicare Advantage Plan.  During your initial guarantee period, you cannot be declined for any reason, and all pre-existing conditions are accepted.    Medicare Supplement (Medigap) Policies are sold to Medicare Beneficiaries by private insurance companies and cover the gaps not covered by Original Medicare.  These include Cost Sharing for Part B services, Outpatient Services, physicians' Co-Pays, and Excess Charges . Medicare Supplement Plans allow you to: Use any Doctor or Hospital that accepts Medicare, anywhere in the US.   You can have peace of mind when traveling between residences or visiting friends and family out of town. Give you peace of mind by knowing your costs. Automatic Renewals – the insurance company can never drop you or change your coverage due to a health condition as long as you do not cancel your policy. Streamlined Claims Process – Medigap providers automatically have cross-filing with Medicare. So, whenever your doctor or hospital files a claim with Medicare, that claim is automatically filed with your Insurance company as well. Medigap is insurance to cover the "Gaps" in what is not covered by Medicare, like your deductibles and co-payments. Some other things to know about Medicare Supplement insurance: To have a Medigap Policy, you must be enrolled in both Medicare Part A and Medicare Part B. Each Medicare beneficiary must have their policy; there are no  "Family"  policies with Medicare. You can drop your Medicare Supplement Policy at any time; however, if you want to sign up again later, your application will be subject to Underwriting for approval.  The  "Guaranteed Issue Period"  is only when you first become eligible for Medicare Benefits. The annual election period , which runs from October through December, is only for Medicare Advantage Plans & Prescription Drug Plans (PDPs ).  Most Medigap companies offer discounts for multiple medicare beneficiaries living at the same address. It is illegal for Medicare Supplement Plans to include PDP (Prescription Drug Plans).  You will need to purchase a standalone PDP if you do not have qualifying coverage from an employer or the VA.   ALL MEDICARE SUPPLEMENT PLANS ARE STANDARDIZED Which Medigap Plan should I choose? The correct answer is the one you feel most comfortable and secure with. You do not want to look at how things are today; instead, project which plan will suit you best 10, 15, and 20 years from now. Each Medicare Supplement (Medigap) Plan is identified by a specific letter. Medicare refers to these plans. These are Medigap Plans A, B, C, D, F, G, K, L, M, and  N . Each of these lettered policies provides the same set of benefits regardless of which company you choose. A Plan K Policy from UnitedHealthcare will have the same benefits as a Plan K from BCBS or Mutual of Omaha.   What differs is the pricing structure each company uses.  Every Insurance provider has its own pricing structure for each area of the country where it operates . I have to emphasize that ALL  Plans with the same letter have the same coverage, but prices vary, so use your Agent/Broker to help identify the best value and coverage for you and your family.  Medigap Plans C and F are available only to individuals who were enrolled in Medicare before January 1, 2020. In 2020, Medicare Supplemental Plan G became the most comprehensive plan. It works precisely like Plan F, except you pay the Part B deductible annually . Your premiums will be lower, resulting in annual savings.    For Medigap Plans K and L, after you meet your annual out-of-pocket limit and your annual Part B deductible ($203 in 2021), the Medigap plan pays 100% of covered services for the rest of that calendar year. Plan N pays 100% of the Part B coinsurance, except for a co-payment of up to $20 for some office visits and up to a $40 co-payment for emergency room visits that don’t result in an inpatient admission. Each Medicare supplement plan in the chart above is assigned a letter from A to N. Each plan letter provides a different set of benefits. However, each lettered plan must offer the same standardized coverage, regardless of the insurance company you choose. For example, Medicare supplement Plan N at Blue Cross Blue Shield has the same benefits as Plan N from Humana Healthcare. Plan F is the only supplemental insurance plan that covers ALL   gaps, leaving you with no out-of-pocket costs .  However, you are eligible for Plan F only if you turn 65 before January 1st, 2020. There are others where you agree to share expenses and, in return, receive a lower monthly premium. If you prefer this middle option, consider Plan G or Plan N, which require a few out-of-pocket expenses in exchange for lower premiums.   HOW DO YOU GO ABOUT PICKING A MEDICARE SUPPLEMENT /MEDIGAP PLAN? Most people enroll in Medicare supplement plans G or N. That’s because these offer the most coverage. However, the choices are intended to help you decide what is most important to you. Some beneficiaries want a plan that covers all the gaps and leaves them with no worries about the cost of medical procedures. Others prefer a Medicare supplement plan that covers some of their deductibles and out-of-pocket copays to achieve lower premiums. Refer to our Medicare Supplement Plan Chart to compare the benefits of all plans side by side. MEDICARE SUPPLEMENT PLANS DURING YOUR OPEN ENROLLMENT INTO MEDICARE Medicare Open Enrollment is a one-time window to enroll in any Medicare supplement plan in your area. According to Medicare’s Guide to Health Insurance, the best time to buy a supplement policy is during your one and only Guarantee Issue/Initial Enrollment Period.  During your one-time Medigap open enrollment, the Medicare supplement company cannot ask you any medical questions. They cannot deny coverage for any health condition. They cannot refuse you coverage or charge you any additional premium due to health conditions, medications, or pre-existing illnesses. You will have your choice of Medicare supplemental plans. After this window closes, however, any insurance companies you apply to may accept or decline your application based on your health . That is why the Medicare Handbook states that open enrollment is the best time to enroll.   GUARANTEE ISSUE RIGHTS IF YOU ARE PAST AGE  65 Some people delay enrollment in a supplement because they have group health coverage through an employer.  Later, when you retire or lose that coverage, you have the right to purchase specific Medigap policies within the 63 days following the loss of your group coverage. This is called your Medicare supplement guaranteed issue rights. The guaranteed issue window operates like open enrollment, but is shorter, and your plan choices are limited to Plans A, B, C, F, G, K, N, and L. The insurance company cannot deny your application for any health reasons.   CAN PEOPLE CHANGE OR SWITCH MEDICARE SUPPLEMENT PLANS ANYTIME? You can apply to change your Medicare Supplement at any time, but if you are past your open enrollment window, you will have to answer health questions in most states.  The Medicare supplement insurance company will review your health history and medication history. They can accept or decline you.    CHOOSING A MEDIGAP PLAN DURING YOUR INITIAL ENROLLMENT PERIOD (IEP) The Medicare Initial Enrollment Period, or IEP, starts 3 months before your birth month and runs 3 months after your birth month. In certain circumstances, an insurance company must accept you for coverage without asking health questions. For example, if you are on Medicaid and you lose your Medicaid eligibility, you have a short window to apply for Medigap without health questions.  Another example is someone leaving employer-sponsored health coverage that is primary to Medicare. They will have a short window to apply for specific Medigap plans under guaranteed issue rules.    HIGH DEDUCTIBLE MEDICARE SUPPLEMENT PLANS How do high-deductible Medigap plans work? Medicare Parts A and B pay 80% of covered costs. Complete Medigap Plans F and G pay the remaining 20%, so you don’t have to pay out of pocket.  High-deductible Medigap Plans F and G don’t pay anything until you’ve met your $2,780 deductible. If you have a High Deductible Plan G, you will also have to pay your Part B deductible, which is $240 in 2024. While that may sound like a lot, many people who choose a high-deductible plan never come close to meeting their deductible. That’s because Medicare covers the full amount of many  Preventive Care services, including: Flu vaccines and other immunizations  An annual wellness exam  Bone density tests  Prostate cancer screening — annual PSA blood test  If you are generally healthy and only see a doctor occasionally, you likely won’t use much of your high deductible.  Assuming you have a High Deductible Plan G (this doesn’t apply to High Deductible Plan F, which covers the Part B deductible), you’ll pay the Part B deductible first before your Medigap plan pays anything. Most people pay the Part B deductible during their first one or two doctor visits.  After that, the billing will look like this: When your healthcare provider charges $200 , Medicare Part B will pay 80%, leaving you responsible for 20% ($40) before you reach your Plan G high deductible .  As you can see, if you’re generally healthy and don’t use healthcare often, you won’t spend enough to reach your deductible ($2,780 in 2024).  The situation changes if you are hospitalized, because Medicare Part A has a $1,632 deductible per benefit period or episode of illness (for 2024).  In that case, you’ll pay a lot upfront. To be safe, you’ll need to have enough money available to pay the $1,632 Part A and the $240 Part B deductibles, which don’t count toward meeting your Medigap high deductible. Then, you’ll need about $700 to cover the 20% of Medicare Part A and B costs due before you meet your Medigap high deductible. Added together ($1,600 + $ 240 + $940), that is roughly $2,780. After you pay that, your Medigap high-deductible plan will cover your remaining eligible out-of-pocket healthcare costs, which for most people is 100%. But that initial hospitalization charge could be a budget-buster.   WHAT TYPE OF PERSON SHOULD CONSIDER A HIGH-DEDUCTIBLE MEDICARE SUPPLEMENT PLAN? Plans F and G are the most popular Medigap plans because they eliminate unexpected healthcare billing surprises. High-deductible F and G Medigap plans do the same thing, but choosing these plans means you have to have enough savings to pay the annual deductible upfront. Premiums for the high-deductible plans are generally significantly lower than premiums for the full version. Most people will have years when they are sick enough to meet the deductible, but some years they won’t use enough healthcare to do that. Whether you’ll come out ahead in the end depends on how healthy you remain as you age, how long you live, and other unknowable things.   QUESTIONS YOU SHOULD CONSIDER WHENEVER YOU ARE THINKING ABOUT BUYING A HIGH-DEDUCTIBLE PLAN ANNUAL PREMIUM INCREASES Before you buy any Medigap plan, ask the person selling it how much the policy's cost has increased over the last 10 years. The U.S. Department of Health and Human Services reports an average increase of about 3.8% from 2010 through 2020.  But some insurance companies raise costs less than others. If the company’s initial price looks low, ensure the premium price increases will also be low. You can get this information from: Your State Insurance Department  Your local nonprofit State Health Insurance Assistance Program Your Insurance Broker   HONESTLY ASSESS YOUR HEALTH AND YOUR FINANCIAL SITUATION While you might be healthy now, that could change in 10-15 years. It can be tough to change Medigap plans after you’ve made your initial choice. Don’t choose a high-deductible plan just because it is the best you can afford today.  It may become burdensome if your finances or health worsen.   IS IT DIFFICULT FOR YOU TO MANAGE YOUR MONEY? Until you meet your deductible, your healthcare providers will charge you 20% of your bill that Medicare hasn’t paid. Medicare will also send you a statement showing how much of your deductible you have met. Some people feel nickel-and-dimed by this billing and the need to track it. With high-deductible plans, you'll need to be patient with record-keeping.   THINGS TO REMEMBER: High-deductible plans — those that require you to pay $2,780 Out-Of-Pocket before your Medigap plan starts paying your expenses — can save you money on Medigap insurance if you have enough money to cover the deductible in a worst-case scenario. But don’t just pick a plan because the premium is cheap. Consider your future health and finances. Ask your Broker for the premium increase history for each company you are considering.

Michael T. Braden, June 9, 2022, VISION INSURANCE Medicare Beneficiary Receiving Instructions From Her Optometrist During Her Annual Vision Insurance Eye Examination MEDICARE DOESN'T COVER ROUTINE VISION INSURANCE There are a few things that Medicare does not cover.  The top 4 of these are Vision, Hearing, Routine Dental, and Feet. VISION INSURANCE FOR SENIORS One of the terms you will need to commit to memory concerning your Medicare coverage is "Medically Necessary". This is the standard Medicare uses to determine whether your Medicare coverage will cover a Medical/Surgical procedure .  Every Doctor must attest that it is medically necessary for you to receive a particular procedure for it to be considered a covered expense.  However, Medicare still has its own rules for specific categories of Health, and in particular, your Vision. As a point of emphasis, Medicare covers cataract surgery and also covers shots for eye diseases such as Macular Degeneration. However, Medicare has never covered annual Eye Exams, Prescription Lenses, Eyeglass Frames, or Contact Lenses. The cost for these services is typically referred to as OOP (Out Of Pocket) Expenses, meaning that you must cover these costs on your own. There are a few ways to reduce the cost of Annual or Bi-Annual Eye Exams and new Eyeglasses.  The most overlooked item might be your AAA Card, if you have one.  If you have an AAA Card, check with your Optometrist's office and your preferred Store that sells Prescription eyewear out of pocket to see which discounts they honor with your AAA Card.   Often, there is only a $25- $35 fee for an eye exam, with significant discounts on frames, lenses, and contacts. The other option is to purchase Vision Insurance from companies that specialize in Vision Insurance. Although I have never seen a Vision Insurance plan that covers everything, most Plans offer significant discounts and savings to help you keep your expenses down.  On the next page, you will find links to review the benefits and monthly costs of the Vision Plans we carry at Braden MSI Insurance. Lastly, my wife Tami and I both wear glasses.  We have had good and so-so Out-of-pocket costs with different Vision Plans over the years, just like you have.  Here are a few other things you might consider that might be beneficial to you, and of course, save you some money as well: If you are a Veteran of Military Service, see if you are entitled to any VA Benefits. If you are not too hung up on fashion, Nationwide Vision and America's Best Contacts and Eyeglasses are generally considered the least expensive places to get Eyeglasses.  You may not find as many "Designer" Frames and Styles, but a serviceable pair of plastic frames can save you significant money. If you like fashion and designer looks, search online for Eyeglasses or Frames.  You can find many stylish frames at significant savings, and most of the time, you can enter your Prescription, and they will have the glasses made and shipped to you. If you are not sure of the correct Frame size, check the numbers on the inside of the temple arms of your current glasses. If you have not already heard, most Onsite Labs have closed due to COVID-19. Companies like Pearle Vision, LensCrafters, and EyeMasters send their Frames out for manufacturing, and it takes 2-3 weeks to receive them. If you have a Sam's Club or Costco Membership, it is worth checking out their selection, as their prices are usually quite competitive. You can also save money by searching for Plans that cover a new pair of glasses every two years rather than every year.

Michael T. Braden February 12, 20234 GENERAL MEDICARE Here at Braden Medicare Insurance, we have the honor and privilege of reaching prospects, clients, and leads daily . Interacting with and helping others to unravel and understand Medicare is arguably the best part of our day. We receive many questions about Medicare, which prompted me to write this article on Braden Medicare Insurance's Top 10 Most-Asked Medicare Questions. WHAT EXACTLY IS MEDICARE? Medicare is the Federal Insurance Plan for individuals 65 and older and for those with Disabilities or ESRD (End Stage Renal Disease).  Medicare is an 80/20 Health Plan.   THE FOUR DIFFERENT PARTS OF MEDICARE: Medicare Part A (In-Patient Hospital Insurance) Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and certain home health care services. Medicare Part B (Out-Patient Medical Insurance) Part B covers sure doctors' services, outpatient care, medical supplies, and preventive services. Medicare Part C (Medicare Advantage) Available as an Option to Original Medicare.   Private insurance companies offer these plans and are not managed by the Government. Medicare Advantage plans are designed to offer everything Medicare does and typically provide more benefits than Original Medicare.  However, they also limit you to using doctors only in their Network.  Medicare Part D (Prescription Drug Coverage) Helps Medicare beneficiaries pay for Prescription medications. Private insurance companies offer these plans, but they must operate under the rules set in place by Medicare, which is part of the Department of Health and Human Services.  Each plan varies in cost and the specific drugs it covers, but it must provide at least the standard level of coverage set by Medicare. Medicare drug coverage includes generic and brand-name drugs. Plans can vary the list of prescription drugs they cover (called a formulary) and how they place drugs into different "tiers" on their formularies.  Each Part D plan has different monthly premiums.  You’ll also incur other costs throughout the year with a Medicare drug plan . The amount you pay for each drug depends on the plan you choose.    THE 3 WAYS YOU CAN CHOOSE TO RECEIVE MEDICARE ORIGINAL MEDICARE Original Medicare includes Medicare Part A  (Hospital Insurance) and Medicare Part B (Medical Insurance).  The Government pays for 80% of all Medicare-covered and Medically Necessary procedures, while you, the Medicare Beneficiary, pay for the other 20% of health services not paid for by Medicare. You typically pay for services as you receive them. When you get services, you’ll pay a deductible at the start of each year, and you usually pay 20% of the cost of the  Medicare-approved service, called coinsurance. If you want drug coverage, you can add a separate drug plan (Part D).   ORIGINAL MEDICARE WITH A MEDICARE SUPPLEMENT Original Medicare covers much, but not all, of the cost of covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy is designed to help "fill in" the gaps left by my Original Medicare. Medicare Supplemental (Medigap) Insurance can help pay some of the remaining health care costs, such as copayments , coinsurance, and deductibles. Some plans will pay for your entire 20% share of your Healthcare  Costs,  emergency medical care when you travel outside the U.S., as well as your Medicare Part A Deductible.   MEDICARE ADVANTAGE Medicare Advantage Plans are plans that fall under the category of Medicare Part C. Medicare Advantage plans are offered from private, for-profit companies and not by the government. These plans are designed to be an alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D. Plans may offer additional benefits that Original Medicare doesn’t cover, such as vision, hearing, and dental services. Medicare  Advantage Plans have yearly contracts with Medicare and must follow  Medicare’s coverage rules. The plan must notify you about any changes before the start of the next enrollment year. Medicare Advantage Plans are still 80/20 Health Plans, but they are managed by private Insurers, who have the final say on which services are covered and which are not . Hence, you are at the mercy of your individual plan; just because something is covered under Medicare does not mean it will be covered entirely or paid for by a Medicare Advantage plan. Each Medicare Advantage Plan can charge different out-of-pocket costs. They may also have different rules for accessing services. And, the majority of Medicare Advantage plans are HMO plans, meaning that you typically must use your plan's "Network" of Doctors and Hospitals to get your services paid for.    IS MEDICARE FREE? Almost everyone seems to expect that Medicare is entirely free; unfortunately, Medicare is not 100% free.  Medicare is , however, the most affordable Health plan in America, and when coupled with a Medicare Supplement Plan G, it is the most comprehensive coverage you can get.  Most people do not pay for Medicare Part A because they have contributed to Medicare through their working careers.  Medicare charges everyone a monthly Part B Deductible of $174.70 for 2024.  Every Medicare Beneficiary is required to pay the Medicare Part B Premium of $174.70 per month, regardless of whether they choose a Medicare Advantage Plan, Original Medicare , or Original Medicare with a Medicare Supplement (Medigap) plan. In addition to the Monthly Part B Deductible, Medicare also has an Annual Medicare Part B Deductible of $240.  This means you will receive a Medicare bill for the first $240 in healthcare costs/services each year.   Medicare Part D Monthly premiums can range from $0.00 to $169.50 per month, not including copayments and coinsurance for your prescription medications .   WHEN DO I SIGN UP FOR MEDICARE Everyone should start researching Medicare when they are 64-1/2.  That gives them plenty of time to determine which Medicare Plan they believe will fit them best, and to decide whether it makes more sense to stay with their employer's plan (if they are working past 65) or to enroll in Medicare.   Everyone who is 65  and works for a company with fewer than 100 Employees must enroll in Medicare at 65 to avoid Part B Penalties for not having Credible Coverage.   Medicare defines Credible Coverage as having the same minimum coverage as Medicare.  Typically, any employer with more than 20 employees is considered to offer Credible Coverage.  Any Employer with 20 Employees or fewer is considered non-creditable coverage . Other types of Non-Credible coverage past age 65 include Veterans Insurance (Champ, VA & Tri-Care), all Private Healthcare plans, COBRA, Retiree plans, and FEHB (Federal Employee Health Plans) .   ENROLLING IN MEDICARE You can Enroll in Medicare by using the Social Security Administration, website at www.ssa.gov ,  by calling your local Social Security Office or by applying in person at the Social Security Administration Office closest to you. You can choose to enroll in Part A & Part B or both Parts A & B.  The process typically takes 4-8 weeks to complete, so starting 3-4 months before your 65th birthday is advised. Anyone who chooses to receive their Social Security benefits before age 65 will automatically be enrolled in Medicare when they turn 65.   WHAT IS THE MEDICARE INITIAL ENROLLMENT PERIOD? You can take advantage of your initial enrollment window as early as three months before you turn 65. For those on disability, your Initial  Enrollment Period window will begin after receiving Social Security for  24 months, and then again when you turn 65. MEDICARE ELECTION PERIODS THAT ARE AVAILABLE EACH YEAR This is one of the few scenarios where you will receive two opportunities during the Initial Enrollment Period. The other scenario is if you retire, return to work, obtain employer group coverage, and then retire again later.  If you choose this, you will qualify for a Special Enrollment Period (SEP ). If you missed your Initial Enrollment Period 7-month window for one reason or another, you could still enroll during the GEP (General Enrollment Period). Keep in mind that if you enroll during the annual GEP, your Medicare will not start until July 1st.  Therefore, you may have a coverage gap. If you didn’t maintain creditable coverage, you’d be subject to an endless Part B Premium penalty.   WHO QUALIFIES FOR AUTOMATIC ENROLLMENT INTO MEDICARE? You qualify for automatic enrollment if you’re collecting Social  Security benefits. You should receive your Medicare card about three months before your 65th birthday. If you’re not collecting Social Security by the time you age into Medicare at 65, you’ll need to enroll yourself, and if you have Railroad Retirement Board disability for at least 24 months.    WHAT HAPPENS IF I MISS MY INITIAL ENROLLMENT PERIOD (IEP)?   Your effective date for Medicare Parts A and B  depends on when you enroll. If you enrolled within the three months before your 65th birthday, your effective date is the first day of your  Birthday month. If you enroll during the month of your 65th birthday,  your effective date is the first day of the month after your birthday.    If you enroll within three months of your birthday, your effective date will be the first of the month three, five, or six months after your birthday . This number increases with each month you wait. For example, if you were born on June 11 and enrolled in Medicare in August (two months after your birthday), your effective date will be November 1 (five months after your Birthday month).     DO YOU HAVE TO JOIN MEDICARE PART D? Technically no, you do not have to do anything you do not want to do, however; if you do not choose to enroll in a Medicare Part D Prescription Drug plan within 63 days of your turning 65 or joining Medicare Part B, you could be subject to a 1% penalty which is about .39 cents per month for each month you went without a Part D plan, and that is not the worst part, this Part D penalty never goes away, so someone who blew off getting a Part D plan for say 2 years would pay about .39 x 24 Months meaning they would owe $9.36 in a Part D Penalty for as long as they are enrolled in a Part D plan.      DOES MEDICARE COVER VACCINATIONS? Medicare covers annual Flu Vaccines,  Shingrix (Shingles Vaccine), Pneumonia, Hepatitis, Tdap, and chickenpox.  If you plan to schedule your Shingrix Vaccine (2 shots, 3 months apart), it is advisable to schedule the first shot in September and the second in December.  Why? Because there is a considerable cost difference for Medicare Beneficiaries.  It will cost $155-$210 for the Shingrix Vaccine if you have not met your annual Part D Deductible, and usually between $10-$20 if you have reached your yearly deductible. (Using GoodRx, you can generally pay around $155 for the Shingles (Shingrix) vaccine.) Under Medicare , some Vaccines are billed under Medicare Part B . In contrast, others are only covered through Part D.  Ask your Broker or call the Member Services Number on the back of your Medicare Supplement or Medicare Advantage Card to be sure.   WHAT IS AND WHEN IS THE MEDICARE AEP (ANNUAL ENROLLMENT PERIOD)? THE MEDICARE ANNUAL ENROLLMENT PERIOD RUNS FROM OCTOBER 15th - DECEMBER 7th EACH YEAR From October 15th to December 7th, you can choose a new Prescription Drug Plan for the next year (Beginning on January 1st), change your Medicare Advantage Plan, or stay with your current Medicare Advantage plan if it is still available.  Your new plan will go into effect on January 1st. If you have a Medigap or Medicare Supplement plan, you do not need to do anything during the Annual Enrollment period.   DO I HAVE TO CHANGE MY MEDICARE SUPPLEMENT EVERY YEAR? No . Once you have a Medicare Supplement Plan, it will never cancel or lapse as long as you make your monthly premium payments.  And, Medicare Supplement plans can be changed any day of the year; there are no special periods to deal with if you have a Medicare Supplement. However, if you switch your Medicare Supplement plan after your initial Guaranteed Issue period, you will be required to answer Medical questions and undergo medical underwriting .    WHAT IS NOT COVERED BY MEDICARE? What Things Are Not Covered By Original Medicare General Annual Eye Exams at an optometrist's office are not covered.  Medicare also does not cover Hearing Aids, Eyeglasses, Contact Lenses, Hearing Tests, or Dental coverage. However, Medicare will cover procedures and treatments from an Ophthalmologist, such as Cataracts, Macular Degeneration, or any other procedure that is deemed Medically Necessary by your doctor, which could include TMJ and Ear Canals.

About Medicare PPO Plans MEDICARE PREFERRED PROVIDER ORGANIZATIONS HOW MEDICARE ADVANTAGE PPO PLANS WORK? A Medicare PPO Plan is a type of Medicare Advantage Plan (Medicare Part C) offered by a private insurance company. PPO Plans have network doctors, other health care providers, and hospitals. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You pay more if you use doctors, hospitals, and providers outside of the network.   WHAT ARE THE LIMITATIONS WHEN IT COMES TO DOCTORS WITH A PPO PLAN? HOW MEDICARE ADVANTAGE PPO PLANS WORK WITH DOCTORS In most cases, you can get your health care from any doctor, other health care provider, or hospital in PPO Plans. Each plan gives you the flexibility to see doctors, specialists, or hospitals that aren't on the plan's list, but it will usually cost more.   DO ALL MEDICARE PPO PLANS COVER PRESCRIPTION MEDICATIONS No, not all PPO plans include prescription drug coverage. Many do, but you will need to confirm, as plans are specific to certain areas. In most cases, prescription drugs are covered in PPO Plans. Ask the plan. If you want Medicare drug coverage, you must join a PPO Plan that offers prescription drug coverage. Remember, if you join a PPO Plan that doesn't offer prescription drug coverage, you can't enter a Medicare Prescription Drug Plan (Medicare Part D).   DO YOU NEED TO CHOOSE A PCP WITH A PPO PLAN? You don't need to choose a primary care doctor in PPO Plans. Many plans still recommend identifying a Primary Care Provider, but enrollment in the plan is not required .   WILL YOU NEED REFERRALS TO SEE A SPECIALIST WITH A PPO PLAN? In most cases, you don't have to get a referral to see a specialist in PPO Plans. If you use plan specialists, your costs for covered services will usually be lower than if you use non-plan specialists.   OTHER IMPORTANT INFORMATION ABOUT PPO PLANS A PPO Plan isn't the same as Original Medicare (Medicare Part A and Part B) or a Medicare Supplement Insurance (Medigap) policy. PPO Plans usually offer more benefits than Original Medicare, but you may have to pay extra for these benefits.   HOW DO MEDICARE ADVANTAGE PPO PLANS WORK? Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are an “all-in-one” alternative to Original Medicare. Private companies approved by Medicare offer them .  If you join a Medicare Advantage Plan, you still have Medicare.  These "bundled" plans include Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), and, in most cases, a Medicare Prescription Drug Plan (Part D). WHAT IS COVERED UNDER MEDICARE PPO PLANS? All Medicare Advantage Plans must offer the same coverage as Original Medicare. And the majority of MA and MA/PD plans include Dental Benefits, Routine Vision Care, Hearing, Hearing Aids, and a Health Club Membership through companies like SilverSneakers, Silver&Fit, and Renew Active. .     ARE THERE ANY RULES WITH MEDICARE ADVANTAGE PPO PLANS? Medicare pays a fixed monthly amount to the companies that offer Medicare Advantage Plans for your care . These companies must comply with Medicare rules. Each Medicare Advantage Plan can charge different out-of-pocket costs. They can also have different rules for how you get services, like: Whether you need a referral to see a specialist If you have to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care These rules can change each year.   HOW MUCH DO MEDICARE ADVANTAGE PPO PLANS TYPICALLY COST? What you pay in a Medicare Advantage Plan depends on several factors. Where you live is the most significant factor. Some PPO plans have a $0 Premium, but they typically have higher MOOP amounts. Overall, PPO Plans can cost $25 - $175 per month, depending on the plans available in the county you live in.   DO MEDICARE ADVANTAGE PPO PLANS ALL COME WITH PRESCRIPTION DRUG COVERAGE? Most Medicare Advantage Plans include Prescription Drug Coverage Medicare Part D). You can join a separate Medicare Prescription Drug Plan with certain types of plans that: Can’t offer drug coverage (like Medicare Medical Savings Account plans) Choose not to offer drug coverage (as some Private Fee-for-Service plans do). You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply: You’re in a Medicare Advantage HMO or PPO. You join a separate Medicare Prescription Drug Plan.   WHICH INSURANCE COMPANY HAS THE BEST PPO PLANS? In my experience, Aetna has the best PPO Networks and plan options . MEDICARE PPO PLANS ARE NOT ACCEPTED BY EVERY HOSPITAL   Did Anyone Mention To You That The Mayo Clinic Hospital & Barrow Neurological Hospital Do Not Accept ANY Medicare Advantage Plans? This is because Medicare Advantage Plans have strict Networks you need to use. If you go out of the Network, you will pay for services out of your own pocket.   It is true.  Many specialty hospitals, such as Cancer Treatment Centers of America, partner with only a few select Medicare Advantage Plans. This is why you need to read the fine print: unfortunately, most Medicare Agents are too focused on making the sale and intentionally side-step the truth.  If you do not ask, they do not volunteer information that will make them or their plan look bad.    In all fairness, Mayo Clinic in Rochester, Minnesota, accepts all Medicare Advantage plans in Minnesota, but that is not the case in Arizona or Florida.

Michael T. Braden, August 29, 2024 LONG-TERM CARE INSURANCE Braden Medicare Insurances Long Term Care Insurance Poster WHAT IS LONG-TERM CARE? Long-term care insurance can be an emotionally charged topic. It’s not exactly something you want to talk about at the dinner table. After all, no one wants to think about themselves or their loved ones being unable to live on their own. But  if you want to make a sound financial decision and protect your nest egg, long-term care insurance is essential ! To illustrate this, consider Steve and Rachel. They weren’t always prudent with money, but they worked hard and built a nest egg of $300,000 . When Steve was 67 years old, he developed Alzheimer’s disease. At first, it wasn’t too bad. Rachel used some of their nest egg to hire a home care specialist to help with Steve for a few hours each day. But as his condition worsened, Steve had to go into a nursing home. Sadly, after five years in the house, Steve passed away. Rachel, now 72, is as healthy as she could be for her age, but she has to work full time because her husband’s stay in the nursing home devoured most of their nest egg.  Unfortunately, Steve and Rachel’s story isn’t unique. It happens to many people every year. But with long-term care insurance in place, you can keep it from happening to you!       LONG-TERM CARE INSURANCE   UNDERSTANDING LONG-TERM CARE Long-term care insurance is nursing home or assisted living insurance. It covers long-term care (LTC) services that some people will need as they age or become ill and require help with daily tasks such as getting dressed, bathing, and more. And long-term care can get expensive—   expensive.  According to the Alzheimer’s Association, the estimated cost of end-of-life care in 2019 ranged from $233,000 to $367,000. Most health and disability insurance won’t cover long-term care, but long-term care insurance will. Finding an independent insurance broker who shops among several long-term care companies and provides quotes can save you thousands of dollars and unnecessary worry .   WHAT DOES LONG-TERM CARE INSURANCE PROVIDE? Nursing Home Care Assisted Living Facilities Adult Daycare Services In-Home Care Home Modifications Care Coordination NOTE: Not all policies are the same, so talk to your independent insurance agent to find the best fit for your needs.   WHY WE BELIEVE EVERYONE SHOULD HAVE A LONG-TERM CARE INSURANCE POLICY Did you know that over 14 million adults needed long-term care services in 2020? Purchasing Long-Term Care Insurance   can give you peace of mind and protect the nest egg you worked so hard to build. You’ll know that if you become ill, you can afford the care you need and still have enough money in your nest egg for you and your spouse to eat. Plus, your kids won’t be burdened with huge payments for your care.  Now you may be thinking:  What about government programs? Can’t they help?  Don’t make the mistake of believing Medicare will cover long-term care costs.  It doesn’t. And while Medicaid—the government program designed for people who genuinely don’t have any money—will cover long-term care expenses, it should never be your first choice. Legal Point: It’s common for people to try to cheat the system by moving assets out of their parents’ name to get the government to pay for LTC without touching those assets. That is considered fraud—a federal crime—and the government will prosecute you!  Don’t fall into that trap.   TRADITIONAL LONG-TERM CARE INSURANCE Traditional long-term care insurance is a no-frills, standalone insurance policy. All it does is offer to pay for long-term care services when you need them. That’s it! When does a traditional policy kick in? The policy is triggered when you can no longer perform two out of six activities of daily living  (such as dressing, bathing, eating, or transferring to a wheelchair) or suffer from severe cognitive impairment. After a 30–90 day waiting period, your benefits should begin .   HYBRID LIFE INSURANCE POLICIES AND LONG-TERM CARE POLICIES Another option is a policy that combines life insurance with long-term care coverage. With a hybrid policy, you can access the death benefit—the money that your beneficiaries would receive in the event of your death—while you are still alive to pay for long-term care. If you do not need care, your heirs receive the full payout.  Rates are considered  “non-cancellable,”  which means premiums are fixed for life. But brace yourselves—the price tag for a hybrid policy is usually  thousands  of dollars more expensive than a traditional policy. That’s because you’re also buying life insurance, which you might not even need, along with LTC  coverage. Unlike traditional long-term care insurance, premiums for hybrid policies are  not  tax-deductible. Similar to whole life insurance, insurance companies invest the money in your hybrid policy. The problem is they’re not making sound investments, and your returns will likely barely keep pace with inflation. Those lost earnings could make hybrids the most expensive long-term care policies of all. That’s why hybrid policies should generally be a last resort. The only time you might consider buying one is if you can’t qualify for a traditional long-term care insurance policy due to medical underwriting.  Other than that, purchase long-term care insurance and life insurance separately—don’t try to marry the two! WHEN SHOULD YOU BUY LTC INSURANCE Okay, Dave suggests waiting until age 60  to buy long-term care insurance because the likelihood that you will file a claim before then is slim .  You’ll want to buy a long-term care policy as a 60th birthday present to yourself.  Statistically, 95% of LTC claims are filed for people over age 70. You may assume you’ll pay less if you buy your policy at age 50 and lock in a lower monthly premium, rather than waiting until age 60. But Dave will never tell you to buy something based on the monthly payment . That’s what broke people do, right? It’s about what  you need  when  you need it.   IT MATTERS WHEN YOU BUY YOUR POLICY While it might seem cheaper to buy LTC at age 50, the numbers tell a different story. An estimated LTC premium for a healthy 50-year-old man is $1,657   per year. If the policy remains in effect until this person is 95, he can spend approximately  $74,565  in LTC premiums. For a healthy 60-year-old man, an estimated premium is  $1,811 . If he keeps the policy until he’s 95, it could cost him $63,385 in total. You can already see how buying at age 60 is a better deal! But what would happen if, instead of buying LTC at age 50, you invest that $1,657  each year until age 60? You could have roughly $30,000! If you keep that money invested until age 95 and never add to it, you could have over $1.3 million. That’s not too shabby! Many people worry that if they wait until age 60 to buy LTC, they’ll develop a medical condition that could prevent them from qualifying for coverage or significantly increase their premiums. If you have a family history of illness at a young age, or you are losing sleep because you’re worried about getting sick and not being able to afford care, then buy LTC when you can afford it. The peace of mind is worth more than any cash you’ll save on premiums. Do not buy LTC at a young age because you think you’ll save money by doing so . As shown above, that’s not true.   WORK WITH AN INDEPENDENT INSURANCE AGENT/BROKER OK, what’s the best way to find long-term care insurance? Go to an independent insurance agent. They’ll shop among several different insurance companies to find you the best price based on your particular location, situation, age, health, and other factors. Long-term care is a significant decision, so make sure you have a professional on your side!   A LITTLE-KNOWN FACT THAT COULD MEAN A LOT LATER Initially, the cost for women was less than for men for an LTC policy.  However, insurance companies began to notice that married women were the primary caregivers for their husbands, and thus they outlived their husbands most often, often by many years.  They also found that, because the wives were the primary caretakers, the men spent significantly less time in long-term care facilities, as they were cared for at home.  But after they were gone, their wives tended to spend more time in a long-term care facility because no one was left to care for them.  This is sad, and I wish children and grandchildren of aging parents understood the importance of repaying the debt our parents undertook when they cared and nurtured us from birth until we left home.  It can be difficult, but it is worth having family discussions so our parents never feel unwanted or forgotten. It really is the least we can do. I know many parents retire to warmer areas to enjoy their retirement years, but having a long-term plan for their parents is something all children should want.   The last thing I want to leave you with is to consider one of the many Riders offered for LTC Policies.  (A rider can add valuable benefits, but you must determine which riders are worth the extra cost. Some riders add to the price without a corresponding increase in benefits. You can purchase various Add-ons or Supplements to your long-term care Policy if you know what to look for.  Here are what we at Braden MSI Insurance Services believe are the top 2 Riders for any LTC Policy. Just a few things we believe everyone should consider.   SPOUSAL BENEFIT RIDER We believe that the Spousal Benefit Rider is one of the "most significant riders. " This enables each spouse to tap the other's pool of benefits. As a result,  each individual could purchase, say, a three-year plan of protection,  which would be significantly less expensive than a five-year benefit." Adding a spousal rider to your long-term care insurance policy might increase the cost by about 15 percent, but it would give both policyholders access to five or six years of benefits.   INFLATION RIDER No matter which long-term care policy you buy, everyone should buy an Inflation Rider.   This option is essential and valuable. These riders help ensure that your long-term care insurance benefits keep pace with the escalating cost of health care. Generally , two riders are offered: one that covers inflation up to 3% annually, which is the more affordable and more popular option .  However, a Compound Rider that automatically increases by 5% will double the initial daily benefit every 14 years.  So, as an example, if you purchased a policy at age 60 with a $100 per day benefit, that daily benefit would be $200 per day when you are 74, in comparison to $154 per day if you chose the 3% Inflation Rider. Because this coverage is so essential, insurance regulators in many states require that any purchaser of a long-term care policy explicitly reject the inflation rider if they don't want it. Nearly all long-term care insurance policies have some form of home health care included in a basic LTC policy. . The most common long-term care policies are classified as "tax-qualified."  That means they follow consumer-protection guidelines set by the National Association of Insurance Commissioners and the Health Insurance Portability and Accountability Act (HIPAA). That also means that when you use a benefit, it is not considered taxable income. In the past, some insurers offered home health care as a rider. All tax-qualified basic long-term care insurance policies now cover some home health care. If you are among those rare few with a non-tax-qualified policy, ask your insurance agent if you have home health care coverage.