Medicare expert, Toni King explains Parts A, B, C, and D. Feeling overwhelmed about enrolling? Toni can help! She puts the rules of Medicare into “people terms.” In this episode, join Toni as she guides listeners through the Medicare alphabet soup!
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Thank you for listening to today’s Medicare moments podcast. Hi, I’m Toni King. I took the Medicare and new handbook that many find hard to understand and put it in people terms. I help America personalize their Medicare. Today, together we are exploring Medicare’s different parts: Medicare parts A, B, C, and D. With Medicare, it’s what you don’t know that will hurt you. So let’s get started exploring the maze of Medicare together. Get your pen and paper out because you may want to take notes. So what is Medicare? Medicare Parts A, B, C, and D? Medicare is a government controlled insurance program that every American can qualify for, giving them medical care coverage when turning sixty-five, during retirement, or if they are unable to work before sixty-five due to a disability. In a world where medical costs continue to rise, retirees income often does not. Medicare provides a safety net to help them address medical issues. We all deal with them as we age, and some of those chronic conditions and the medications used to treat them can have a huge financial impact. Medicare is not just one insurance plan that covers everything. Medicare is divided into parts. Four parts: A, B, C, and D. Each of these parts cover a specific aspect of your medical care. Tailoring your Medicare choices can be done based on who you have as doctors, what your health conditions are, what types of medications you take, and what they cost. I want to start with talking about Medicare Part A and what it covers. What is Medicare Part A? It is your hospital insurance for Medicare. Medicare Part A is the inpatient hospital part of original Medicare. Most people do not have to pay for Medicare Part A. You are your spouse must have worked ten years, or forty quarters paying into the social security system, to receive Medicare Party A premium free. Usually, Medicare Part A begins the first day of the month you turn sixty-five and are enrolled into Medicare, or the twenty fifth month if you are under sixty-five and receiving social security disability benefits. For those who are not receiving social security at sixty-five, such as what I was doing when I turned sixty five, and are still working and want to enroll in Medicare, here’s what you need to do. You must go online to www.ssa.gov/benefits/Medicare, three months prior to turning sixty-five, and enroll in Medicare to be sure your Medicare begins the month you turn sixty-five. This is very important. For those who are still working and you have an HSA, you may consider—now listen to this; this gets confusing—you may consider not enrolling in Medicare due to the fact that even if you are enrolled in Medicare Part A, you can no longer fund your HSA. We’re gonna talk more on Medicare Part A and what it covers, and I have it also in the Medicare Survival Guide Advanced Edition, which is available at ToniSays.com. So let’s talk about what Medicare Part A does pay for. There is more to this than just an inpatient hospital’s day. For instance, if you have surgery and it’s inpatient, then it will be covered under Medicare Part A. It also covers a skilled nursing stay or a rehab stay. And if you need a blood transfusion that is covered under Medicare Part A, your chronic condition might require home health. Or maybe you’re at the end of life and you need hospice that is covered under Medicare Part A. So let’s go over what Medicare Part A covers. It covers blood, such as a blood transfusion. It covers home healthcare. It covers a hospice day or end-of-life issues with hospice care. It covers skilled nursing facility or a rehab facility. And most important, it covers your inpatient hospital stay. Now, let’s go down the Medicare alphabet suit and talk about Medicare Part B, which is Medicare’s medical insurance part. Medicare Part B pays for medically necessary services—your doctor’s care, whether it’s having surgery or an office visit. It also covers outpatient care—that is covered under Medicare Part B. It covers home health care. That is not covered under Medicare Part A, and it also pays for preventive care. That is most important—it does pay for preventive care. Recognize that while you might not have a premium for Medicare Part a, you are going to have a premium with Medicare Part B. And this is what confuses a lot of Americans, because the premium can be deducted from your social security check. But if you are not collecting social security, then what happens? You are going to have to pay your premium monthly and Medicare or social security will bill you. I also want to be clear that your Medicare Part B premium is not frozen at one price. In fact, it is going to change from year to year. Now, you might decide to not take Medicare Part B for a variety of reasons. For instance, you might think that the premium is out of your reach, because you can’t afford your car payment anymore if you pay for the premium. And you might think, “Well, I don’t get sick, so why do I need to pay for this?” These are some of the reasons that people give us in the office to avoid enrolling in Medicare Part B. Well, there are no exceptions to enrolling in Medicare Part B, so make sure when you are ready to get on Medicare to enroll and take Part B, or you will have a problem down the road. The Part B penalty is ten percent for each twelve-month period or year that you could have had Medicare Part B, but you chose not to enroll. This penalty is not limited to a specific time frame, but must be paid in addition to what your monthly Medicare Part B payment is—not for one month, but for the rest of your life. You can see how this could be very expensive. After one year of not enrolling in Part B the right way, your penalty is ten percent. After three years, it is up to thirty percent. And so, it goes on and on and on. So let’s discuss what Medicare Part B pays for. It pays for medical services. Such as—outpatient surgery is covered under Medicare Part B. Your doctor performing surgery. Going to the doctor’s office. An anesthesiologist is covered under Medicare Part B. Pathologists. Getting a second surgical opinion. And the list goes on and on. You’ve also got clinical laboratory services—you go and you have to get your lab work done. You may have a home healthcare need your doctor has ordered, and you have not been in the hospital. That will be covered under Medicare Part B. Durable medical equipment. Maybe you need a wheelchair or a walker. Or oxygen. Or diabetic supplies. This is covered under Medicare Part B. And you may have to have an outpatient blood transfusion—that is covered under Medicare Part B. Be sure that your doctor is accepting Medicare assignment. Remember—doctors and medical suppliers must agree to accept Medicare assignment. This assignment means that the patient will not be required to pay any expenses that Medicare does not approve. So, you want to make sure that you are under Medicare’s assignment. Original Medicare Part A and B and a Medicare supplement. Let’s discuss it. To have Part A and B deductibles and copays, the out–of-pocket cause picked up and paid for when you are ready to get on Medicare, enroll in original Medicare with a Medicare supplement. In the Medicare and You handbook, it states: “When is the best time to buy a Medicare supplement or a Medigap policy without having to answer any health questions?” This is very, very important. This is a special time—is called your “Medicap open enrollment period.” This period lasts for six months and begins on the first day of the month when you are either turning sixty-five or older and have enrolled in Medicare Part B. At the Toni Says Office, when a Toni Says Medicare team member consults with a Medicare client, we treat enrolling in Medicare Part B like gold, because if you are past your Medigap open enrollment period, then you must answer health questions. And that can keep you from enrolling in a Medicare supplement, because you can be declined. So the six-month window, which is called the Medigap open enrollment period, when you are sixty-five or older and you are getting part B for the first time, is very important. We have discussed Medicare Parts A and B, which is original Medicare. Now, let’s go on and go farther down the alphabet soup and discuss Medicare Part C, which is your Medicare Advantage Plan. I’m sure that most Americans are just bombarded with Medicare Part C, Medicare Advantage Plans marketing material, with all of the mail that is coming to you—especially the telephone calls. It’s like your phone blows up when you’re turning sixty-five and getting on Medicare for the first time. Medicare Part C, which is your Medicare Advantage Plan, is another way to get your Medicare benefits and have what original Medicare does not pay for paid by the Medicare Advantage Plan. Private insurance companies approved by Medicare manage Medicare Part C. These Medicare Advantage Plans must cover medically necessary services but can charge different copays, different coinsurance and deductibles, and out-of-pocket for these services. There is a variety of Medicare Advantage Plans available, and each of them has a different pro and con, depending on your medical needs. You need to review each of these plans every year during Medicare’s annual enrollment period, which is from October 15th through December 7th, and make sure that your Medicare advantage plan fits your current medical needs. Always—and I repeat this—put a star around it while you’re writing your notes. Always ask your medical provider and the facilities that you like to go to if they are accepting the Medicare Advantage Plan which you are deciding to enroll in. Just because it is online, or it’s in their Medicare booklet, they may not be in the network anymore. So again—I repeat—always ask your medical provider or facility if they are still in that Medicare Advantage Plan Part C’s network. It is important to note that the Medicare Advantage Plans is not the same as a Medicare supplement. Here’s the different kind of Medicare Advantage Plans Medicare has. First, a Medicare Advantage Plan, or Medicare Part C, is a health plan option. Such as—HMO, A PPO, a private fee for service plan, a Medicare savings account, or a special needs plan which is operated by an insurance company to help with the coverage you need. And what you have to do is present your Medicare Advantage insurance card. Now, hear what I’m saying. You give them your Medicare Advantage insurance card and not your Medicare card. Because Medicare is paying that Medicare Advantage Plan each month for your care. Medicare will not pay the claims. Your Medicare Advantage Plan will pay the claim. It is also important to note that a Medicare Advantage Plan is not the same as a Medicare supplement. There are different costs, different rates, and this could impact your out-of-pocket costs. So a MAPD plan provides—or a Medicare Advantage Plan provides—your Medicare Part A hospital insurance and Medicare Part B medical insurance medically necessary services that original Medicare provides. So, you’re gonna have that provided. An MAPD plan charges copays, co-insurance, and has deductible and maximum out-of-pocket for all services. A MAPD plan—Medicare Advantage Prescription Drug Plan—also offers extra benefits. And this is what a lot of people are really seeking. And they missed the medical side of everything, because they are looking at the vision and hearing and dental, going to an exercise class, going to a gym. And they miss the medical side when they have a major disaster and wonder why they are paying so much out of pocket, because their maximum out-of-pocket can be high. So, here’s one Medicare Moments podcast alert. Here’s what you need to do: Check with your hospital and doctor before you attempt to enroll in a Medicare Advantage Part C Plan. Find out if your doctor or the hospital or accepting the plan you are choosing. That is extremely important. Finally, let’s discuss Medicare Part D—Medicare’s prescription drug plan, which addresses another area where your medical costs can be impacted. Medicare Part D is your Medicare prescription drug plan. Your Medicare prescription drug plan covers prescription drugs and can be especially important if you’re dealing with a chronic condition. Today, I had a gentleman come in who takes about eight prescriptions. He came in for a Medicare consultation, and his prescriptions are gonna cost over 1,600 dollars a month. He will go in the doughnut hole in three months. So you want to make sure that you are looking into the different prescription drug plans. You need to realize that this coverage helps to lower your prescription drug cost. You are only required to have Medicare Part A; that’s where it starts to be eligible for a Medicare prescription drug plan. Most people enroll in both Medicare Part A and B when they are eligible for Medicare, but some wait ’til later to get a Part D or Medicare Prescription Drug Plan. There are many reasons for delaying Medicare Part D. Such as—having group benefits. If you have a group plan, you have credible coverage, or having VA benefits—that can be credible coverage. Medicare does not force you to enroll in a prescription drug plan. However, here’s the catch: if you fail to enroll when you are first eligible, then you could face a penalty, which is one percent per month that you waited to not enroll. Okay? And people go, “What’s one percent? Why should that be important?” You can only change or enroll in your Medicare Advantage Plan with prescription drug—or your Medicare Part D Plan—during Medicare’s annual enrollment period, which is from October 15th through December 7th each year.. And this is what Medicare calls their “annual enrollment period.” This enrollment period allows you to make changes to your plan that you might have previously chosen, as well as enroll if you previously delayed or you didn’t enroll at the right time. Let’s say you waited three years to enroll in a prescription drug plan, and now you’re going to get the Medicare Part D penalty. It’s one percent for each month you could have waited. That’s gonna be thirty-six months, times one percent. It will be thirty-six percent a month forever. A lot of money. So we advise everyone who comes in the office and sits down for a Medicare consultation to enroll in a prescription drug plan. Don’t wait. Enroll in a Medicare Part D Prescription Drug Plan. Please do not wait because you do not want to get a penalty, which will last as long as you are on Medicare. Here is what you need to know about Medicare Part D Plans. First, there are two ways to enroll. You can enroll in a Medicare Part D Plan standalone with just original Medicare or with a Medicare supplement, or you can enroll in a Medicare Advantage Plan— which has prescription drug plan included. That’s called a MAPD. There are different tiers involved with a Medicare Prescription Drug Plan, whether standalone or with a Medicare Advantage Plan and MAPD. First, there’s tier one, which is your preferred generics such as Lisinopril or Metformin. There’s tier two, with the higher cost of a non-preferred generic drug. And there is tier three, which is your preferred, brand name drugs, such as NovoLog or Eliquis or Xarelto. Those are expensive, preferred, brand name drugs. And number four—tier number four—is non-preferred, brand name drugs. And then there is tier five, which is your specialty drugs. And that can be expensive Parkinson meds. It can be expensive cancer medications. Or it could be, like, Humera; something for rheumatoid arthritis. When someone comes in the office with specialty drugs, we know sometimes they can be thousands of dollars. And then, there is the famous doughnut hole, which we will discuss in length in a future podcast. Stay tuned for some of the Medicare Moments podcasts, so that you can learn about the doughnut hole. As you are choosing a plan, it is critical to verify that your prescriptions are covered under that plan. Don’t just pick something because you like the name. Make sure that all of your prescriptions are covered under the Medicare Part D Plan or Medicare Advantage Plan which you are choosing. Visit Medicare.gov to explore your Medicare Part D Plan options. If you are not going to enroll in a Medicare Part D Prescription Drug Plan, then you need to make sure that your current prescription drug plan is creditable. That is credit-able. Creditable plans can be veterans’ benefits, or employer and union health coverage or group plans. Social Security will allow you to delay your Medicare with a creditable prescription drug plan, but you need to make sure that you have documented your previous coverage. When you are leaving your employer benefits and you are past sixty-five, you will have a sixty-three day window to enroll in a Medicare Prescription Drug Plan without getting a penalty. So, it’s very important to enroll at the right time. Now that you have basic understanding of each of the Medicare parts—Medicare Part A, B, C, and D—and some critical points that you will need, future Medicare Moment podcasts will discuss Medicare’s enrollment periods and how they can impact your enrollment. I want to thank you for being part of the Medicare Moments podcast. If you still have questions about personalizing your Medicare, making it for you, or if you’d like to just find out more, visit www.seniorresource.com, where the Toni Says Medicare articles can be found. You can read them, you can download them, and you know—I just want to say—have a great day. We are in the best country there is. God bless you, and God bless the USA. Have a good day!
What You Don’t Know Will Hurt You!
Turning 65 in America is a milestone and one of the markers is enrolling in Medicare. But the system is so complicated, and there is a lot of false information out there.
In Toni King’s Medicare Survival Guide Advanced: Basics and Beyond, Toni gives you the critical steps you need to enroll in Medicare properly. Toni shares various situations that she has experienced with her many clients during Medicare consultations, and gives you the information and tools you need to enroll on time to avoid the “famous” Medicare Part B and D penalties.
Medicare Survival Guide Advanced helps you understand Medicare step by step…
Learn How to Enroll the Correct Way
• Still Working Past 65
• Turning 65
• VA Benefits
• Laid-off or Retiring
What Medicare Option Is Best for You
• Medicare Supplement vs. Advantage
• Losing Retirement Benefits
How to Avoid
• The Donut Hole
• Part B Penalties
• Part D IRMAA Penalties
If you are enrolling in Medicare and are confused by the commercials and telemarketers, or from the information that well-meaning friends or family members give, let Toni guide you through the maze of Medicare. Order TODAY!
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Originally published September 07, 2022