Michael M Insurance Services Blog
Some states have help for seniors that are on expensive prescription Medications. New York is one of them and their program is called EPIC. For individuals that don't qualify for programs such as Medicaid or Extra Help because of income, they will often qualify for EPIC. Currently, the income ceilings are-
$75,000 for an individual
$100,000 for a couple filing jointly.
For lower income individuals there will be a small fee to participate. For higher income individuals there will be a deductible that is satisfied by the individual paying for their medications but, the Part D Deductible, if any, must be satisfied first. Once EPIC is functioning, individuals will see a substantial decrease in their Medications costs.
If you live outside of New York, check with your state to see if there is a similar Rx assistance program. For you New Yorkers, there is more information on EPIC below.
Signing up for Medicare is relatively easy. For those that are uncomfortable with doing things online, there is the option of visiting your local Social Security office. The button below will help you locate nearest location.
If you would like to do it online, this can be accomplished by visiting the Social Security Web site. You will need to create an account which will be automatically done after beginning the application. A link to the online app. is below.
Medicare Advisor Mike is actually a Broker certified with multiple Insurance Carriers and licensed in several states. Unlike the Captive Agent, Mike is not constrained by one company's product offering and can offer a variety of options. This will always result in a better fit for an individual's healthcare needs. As a Medicare Advisor, Mike must recertify each year with the Centers for Medicare and Medicaid Services, maintain state licensing requirements, stay abreast of industry changes through continuing education and recertify with the individual insurance carriers he/she represents.
An HSA is a type of savings account that let's you set aside money on a pre-tax basis to pay for qualified medical expenses. By using un taxed dollars in a Health Savings Account (HSA) to pay for deductibles, coinsurance, copays etc, you may be able to lower Health Care costs. The funds generally are not used to pay premiums.
While you can use the funds in an HSA at any time to pay for qualified medical expenses, you may contribute to the HSA only if you have a High Deductible Health Plan. For 2022 the minimum deductible amounts are $1400 for an individual and $2800 for a family. Contributions can be made up to $3650 for an individual and $7300 for a family. Funds roll over from year to year if you don't spend them and an HSA my earn interest which is not taxable.
Medicare recommends stopping contributions to an HSA 6 months prior to enrolling in Medicare to avoid tax consequences.
Medicare is made up of 4 parts, A,B,C and D. Each letter designation represents a different area of medical coverage. It all begins with what is known as "Original Medicare," Hospital Part A and Medical Part B.
Hospital Part- Is an admitted hospital stay (Not the Emergency Room). It also covers skilled nursing care following an admitted hospital stay.
Medical Part B- Is all coverage outside of an admitted hospital stay. That coverage includes Doctor visits, Tests, Blood work etc.
In addition to Original Medicare(Parts A and B) there is also-
Medicare Part C- Medicare Advantage Plan- These are Health Insurance Plans provided by private insurance companies to help cover the cost sharing associated with Original Medicare and provide coverage for some items not covered by Original Medicare like Dental and Vision.
Medicare Part D- Prescription Drug Plan- Original Medicare does not cover prescription medications. Part D plans are provided by private insurers and some Part C Medicare Advantage Plans have Part D Drug plans embedded in them.
Your Enrollment period for Medicare begins 3 months before your
birthday and continues through your birthday month plus another 3
for a total of 7 months. If you are definitely going to sign up do it
during the first 3 months to ensure it begins on the first day of your
birthday month(Which is the earliest it can start). Waiting will delay
the start. The choice to sign up or not depends upon your current
Employer Coverage - If your employer has over 20 employees
then the coverage is considered “creditable” which means that is
as good if not better than Medicare and you don't have to sign up.
Most people sign up for Part A because for most people it is Free.
If you have an HSA then it is advisable to not sign up because then
your contributions become taxable. If your employer has less than
20 employees then you will have to sign up. Even if you don’t have
to sign up it is a good idea to ask your Medicare Advisor (me) to
do a comparison between getting on Medicare and keeping your
current coverage. Some company plans have steep deductibles
and are expensive.
State Health Exchange - You will have to sign up.
Union Coverage - It is advisable to connect with Human
Resources because some unions require members to sign up
when first eligible for cost share reasons.
Having nothing and doing nothing is not an option(It can be, but
then things will get expensive).
Part A - There are penalties when not having it when you’re
supposed to but everybody signs up because it is free to all that
have worked 40 quarters(10 years) or more.
Part B - Some people blow this off because of the premium. If that
happens and you miss your initial 7 month window then you have
to wait for the Part B enrollment period which is from 1/1 to 3/31
for an effective date of 7/1. The penalty will be 10% of your
monthly premium per year not enrolled. If you waited 2 years to
enroll you would add $34 to your Part B premium for as long as you
Part D - Some folks blow this off because they don’t take Meds. Big
no no. The penalty will be 1% of the national monthly average
premium(About $30) times the number of months you were without
it added to your Rx plan monthly premium.
In short, the individuals that get penalties have nothing and do
Medicare was created as part of the 1965 Amendments to Social Security that created Medicare and Medicaid. Medicare is Health Insurance Coverage (Hospital Part A and Medical Part B) for people 65 or older, certain people under 65 with disabilities and people any age with End Stage Renal Disease(ESRD). Your first chance to get Medicare usually begins 3 months before you turn 65 and ends 3 months after. But, there are other Special Enrollment Periods(SEP’s) when you can enroll as well.
You can only enroll in Medicare at certain times and the cost can go up the longer you wait. Signing up late can mean a lifetime of penalties and delays in when your coverage can start. Deciding to enroll is an important decision and largely depends upon the coverage you have now. If you are already collecting Social Security or getting benefits from the Railroad Retirement Board(RRB), you will be automatically enrolled.
The Captive Agent is an agent that is employed by the individual Insurance Company. While the captive agent is probably honest and governed by standards set by the carrier, here are a few things to take into consideration.
1) The Captive Agent only represents one plan, the one he/she are employed with. You will not get a good comparison with the other choices that are out there.
2) Sometimes you will be speaking with a Temp. A little scary because sometimes important plan items are omitted, like a deductible or coverage parameters.
3) What if you have questions after signing up? Well, one thing is certain, you will not be able to get that agent on the phone again, the 800 number will send you to the next available agent.
4) A Medicare Advisor, like yours truly, is paid when an individual plan renews therefore and has a vested interest in keeping clients and their satisfaction with his/her services is extremely important.
Identity Theft is very real and seniors are particularly vulnerable. When your turning 65 your on a list and entities are out there with one mission, sign you up for a plan and get paid. While these are probably legitimate it's easy to lose track of who's who and who is legit or not. Here are some examples of what you will be asked for in an email or phone call-
Your Full Name- Not needed to look up plan availability.
Your Email- Still not needed to look up plan availability.
Your Zip- Needed, Medicare Advantage Plans are area specific.
Your Medicare Claim Number- Not needed to look up plan availability.
Your Home Address- Not needed, Zip code is sufficient.
Social Security Number- A big No No, and definitely not necessary to determine plan availability.
Date of Birth- Nope, don't need to know that either.
Anybody that's asking for this stuff is either Phishing or generating leads that can be sold to Brokers. Oh, and by the way. If a plan looks like it is too good to be true, it probably is. Don't fall for Triple Zeros $0 premium, $0 Copays and $0 Medication costs. There is fine print that nobody can read and it's designed for one purpose. To get you to call and give your information.
Final Word of Advise- Set up a "My Social Security" account in the Social Security website, SSA.gov. If you set it up no one else can set it up in your name and collet your benefits.
Your Medicare Advisor is well aware of the solicitations that come with turning 65 and becoming Medicare Eligible being a card carrying Medicare Member himself. Be on the lookout for-
Mail Solicitations (A Flood Of Paper)
Phone calls from Company Agents (See Captive Agent)
Advice from friends and relatives
If your in it you know that this is a confusing mess at best. What can you do?
Utilize a Medicare Advisor. A Medicare Advisor is Certified with Multiple Insurance carriers, Licensed in multiple states and Certified with the Center for Medicare and Medicaid Services. He has to recertify each year as well as complete Continuing Education so there is no motive to put you into one company over an other. He is in the best position to advise you on the plusses and minuses of each plan. The advice is free as your Advisor is compensated by the carrier if he/she can help you.