Some very important points to remember about Medicare and the choices you make:

• Some of the decisions you make may be irreversible even during open enrollment, so regarding your coverage elections, “hope for the best but plan for the worst”.
• Rules and guidelines can vary significantly by state, so advice from your out-of-state friends may not apply.
• Financial penalties for not following the rules will stay in place forever. 
• Medicare is always bought on an individual basis, and you and your spouse can make different choices.

If you are sorting through the Medicare choices the best advice is to “get free help” from the LBA advisors.

In general, Part A covers: 

• Hospital care
• Skilled nursing facility care
• Hospice
• Home health services

Part B covers things like:

• Doctor’s Visits
• Emergency Rooms Visits
• Ambulance services
• Durable medical equipment (DME)
• Mental health
• Lab services

Both Part’s A and B however, don’t cover 100% of the cost of these services.  As such, Medicare eligible individuals often purchase either Medicare Supplemental coverage, or a “Medicare Advantage” plan.

If you have worked the necessary forty quarters, and paid into Medicare during your working career, Part A coverage is available to individuals age 65+ for free. If you do not have forty quarters you may have to pay part or all of the cost of Part A.

Part B coverage has a monthly premium charge for everyone which varies depending on when you start Part B coverage, and depending on your income in previous years. For 2020, the Part B monthly premium starts at approximately $150. If you are over age 65 and have “creditable coverage” you may elect to delay turning on Part B. If you have no coverage or have coverage which is not “creditable”, when you do decide to turn on Part B you may face forever penalties, and you may have to wait for open enrollment to actually secure your Part B coverage.

Medicare recipients may secure extra coverage to fill the gaps in Original Medicare in one of two ways.  One option is to purchase a Medicare supplement plan, also known as “medigap” coverage, which covers some or all of the benefit gaps in original Medicare.

Medigap coverages are offered by multiple carriers in every state, but the benefits are classified by the federal government as “Plan A” through “Plan N”.  Every like-named Plan covers the exact same benefits, regardless of the carrier you choose.  These Plans all cover various gaps in coverage that original Medicare doesn’t – like hospital deductibles, Part B deductibles, and various other gaps.  LBA educates individuals on all the details, and helps you select the right plan for your health, lifestyle, and budget.

The guidelines surrounding your ability to secure medigap coverage differ by state. You should consult with a professional so you are not potentially locked out.

If you purchase a Medicare Supplement, you typically also purchase a separate prescription drug plan (Part D) to cover prescription costs. 

Drug plans typically have their own “formulary” or list of drugs that are covered through the plan, along with an annual deductible and varying copays for generic, brand, and specialty drugs.  They may also have different networks of pharmacies that are included/excluded from coverage.  Every state has a different number of carriers offering coverage, and choosing the right plan can save individuals hundreds of dollars a year.

In addition, formularies, deductibles, copays, and networks all change from year to year, so shopping for the right plan should be an annual exercise for everyone. 

LBA utilizes software that plugs in all your prescriptions, and automatically directs you to the most cost effective plan every year.

Shopping your Part D coverage annually is essential and is part of the no cost service available to LBA clients. The savings can be significant.