Get the 2023 Medicare Benefits You are Entitled to

Aging into Medicare opens you to a wide variety of great benefits and money savings. 

If you are receiving Social Security, you are automatically enrolled in Medicare Part A if you have earned 40 credits through payroll taxes while working. If not, go to the Medicare web site or visit your local Social Security office either three months before your birthday month, on your birthday month, or no later than three months after your birthday month. This is your eligibility window.

Medicare Part A covers hospitalizations, blood transfusions during hospitalization, home health care, hospice care, and stays in skilled nursing facilities.

With regards to Medicare Part B, you do not need any work credits to qualify for Part B. However, if you don't sign up during your eligibility window, but then decide to enroll later, your premium goes up 10% for each 12 month period.   As an example, if you wait five years to sign up, your premium would then be 50% higher than someone who signed up on time.

If you have health insurance through your work or your spouse's work, you can delay enrolling in Part B. But if your employer has fewer than 20 workers or if you are on a company retirement plan, you must enroll in Part B as soon as you turn 65. Your workplace or retiree plan will become your secondary plan.

Remember that Part B Medicare which pays 80% of doctors, supplies, outpatient services, physical or speech therapy does not have a cap after the 80% is paid by Medicare.

However, you can choose Medicare Part C, which is Medicare Advantage and self enroll  These are managed care type plans which covers all your benefits under Part A and Part B, and often will cover your Part D Prescription benefit and may include dental, vision, physical fitness and transportation.  These plans usually have zero or minimum monthly premium and have a cap on how much you will pay out of pocket annually. They are comprehensive plans and I highly recommend that you choose one. 

You will need to check your prescription benefits every year because the list of covered drugs can change. Make a list of the medications you are taking, and check to see if they are covered under the plan you are considering.  

Leave your questions or comments below. Or, email me at bwillbar@gmail.com

Will Barnes, Medicare Consultant

Here's What You Need to Know About Medicare 2022

Know Your Medicare 2022 Benefits

Knowing about  your Medicare 2022 benefits is deeply important. You paid into it during your work life and you deserve all the benefits you have coming. You have come to the right place for all the information you need. 

Medicare has Four Parts

Part A is inpatient hospital insurance. It also covers skilled nursing facility stays, home health care, and hospice care.

Part B is medical insurance, covering doctors' services, diagnostic tests, durable medical equipment, and outpatient hospital services. 

Part C covers Medicare Advantage Plans, and Part D covers prescription drug plans. 

Part A, which is free for most Americans, and Part B, which charges a monthly premium of $158.50 for most people, provides the foundation of health insurance for Americans 65 and over.

But here's more. Medicare Part A has large deductibles (for example, $1,556 for a hospital stay of 60 days or less). Medicare Part B has no cap on out-of-pocket costs after Medicare pays 80 percent of approved expenses. 

Once the annual amount of $217 Part B deductible is met, as an example, Medicare will pay 80 percent of  your bill and you will have to pay 20% of whatever amount remains with no limits. The $217 is the 2022 deductible up from 2021. All deductibles, premium, and co-insurance amounts above are for Part A and Part B effective January 1, 2022. 

Medicare Additional Coverage

The limitations of Parts A and B prompts an estimated 39 percent of people on Medicare to enroll in a Medicare Advantage Plan. Medicare Advantage plans, Part C, are offered by private companies approved by Medicare, Besides services included in Medicare Parts A and B, they usually offer additional coverage, including vision and dental, health club membership, and both prescription drugs and transportation. 

Go to Medicare Advantage Plans And see what plans are available to you and take advantage of the benefits you have coming.

If you have additional questions call (773) 614-3201 or email me at bwillbar@gmail.com

7 Free and Important Medicare Benefits for 2019

Take advantage of Medicare preventative screenings and services in 2019. 

Here's an update on some no or low cost preventive tests and services available for Medicare Part B recipients under  Medicare's Medicare Advantage Plans.  

In most Medicare Advantage Plans , the free services include various exams, lab tests, and screenings. Also included are vaccinations and programs for health assessment, as well as counseling and education to guide you in caring for your own health and well-being. 

Here are the 7 Medicare benefits for 2019 :

1.   Flu shots -- once a year. Pneumonia shots are also free.

2.  Diabetes screening -- once a year, or every six months for those at risk.

3.  Cholesterol screening -- once every five years. This also includes test for lipid, lipoprotein, and triglyceride levels.

4.   Bone density measurement -- once every two years or more if you have certain medical conditions or meet certain criteria.

5.  Mammogram screening once a year for  all women with Medicare, 40 and older.  Medicare covers one baseline mammogram for women, 35 to 39.

6.  Prostate cancer screening -- once a year. Annual PSA (prostate specific antigen) and a digital rectal exam -- available to all male Medicare enrollees age 50 and older. Under medicare, you pay 20% of the Medicare  approved amount, and the Part B deductible applies for the digital rectal exam. Your Medicare Advantage Plan or your Medigap may cover a portion of all of the 20% and/or deductible.

7.   Colonoscopy -- once every two years for people at high risk, once every 10 years for others, or 48 months after a previous flexible sigmoidoscopy.

These services are mostly free because they re viewed as preventive steps and can effectively reduce the need for  more intensive treatment or hospitalization. 

Please take advantage of them. Leave your comments below. of call (773) 614-3201 for a free consultation.

How to Choose the Best Medicare Supplement Plan for 2018

The Medicare Supplement Plans, sometimes called Medigap Plans, were required in August 1, 1992 to become standardized. 

That means that all companies that sell these Plans have to sell the exact same type of Plan.

Original Medicare has significant deductibles and coinsurance features that you as a Medicare recipient are required to cover.

What Med Supp was Designed For 
If you don’t have adequate personal finances to do so and you experience a serious illness and have to be hospitalized, you may find yourself in bankruptcy. The Medicare Supplement Plans were designed to address this type of situation.

After the recent revision in 2010 of the Medicare Supplement Plans, the new Plans are identified by these numbers – – Plan A, B, C, D, F, G, K, L, M, and N.

Take these factors into consideration when you make your choices. The most popular Medicare Supplement Plans for 2018 are Plan F, N, and G.

Plan F Medicare Supplement Plan
The best Medicare Supplement Plan is Plan F. This Plan pays 100% of the gaps in coverage left by Medicare and covers you quite well. With this Plan, and there are no co-pays, no deductibles, and no coinsurance. You also have the ability to go any doctor or hospital in the U.S. that accepts Medicare.

Plan G Medicare Supplement Plan
The second best Medicare supplement plan is Plan G. Plan G offers all the same coverage as Plan F, although plan G has an annual deductible, it often costs about $300 less per year in premium, so the savings can be worth it if you don’t mind paying the deductible each year at your first doctor visits.

Plan N Medicare Supplement Plan
The third popular plan for 2018 is Medicare Supplement Plan N. This Plan is similar to Plan G in that it also has a deductible. But it also requires a co-pay for office visits and a co-pay for ER visits. However, the ER co-pay can be waived if you are admitted to a hospital.

Plan G - The Best Medicare Supplement Plan
I think that the best Medicare Supplement plan overall for 2018 is the Plan G. Plan G offers you the best value for your money. After the annual deductible Plan G gives you the convenience of no co-pays and no other out-of-pocket costs, as well as ability to choose your own doctors and hospitals.

Moreover, in that this is not the most expensive plan, it will allow you to save as much money as possible while still maintaining good health care coverage. Now the next steps in securing your family's financial independence.

If you would like to learn more about the Plans and prices available in the Chicagoland area, call me at (773) 614-3201. Looking forward to hearing from you.

Medicare Enrollment Periods You Must Know About

The issue of the Enrollment Periods needs to be expanded upon. Remember, the Center for Medicare and Medicare Services (CMS) has established four basic enrollment periods in which Medicare recipients with both Part A and Part B can enroll in a Medicare Advantage Plan (MAP), Part C or a stant alone Prescription Drug Plan (PDP).

Enrolling in Medicare Advantage Plans
Enrolling in Medicare Part C or Medicare Advantage Plan (MAP) is optional. If you want to enroll in a MAP, you must be entitled to both Part A and Part B.

Your Enrollment Periods

• Initial Enrollment Period (IEP) allows you to join a MAP three months before your birthday month, your birthday month, and three months after. 
• the Annual Enrollment Period (AEP) from October 15th to December 7th, 
• the General Enrollment Period (GEP) from January 1st to March 31st 
• and, the Special Election Period (SEP)

During the AEP beneficiaries may change their PDP, change their MAP, return to Original Medicare, or enroll in a MAP for the first time.

Re-enrollment and Dual Eligibility
During the GEP, if you didn't enroll in Part A or B during the IEP, or terminated your Part A or Part B benefits and want to re-enroll in either or both Parts, you may do so during this period. If you enroll during the GEP, your benefits will begin the following July 1st.

Finally, during the SEP if you  have special needs, specifically diabetes or have Dual Eligibility (qualify for both Medicare and Medicaid) ,you can change your plan anytime during the year with no limit to the number of changes. This includes your prescription drug plan. This choice under the SEP is also available to those who move into, reside in, or move out of a nursing home.


If you have any questions regarding what plan would be best for you, call (773) 614-3201.

Any comments? Leave them below.

5 Ways You Can Save Money on Medicare Prescription Drugs

Medication costs can make up a large part of your budget, but a few tips on saving money can easily save you hundreds of dollars a year. 

The biggest single cost-saver? Picking the right Medicare plan.

Whether you are preparing to change your Medicare plan, or signing up for Medicare for the first time, you will want to make a careful selection so you don't end up spending more than you need to.

Asking your doctors a few key questions—such as, Is there a generic?—can save you a bundle more. 

Here are 5 tips you can save money on your prescription drugs:

1. Focus on choosing the right drug plan, which depends in part on which drugs you take.
The majority of seniors are enrolled under original Medicare, which includes hospital insurance (known as Medicare Part A) and medical insurance (Medicare Part B).

Getting drug coverage requires one of two additional extra steps. Seniors can either get drug benefits via a private plan regulated by the government, under what's called Medicare Part D, or they can get drug coverage bundled with a private Medicare Advantage plan. 

The alternative is a Medicare Advantage plan, also called Medicare Part C, which replaces original Medicare and often providesprescription-drug coverage as well. 

It is essentially a way to get Medicare A, B, and D all lumped into one. Medicare beneficiaries can enroll in Medicare Advantage to receive their benefits in a private health plan, such as a health maintenance organization (HMO).

You need to  evaluate on an individual basis which is your the best option. Depending on your prescriptions and other health care needs, Medicare Advantage may or may not be better for you than original Medicare.

2. Have Drugs Delivered.
For medications you take regularly for a chronic condition, opt for the convenience and potential cost-savings of mail-order. In addition to sparing you unnecessary trips to the pharmacy, mail-ordering can sometimes include a 90-day supply at a reduced cost, depending on your insurance company and what kind of meds you need.

Once you enroll in an insurance plan you should be able to go that insurer's website to order your prescriptions delivered, or you can do it over the phone.

Be sure to ask your doctor whether he or she needs to sign off on a 90-day supply. And take care to order refills before you need them so there isn't a gap of time when you don't have any pills.

Also beware of illegal pharmacies on the Internet, which can pose a serious danger by sending you fake or incorrect prescriptions. Legitimate pharmacies will ask for a faxed prescription from a licensed doctor and a detailed medical history. They will also clearly state their payment, privacy, and shipping fees, according to FBI warnings.

3. Go Generic.
Ask your doctor if this is an option. The brand-name version of the drug you take is significantly more expensive than the generic form, if one is available.For example, simvastatin is the generic version of the drug Zocor, which is prescribed to control elevated cholesterol. Thirty 40mg tablets of the brand version of the drug may cost between $88.90 and $113.20 a month, while the generic equivalent can go as low as $15 a month.

4. Double the Dosage, and Split the Pill. 
Sometimes pills that are double the dose of your medication cost the same as a single dose, and can easily be cut in half. For instance, if your doctor says you need a 10 mg dose of a particular drug each day, ask him or her whether your medication comes in doses of 20 mg and if they can safely be split in half.

Many drugs used to treat high blood pressure and depression can be split, as can all cholesterol-lowering drugs known as statins.

5. Enroll on Time.
The open enrollment period for Medicare is from October 15 to December 7, with changes taking effect January 1. You can enroll for the first time when you turn 65, and there are also Special Enrollment Periods for when you move or become eligible for Medicaid.

  

Though Medicare drug coverage is considered voluntary, you must be getting drug coverage from another source that is at least as good as the offerings through the federal government. If you do not, you can face a penalty fee that grows each month you delay enrollment.

If you are receiving another form of drug coverage, you may actually end up spending more if you sign up with Medicare. This applies to members of the Federal Employee Health Benefits Program, TRICARE (military health benefits), and Veterans Affairs. 

If you are an active worker on an employer plan, you will want to talk to your human resources department to make sure you understand all of your options.

If you have questions regarding your Medicare benefits, email me at 
Ask Will, bwillbar@gmail.com or call (773) 614-3201.

Medicare Most Frequently Asked Questions - Part 1

Understanding the Medicare system can be confusing. Here are answers to Frequently Asked Questions on Medicare. 

1. What is Medicare?

Medicare is the Federal health insurance program established in 1965 which is administered by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health Services. Medicare is health insurance for the following people:

  • Age 65 or older;

  • Under age 65 with certain disabilities who qualify for disability benefits from Social      Security or Railroad Retirement Board (RRB);

  • Any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant);

  • Diagnosed with ALS (Amyotrophic Lateral Sclerosis), also called Lou Gehrig's disease) the month your disability benefits begin.

2. How do I enroll in Medicare Part A (Hospital) and Part B (Medical)?

  • If you aren't getting Social Security or Railroad Retirement (RRB) benefits, you will need to sign up in one of three ways: 1) online at www.socialsecurity.gov; 2) call Social Security at 1-800-772-1213, or; 3) visit your local Social Security office.

  • In most cases, if you're already getting benefits from Social Security or the Railroad Retirement Board (RRB), you will automatically get Part A and Part B starting the first day of the month you turn 65. If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.

  • If you're under 65 and disabled, you automatically get Part A and Part B after you get Social Security disability benefits (SSDI) or certain disability benefits from the RRB for 24 months.

  

3. What does Medicare Part A (hospital) cover?

  • Inpatient care in hospitals;

  • Inpatient care in a skilled nursing facility (not custodial or long-term care);

  • Home health care services;

  • Hospice care services;

  • Blood.

4. What does Medicare Part B (medical) cover?

  • Doctor's services and tests

  • Outpatient care

  • Home health care services

  • Durable medical equipment and other medical services  

  • Ambulance services

  • Chiropractic services

  • Diabetes supplies

  • Preventive services

5. What is NOT covered by Medicare Part A and Part B?

Medicare doesn't cover everything. If you need certain services that Medicare doesn't cover, you will have to pay for them yourself unless you have other insurance to cover the costs. Even if Medicare covers a service or item, you generally have to pay deductibles, coinsurance, and copayments. Some of the items and services that Medicare does not cover include the following:

  • Long-term care;

  • Routine dental care;

  • Dentures;

  • Cosmetic surgery;

  • Acupuncture;

  • Hearing aids;

  • Exams for fitting hearing aids.

6. What are Medicare Advantage (MA) plans (Part C plans)?

Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan.  

7. What is Medicare Part D (Prescription Drug Plan)?

Medicare offers prescription drug coverage to everyone with Medicare. Even if you don't take a lot of prescriptions now, you should still consider joining a Medicare Prescription Drug Plan (PDP). To get Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered. Take time and read the Formulary for each company.. If you decide not to join a Medicare drug plan when you're first eligible, and you don't have other creditable prescription drug coverage, you will likely pay a late enrollment penalty.

8. How can I get help paying for my prescription drugs?

Frequently Asked Questions by Medicare Beneficiaries I Senior Advocacy Services

You may qualify for "Extra Help", also called the low-income subsidy (LIS), from Medicare to help pay prescription drug costs if your yearly income and resources are below the following limits: Single Person: Monthly income less than $1,471 and resources less than $13,640; Married Person Living with a Spouse and no other Dependents: Monthly income less than $1,991 and resources below $27,250.

9. What other Low-Income programs are available?

You may qualify for the Medicaid program or any of the Medicare Savings Programs (MSP) if you meet certain monthly income and asset levels. 

10. What are Medicare Supplement plans (Medigap plans)?

A Medigap policy, sold by private insurance companies, can help pay some of the health care costs ("gaps") that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S.

If you have Medicare Parts A and B and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share. Medicare doesn't pay any of the premiums for a Medigap policy. 

11. What if I am still covered by my Employer Group Health Plan when I become eligible for Medicare (either while I am still working or now that I have retired)?

Do you have, or are you eligible for other types of health insurance or prescription drug coverage (like from a former or current employer or union)? If so, read the materials from your insurer or plan, or call them to find out how the coverage works with Medicare. If you have coverage through a former or current employer or union or other source, talk to your benefits administrator, insurer, or plan before making any changes to your coverage. If you drop your coverage, you may not be able to get it back.

In Part 2, I will answer additional questions. So be sure to send yours if you have particular ones. Be sure to watch for my next blog on how to qualify for Medicare Advantage Plans all year around.  Call (773) 614-3201 or e-mail me at bwillbar@gmail.com with your urgent questions.

Medicare Fundamentals: Part A and Part B

Over 47 million seniors age 65 and older, and people with certain disabilities and medical conditions, get their health care coverage through Medicare. While Medicare covers many health care services, it does not cover everything. Below is what you should know.

If you have Original, Fee-for-Service Medicare, the following applies to you:

Medicare Part A ("Hospital Insurance") does over: 

Inpatient care in a skilled nursing facility for a limited number of days, following a qualifying three-day minimum inpatient hospital stay for a related illness or injury

Home health services as ordered by a doctor (or other health care provider), including nursing care; physical, speech or occupational therapy; medical social services; home health aide services and medical supplies for use at home

Hospice care if you have a terminal illness with a life expectancy of 6 months or less, as certified by doctor, at home or facility where you reside. Limited coverage for stays in a hospice facility, hospital or skilled nursing facility for pain or symptom management

Services Medicare Part A does not cover include:

Custodial care or long-term care in a skilled nursing facility or nursing home. Custodial care includes non-skilled personal care, such as help with  bathing, dressing, eating, getting in and out of a bed or chair, or toileting.

Medicare does not pay for room and board costs or non-skilled personal(custodial) care in a nursing home, or long-term care or assisted living facility. It does cover Medicare-approved medical care and services, ordered and rendered by a Medicare-enrolled health care provider, such as a doctor or physical therapist, to the beneficiary who is a resident.                                                                            

    Services Medicare Part B ("Medical Insurance") does cover:         

• Doctors' visits, services and tests; outpatient care and services; some home health   services       not covered under Part A; Medicare-cove red durable medical equipment (DME), prosthetics, orthotics and supplies
• Medicare-covered services provided by non-physician health care providers, such as nurse practitioners, physician assistants, social workers, psychologists, physical therapists, and other
• Many preventive services and test
• Outpatient mental health care
• Kidney dialysis services and supplies
• Ambulance transport for medically-necessary services (limited)
• Chiropractic services (limited)
• Eyeglasses (limited to after-cataract surgery that implants an intraocular lens)
• Some prescription drugs (i.e. injections in doctor's office, certain oral cancer drugs
• Transplants and immunosuppressive drugs

Things that are not covered by Medicare, under either Parts A or B, include: routine dental care, dentures, hearing aids and exams for fitting hearing aids, cosmetic surgery and acupuncture.

For those who get coverage through a Medicare Advantage Plan (Medicare Part C), the story is a bit different. Medicare Advantage Plans are offered by Medicare-approved private insurers, and must cover all the services covered under Original Medicare, except hospice care, which continues to be covered by Original Fee-for­-Service Medicare even when a person is enrolled in a Medicare Advantage Plan.

These plans, which may charge a premium, deductible and co-insurance, may include extra benefits and services not covered under Original Fee-for- Service Medicare, such as dental and vision care, glasses, hearing aids and health and/or wellness programs. Most plans also include prescription drug coverage, available to those in OriginalMedicare under Part D.

 E-mail your Medicare questions to me at Ask Will at wwillbar@gmail.com