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UnderstandingMedicareKNOW YOUR OPTIONS AND COSTS2024
FSA Advisors d/b/a Financial Services of America AdvisorsFirm BrochureKAITLYN SNYDER Licensed Healthcare AdvisorPhone: (586) 842-3688Email: kaitlyn@fsahealth.org FSA Health Insurance Agency • 50 W. big Beaver Rd, Ste. 500, Troy, MI 48084Updated 2/27/2024FSA HI AEST. 2015
3When it comes to Medicare, simply understanding the basics can be a challenge. If you’re enrolling for the rst time, you probably have a variety of questions, including: ∙ When is initial enrollment?∙ How much will premiums cost?∙ Will I still be able to see my doctor?∙ And all those parts: Which part coverswhat services, and why am I payingseparately for them?Even experienced Medicare recipients may have questions about their coverage. Some older Americans feel they're paying too much for plans and premiums.But did you know you have options for switching — and potentially lowering — your Medicare plan costs?Whether you’re approaching age 65 and about to enroll in Medicare for the rst time or you’re looking for new coverage options, read on to nd out more about the basics of Medicare and discover how you can help maximize your Medicare benets.Navigating Medicare can be confusing and overwhelming. We’re here to help you understand how Medicare works and identify the right plan for you.
3The Sum of Its PartsIn July 1965, President Lyndon B. Johnson signed the bill creating the original Medicare and Medicaid programs. At its conception, Medicare had two parts: Part A (hospital insurance) and Part B (medical insurance). ese parts are called original Medicare.1Today, original Medicare still exists, with some major changes. In 2003, the Medicare Prescription Drug, Improvement, and Modernization Act made it possible for insurance companies to oer private health plans, known as Medicare Advantage plans (also called Part C). e act also added an optional prescription drug benet known as Part D.2From hospital services and hospice care to doctor visits and mental health services, each part of Medicare provides coverage for dierent services. In addition, each part has unique requirements for premiums, deductibles and coinsurance. Read on to learn more about each part and how it aects the health care you receive.4
WHAT IT COVERSPrescriptionsDPARTWHAT IT COVERSSame services as Part A and Part B, and often prescription drug coverage, as well as other servicesCPARTWHAT IT COVERSDoctor services, outpatient services, medical equipmentBPARTWHAT IT COVERSHospital stays, hospice, skilled nursing care following a qualifying hospitalization, home health careAPARTMedicare PartsAT A GLANCE35
Medicare Part A isprovided throughoriginal Medicare or ina Medicare Advantage plan. It generally covers hospital-related expenses, including stays in a hospital or a skilled nursing facility following a qualifying hospitalization, hospice care and home health care. Most people pay nothing for Part A coverage, because they’ve paid Medicare taxes for 10 years or more. However, if you’ve paid Medicare taxes for less than 10 years, you could pay up to $505 in monthly premiums for Part A. Part A runs in benet periods, which begin the day you start geing inpatient care and end when you haven’t received any care for 60 days in a row. You’ll pay a deductible of $1,632 for each benet period. As an example, if you have a hospital stay April 1 through April 3 without subsequent care, that benet period will end June 3. An additional hospital stay later in the same year would require a new deductible.You’ll also pay coinsurance within each benet period. For a hospital stay, coinsurance is $0 for the rst 60 days of inpatient care during the benet period, $408/day for days 61 – 90 and $816/lifetime reserve day (up to 60 days over your lifetime). Coinsurance for a skilled nursing facility is $0 for the rst 20 days of inpatient care and $204/day for days 21 – 100 of the benet period.4APART2024 MEDICARE PART A COSTS5 6PremiumIf you’ve worked 10 years or more $0 If you’ve worked 7.5 to 10 years $278/monthIf you’ve worked less than 7.5 years $505/monthDeductible*For each benet period $1,632Hospital Coinsurance*First 60 days of inpatient care $0 Days 61 – 90 $408/dayAer day 90 $816/lifetime reserve daySkilled Nursing Facility Coinsurance*First 20 days of inpatient care $0Days 21 – 100 $204/day*For each benet period
Whether you receive Part B through original Medicare or a Medicare Advantage plan, two types of services will be covered: medically necessary services and preventive services. Medically necessary services are those that are needed to diagnose or treat your medical condition, while preventive health care is designed to prevent illness from happening.Doctor visits, lab tests and other related expenses are covered by Part B. Other items it covers include ambulance services, durable medical equipment (such as a walker or an oxygen tank), mental health treatment and limited outpatient prescription drugs.BPARTPremiumStandard premium $174.70/monthMay be higher depending on incomeDeductibleAnnual amount $244.60/yearAer your deductible is met, you typically pay 20% of the Medicare-approved amount2024 MEDICARE PART B COSTS67
D stands for drugs — and Part D provides prescription drugcoverage. While Part B provides for limited outpatient prescriptions, Part D plans include a more extensive list of formulary and generic drugs. Medicare recipients can choose to add a stand-alone prescription drug plan. Premiums vary by plan coverage and income levels. If you enroll in a Medicare Advantage plan, your premium may include prescription drug coverage.7Individuals who need assistance paying for prescriptions or drug coverage can apply for the federal Extra Help program. You may be eligible for assistance if your annual income is less than $20,385 for an individual, or $27,465 for married couples, and your assets are below specied limits.8 For more information about the Extra Help program, visit www.ssa.gov/benets/medicare/prescriptionhelp/.A late enrollment penalty is added to your Part D premiums going forward if you go without Part D or other creditable prescription drug coverage for 63 days or more aer your initial Part D enrollment period. e penalty increases for every month you go without coverage.9DPART2024 MEDICARE PART D COSTS10, 11 8PremiumVaries by planInitial Coverage PeriodBegins aer you meet your deductible (cost-sharing varies by plan). For example:Coverage GapBegins when you and your plan have paid a total of $5,030 for covered drugs (not including Part D premium)Catastrophic CoverageBegins when you have paid $8,000 out of pocket for covered drugs (not including Part D premium)Your plan pays 75%You pay 25%70% discount on brand-name drugsYour plan pays 75%Deductible AmountVaries by planYour plan pays 5%whichever is greaterYou pay 25%You pay 25%You pay $0 for covered Part D drugs for remainder of the calendar year
Also known as Medigap, a Medicare Supplement insurance policy picks up where original Medicare leaves o. ese policies are sold by private insurance companies to help cover copayments, coinsurance and deductibles that aren’t otherwise covered. ese policies may also pay for additional services not covered in Parts A and B. However, Medicare Supplement policies do not provide coverage for prescription drugs, long-term care, or vision or dental services.Medicare Supplement insurance is not the same as Medicare Advantage; Medigap is designed to cover the “gaps” in your Medicare. In fact, it’s illegal for someone to sell you a Medigap plan if you have Medicare Advantage.To purchase Medicare Supplement insurance, you must already have Medicare Parts A and B. e insurance company will charge a monthly premium in addition to the monthly Part B premium you pay directly to Medicare. As long as you pay the premium, Medicare Supplement policies are guaranteed renewable without regard to your health status.12For Medicare recipients who divide their time between dierent regions, a Medicare Supplement insurance policy goes with you wherever you go. Some plans even travel with you outside of the United States.MEDICARE SUPPLEMENT INSURANCEPremiumVaries by planDeductible & CoinsuranceVaries by planMEDICARE SUPPLEMENT INSURANCE POLICY COSTS9
MEDICARE ADVANTAGECPARTPremiumVaries by planDeductible & CoinsuranceVaries by planMEDICARE ADVANTAGE PLAN COSTSMedicare Advantage plans take Parts A and B and, in most cases, Part D and bundle them together as a comprehensive alternative to original Medicare. Sometimes referred to as “Part C” or “MA” plans, they are oered by private insurance companies and provide coverage for one monthly premium. Some Medicare Advantage plans also provide coverage for vision, hearing and dental services — coverage that’s not provided in original Medicare.13Each Medicare Advantage plan has its own premiums, deductibles and out-of-pocket limits. ey also have dierent rules for referrals and where you can go for care, unlike original Medicare and Medicare Supplement insurance policies, which allow you to go to any doctor or facility that accepts Medicare.While Medicare Advantage plans usually have a lower monthly premium than Medicare Supplement policies, a Medicare Advantage plan could result in higher out-of-pocket costs. However, Medicare Advantage plans also have the benet of covering more services, potentially oseing some of the cost savings a Medicare Supplement policy may provide.Medicare Advantage plans are a less portable option than Medicare Supplement insurance policies, since most Medicare Advantage plans only operate within a certain region. is can be problematic, especially if you love to travel or split your time between residences.In 2019, Medicare Advantage plans gained the ability to expand the services they cover to include supplemental benets aimed at maintaining health, such as adult day health services.14 Many Medicare Advantage plans added vision, dental and hearing coverage, as well as nutrition services and non-skilled in-home support. e additional exibility within these plans could allow many older Americans to stay in their homes longer while still receiving the care they need.To enroll in a Medicare Advantage plan, you must be enrolled in Medicare Parts A and B. Since Medicare Advantage plans are only available within a specic region, you must live in the plan’s service area. 910
10CHOOSING BETWEEN MEDICARE ADVANTAGE AND ORIGINAL MEDICARE PLUS A MEDICARE SUPPLEMENTWhen it comes to deciding between a Medicare Advantage plan and original Medicare plus a Medicare Supplement policy, there are three major factors to consider: COST Medicare Supplement policies usually require a higher monthly premium but couldresult in lower out-of-pocket expenses than some Medicare Advantage plans. However, Medicare Advantage plans may cost less but cover more services, which might be a beer option for your monthly budget.CHOICE With a Medicare Advantage plan, your choice of medical providers islimited to those within the HMO or PPO. e plan also may not cover services provided outside of the network. Original Medicare and Medicare Supplement policies cover any medical provider who accepts Medicare for payment. No maer which plan you choose, it’s a good idea to check with specialists or hospitals to ensure they accept Medicare before receiving services.LIFESTYLE Medicare Advantage plans are limited to certain states or regions.Medicare Supplement policies, on the other hand, are portable and provide coverage across all 50 states, and some plans include coverage outside of the country. If you’re a snowbird living in more than one state throughout the year or you travel extensively, you’ll probably benet from choosing original Medicare plus a Medicare Supplement policy.MEDICARE SUPPLEMENT PLANMEDICARE ADVANTAGE PLANMonthly premium HIGHER LOWERIncludes Part D and dental/visionNO USUALLYCopayments to providersNO YESUp to $10,000 in out-of-pocket costsNO YESRestrictive network of doctors and hospitalsNO YESAllows appeal of coverage decisions to MedicareYES NOYour doctor can be dropped by plan NO YESYour plan can be canceled NO YESHealth plan decides which procedures and tests are approvedNO YESAllows one to travel the country and use any doctor and hospitalYES NO11
Medicare and YouINITIAL ENROLLMENTIf you’re approaching your 65th birthday, you’ve probably started receiving an avalanche of Medicare-related advertisements in the mail. ey all scream dierent messages: Buy this plan! Get that plan! Sign up — or make the switch — today! When you rst become eligible for Medicare, you have seven months to complete initial enrollment. e period begins three months before the month you turn 65, runs through your birthday month, and ends three months aer the month you turn 65. For example, if your birthday is April 23, your enrollment period begins in January and ends in July. Once you’ve enrolled, coverage starts the rst day of the next month.If you miss the enrollment deadline when you’re rst eligible, you’ll pay a lateenrollment penalty — and you’ll continue to pay the late enrollment penalty aslong as you have Part B. You may also have to wait until the General Enrollment Period begins the following January. en the coverage for that starts the month aer you sign up.15If you’re taking Social Security benets before age 65, you’ll be enrolled in Medicare Parts A and B automatically. You will receive a Medicare card in the mail three months before your 65th birthday. If you’ve delayed taking Social Security, you’ll need to enroll, even if you have health insurance through an employer. It only takes a few minutes to enroll in Medicare online. To enroll, visit www.ssa.gov/benets/medicare/. MEDICARESUPPLEMENTPLANMEDICAREADVANTAGEPLANMonthly premiumHIGHER LOWERIncludes Part D and dental/visionNO USUALLYCopayments to providersNO YESUp to $10,000 in out-of-pocket costsNO YESRestrictive network of doctors and hospitalsNO YESAllows appeal of coverage decisions to MedicareYES NOYour doctor can be dropped by planNO YESYour plan can be canceledNO YESHealth plan decides which procedures and tests are approvedNO YESAllows one to travel the country and use any doctor and hospitalYES NOYou have a seven-month period for Medicare initial enrollment: Three months before the month of your 65th birthdayThe month of your 65th birthdayThree months after the month of your 65th birthday12
WHAT YOU’LL PAYInitial enrollment includes Medicare Parts A and B. Most recipients don’t pay premiums on Part A,which is covered by Medicare taxes you paid duringyour working years. Every recipient pays a monthlypremium for Part B. For 2024, the standard premiumis $174.70/month, although that amount can varydepending on your income and when you enroll inPart B.16Parts A and B can be received in one of two ways: Original Medicare or a Medicare Advantage plan. You can also choose to receive additional coverage through a Medicare prescription drug plan (Part D) or Medicare Supplement insurance (Medigap) plan. Additional premiums will apply to supplemental coverage. SUBSEQUENT ENROLLMENTEach year after your initial enrollment, you’ll have the chance to change your Medicare plans. e Medicare Annual Enrollment Period (AEP) runs Oct. 15 through Dec. 7, and new coverage begins Jan. 1. Each September, you will receive an Evidence of Coverage (EOC) document, which provides current details about your plan’s coverage, premiums, coinsurance and deductibles, and more. You’ll also receive an Annual Notice of Change (ANOC), a document listing any changes to your plan starting Jan. 1. It’s important to review the EOC and ANOC before choosing your Medicare coverage for the following year. During the Annual Enrollment Period (AEP), you can make a variety of changes:Switch from original Medicare to Medicare Advantage, or vice versaSwitch from one Medicare Advantage plan to anotherSwitch from one Medicare prescription drug plan to anotherEnroll in a Medicare prescription drug plan (if you haven’t already)ere’s also a Medicare Advantage Open Enrollment Period (MA OEP). It runs from Jan. 1 through March 31 and is similar to the Annual Enrollment Period but more limited in scope. During this time, you can change Medicare Advantage plans or switch from Medicare Advantage to original Medicare.If you don’t want to make changes for the upcoming year, you won’t need to take any action. Should I consider changing my plan?While it’s a good idea to review your plan every year, it might be time to look into other options if:• Your health has changed insome way• You need additional benefits• You’ve had the same plan fora long time• Your financial needs havechanged13
KEY DATESINITIAL ENROLLMENT PERIODBegins three months before the month of your 65th birthday and ends three months aer the month of your 65th birthdayEVIDENCE OF COVERAGE (EOC) AND ANNUAL NOTICE OF COVERAGE (ANOC)Mailed to current Medicare enrollees annually in SeptemberMEDICARE ANNUAL ENROLLMENT PERIOD (AEP)Oct. 15 – Dec. 7, annuallyMEDICARE ADVANTAGE OPEN ENROLLMENT PERIOD (MA OEP)Jan. 1 – March 31, annuallyMEDICARE SUPPLEMENT OPEN ENROLLMENT PERIODStarts in the rst month that you’re covered under Part B, and are age 65 or older, and lasts for six monthsHelpful ResourcesAPPLY FOR MEDICARE www.ssa.gov/benets/medicare/COMPREHENSIVE LIST OF SERVICES IN MEDICARE PARTS A, B AND Dwww.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicareMEDICARE COSTS AT A GLANCEwww.medicare.gov/your-medicare-costs/medicare-costs-at-a-glanceEXTRA HELP WITH MEDICARE PRESCRIPTION DRUG PLAN COSTSwww.ssa.gov/benets/medicare/prescriptionhelp/14
Benefit PeriodApplies to Medicare Part A. Each benet period begins on the rst day services are provided and ends when you haven’t received benets for 60 days in a row.ClaimA request for payment by Medicare for medical services you receive. Claims can be made by you (the insured) or by the medical facility where the service is provided.Coinsurancee share of costs you pay aer the deductible is met, usually designated as a percentage.Copaymente share of costs you pay for medical services, usually designated as a set amount.Deductiblee amount you (the insured) must pay before an insurance company will pay a claim. is is in addition to monthly premiums paid for by you.FormularyList of prescription drugs that are covered by a prescription drug plan.Initial Enrollment PeriodPeriod of time when you can enroll in Medicare for the rst time. is period begins three months before your 65th birthday and ends three months aer the month when you turn 65.Medicare Advantage Open Enrollment Period (MA OEP)During this time, Medicare Advantage enrollees can switch from their current Medicare Advantage plan to another Medicare Advantage plan or to original Medicare. Occurs each year from Jan. 1 through March 31. Medicare Annual Enrollment Period (AEP)Medicare enrollees can switch plans to reduce premium costs or add additional benets. Occurs each year from Oct. 15 through Dec. 7.Premiume amount you pay each month for coverage. You may pay separate premiums for each part of Medicare.Medicare Terms You Should Know15
16Not Sure Where to Start?With all the options, we know that choosing the right Medicare plan for you can be a daunting task. If you’re not sure where to start, call us! We can help you navigate the different parts of Medicare and identify which benets are important for you to receive.Our experienced licensed insurance agents have access to a wide variety of plans, and we will work with you to help determine which plans t your health and budget. Whether you’re tackling initial enrollment or looking to lower your Medicare costs, we can help nd the right plan to t your needs. We’ll also walk you through the enrollment process from start to nish to ensure you don’t miss out on even one day of coverage. 1 Centers for Medicare & Medicaid Services. “CMS’ program history.” https://www.cms.gov/About-CMS/Agency-Information/History/index. Accessed Nov. 14, 2022.2 Congress.gov. “H.R.1 – Medicare Prescription Drug, Improvement, and Modernization Act of 2003.” https://www.congress.gov/bill/108th-congress/house-bill/1. Nov. 14, 2022.3 Medicare.gov. "Parts of Medicare." https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare. Accessed Nov. 14, 2022.4,5,6 Medicare.gov. Sept. 27, 2022. "Fact Sheet." https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income- related-monthly. Accessed Nov. 14, 2022.7 Medicare.gov. “Monthly premium for drug plans.” https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/monthly-premium-for-drug-plans. Accessed Nov. 14, 2022.8 Q1Medicare.com. “Extra Help with Medicare Prescription Drug Plan Costs.” https://q1medicare.com/PartD-ExtraHelp-Low-Income-Subsidy-LIS.php. Accessed Nov. 14, 2022.9 Medicare.gov. “Part D late enrollment penalty.” https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/part-d-late-enrollment-penalty. Accessed Nov. 14, 2022.10 Medicare.gov. "Costs in the coverage gap." https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/costs-in-the-coverage-gap. Accessed Nov. 14, 2022.11 National Council on Aging. Sept. 30, 2022. "Medicare Part D Cost-Sharing Chart." https://www.ncoa.org/article/medicare-part-d-cost-sharing-chart. Accessed Nov. 14, 2022.12 Medicare.gov. “What’s Medicare Supplement Insurance (Medigap)?" https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap. Accessed Nov. 14, 2022.13 Medicare.gov. “How do Medicare Advantage Plans work?” https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work. Accessed Nov. 14, 2022.14 Centers for Medicare & Medicaid Services. April 1, 2019. “CMS nalizes Medicare Advantage and Part D payment and policy updates to maximize competition and coverage.” https://www.cms.gov/newsroom/press-releases/cms-nalizes-medicare-advantage-and-part-d-payment-and-policy-updates-maximize-competition-and Accessed Nov. 14, 2022.15 Medicare.gov. "When does Medicare coverage start?" https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start. Accessed Dec. 6, 2022. 16 Medicare.gov. Sept. 27, 2022. "Fact Sheet." https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income- related-monthly. Accessed Nov. 14, 2022.Call us to get started today!
FSA Health Insurance Agency does not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area, please contact Medicare.gov or 1-800-MEDICARE to get information on all your options. Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. FSA Health Insurance Agency is not connected with or endorsed by the U.S. government or the federal Medicare program.