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It is always a good idea to evaluate the plan you are enrolled in each year with your independent agent. With a backdrop of COVID-19, it is more important than ever to work with a Medicare expert to ensure you have the right coverage for your financial and health situation. 

Most people are not aware that with Original Medicare alone there can be substantial out-of-pocket costs. The Part A inpatient deductible alone is $1,408 in 2020 for each benefit period. However, there are many ways you can fill those financial gaps. 

The following is a list of the top 3 things you should be reviewing with your Medicare agent each year when it comes to your Medicare coverage. 

1. Premiums

2. Doctors and Hospitals

Co-Pays, Coinsurance & Deductibles 

There are a significant amount of variables that come into play when it comes to Medicare and your situation is unique to you. If you are turning 65 soon, working with a Medicare expert will be important to understand the options and entitlements available to you. 

Medicare Part B helps cover medically necessary services from doctors and other healthcare providers, outpatient care, some home health services, durable medical equipment, and many preventive services. Part B is also known as the medical side of Medicare and works in conjunction with Part A.

  Medicare Part A helps cover; inpatient care in hospitals, inpatient care in a skilled nursing facility, nursing home care (provided custodial care isn’t the only care needed), some home health care, and hospice care. Medicare Part A is also known as the hospital or facility side of Medicare.

If you choose not to enroll in a Part-D prescription drug plan when you turn 65 you could be penalized if you enroll at a later time. The penalty is assessed for any continuous period of 63 days or more without drug coverage after the Initial Enrollment Period is over. It is 1% times the number of full uncovered months and once assessed it never goes away.

In 2020, the standard Medicare Part B monthly premium is $144.60. However higher-income beneficiaries pay an additional amount, this is called the income-related monthly adjustment amount (IRMAA). The maximum Part B premium at the highest income level is $491.60. IRMAA also impacts Part-D premiums.

Medicare Advantage plans offer the convenience of a single plan with many including prescription drug coverage for no additional premium. Additionally many offer additional benefits not covered by Original Medicare (e.g. dental, vision, hearing, transportation, and more). Another advantage is that enrollment eligibility is not affected by your health or financial status.

Medicare Special Needs Plans (SNPs) limit membership to people with specific diseases or characteristics. Dual-Eligible Special Needs Plans (D-SNP) are the most popular types of SNPs. These plans serve people who have both Medicare and Medicaid benefits, also known as dual eligibles. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of dual eligibles.

 Medicare Advantage Is privatized Medicare (subsidized by CMS) that replaces Medicare for a year at a time and is required t a minimum to cover ALL of traditional Part A & Part B expenses. Low and $0 premium plans are available. All MA plans are required to offer preventive coverage with no out-of-pocket cost and many offer substantial additional benefits.

Medicare provides guidelines about the type of drugs to be covered by Part-D drug plans but not the specific drugs. Each plan has a formulary which is a list of covered drugs. Medicare has excluded some types of drugs, but some plans may include them as part of an enhanced formulary. Drug formularies can have multiple tiers (1, 2, 3, 4 & 5) Lower tiers = lower copays, higher tiers = higher copays.