By Ulla-Undine Merritt (Dee) National Producer Number (NPN) 8853366
“DID YOU KNOW”? Well just the other day I received a call from a nice lady by the name of Eddi. She thanked me and told me that she had saved my article and that it was so helpful with guiding her through Medicare and their Employer Group coverage. So, I am going to try to list important things you need to know regarding all types of health insurance.
MEDICARE DID YOU KNOW:
• When you turn 65 you are eligible (residential restrictions apply)
o Medicare starts the 1st of your birth month unless you were born on the 1st then it is effective the 1st of the month before your birth month.
• If you paid Medicare Taxes for 40 quarter’s (approx.) 10 years, there is no charge for Medicare Part A (Hospital, Skilled Nursing, Home Health, Hospice) deductibles and coinsurance apply. If not, you can purchase Part A for up to $458.00 per month
• If you are receiving Social Security, you should receive your Medicare Part A & Part B ID card. If you do NOT want Part B you need to decline Part B
• Part B average monthly premium in 2020 is $144.60 (Part B –Medically necessary services, Preventive, Clinical Research, Ambulance, Durable Medical Equipment) deductibles and coinsurance apply
• Part B & D premiums are income based, if you make over $87,000 individual or $174,000 jointly you will pay a high-income earner surcharge in 2020, income is based on 2018 Tax Return.
• If your income is much lower in 2020 than it was in 2018 you can dispute and ask for a reconsideration
• Part B Premium for low income individuals/ couples can be waived subject to income and asset limitations, you do not need to eligible for
• Part D is Prescription Drug coverage
• Part B and Part D – If you don’t apply for them when you are eligible, there is a waiting period and a penalty for each month that you did not have them when you decide to take them and that penalty applies each month for as long as you have Part B & D.
• You DO NOT need to take Part B & D if you are on a large employer health plan. When you decide to take them, you will need a form from your employer stating you had creditable group coverage.
• Just because you are eligible for group coverage does not mean you have to take it. What is your cost and what are your copays and out of pocket maximums? You may be better off financially and have access to more coverage on Medicare.
• I see people stay on group coverage because their spouse is younger. If you go on Medicare, they have access to Cobra for 18 months. Most of the time the employer does not pay anything for the spouse so you premium for the spouse will not change much.
• Cobra is not considered group coverage so a penalty and waiting period will apply if you elect to stay on Cobra once your eligible for Medicare.
• Do not wait too long to apply for Medicare if you are losing group coverage. Medicare has up to 60 days to make Medicare A&B effective and it will always be effective the 1st of the month.
• You may qualify for financial help with your prescriptions, check qualifications an easy online application is available. I normally help people apply a breakdown on your annual income and assets is needed.
• Medicare & Medicaid There are dual eligible plans available that offer additional services that are not covered by Medicare such as dental, vision, hearing, over-the-counter products, and a lot more.
Individual/Family Health Insurance DID YOU KNOW:
• Do you have access to group coverage? If so, what are you paying monthly, what are your benefits along with your worst case out of pocket maximum?
o Get the cost for yourself, and options for spouse, children, and family.
o Separating family members might be a better option
o Not all insurance company networks are the same even within a carrier, a company may have an HMO and PPO, or EPO and the provider network is more than likely different
• Compare your options based on cost and medical needs
o Market Place (Obamacare) this is NOT only for people that have low income. If you are low income you may get help with the monthly premium and possibly help with you cost share for provider services.
o Short-Term, Tri-Term Policies are similar to the old Major Medical Policies where they are medically underwritten (you may be denied). They do not pay or pay 100% for preventive services, they have lifetime limits and they do not cover pre-existing conditions. If you do not qualify for subsidy these plans are often a lot less expensive and a good option for many.
o Indemnity Plans they normally pay a portion of a bill and there is a clear maximum benefit for each service. Example it may pay $50 toward an office visit and then you pay the remainder. This is my least favorite and requires medical underwriting and does not pay for pre-existing conditions
We are happy to help, we have agents from Bradenton down to Marco Island, our headquarters are in Fort Myers and we also have an office we use part time in Naples.
To learn more about your options call to schedule an appointment contact:
Logical Insurance Solutions
HDQ 2365 West First Street, Fort Myers, FL 33901
Local Agents – Marco Island, Naples, Bonita Springs, Fort Myers, North Fort Myers
*We also do a complimentary homeowner, health insurance and employer group review’s