When it’s time to start navigating into Medicare, the mountain of information available may be overwhelming. Deadlines, benefits, penalties, all add to the stress of entering the Medicare system. Enrolling in a Medicare Supplement, Medicare Advantage, or Part D plan is easy. Making the decision on which type of plan will fit your lifestyle and offer the benefits most appropriate for you is the hard part.
Med-Care Senior Insurance is here for you. Let us help you learn how Medicare operates, what options are available and determine the style of plan that offers the benefits to fulfill your health care needs. That’s what we do. We care about each individual we talk with and do our best to make this experience a simple and enjoyable one.
Original Medicare Parts A & B
Medicare Part A and B is also known as Original Medicare. Medicare is available for people 65 years of age or older, people of any age with permanent kidney failure or Lou Gehrig’s disease (ALS), and some individuals with disabilities under the age of 65.
Medicare Part A
Medicare Part A is commonly known as hospital insurance. For most people, Part A is premium-free with no monthly payment for coverage. It pays your hospital bills and certain skilled nursing facility expenses. It also provides limited coverage for skilled nursing care after hospitalization, rehabilitative services, home health care, and hospice care for the terminally ill. There are deductibles and copayments associated with Medicare Part A.
Medicare Part B
Medicare Part B is commonly known as medical insurance. It helps pay your doctors’ bills and certain other charges such as surgical care, diagnostic tests and procedures, some hospital outpatient services, some preventative services, laboratory services, physical and occupational therapy, and durable medical equipment. The premium is automatically taken out of your Social Security check each month if you receive Social Security benefits. If not, you may be billed for it. There are deductibles and copayments associated with Medicare Part B.
If you are still using an employer, union, retirement, or individual health plan, talk to your benefits administrator about the rules governing the plan. In some cases, joining a Medicare plan might cause you to lose employer or union coverage. If you lose coverage for yourself, you may also lose coverage for your spouse and dependents.
Please note: depending on your circumstance, if you do not sign up for Medicare Part B when first eligible, you may have to pay a late enrollment penalty that will continue to be charged each month. The penalty will never go away. Our goal is to assure no one pays late enrollment penalties. Please contact us to discuss your situation so you can proceed with confidence.
Medicare Supplements (Medigap)
Original Medicare pays for many, but not all health care services and supplies. Medicare Supplement Insurance policies (Medigap policies) are sold by private insurance companies. Every Medicare Supplement policy must follow federal and state laws designed to protect you and it must be clearly identified as “Medicare Supplement Insurance.” Medicare Supplement policies sold in the State of Wisconsin are “standardized” and must include mandated benefits. All policies offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs.
Medicare Supplements work directly with Medicare and can help pay some (fill the gaps) of the health care costs that Original Medicare doesn’t cover like copayments, coinsurance, and deductibles. Some Medicare Supplement policies also offer coverage for services Original Medicare doesn’t cover such as medical care when you travel outside the U.S. There is a monthly premium associated with a Medicare Supplement.
Things to know about Medicare Supplements
- You must have Medicare Part A and Part B to apply for a Medicare Supplement.
- You pay a monthly premium for your Medicare Supplement policy in addition to your monthly Part B premium.
- A Medicare Supplement policy only covers one person. Spouses must apply for separate policies.
- In the State of Wisconsin, you cannot have prescription drug coverage attached to your Medicare Supplement policy. A Part D prescription drug plan must be a separate policy.
- It’s important to compare Medicare Supplement policies since the costs can vary and may go up as you get older.
Medicare Supplement plans in Wisconsin may include the following:
- Medigap/Basic Plans. This plan covers Medicare Part A coinsurance and hospital costs as well as Medicare Part B coinsurance or copayment. In Wisconsin, it’s possible to customize the plan to have the level of coverage you need.
- Medicare Cost-Sharing Plans. This may include co-pays or a 50% and 25% cost-sharing option.
- Medicare SELECT. This supplemental insurance restricts doctors and hospitals. It only works with in-network providers.
Medicare Advantage Plans (Medicare Part C)
A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare, but you will get your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare.
Private insurance companies who offer Medicare Advantage plans in the State of Wisconsin must follow rules set by Medicare. Medicare Advantage plans bundle all Medicare health benefits (with or without Part D drug coverage) and may include limited extra services such as vision, hearing, dental and more.
However, each Medicare Advantage Plan may include deductibles and copayments and/or coinsurance amounts (out-of-pocket expenses) that don’t apply to Wisconsin standardized Medicare Supplement policies. Most plans are network based and each plan can charge different out-of-pocket costs and have different rules for how you get services (like pre-authorizations for services, referrals to see a specialist, whether you must go to specific doctors, facilities, or suppliers that belong to the plan network for non-emergency or non-urgent care). These rules can change each year. There is a low monthly premium associated with a Medicare Advantage plans. You cannot purchase a Medicare Supplement to cover the deductibles, copayments and/or coinsurance associated with a Medicare Advantage plan.
Things to know about Medicare Advantage Plans
- You must have Medicare Part A and Part B to apply for a Medicare Advantage plan.
- You pay a monthly premium for your Medicare Advantage plan in addition to your monthly Part B premium.
- You must live in the plan’s service area.
- You can join a Medicare Advantage plan even if you have a pre- existing condition, except for End-Stage Renal Disease (ESRD)
- You can only join or leave a plan at certain times during the year.
- Each year, Medicare Advantage plans can choose to leave Medicare or make changes to the services they cover and what you pay. If the plan decides to stop participating in Medicare, you’ll have to join another Medicare health plan or return to Original Medicare.
- You may receive prescription drug coverage (Part D) through the Medicare Advantage Plan. Some types of plans don’t offer drug coverage. In this case you can join a standalone Medicare Prescription Drug plan. Be careful when joining a standalone Part D plan while on a Medicare Advantage plan. You may be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.
Medicare Advantage plans in Wisconsin may include the following:
- Adults living with permanent disabilities and complex medical issues are eligible for Special Needs Plans.
- Health Maintenance Organizations comprise a group of medical providers. As an HMO beneficiary, you can only go to an in-network provider. Otherwise, out-of-network expenses are not covered.
- Preferred Provider Organizations also comprise various medical professionals that offer in-network healthcare to beneficiaries. However, PPOs may cost more than HMOs since they are generally more flexible and have additional benefits.
- Some Medicare-approved providers accept Private-Fee-For Service Plans. Under this plan, you can negotiate coverage and payment terms directly with the provider.
Medicare Prescription Drug Plans (Medicare Part D)
Medicare Part D is also known as prescription drug coverage. Medicare offers prescription drug coverage to everyone with Medicare. Each year many plans are available in the State of Wisconsin and you can purchase this additional policy from a private insurer. Under the rules of Medicare, it is necessary to have credible drug coverage as Original Medicare does not cover prescription drugs. Each plan may vary in cost, copays, and drugs covered.
Things to know about Prescription Drug Plans
- You need to have Medicare Part A and/or Medicare Part B to apply for a Medicare Part D plan.
- You must live in the plan’s service area.
- Make sure all of your medications are included in the plan’s formulary.
- Make sure your medications are on the lowest tier possible to save in copays.
- Make sure your pharmacy in on the “preferred” list to save in copays.
- You can only join or leave a plan at certain times during the year.
- Be sure to have an Agent review your Part D plan each year as plans change yearly as do your medications. Lack of review each year will cost you money.
Forms of Credible Prescription Drug Coverage in Wisconsin
- Insurance from a current or former employer or union
- Medicare Part D plan
- VA coverage
- Wisconsin Senior Care
Please note: When you are first eligible for Medicare and if you don’t get extra help from the State, you must have some form of credible drug coverage or Medicare will give you a late enrollment penalty. This penalty is added to the cost of your monthly Part D premium. The penalty will never go away. Please allow us to assist you in finding the right Part D plan for you. We review all customer Part D plans each year to make sure you are always saving the most money possible on your prescription drugs.
Did you know your oral health is closely linked to your overall health? Studies have shown dental disease can contribute to cardiovascular disease, diabetes, and other health issues. Dentists emphasize prevention. Regular exams and cleanings can help identify warning signs and symptoms of these diseases before they become a larger problem. Individuals with a dental plan are more likely to visit their dentists more often, resulting in better oral health and lower treatment costs down the road.
Cancer affects millions of Americans each year. In the U.S. alone, costs associated with cancer exceed billions of dollars annually. Unfortunately, we live in an age where Cancer is prevalent. While many positive steps have been made in cancer research, cancer treatments can be very expensive. Medicare and Medicare plans go a long way in paying for the costs associated with a cancer diagnosis but may not cover the costs completely. Treatments including soaring drug costs could leave you with thousands of dollars of out-of-pocket costs.
Med-Care Senior Insurance offers a variety of Cancer policies to help pay the financial burden associated with a cancer diagnosis. Plans range from one-time benefits to plans paying cancer services throughout the life of the policy paid directly to you. With cancer being so prevalent today, Cancer plans are becoming an important part of your healthcare protection. To learn more about Cancer plans, use the quote form, send an email, or give us a call to get started.
Hospital Indemnity Insurance
Wisconsin hospital stays can be quite costly, even with medical coverage. This is where a hospital indemnity insurance policy comes in. Suppose you are hospitalized due to a covered illness or injury; a Hospital Indemnity policy will disburse a fixed benefit amount you can use to relieve the financial pressure. It’s up to you how you use the money, whether for transportation costs, at-home care, or cover deductible costs and other out-of-pocket expenses. In addition, you don’t have to worry about copayments, deductibles, coinsurance, or in-network providers. Depending on your needs, hospital indemnity coverage may include accidents, personal injuries, specified diseases, surgery, and other hospital exams and procedures.
Life Insurance (Term and Whole Life)
Life insurance provides you the peace of mind that you are protecting your loved ones financially at the time of your death. There are two main types of Life Insurance in the State of Wisconsin:
Term Life Insurance
This insurance policy only covers a specific time period. So, if the insured person passes away within the covered period, the ensure will pay a death benefit to the designated beneficiaries. However, if the insured person is still alive at the end of the specified term, the insurer will not pay out a death benefit.
Term life insurance has no cash value component. However, it’s generally more affordable since it only applies over a fixed term. It may also be more flexible since you can select the period you want to cover.
Whole Life Insurance
Whole life or permanent insurance applies for a lifetime. After the insured person passes away, the insurer will pay a death benefit to beneficiaries. It also comes with a cash value component, meaning a portion of your policy will earn interest, and you can withdraw it or use it as collateral when borrowing. The biggest benefit of whole life insurance is it provides lifetime coverage so your beneficiaries will get a death benefit regardless of when you pass away.
However, whole life insurance policies generally come with higher premiums.