SSA Insider Explains: New to Medicare Important Decisions

so you've just signed up for Medicare part A and Part B or you've just gotten your Medicare part A or Part B cards in the mail so let's answer today what's next my name is Ed Weir I'm a retired district manager the Social Security Administration I've helped hundreds of thousands of people out with all things Social Security Medicare um the Affordable Care Act Now survivor benefits disability benefits early retirement late retirement delayed retirement um the Medicare part A Part B part C Part D so there's not many people in the country that have my background expertise and experience particularly on the inside so if you're looking for help now that you've got your cards give me a call and we'll walk through the entire process and of course use my background with Social Security to make sure you're getting all the benefits you're entitled to all right so you've got your cards your you have what we call original Medicare just part A and Part B let's go over today what exactly you have in your hand or you're about to get all right so part A is the hospital and for most most people it's free if you didn't work you didn't pay FICA taxes for a certain amount of years then you might be paying for your part A but for the most part let's go with most people receive part a free again this is the hospital there are some gaps there are essentially six gaps in original Medicare three in part A and three in Part B so you have some options to fill those gaps and that's what we're going to talk about today but let's find out what those gaps are first of all part A there is a deductible in 2023 that deductible is sixteen hundred dollars a benefit period okay this gets a little complicated but it's not an annual deductible where you pay the sixteen hundred dollars one you know one time a year and you're done it could be multiple times a year so if you go into the hospital and you're actually admitted to the hospital then you'll have to pay sixteen hundred dollars before Medicare will cover anything so that's the deductible if you go out of the hospital you're discharged and uh you're good and you don't return to the hospital for 60 days then you don't have that deductible but after that 60-day period if you go back to the hospital again you'll have to pay another sixteen hundred dollars deductible so it could be multiple times per year okay so that's the first Gap in original Medicare that you have to consider once you make your choices on whether you're going to add some type of supplement which we'll talk about here in a bit all right so that's the first Gap the second Gap is I'm going to put up a chart here and we'll uh we'll we'll go down through the list the second Gap as you can see is when you actually go into the hospital so from Days 61 to 90 Medicare covers all eligible expenses after the patient pays their per day co-payment and in 2023 that per day co-payment is 400 a day so that's from 61 to days 90. so again for the first 60 days you don't pay anything except for that deductible from 61 to 90 you have to pay 400 a day days 91 through 150 you'll have to pay eight hundred dollars copay so that's part A of hospitals in terms of so this is the the hospital deductible and the co-pay so that's gap one Gap two and the third Gap is skilled nursing confinement so that's following the inpatient Hospital stay of at least three days and then you go into a Skilled Nursing Facility um to kind of recuperate from whatever procedure you had done in the in the hospital so Medicare pays all eligible expenses for the first 20 days then all eligible expenses for days 21 through 100 after patient pays a per day co-payment and that after the again the first 20 days is two hundred dollars so that is the third major Gap all right so that's the gaps for part A now let's talk about the gaps for Part B Part B Gap is the num first one is there is a deductible again just like part A the deductible for 2023 is 226 dollars and that's a one time one one time a year so you just pay the 226 dollars one time a year and you're done okay the other gap is the 20 co-insurance so if you go to a a hospital and the hospital is taken care of by part A but the doctor the surgeon is taken care of by Part B do an outpatient surgery or something like that let's say it costs a hundred thousand dollars then Medicare will pick up eighty percent of that so they will pay eighty thousand dollars under Part B but you will be obligated for the remainder the 20 so you'll have to come out with twenty thousand dollars out of your pocket Okay the third Gap is what's called excess charges most doctors in the country take assignment which basically means they accept Medicare and they accept Medicare rates what there are a few doctors not many uh two three four percent or so the number varies every year but not many um don't take assignment and they charge essentially their own rates but Medicare limits that to the Medicare rates plus essentially 15 percent this is called what's excess charges and you can find out whether your doctor you know takes assignment and you know charges the extra 15 and it gets kind of complicated it's not technically 15 because there's like a five percent charge there yeah but most doctors uh in the country accept Medicare but there's a few doctors and Facilities that don't and those will charge the excess charges okay so that is your first option stay with original Medicare part A Part B and go on with your life um if you have other health insurance federal employee health benefits if you have Tricare for life if you know some other type of health insurance to cover those gaps then fine it's a beautiful thing we've got a few hundred thousand dollars laying around that uh you know that you can pay that twenty percent Part B you know premium or the um the coinsurance with then you're good stay with part A Part B um for those that don't have a few hundred thousand dollars laying around there are a couple of options and the two options are option A which is a Medicare Supplement Plan also called a Medigap plan and option b which is the Medicare Advantage plans okay so let's get into the difference between a Medigap or Medicare Supplement Plan and a Medicare Advantage plan the Medicare um supplement plans those are kind of like traditional insurance so you keep your part A Keep Your Part B and then you buy a Supplement Plan from a particular company a private company there's a United Healthcare and Aetna neutral of Omaha many companies out there in your particular area and you buy one of those plans and there's a premium the premiums are about 125 dollars on average throughout the country it depends on your particular state area um but uh about 125 dollars and then it covers a lot of the gaps and it depends what plan you get the most popular right now are Plan G and plan n there was another plan called f but those are for people um they're no essentially no longer offering those anymore unless you're essentially way over 65 you had to be 65 before 2020. um so Plan G and plan n and I'll have another video up there um to uh kind of go through the different differences between a plan G and a plan n but for the most part um they cover the um they don't cover the part B deductible they cover the part a deductible the sixteen hundred dollars they cover that 20 the the big one is the 20 co-insurance on Part B they cover that um one of them the par G does not does cover excess charges plan n does not cover excess charges but the Medicare Supplement Plan is usually a plan n is is cheaper because it's not a guaranteed issue but again watch my other video on the comparison between Plan G and plan n and uh a little bit more detail on it um people often ask uh what what if I had to choose for myself and my family what would I choose well there is no perfect plan for everybody it really depends on your particular situation I've got another video up there where I say well um in order to get the most bang for your buck I would probably choose a plan n if you could afford the monthly premium if you can't afford the monthly premium then Medicare Advantage might be uh the way to go so it's a really individualized decision on your particular Health your particular budget so give us a call and and we can help you and walk you through all of the um the variables and the decision points that you need to think about when you decide to go down option one or option two option A or option b so the Medicare Advantage plans most of those particularly the ones uh we usually offer to people that contact us are zero premium and first question is okay why would I take a Medicare Supplement Plan when I have to pay you know 125 dollars a month for it um and not take a Medicare Advantage plan with zero premium well the Medicare Supplement Plan a lot of advantages to them you don't have to get referrals you don't have to get permission from a an insurance company to do X Y or Z procedure as long as Medicare covers it then you're good so there's a lot more freedom there you can see any doctor there's no networks or anything like that again a Medicare Advantage plan zero premium but you do have some limitations and one of the limitations is in order to save the most money it's an HMO so you have to see whatever company you pick you have to make sure you go to their in-network doctors you can go out but then the price is going to be quite a bit more um so when you pick a Medicare Advantage the first thing you do is you make sure you pick a Medicare Advantage plan that covers the doctors you want to go to and the prescriptions Medicare Advantage plans most of them have prescription drug coverage bundled in with the Medicare Advantage plan Medicare supplement plans do not have the part D in there so you have to buy a separate Part D plan as well all right so how do you know what's best for you well you can give us a call um do a little research go on to medicare.gov um the how do you sign up well if you there's probably dozens of dozens of different plans in your area Medicare supplement plans Medicare Advantage plans um you can request the help of an agent like myself we are Brokers here and we've contracted with most of the major carriers in the country and so we look for a plan in your particular area if it's a Medicare Supplement Plan we're just looking for you know the best price because they're all the same doesn't matter what company it is is if you're going to pick G essentially all the companies are the same they offer the same type of benefits Medicare Advantage plan again we ask you what your what doctors you want to continue to see your prescriptions and then out of the dozens of dozens or so probably in your area we give you a couple of recommendations say well this one looks like it you know it covers all your doctors covers your prescriptions and it's the you know the best price in terms of Maximum out of pocket in your prescription drug costs and all the rest of it um and what do we charge for that well we don't charge anything all agents are brokers in the country um get paid directly from the insurance companies and you'll say well why don't I just go directly to an insurance company well it's the same exact price uh whether it's a Medicare supplement a Medicare Advantage plan it's exactly the same if you go directly to the company then if you have any problems you call the company um if you go through a broker like ourselves if you have any issues you could call the company but you also have a fallback position you contact us and then we can help you navigate the bureaucracy and one of the benefits of contacting me personally is that my Decades of inside Social Security experience I can help you your family relatives with all things Social Security so if you've got any relatives looking to early retirement or delayed retirement or want to you know sign up for Medicare or disability then you've got an extra resource free resource at any time to refer them to us and we can definitely help them through any of the bureaucracy um that uh that they need help with so once you contact an agent or a broker what happens then again you have to figure out what you want to go with you want to go with a Medicare supplement or Medicare Advantage plan and then the individual can give you your recommendations on Medicare supplement which one is the the best one in your particular area when can you enroll can you enroll um if you decide to you want to go with the zero premium Medicare Advantage plan again go to the doctors go through the prescriptions and it's important to make sure that you ever contact it's kind of the old Henry Ford thing that you can have any color car you want as long as it's black if you contact um you know Acme broker and that Acme broker is only contracted with Acme Medicare company then guess what Medicare Plan you're going to get you're going to get Acme Medicare so it's important that whoever talk to is contracted with many or most of the Medicare insurance companies in your particular area so they can offer you the best of all of them and the choice will be left up to you all right so that's one of the reasons when when you call a Medicare insurance agent under the new Medicare guidelines they have to read a little thing we do not offer every plant available in your area every offering so everybody has to read this little blurb about uh you know we do not offer every plan in your area and all calls are being recorded Medicare is the government is trying to shut down some of these kind of shady Medicare companies particularly the ones you see on TV those are usually not necessarily selling Medicare they're more selling leads so they get some famous person and you know they make all kinds of different offers and you know we'll give you the world you call them up they get all your information and they forward it they sell that information to insurance agents or Brokers a Company call center somewhere and then then they harass you for the next 20 years um so uh there's that um so you can again give us a call and we can walk you through the entire process um if you have a local agent or broker that in your area that that you trust that you know that and one of the things be careful of there's a lot of people out there that say they are Social Security Experts there's a company that offers a two-day seminar on Social Security and then they print up a cute little certificate that says you are now a social security expert I spent a few decades I ran the third busiest Social Security office in the country I've helped hundreds of thousands of people out with Social Security Medicare Medicaid I worked at the Department of Welfare before I worked for Social Security I was a sergeant in the Marine Corps before all of that so I'm familiar with veterans benefits so if you're looking for someone with a government bureaucracy bureaucratic experience that it inside knowledge Insider tips tricks and secrets then absolutely give me a call and I can walk you through the entire process and make sure you don't make any mistakes this is your your finances this is your health it's very important that you make the right decision the first time because the government is many things but it's uh it's not always forgiving and so oh I didn't know well that's one of the the biggest responses I get well I didn't know I had to do this that or the other um the government doesn't always allow that as a as an excuse to get around circumvent the law so it's important that you do things the right way from the beginning so there are no issues the government also takes long a long time coming back around so you might be good for you know a few months or a few years but uh then the government comes back and oh yeah we should have never done X Y or Z so give us all this money back so um that's one of the unfortunate parts so let's make sure that's not you give us a call so we can make sure you're doing the right thing from day one and as always have a beautiful day

Channel: Dr. Ed Weir, PhD, Former Social Security Manager

Views: 721

Keywords: retirement planning, social security, medicare part b, medicare explained, retirement planning at 55, what is medicare, medicare supplement, medicare basics, medicare 101, medicare advantage plans vs. supplemental insurance

Id: F7ZPOIWt_o0

Length: 19min 19sec (1159 seconds)

Published: Mon May 15 2023