Medicare

At Simmons Capital Group, we offer assistance with the selection and enrollment in a Medicare plan that best fits your insurance needs and help you navigate changing coverage needs throughout retirement. If you are turning 65, ready to retire or losing coverage under your employer’s plan, you may be eligible to enroll now.

It is important to know the basics of Medicare and its important deadlines for enrollment.  Delays in enrollment can cause lifetime penalties in the form of higher premiums.

Which Plan Should I Choose?

Step one is always to do your homework and compare what your current coverage provides with the various Medicare coverage plan types. Below you will find the basic plan types and a general description of what they each provide. Keep in mind that it is important to review your current care providers and medications to ensure the plan you choose will allow you the ability to see the doctors and specialists you prefer, along with the ability to have coverage for the required prescriptions.

The good news is, that over time should your needs change, you will have at least one opportunity each year to change your plan as appropriate.

We invite you to call 518.406.5624 or use Request Form below to schedule an appointment to discuss your retirement health plan options. Thank you.

Disclaimer: By submitting this form, a financial advisor may call or email you to discuss Medicare Advantage Plans, Medicare Prescription Drug Plans, and Medicare Supplement Insurance. This is a solicitation for insurance.

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Medicare FAQ’s

What is “original Medicare” and what other options do I have?

Medicare Part A and Medicare Part B are often referred to as Original Medicare. Original Medicare is managed by the federal government and provides Medicare eligible individuals with coverage for and access to doctors, hospitals, or other health care providers who accepts Medicare. It is a fee-for-service plan, meaning that the person with Medicare usually pays a fee for each service. Medicare pays its share of an approved amount up to certain limits, and the person with Medicare pays the rest.

What do Medicare Parts A, B, C and D mean?

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)  

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part C (Medicare Advantage Plan)

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, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.

Medicare Part D (prescription drug coverage) 

Part D adds prescription drug coverage to:

  1. Original Medicare

  2. Some Medicare Cost Plans

  3. Some Medicare Private-Fee-for-Service Plans

  4. Medicare Medical Savings Account Plans

Is Medicare Alone Enough Health Coverage?

You can have Original Medicare and enroll in a stand-alone Medicare Part D Prescription Drug Plan. You can have Original Medicare and purchase a Medigap (Medicare Supplement) plan. There are 10 standardized Medigap policies in most states, and they cover varying amounts of your Medicare Part A and Part B costs (such as coinsurance and deductibles), depending on the Medigap policy.

See the descriptions of coverage provided by each part of Medicare to better determine if all your needs can be satisfied with using original Medicare and a drug plan alone.

Are my Prescriptions Covered? 

Medicare Part D coverage for prescription drugs is offered by private insurance companies contracted with the Medicare program to provide these benefits.  Each plan sets its own coverage rules and guidelines, subject to requirements under Medicare. These plans each use a formulary, which is a list of approved medications and the benefits available for each, to determine coverage. All Medicare Part D Prescription Drug Plans must cover a variety of medications to treat most conditions. Plans may change their formularies from time to time, but they must notify you in writing before they do.

To see if your medication is covered, you can check the plan’s formulary, which is usually available on its website. You can also use the Compare Plans tool on this page to look for plans that may cover prescription drugs you take regularly. Just enter your zip code in the box on this page to begin.

What are the monthly premiums?

Most people don’t pay a Part A premium because they paid Medicare taxes while working. If you don’t get premium-free Part A, you pay up to $437 each month.

The standard Part B premium amount in 2019 is $135.50 or higher depending on your income. However, most people who get Social Security benefits pay less than this amount ($130 on average). Social Security will tell you the exact amount you’ll pay for Part B in 2019.

You pay the standard premium amount (or higher) if:

  1. You enroll in Part B for the first time in 2019.

  2. You do not get Social Security benefits.

  3. You are directly billed for your Part B premiums.

  4. You have Medicare and Medicaid, and Medicaid pays your premiums. (Your state will pay the standard premium amount of $135.50 in 2019.)

  5. Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount.               

When Can You Enroll & What Can You Change?

OPEN ENROLLMENT: October 15 - December 7 (Changes take effect January 1)

Plan Changes You Can Make at Open Enrollment:

  1. Change from Original Medicare to a Medicare Advantage Plan.

  2. Change from a Medicare Advantage Plan back to Original Medicare.

  3. Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.

  4. Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.

  5. Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.

  6. Join a Medicare Prescription Drug Plan.

  7. Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.

  8. Drop your Medicare prescription drug coverage completely.

Medicare Health Plan Options:

Medicare Supplement Plans

Medicare Supplement Insurance Plans are health insurance plans designed to supplement Original Medicare. They help pay some of the health care costs that Original Medicare does not cover (like copayments, coinsurance, and deductibles).  These plans allow you to go to any doctor or hospital in the United States that accepts Medicare patients.

Medicare Supplement Plans A, B, C, F, G, K, L, and N (except in Massachusetts, Minnesota and Wisconsin, which have different plans and plan designations). Each plan has specific benefits allowing consumers to find a plan to best meet their needs and budget.

Medicare Drug Plans

Medicare prescription drug coverage is an optional benefit.  Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to get Medicare drug coverage when you're first eligible, you'll likely pay a late enrollment penalty if you join later, unless one of these applies:

·       You have other Creditable prescription drug coverage

·       You get Extra Help from Medicare to cover drug costs

Generally, you'll pay this penalty for as long as you have Medicare prescription drug coverage.

To get Medicare drug coverage, you must join a plan approved by Medicare that offers Medicare drug coverage. Each plan can vary in cost and drugs covered.

How to Get Prescription Drug Coverage:

  1. Medicare Prescription Drug Plan (Part D). These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.

  2. Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription Drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.

Medicare Advantage Plans

Medicare Advantage (MA) plans are health plan options approved by Medicare and offered by private insurance companies that are contracted by the federal government.  Medicare Advantage plans provide Medicare Part A (hospital) and Medicare Part B (medical) coverage, and some plans include Medicare Part D (prescription drug) coverage.

Medicare Advantage plans typically provide additional benefits and services that Original Medicare does not cover.  The following is not an exclusive list; please refer to our Product Positioning Sheets for the additional benefits available in your market by plan:

  1. HouseCalls

  2. Renew by UnitedHealthcare

  3. Routine Hearing

  4. Routine Vision

  5. NurseLineSM

  6. Fitness membership

Dual Special Needs Plans (DSNP)

Dual SNPs focus on those individuals who receive state assistance with cost sharing. These plans are tailored to low-income, aged and disabled people who need help to get the most from what is available to them through Medicare and Medicaid. Dual SNPs provide consumers with benefits in addition to the benefits covered by Original Medicare, such as routine eyewear and transportation to doctor appointments. Members must have Medicaid to enroll.

We invite you to call 518.406.5624 or use Request Form below to schedule an appointment to discuss your retirement health plan options. Thank you.