Medicare Help for Seniors: 5 Reasons to Talk to the Professionals

At age 64, it’s time to start thinking about Medicare. Unfortunately, many people have difficulty enrolling in Medicare. Even if they don’t struggle to enroll, it’s often difficult to take a realistic, objective look at your financial and health coverage needs. That’s where Medicare help for seniors comes in. From avoiding late enrollment penalties to deciding the best vision and dental coverage for your needs, Senior Solutions Group can help you find the perfect combination of plans.

5 Reasons to Talk to the Professionals

1. There Are More Options Than Ever

Options aren’t necessarily a bad thing. However, in 2007 there were only 2,098 Medicare Advantage plans, excluding SNPs, demonstrations, employer-sponsored group plans, PACE plans, HCPPs and special population plans. In 2019, there were 2,734 Medicare Advantage plans available and, based on the past five years as a trend, that number is set to increase drastically in 2020.

2. You Can Save a Lot of Money

According to the Bureau of Labor Statistics Consumer Expenditure Survey Interview and Expense Files, in 2016, Medicare households spent 14% of their income on health care compared to non-Medicare households, which spent only 6% of their income on health care. In part, this is due to the vast majority of Medicare households being comprised of retired people living off of Social Security income and their nest egg. This household income is often lower than that of non-Medicare households with two working adults.

This is also due, in part, to Medicare households typically needing more health care. However, with professional Medicare help for seniors, you can find the perfect plan for your household’s situation. If you’re not eligible for premium-free Medicare Part A, we’ll make sure you’re not spending too much on supplemental coverage you and your partner don’t need. Similarly, we’ll ensure that you have enough coverage to not pay out of pocket for necessary medical expenses.

3. Avoid or Minimize Steep Penalties

One of the reasons the cost of Medicare is so high is people miss their initial enrollment period and have to pay penalties. The amount and duration of the penalty depends on the plan you did not enroll in on time and how late you were in enrolling.

Medicare Part A Late Enrollment Penalty

If you fail to enroll for Medicare Part A, you are subject to a penalty of 10% of your premium for twice the number of years you were late. For example, if you enrolled in Medicare Part A when you were 66, you would have to pay your premium plus an extra 10% until you are 67. Only in special circumstances can you enroll during an SEP (special enrollment period) without a penalty.

Medicare Part B Late Enrollment Penalty

The late enrollment penalty for Medicare Part B is far steeper than that for Medicare Part A. Some beneficiaries are enrolled in Original Medicare (Medicare parts A and B) automatically. However, if you’re not enrolled in Medicare Part B automatically, you are subject to a penalty of 10% of your premium for the first 12 months that you were eligible but not enrolled. This penalty increases by an additional 10% of your premium for every year that you were eligible and unenrolled.

For example, if you do not enroll in Medicare Part B until you are 70, you must pay your premium plus a penalty of 50% of your premium until you are 75. You are also subject to a Medicare Part B penalty if you suspend your coverage for a period of time and re-enroll at a later date. For example, if you had a two-year lapse in coverage, you are subject to your premium plus a penalty of 20% of your premium for two years.

Medicare Part D Late Enrollment Penalty

The penalties associated with late enrollment of Medicare do not end with Original Medicare plans. If you don’t enroll in Medicare Part D or a Medicare Advantage plan that includes adequate coverage of prescription drugs, you are subject to a penalty if you choose to enroll later. To avoid paying this penalty, you may not go without creditable coverage for a period greater than 62 consecutive days. Review your plan annually to ensure your prescription coverage is creditable.

There are only a few exceptions that exempt you from paying this late enrollment penalty. For example, you can’t be forced to pay it if you never enroll in Plan D or a Medicare Prescription Drug Plan. Finally, you are exempt from this penalty if you qualify for Medicare Extra Help.

4. You Can More Easily Locate the Highest Quality of Care

Few things, if any, are more important than the health of you and your partner. When you reach out to a professional regarding Medicare help for seniors, we will help you pick the plan that covers health care provided by the highest quality physicians.

Review your plan and physicians covered on your plan annually to ensure that they are still in-network and read reviews from Medicare beneficiaries with your current plan and other plans available to you. This ensures that you have the best plan for your health and financial needs and your plan remains optimal as your needs change.

5. You Can Find Travel Coverage

One of the most significant benefits of seeking help from professionals for Medicare help for seniors is our vast knowledge of travel needs. Original Medicare very rarely covers health care performed outside of the United States. Even Medicare Advantage rarely covers health care performed outside of the U.S. We will help you find affordable supplemental insurance that offers enough travel coverage to meet your needs.

2 Essential Things to Consider When Choosing Coverage

1. Doctor and Hospital Choice

Many seniors love their primary care physician. But it’s important to check that he or she accepts Medicare. If your primary care physician does not accept Medicare, it is time to start looking for a new provider. But that isn’t as easy as finding the highest-rated doctor in your area who accepts Medicare. You have to make sure he is looking to take on new patients at this time. You must also verify which local hospitals and desired specialists in the area take Medicare and verify whether you need a referral or not to see your desired doctor.

When it comes to Original Medicare, you can go to any doctor who accepts Medicare. In the case of Medicare Advantage, you must use health care providers who participate in your particular plan’s network. Otherwise, you will have to pay out-of-pocket. If there are no convenient doctors and pharmacies in your area, look into getting a plan that offers out-of-network coverage. You may have to pay upfront, but you will be reimbursed for your expenses.

2. Prescription Drugs

One of the most important things to consider when picking your Medicare plans is whether you anticipate needing prescription drug coverage. If you think that at any time in the future you would benefit from prescription drug coverage, enroll in Medicare Part D now. You never know when you will need prescription drugs, whether they are for a chronic or acute illness.

Since seniors succumb to illnesses more often than any other age group, it is better to be safe than sorry. Questions you should ask yourself when considering a prescription drug plan include:

  • Will my medications be covered by my plan’s formulary?
  • What is the overall star rating of my plan?
  • How much will my prescriptions cost under my plan?
  • What coverage rules, if any, apply to my prescriptions?
  • Am I eligible for a free MTM program? ´╗┐

Original Medicare

One of the most frequently asked questions we get relates to prescription drug coverage in Original Medicare. To get drug coverage, you will need to join a Medicare Prescription Drug Plan (Part D). This adds coverage to an Original Medicare plan, some Medicare Cost Plans, Medicare Private-Fee-for-Service plans and Medicare Medical Savings Account Plans.

Medicare Advantage

Most Medicare Advantage plans offer coverage for prescription drugs. If you are not enrolled in such a plan, we strongly recommend that you join a separate Medicare Part D plan. Once you are enrolled in a plan, whether it is a Medicare Advantage plan or not, review the EOC (evidence of coverage) annually when it comes in the mail. This is typically sent every September and helps you see a little more clearly if your plan will continue to be optimal for your needs in the coming year.

Medicare Help for Seniors | Contact Us Today

By the time you reach the age of 64, it is time to figure out Medicare enrollment. Unfortunately, navigating Medicare is extraordinarily difficult. That’s why you need the help of a professional agent dedicated to Medicare help for seniors. Whether your birthday is a few months or a few days from now, visit Senior Solutions Group to find the best supplemental plan that does not leave you overpaying on coverage or out-of-pocket expenses.

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