Seniorstar Insurance Group

Tag: turning 65

What Does Original Medicare Cost in 2023?

2023 Medicare Part A and B Deductibles, Premiums, and Medicare Part D Income-Related Monthly Adjustments Amounts

In late 2022, the Centers for Medicare & Medicaid Services (CMS) delivered the dollar amounts for the 2023 Original Medicare Part A & Part B co-insurance, premiums, and deductibles. This article will give you what you need to know about these amounts, how these amounts are calculated, and how these amounts affect Medicare beneficiaries.

Medicare Part B: Premium and Deductible Information and Amounts

Original Medicare Part B is the part of Medicare that covers outpatient hospital services, physician services, some home health services, medical equipment, and other services not covered by Medicare Part A. The prices of the deductibles, coinsurance rates, and premiums for Medicare Part B are settled by the Social Security Act. For 2023, the standard monthly premium for Medicare Part B enrollees is $164.90. All Medicare Part B beneficiaries will also pay $226 for 2023’s annual deductible. These costs are lower than in 2022, primarily because of a larger reserve in the Medicare Part B sliver of the Supplementary Medical Insurance Trust Fund. There is also a small stipulation for Medicare enrollees that are 36 months post kidney transplant, making them no longer eligible for full Medicare coverage. Starting this year, they can pay a premium of $97.10 for coverage of immunosuppressive drugs.

Medicare Part B: Income-Related Monthly Adjustment Amounts

The Medicare Part B monthly premium each beneficiary pays is based on their income. The standard price of $164.90 for 2023 is the price most beneficiaries will pay. Depending on their adjusted gross income, the premium may increase as shown in the chart below.

The same levels of adjusted gross income affect the premium the 36-month-out kidney transplant beneficiaries pay for their immunosuppressive drug coverage. The amounts are shown in the chart below.

How you file your yearly tax returns can affect these prices as well. Below are two charts respectively showing the two different Medicare Part B premiums discussed above for married beneficiaries who lived with their spouse for any period during the last year but filed a separate tax return.

Medicare Part A Deductibles and Premiums

Original Medicare Part A is the part of Medicare that covers skilled nursing facilities, inpatient hospital stays, hospice, inpatient rehabilitation, and several home healthcare services. Beneficiaries with at least 40 quarters of Medicare-covered employment don’t have to pay an Original Medicare Part A premium which amounts to around 99% of all beneficiaries.

In 2023, the inpatient hospital deductible that Original Medicare Part A beneficiaries will pay if admitted will be $1,600. This deductible covers the beneficiary’s costs for the first 60 days of inpatient hospital care in a benefit period. If any more inpatient hospitalization is necessary in a benefit period, the beneficiary is required to pay a coinsurance amount per day. For days 61-90, the beneficiary will pay a coinsurance amount of $400 per day. If the beneficiary uses any of their lifetime reserve days, they will pay $800 daily. In skilled nursing facilities, days 21-100 of extended care services in a benefit period will require beneficiaries to pay a $200 daily co-insurance.

A monthly premium for Original Medicare Part A is required to enroll in Original Medicare Part A under certain circumstances voluntarily. These circumstances include being age 65 and over and having fewer than 40 quarters of coverage, and certain people with disabilities. If an individual had fewer than 30 quarters of coverage or was married to someone with at least 30 quarters of coverage, they may buy into Medicare Part at a discounted monthly premium rate. This discounted rate in 2023 is $278 per month. Some uninsured aged persons who have less than 30 quarters of coverage will pay the entire premium, which is $506 a month in 2023. If certain individuals with disabilities have drained other entitlement, they will also pay this premium for Medicare Part A.

Medicare Part D Prescription Drug Plan Income-Related Monthly Adjustment Amounts

Medicare Part D Prescription Drug Plan premiums depend vary based on the individual plan, but there are income-based adjustments for beneficiaries with a higher income. The income-related monthly adjustment amounts can follow these same payment routes. These amounts are as follows:

Again, just like Original Medicare Part B, tax returns affect these amounts. Individuals who are married and lived with their spouse for any period of the taxable year but file a separate return will pay different amounts, which are listed below:

Medicare Savings Programs

These deductibles and premiums can add up for extensive hospitalization, specialized care, nursing facilities, etc. For low-income beneficiaries or those on a fixed income, this can be extremely frustrating and difficult to handle financially. However, there is help in the way of the Medicare Savings Programs for some of these individuals. These programs can help reduce the costs of the high-quality care a beneficiary may need. They help pay Medicare premiums and possibly cover co-insurance, deductibles, and co-payments for those who meet eligibility.

For any additional information on Original Medicare Part A & Part B or Medicare Part D Prescription Drug Plan premiums, co-insurance, co-payments, deductibles, or Medicare Savings Programs, contact Seniorstar Insurance Group at 844.779.5010.

Medicare Savings Programs List

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January 10, 2023
Is a Medigap Plan Right For You?

You’ve decided that you want to go into a Medigap plan, also known as Medicare supplement, and you’re concerned the preexisting conditions affect your coverage. Do they affect your costs? Well, it depends. It depends on whether you’re already in a Medigap plan, whether you have a Medicare Advantage plan and for how long, whether you’re coming into Medicare for the first time and you’re in your open enrollment period. I’ll give you a quick explanation. This is Jamie Sholom with Seniorstar Insurance Group. Welcome to the Seniorstar Minute.

When you’re enrolling in Medicare for the first time, when you’re turning 65, there will be no preexisting conditions that anybody can pay attention to, no matter what kind of Medicare plan you want to go into if you want to go into a supplement plan at that point. You can do it with any company or any plan that provides those policies in your area. Now, if you’re coming off of existing Medicare insurance, whether that be a different supplement plan, maybe you’re looking to lower your rate.

Maybe you’re looking to switch plans or companies. Or if you’re coming off a Medicare Advantage plan and you want to opt out of that. You may have to answer health questions now, these insurance companies can deny you coverage if you have certain criteria met, certain chronic conditions, certain combinations of conditions. If you’re on certain medications, they can say no, which will make your ability to lower your costs or save money much more difficult. Now, there are other situations where they would where insurance companies with Medigap plans would have to give you what’s called a guarantee issue, meaning they can ask your health questions, but under limited circumstances.

And you would have a limited option in terms of what type of Medigap plan and which company to go into. If you need any more information or if you have any questions about your specific situation, please give me a call. My phone number, my website there on the screen. It’s been a pleasure to talk to you. Hope to hear from you soon.

July 9, 2021
The Cost Of Cancer

Did you know that May is melanoma skin cancer detection and Prevention Month?

Now, of course, you didn’t, most people don’t, but it is and it had me thinking about cancer and the fact that we don’t talk about cancer when we discuss Medicare coverage enough, it’s a very important topic.

It’s one that can cost an enormous amount of money besides the medical toll it can take. It’s a subject I wanted to touch on. This is Jamie Sholom from SeniorStar Insurance Group.Welcome to the SeniorStar Minute.

Everybody knows somebody personally that’s been affected by cancer.In fact, according to the CDC and the American Cancer Society, it’s the second leading cause of death in the United States right behind heart disease.

What’s worse for my population that I serve the seniors is that eighty seven percent of all diagnosis of cancer in the US are from 50 year olds are older. Forty one percent of all males and thirty eight percent of all females will have a diagnosis of cancer at some point in their lives. Now, the good news is that cancer survival rate is thirty one percent higher than it used to be, but along with those higher survival rates are the costs.

The treatments are better and the costs are going higher. Now, why am I telling you this? If you’re covered by Medicare, if you have a great Medicare coverage package or even an average Medicare coverage package, it’s going to cover cancer, isn’t it? Well, yes and no cancer has two open holes that affect a lot of people that didn’t think they were going to be affected by it financially. The first is the enormous cost of cancer, prescription drugs.

The second are the untold costs that are indirect with cancer treatments. I’m going to talk about them both a little bit. The drug costs were studied by the Kaiser Family Foundation recently.

They did a study of 13 popular, for lack of a better word, drugs that were for various forms of cancer. These were Medicare recipients that had Medicare drug coverage. What they determined was that the average cost for these drugs, the out-of-pocket costs for Medicare beneficiaries, was between eight thousand and sixteen and a half thousand dollars. You heard that right. Medicare beneficiaries with a Medicare drug plan had to spend an additional eighty one hundred dollars to sixteen and a half thousand dollars out of their own pockets each year because of that cancer drug that they were on unplanned for.

And it’s enormous. There are studies that come out every year that talk about how people can’t afford their cancer medications.

They also go through their retirement funds and deplete them at a much higher rate than they thought they were going to. There are also studies that show how indirect costs of cancer affect people in ways that they didn’t expect. Downtime from work counseling, getting family help for the family members that you took care of. Home health aides travel and lodging for cancer treatments, all of these add up to forty two percent of cancer costs. That’s right. Indirect costs are costing you forty two percent of your overall cancer costs.

Now, the reason I’m letting you know this, there is a solution.

There are cancer protection and critical care policies out there that can give you coverage and protection from a diagnosis of cancer. These plans are fairly low monthly premium plans that will give you a lump sum payment, typically between fifteen thousand dollars and seventy five thousand dollars, with which you can do whatever you want. If you get a diagnosis of cancer, you get a lump sum of an amount that you can afford the premiums for and you can choose if you need to use them on cancer drugs, on some of the indirect costs or in any other way that you choose.

If you’re interested in getting more information about this very important product, please contact me Jamie Sholom at SeniorStar Insurance Group. My contact information is on the screen. I hope to speak to you soon. Thank you for listening.

May 8, 2021
Do You Have to Sign Up for Medicare?

Do You Have to Sign Up for Medicare?

Many people look forward to the day when they finally can sign up for Medicare but not everyone feels that way. This is an important question for anyone approaching 65 but it really breaks down into two smaller questions: Are you eligible for Medicare and, are you required to enroll in Medicare if you are?

Eligibility:
You are eligible for premium-free Part A (hospital coverage) and Part B (outpatient coverage usually with a premium attached) if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can also get Medicare at 65 if you are receiving retirement benefits from Social Security or the Railroad Retirement Board, you are eligible to receive Social Security or Railroad benefits but you have not yet filed for them or you or your spouse had Medicare-covered government employment. If you are under age 65, you can get Medicare if you have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months or you are a kidney dialysis or kidney transplant patient. But if you’re turning 65 and you are eligible, Medicare often provides the least expensive and most comprehensive protection available.

Requirements:
You are not required by law to enroll in Medicare but if you do not enroll when you become eligible, without having other “creditable” insurance, you will likely be penalized for the delay when it comes times for you to eventually enroll in Medicare. Creditable coverage includes many retirement health and many employer group plans but COBRA and the ACA individual plans are not considered creditable by Medicare standards. The late enrollment penalty, (LEP) imposes a higher monthly premium for Part B benefits and/or Part D (Medicare prescription drug plan) benefits. The longer the delay in enrollment in Medicare without other creditable coverage, the higher the penalty will be and it never goes away. For that reason, it is very important to find out if the coverage you have now is considered “creditable”, by Medicare standards to help guide your decision. If you are receiving social security benefits when you turn 65, you will be enrolled in Medicare automatically and your Medicare card will be mailed to you around three months prior to the month of your 65th birthday.

Penalties:
Part B has a monthly premium which for most people in 2021, is $148.50 but it can be higher depending on income. The LEP for Part B is 10% of the standard premium for each 12-month period that you could have had Part B but didn’t and you’ll have to pay this penalty on top of your premiums for life or disenrollment. For example, if you delay enrolling in Part B for 2 full years you will have an additional 20% to pay on top of the $148.50, which equals $29.70.
For Part D, Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($33.06 in 2021) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $0.10 and added to your monthly Part D premium. In this case, the same 2 year delay would result in a an additional $8.00 per month above the premium you pay for your drug plan.

There is no penalty for not enrolling in a Medigap plan or a Medicare Advantage plan but not doing so when you are first eligible for Medicare could also have negative implications for you. For example, preexisting health conditions may be considered, or you might have to wait for the annual enrollment period to obtain coverage if you do not obtain coverage during your initial election period.
So, should you sign up? Well, if you don’t have a qualified employer group plan or you’re not covered under a spouse’s plan, then it makes a lot of sense to get on Medicare. Health insurance is a great idea at any age, but it is vital for seniors who may have fixed incomes and have ever increasing medical needs.

Bottom line?
Navigating your entry into Medicare can be tricky and confusing but making the wrong decisions could cost you money and limit your coverage at a time when you can least afford either. For a FREE one-on-one review from a Medicare expert call (732) 658-5100, email jamie@seniorstarig.com or go to our website at www.seniorstargroup.com.

May 3, 2021
Is the Lowest Costing Option Always the Best One?

With Medigap Plans, Is the Lowest Costing Option Always the Best One?

Medicare Supplement plans (also known as Medigap plans) are offered by private insurers and fill many of the coverage gaps in Original Medicare. There are several plan types, all identified by a letter, but the most popular are Plans G and N. These two plans compromise the vast majority of new Medicare eligibles who elected to enroll in a Medigap plan since January of 2020.

Medicare Supplement plans of the same type which are offered by different insurers, may have significantly varying rates while providing the same basic benefits and levels of coverage. For example, a plan G that costs $140 per month with a lesser-known carrier is the same coverage as a Plan G for $172 per month with a widely-known carrier. Premiums can vary so dramatically between carriers for the same plan, because of market conditions, risk tolerance, claims ratio, management and marketing decisions, etc…

As such, wouldn’t it seem to reason that it’s always best to choose the company with the lowest rate available? NOT SO FAST…. Medicare supplement plans have rate increases every year and some insurers raise their rates higher and faster than others. That means that a carrier with the lowest costing Plan G for 65 year old’s today might be on the high side at age 71.

Although it is possible to shop for different carriers for lower rates as often as one wants, (in fact most my time is spent on helping clients find lower rates for the same coverage), there is a risk that a medical condition will arise which “locks” the beneficiary into their current plan. That’s because after the short initial enrollment period ends, Medigap applicants will have to answer health questions on the application and certain preexisting conditions may become a disqualifier for coverage.

For that reason, it makes sense for someone considering a Medigap policy, to factor in a carrier’s history of rate stability, their financial strength and their customer service record as well as their rates. Finding that balance is what we help our clients do. Please contact me for more information.

April 26, 2021
Medicare! What is it, and what does it cover?

Medicare! What is it, and what does it cover?

Medicare is a public healthcare program, funded by the government, workers and employers, and available to people at age 65 or who have qualifying disabilities. But contrary to popular belief, the program was not intended to cover all services at no cost. Generally, it provides a core set of basic medical benefits to cover inpatient and about 80% of outpatient care. Medicare beneficiaries face out-of-pocket expenses, such as deductibles copayments and/or coinsurance.

When you initially become eligible for Medicare, you can pick any plan available in the zip code of your primary residence and are not asked about preexisting health conditions. Once that initial enrollment period (IEP) ends, there are certain times during the year when you can make changes depending on the plan type you choose.

Seniorstar Insurance Group is a licensed, independent Medicare agency working with more than 20 highly rated insurance carriers in Medicare supplement, Medicare Advantage, Medicare prescription drug, dental, vision, hearing, critical care, hospital indemnity, final expense and long term care plans. Our services are completely FREE. Why not let Jamie Sholom and the team at Seniorstar become your ongoing resource for your senior benefits.

April 26, 2021