Annual Open Enrollment

OCT 15 – DEC 7

Medicare Resources

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    Note: By providing information via our contact form, you agree that an authorized representative or licensed insurance agent/producer may contact you by telephone, email or mail to answer your questions or provide additional information about Medicare Insurance plans.

    Unbiased, Free Advice on Medicare

    We work with individuals turning 65, or who have already enrolled in Medicare, and would like to know more about their Medicare options and reduce healthcare costs.

    Idaho Medicare is complex.  There are many rules and deadlines when it comes to enrolling in Original Medicare, as well as Medicare Advantage, Medigap and Part D Plans (prescription plans).  Our goal is to guide you through your options to help you avoid making mistakes that could wind up costing you, sometimes for life.

    Did you know?  The best time to buy a Medigap policy without underwriting is during your initial enrollment period when you turn 65, otherwise, your application will be priced and subject to preexisting conditions, and you may not be able to get coverage.

    We have thirty years of experience with Idaho Medicare, and work with many top quality Idaho Medicare carriers, which allows us to take an unbiased approach in finding solutions that are right for you.  Call us today and let us help protect your financial future.

    Please review the following Medicare products we offer below, and the additional Medicare resources provided to the left. Fill out our Request Quote form for FREE expert guidance.

    Medicare Advantage Plans are offered by private carriers and replace your original Medicare Parts A and B, as they are rolled into one plan, and often may include additional benefits such as dental, vision or hearing.  Note you must already be enrolled in Medicare Parts A & B to switch to a Medicare Advantage Plan.

    Much like regular insurance, you can select different plan types, such as a Health Maintenance Organization (HMO), or a Preferred Provider Organization (PPO), or a Medicare Medical Savings Account Plan. Premiums will vary, based on coverage, carrier and geographical location.

    We are familiar with many of the quality carriers who offer Medicare Advantage and can help you select a carrier/plan for your needs and budget.

    To get more information or request a quote, please fill out the form to the left and we will contact you soon.

    Medicare Supplement Insurance policies complement and fill in the gaps of your Original Medicare Parts A and B. They cover some, if not all, of the expenses that Part A and B do not cover, like co-pays, deductibles and other charges.

    There are many different types of Medicare Supplement policies available, yet they are regulated so the benefits for these various policies (known as Plan A through N), are all the same regardless of the carrier.  However, premiums can vary greatly among carriers.

    Ultimately, the best Supplement Plan is one that is purchased from a quality carrier, has a low premium and leaves you with the least or no out of pocket expenses.

    We are familiar with all of the various Supplement Plans available and can help you select a carrier/plan for your needs and budget.

    To get more information or request a quote, please fill out the form to the left and we will contact you soon.

    Medicare Part D adds prescription drug coverage to Original Medicare and is offered through private insurance companies that are contracted and approved by Medicare.

    Premiums can vary greatly between the numerous options and carriers, therefore it’s necessary to carefully weigh your prescription costs against all variables of these plans. Selecting the wrong plan can wind up costing you thousands.

    Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

    NOTICE:  Once you are eligible for Medicare, do not wait to enroll in a Medicare Part D Plan or you could end up paying a penalty every month.

    We are familiar with the various Part D Plans available and can help you select the best plan for your needs and budget.

    To get more information or request a quote, please fill out the form to the left and we will contact you soon.

    More About the Medicare Insurance Program

    Medicare is the federal health insurance program for people who are 65 or older.  The different parts of Medicare help cover specific services:

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

    Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.  Most people will pay a standard Part B premium which varies depending on income.

    Medicare Advantage Plans (Part C) roll Part A & B into one plan and have several options that may provide more coverage than your original Medicare.

    Medicare Supplements work together with your original Medicare to cover things like your deductible, co-pays and other out-of-pocket expenses.

    Medicare Part D adds prescription drug coverage to your original Medicare.

    To sign up for original Medicare Parts A & B, along with Part D, most people will have an Initial Enrollment Period which is a 7 month period around the time they turn age 65. This period begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

    Once  your Initial Enrollment Period is over, if you wish to change or purchase Advantage or Part D Plans, you must act during the open enrollment period, which is October 15 through December 7 annually.

    If you missed the deadline, you may qualify to enroll outside of the open enrollment period.

    Once enrolled in Medicare, if you wish to change or purchase Medicare Advantage and Part D Plans, you must act during the open enrollment period.

    You can purchase Supplements year round, but you can skip medical underwriting if done during open enrollment.

    When open enrollment is closed, there are special circumstances in which one may qualify to enroll outside of the enrollment period. Listed below are the qualifying events:

    • You are turning 65
    • You move to a new area that is not in your current plan’s service area
    • Recently moved back to the US
    • You lose your current coverage (either Group or Medicaid)
    • You now need a SNP (Special Needs Plan) or you no longer need a SNP

    Medicare Part Premiums – 2022 National Average

    Medicare Part A & B

    Medicare Premiums Beneficiary Pays for Part A Monthly Premium 

    Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.

    • $499/month for those with fewer than 30 quarters of Medicare-covered employment
    • $274/month for those with 30-39 quarters of Medicare-covered employment
    Beneficiary Pays for Skilled Nursing Facility Sta
    • $0 for the first 20 days of each benefit period
    • $194.50 per day for days 21–100 of each benefit period
    • All costs for each day after day 100 of the benefit period
    Beneficiary Pays for Hospital Stay
    • $1,556 deductible per benefit period
    • $0 for the first 60 days of each benefit period
    • $389 per day for days 61–90 of each benefit period
    • $778 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)
    Medicare Premiums Beneficiary Pays for Part B Monthly Premium 

    Most people pay the standard Part B premium amount which is $170.10 in 2022

    • If your income was more than $91,000 ($182,000 filing joint) you’ll pay $238.10
    • If your income was more than $114,000 ($228,000 filing joint) you’ll pay $340.20
    • If your income was more than $142,000 ($284,000 filing joint) you’ll pay $442.30
    • If your income was more than $170,000 ($340,000 filing joint) you’ll pay $544.30
    • If your income was more than $500,000 ($750,000 filing joint) you’ll pay $578.50
    Beneficiary Pays for Part B Services 
    • $233.00 deductible per benefit period
    • After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, outpatient mental health services, certain home health services, and durable medical equipment

    Medicare Part C – Medicare Advantage

    Medicare Advantage plans combine Part A and B into one plan and are offered by Medicare-approved health insurance companies as an alternative option to your Original Medicare coverage. Premiums and out-of-pocket costs may vary depending on your plan, however some premiums can be as low as $0, in addition to your monthly Medicare Part B premium (see above). To ensure you find a plan that fits your specific healthcare needs and budget, please contact our licensed Medicare agent for professional assistance.

    Medicare Part D (Prescription Drug)

    For 2022 Medicare Part D Costs, most drug plans charge a monthly fee that varies by plan. You pay this in addition to the Part B premium. If you’re in a Medicare Advantage Plan (Part C) or Medicare Cost Plan with drug coverage, the monthly premium may include an amount for drug coverage.

    • If your income was more than $91,000 ($182,000 filing joint) you’ll pay $12.40 + your plan premium
    • If your income was more than $114,000 ($228,000 filing joint) you’ll pay $32.10 + your plan premium
    • If your income was more than $142,000 ($284,000 filing joint) you’ll pay $51.70 + your plan premium
    • If your income was more than $170,000 ($340,000 filing joint) you’ll pay $71.30 + your plan premium
    • If your income was more than $500,000 ($750,000 filing joint) you’ll pay $77.90 + your plan premium

    Deductibles vary between Medicare drug plans.  Some Medicare drug plans don’t have a deductible.

    • No Medicare drug plan may have a deductible more than $480 in 2022.

    Once your deductible is met, you’ll pay a coinsurance (copay) for prescription drugs.  Note that the amount of your copay may change during the benefit period, if the drug price fluctuates.

    • Initial coverage limit is $4,430 (plan pays 75% – you pay 25%)
      • Once you and your plan pay this amount, you’ll continue to pay 25% of the cost of your prescriptions drugs until you reach your threshold
    • Annual out-of-pocked threshold is $7,050

    Once you and your plan have spent $4,430 on covered drugs in 2022, you’re in the coverage gap (a temporary limit on what the plan covers).  Even though you’ll only pay 25% for both brand name and generic drugs at this point, almost the full price of the drug (except for what the plan pays) will count as out-of-pocket costs to help you get out of the coverage gap.

    • The manufacturer pays 70% of drug costs
    • The plan pays 5% of drug costs
    • You pay 25% of drug costs
    • The plan also pays 75% of a dispensing fee, you pay 25% of the dispensing fee

    Once you reach your threshold ($7,050), you are out of the coverage gap (donut hole) and you’ll automatically get catastrophic coverage. This assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.

    • You’ll pay 5% or a small copay (whichever is greater) of the cost of your medications for the rest of the year.
    • Your plan pays the rest

    Information obtained from Medicare.gov

    Disclaimer:
    Benefits: The benefit information provided herein is a brief summary, not a comprehensive description of benefits and may contain inaccuracies. For more information contact the plan. Limitations, copayments, and restrictions may apply.
    Agent: Balanced Rock Insurance Agency, Inc. is a licensed insurance agency authorized to market Medicare health plans. This is a solicitation for insurance. Please note you have no guarantee issue. Offerings of insurance are made based only on submitted applications.

    Neither Balanced Rock Insurance Agency, Inc., nor its agents, are connected with the Federal Medicare program.

    The premium estimates on this page are national averages. While Medicare premiums are the same in many states across the US, rates can and do vary in other states, and depending the type of Medicare coverage you have, as well as what health insurance company is approved for your area.