Medicare in Austin, Texas

There are many options with Medicare, and if you make the right choice, you can have greater financial Security. The truth is that Medicare A & B alone isn’t enough for most people because Medicare doesn’t cover everything. There are “gaps,” such as deductibles, copayments, and other costs that you may have to pay out of pocket. Many people with Medicare quickly realize these costs can add up and affect their finances. Today, we’ll discuss detailed information about Medicare plans. 

If you live in Austin, Texas, and need help choosing the best Medicare insurance option, this article will help you decide.

What is Medicare?

Medicare is a U.S. government Health insurance program that began in 1965 under the Social Security Administration (SSA) administered by the Centers for Medicare and Medicaid Services (CMS). Primarily, it offers health insurance to Americans 65 and older, but also to some younger people with a disability status established by the SSA, including people with end-stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig syndrome). 

How to pick the right Medicare Plan

When you turn 65, you need to enroll in Medicare through Social Security, and this process can be confusing. Doing these key facts can help you decide on the best plan.

1. Know the upcoming deadlines: For most people, the enrollment starts three months before their 65th birthday and lasts up to three months after their birthday. You may be able to delay enrollment if you have work-related health insurance. However, check with your benefits administrator to see if your employer’s plan qualifies. If you don’t enroll when you’re first eligible, you may have to pay higher premiums after registering. Suppose you already receive social security or disability benefits. In that case, Medicare will automatically enroll you in the plan.
2. Learn the different parts of Medicare: There are four parts of Medicare. These are Medicare Parts A and B, Medicare Part C, also known as Medicare Advantage, and Medicare Part D, also called Prescription Drug Plan.
3. Decide on which type of plan you want:  Medigap or Medicare Advantage.
   1. If you want to purchase a Medigap Plan: It’s often best to shop for a Medigap policy when you sign up for traditional Medicare because you’re guaranteed coverage regardless of your medical history.
   2. Suppose you want to enroll in a Medicare Advantage Plan. In that case, you’ll want to do additional research to be sure the plan covers all the providers and benefits you seek.
4. Calculate the cost: Your costs are different if you choose a Medicare Advantage plan instead of a traditional Medicare. 
5. Compare Plans: The cheapest premium doesn’t always translate to the lowest total costs. Use the Medicare Plan Finder to compare plans, benefits, and expenses.

Medicare Open Enrollment Period

Medicare open enrollment runs every year from October 15 through December 7. It is the time when you can change your Medicare health plans and prescription drug plan for the following year to meet your needs better.

Now that you know what to do to choose the right Medicare plan let’s discuss more about the different types of Medicare.

Four Parts of Medicare:

Each has its coverage for qualified people.

• Medicare Part A: Includes hospitals (hospitalized patients, only formally admitted), qualified Nursing (only after formal admission to the hospital for three days and not for custodial care), and Hospice services. 

You likely qualify if you are 65 or older (or disabled for at least two years). You must be a citizen or permanent resident of the United States. You or your spouse must also have contributed to Medicare for at least ten years (40 quarters).

Most people usually get Medicare Part A for free, but you’ll pay up to $499 monthly if you buy Part A. In 2022, the deductible is $1,556 for each benefit period, and there may be more than one benefit period per year. 

• Medicare Part B: Part B covers the costs of doctors and other medical providers. Part B includes, for example, Medicare Part B medical services, preventive services, outpatient hospital care and emergency services, and other medical services such as DME (durable medical equipment), chemotherapy, radiation Therapy, part-time or intermittent home care, and services of rehabs (for example, physical and occupational therapy). It may even cover comprehensive dialysis care for people with kidney failure. Think of Part B, which covers services related to people, and Part A, which covers the building where you stay.

Medicare beneficiaries pay a monthly premium. The monthly premium for 2022 will be $170.10 for most people. However, if you have a high income, you could be subject to IRMAA, increasing your premium. If you didn’t select Part B when you were first eligible, you’d pay the penalty unless you had creditable coverage. 

• Medicare Part C: It’s an alternative called Managed Medicare or Medicare Advantage. It is a health insurance plan offered by private health insurance companies. While it doesn’t technically replace parts A and B, it replaces how you use those benefits. You must register for Parts A and B before registering for Part C.
  

Medicare Advantage plans include prescription drugs, hearing, vision, dentistry and fitness programs, meals after surgery, and more. 

The cost of each plan varies. There are zero premium plans and plans that cost more than $100 per month. Visit the Medicare.gov plan finder or work with an agent who can help you decide between several programs. Remember that Plan Finder doesn’t give you information about whether your doctor will accept the Medicare Advantage plan, so we recommend using one of the brokers on this site to help you. 

• Medicare Part D: Also called Prescription Drug Plan (PDP). It provides coverage for prescription medicine. The Federal Government created them to help remove the higher cost of your Retail prescription drugs. Each Part D plan includes a list of covered drugs, known as the drug formulary. The formulas indicate what level your medication is. In general, the higher the level, the higher your costs. You also pay a monthly premium for the drug plan in addition to Medicare. 

Part D is an optional plan. If you qualify and delay enrolling, you risk paying the penalty for increased insurance premiums if you register later. The monthly premium for Medicare Part D varies by plan. If you have a higher income, you can pay more due to IRMAA. 

Medigap Plans (Also called Medicare Supplement Insurance)

Medigap insurance is a contract that helps close the gaps in original Medicare. It helps cover cost-sharing, such as paying the deductible, copayments, and coinsurance. Medigap is standardized, making it almost easy to compare prices between insurance companies that offer the same program. All Medigap plans cover additional 365-day hospital benefits beyond Medicare. Exceeding hospital stays is also rare. 

Since Medigap plans are standardized, beneficiaries receive the same benefits regardless of their carrier. The Medigap plan covers all doctors or hospitals that accept the original Medicare. 

If you plan to move to another state, you can still keep your current Medicare supplement plans. If you are moving, contact your carrier to update your address. Your benefits remain the same, but the premium may increase or decrease depending on the state. 

Medicare Supplement Open Enrollment Period

Open Enrollment for Medigap is when you can enroll in any Medigap plan without answering any health questions. The open registration period prohibits Medicare supplemental insurance companies from denying coverage due to pre-existing health problems.

For most people, the enrollment period only happens once in a lifetime. It’s best to enroll during this period, as the open enrollment period for the Medicare Supplement offers an opportunity to get the lowest possible monthly premium costs. The open enrollment period lasts six months from the effective date of Part B. 

However, if you are in good health, you can enroll in a Medigap plan anytime.

Medicare Advantage Plan

Medicare Advantage plans offer all parts of Medicare in a single policy, making it less confusing. While they comply with the rules and regulations established by Medicare, the cost of an M.A. plan varies depending on the location and type of plan. Many of these plans don’t have monthly premiums. Instead, the Medicare program pays insurance companies directly. 

You are still responsible for Part B premiums regardless of whether you go with Medicare Advantage or Medicare Supplement Insurance. 

10 Reasons to choose Medicare Advantage Plan:

• Maximum Out-of-Pocket Limits: If you have a severe medical condition, you limit how much you have to pay for covered benefits. 

• Dental Benefits: Original Medicare does not provide any dental services. Medicare Advantage plans often include dental benefits, either as a value-added service or as an additional payment for the benefit. 

• Hearing Benefits: If you need a hearing aid and have an original Medicare or Medigap plan, you won’t get additional for this item. However, many MAPD plans include hearing assistance as part of the plan. 

• Gym Membership: Original Medicare doesn’t offer gym memberships, although some M.A. plans do.

• Skilled Nursing Facility Stay: you must have a 3-night inpatient stay in a skilled nursing facility (SNF) before Medicare (or a Medicare Supplement Plan) pays a penny. Some MA plans don’t have this requirement.

• Transportation Benefits: Some Medicare Advantage plans offer transportation benefits if you need help getting to and from the provider’s office or picking up your prescription drugs. 

• Over-the-Counter Item Discounts: Some MAPD plans offer discounts on over-the-counter items when you use network pharmacies. 

• Medicaid Coordination: If you use Medicaid, you can get a special needs plan that coordinates your benefits between the two programs. 

• Emergency Coverage outside the USA: Original Medicare doesn’t cover any care outside the USA except in rare cases. Many MAPD plans offer emergency care when you Travel abroad, which is more comprehensive than Original Medicare. Many Medicare supplement plans also provide a foreign travel benefit.

Helpful information if you or your Elderly loved one is battling addiction or seeking Medicare coverage for alcohol or drug rehab

Does Medicare Cover Alcohol And Drug Rehab?

Medicare pays for specific alcohol and drug rehabilitation and treatment. However, there are things to consider for this access, such as the type of rehabilitation you or your loved one needs and where you seek treatment. Private treatment centers don’t easily accept Medicare or Medicaid.

Medicare Drug Rehab Facilities In Austin, Texas

Older people are among the fastest-growing age groups with rates of substance use disorders. Even if Medicare does not have a specific insurance category for substance use treatment, some services are covered when appropriate and necessary. Click HERE  to see Medicare Coverage of Substance Abuse Services.

Substance Use Services Medicare Cover

The amount of Medicare coverage for substance use depends on several factors, such as the type of plan you have, the state where you live, and others. 

• Inpatient Treatment: It will be covered if reasonable and necessary, including behavioral rehabilitation, physician-supervised detoxification and withdrawal treatment, and medication-assisted treatment. 
• Outpatient treatment: It includes behavioral rehabilitation and counseling. As with inpatient treatment, outpatient treatment coverage would depend on the provider. 
• Partial Hospitalization Programs (PHP) treatment: includes individual or group psychotherapy with doctors, psychologists, or other Mental Health professionals and work-based and activity-based therapies. 

Eligibility for Medicare

You and your loved one are eligible for Medicare if:

• You’re 65 years of age or older.
• Or you are younger than 65 and have a disability.
• Or you are younger than 65 and have an end-stage renal disease (permanent kidney failure that requires dialysis or a transplant).

Criteria to meet to be covered by Medicare for rehab or substance use disorder treatment

• Your doctor or health care provider believes rehabilitation is a medical and behavioral need. 
• Medicare-approved facilities.
• The doctor or health care provider establishes the treatment plan.

Your Medicare plan includes the number and frequency of rehabilitation services you receive, including medications, therapy, counseling, and more. 

Types Of Rehab And Treatment Services Medicare Cover

Medicare covers a wide range of inpatient and outpatient services, divided into parts A and B: 

• Medicare Part A covers inpatient treatment services. Hospital care requires patients to remain in a residential facility while recovering from substance use disorder. These programs usually last between 30 and 60 days.

• Medicare Part B deals with outpatient rehabilitation and Partial Hospitalization Program (PHP) for alcohol and drug rehabilitation. PHP Rehab is a complete version of outpatient care, which can also allow patients to spend the night in sober living residences during their stay.

Original Medicare covers 80 percent of the Medicare-approved amount for these rehabilitation components. Licensed primary care physicians, nurse practitioners, physician assistants, psychiatrists, clinical psychologists, clinical social workers, and clinical nurse specialists administered these Services. Medicare Advantage Plans vary.

Original Medicare generally covers inpatient rehabilitation for up to 60 days. Suppose Medicare no longer covers your rehabilitation. In that case, you will need to stay out of the hospital or qualified care facility (SNF) for 60 straight days before trying to re-enroll in a Medicare-approved treatment program.

A well-experienced Medicare agent is essential because these points can be confusing.

How a Medicare Agent can help you find the best Medicare plan

An agent reviews your health insurance plans and helps you decide or evaluate your needs based on the coverage and services you’re eligible. Medicare agents also represent several insurance companies to help you choose the best plan. They will educate and help you understand the differences between plan types (will show you various carrier options). Agents also help in the management of your insurance enrollment.

Medicare agents provide One-on-one direct customer service. Thanks to Technology, you can talk to them via phone, video, or email. You can even stop by their office if they have one. Medicare agents can complete the application for you. You will answer the questions, and they’ll take care of the rest. Working with an independent agent will not cost you anything as the price is the same.

Two types of agents:

1. Independent Agent: They represent different insurance companies. 
2. Captive Agent: These agents only work with a single or one insurance company

Medicare Agents in Austin:

Are you looking for a comprehensive Medicare Advantage Plan, prescription medicines coverage, or Medigap supplemental plan? An independent Medicare Agent can help you with your inquiry. Visit Certified Medicare Agents Directory and use our free online directory to see our wide range of services. Shopping for Medicare insurance online has never been easier with The Certified Medicare Agent Directory.

Originally Published on https://www.certifiedmedicareagents.com/blog/

Katherine Kline Podcaster, Blogger

I host the Rock Your Retirement Show, which is about Lifestyle, not money or insurance! I started the show in 2016 before anyone knew what a podcast was, and now it's had over one million downloads. At this point, there is a lot of information in our back catalog and we try to release an episode every month.

I'm a retired Financial Advisor (after 25 years) and now I try to have fun with my husband, my dog, and my friends.

I'm also the founder of CertifiedMedicareAgents.com, a site that brings insurance agents together with people who are looking for help with Medicare.