FAQ

The best thing to do is do some math to determine what is in your best interest. This task can be complicated yet simplified when the right questions are asked. Here are a few of the questions I ask when speaking with someone in this position: Do you have coverage now? If not, Medicare sign up would be strongly suggested. Where do you get the existing coverage? How much does it cost? If there is a cost, we compare that cost/benefit structure against going onto Medicare as we run an A/B comparison. Are there others on the current plan that need to be considered? How is your current plan working for you?

We like to perform a brief comparison for you based on overall costs and benefits. If we know your current situation and how it will look into the future, we can compare that with Medicare plans with several different options and considerations. Often this is a lot simpler than you imagine. One example would be if your employer coverage is ending when you turn 65.

Because this topic is confusing and we can help. Yes, you could probably do it all on your own, however, even the most astute of us may not be able to know details left unprinted and unspoken. In short, you don’t need us, however, we can make the entire process much simpler and time-consuming for you. We also keep current on the Medicare industry so we can make suggestions to change your plan as your life continues to change.

That is part of our job - to look them up across all plans available that are being considered. Network physicians may also be looked up in the company directory, online or by calling your physicians’ billing department.

Give us a ring - 845.532.2270

Typically yes. The only exception I know of is if you have been on social security disability for 2 years. Then enrollment in Medicare is automatic.

This may be done in several ways: Online at www.ssa.gov Online at www.medicare.gov By calling Medicare (1-800-MEDICARE) - *Usually this requires a callback at a far out future date. By going into a local Social Security Office *Highly recommended

This is a moving target. I’ve heard of some people walking into the local SS office and walking out with Medicare and the awards letter. Others take time. One gentleman told me he applied online and the 7th attempt finally worked, yet he achieved his goal. Online, if all goes well, it can happen quickly and the awards letter is available within a week of a successful application.

Part A covers hospitalization in a semi-private room, with copays (part A has no cost if you are fully vested in SS). Also included is the skilled nursing benefit. Part B covers Medical expenses such as doctors, specialists, testing and surgery to name a few. There are some drugs covered under part B as well. Particularly drugs that are administered in a hospital, clinic or physician office setting.

This is a complex topic that we should discuss in detail. Generally speaking, but not always, I prefer to say Medicare Supplements (synonymous with MediGap Plans) typically offer scenarios where you have a larger premium and have more robust hospital and medical coverage (reduced financial exposure). That is one advantage. No network is also an attractive attribute to many as any doctor or facility that takes Medicare will work with these plans. These supplemental plans do not include drugs and we will locate a suitable drug plan matching your particular needs for you to add.

Medicare Advantage plans (synonymous with Part C plans) are more like a “buffet” of benefits. The history of the birth of these plans is noteworthy. Essentially, they were built as a less expensive (from a premium perspective - but not always- to the Medicare Supplemental platform). As supplements rose in price, insurance companies petitioned Medicare suggesting that they administer Medicare for any individual, in a particular market, that elected to do so. Medicare approved this new configuration providing the insurance companies offer coverage that is as good as if not better than original Medicare. Generally, they utilize networks of providers (many offer out of network benefits as well) where copays may be lower. Usually, you have some cost sharing for most, if not all services. Many include a drug plan (part D plan) as well. The most popular ones we larket have significantly lower premiums than the supplemental alternatives. Some also offer enhanced, albeit limited, additional benefits like dental, vision and/or gym memberships with the plan.

Many states have pharmaceutical plans that can really help reduce costs. In New York, it is called EPIC. In NJ it is called PAAD. In Ny, the income threshold for assistance is generous by the standards from other states. Nor is there an asset test to qualify. At the time of this writing, the married maximum income is $100,000 & $75,000 for a single person. While there are many, here are are a few other ways to save: Reach out to the manufacturer for a program they may have LIS (low income subsidy) also known as the extra help program may be the most helpful if you qualify Foreign sources.

Contact us and we can look at options, speak with you and see if you may qualify for any one of the many programs you may have access to. You can also go to the local Office for the Aging or call the social security office. There are many ways to save money if you know what they are.

Yes you can! If your income is below a certain threshold (in 2020 it's ~$1450/month for a single and ~$1950/month for a married couple). If your income is even close, I urge you to speak to a specialist. Here we can be very helpful. We help many people with this as most DON’T EVEN KNOW THEY QUALIFY! It is notable that in New York State, there is no asset test for this program known as an MSP, the Medicare Savings Plan.

Penalties can ensue if you do not have “creditable” coverage in place. This determination is made by CMS (Center for Medicare & Medicaid Services). You can inquire with your current plan and they can draft a letter stating your current coverage meets those standards. This documentation is important especially if you have a delayed entrance into part B or have not accepted a Part D plan when originally eligible for Medicare Part A. Medicare and your Medicare Part D plan will need this letter to avert any potential penalty as it remains with you for life! The penalty is 1% of the average national cost for a Part D plan and it can add up; not to mention you may not have rx coverage during that time elsewhere as well.

Medicare remains with you for life. Deductions from your SS check are made to cover the cost. If you are not actively collecting SS, they will bill you quarterly.

Not under medicare, They will have to locate an outside source for this.

Again, we like to look at scenarios for comparison. Where is the least expensive option and what do those benefits look like in comparison to the alternatives. Currently, the most popular solution has been to guide people to the exchange as there may be subsidies available to you depending on your household income and a variety of other things. If there is a subsidy (premium assistance) available, then it will be difficult to argue not using that platform for family members that are not Medicare eligible.

You may or may not. Probably not if you are moving to a supplemental plan. For a Medicare Advantage plan, maybe, We like to have at least two main coordinates to consider a Medicare Advantage Plan for you….those are - all or the majority of your doctors are in the network (so they don’t have to change) and second, that your drugs are treated fairly by the plan. If these two “tests” are met, the plan may be a suitable solution for consideration.

This is a federal program that can help reduce the cost of drugs drastically (and reduce or eliminate part D premiums). This is one of many programs that can change things substantially for individuals. Qualifications are income and asset limits.( IMO, the income thresholds are generous). We can point you in the right direction. You can also reach out to social services or social security directly for determination and application.

These are the questions I think you should ask yourself about your plan: Is it working for you? Are you happy with the copays, doctors and premiums? Have you had to use it much? Have you compared it with all available plans in your area?

No and yes. Between 10/15 - 12/7 it is AEP (annual enrollment period) and everyone can make a change to be effective for 1/1. Most years they allow a single change during the 1st quarter. Other than that, you will need an SEP (special enrollment period). If you have EPIC in NYS, this is an automatic SEP and it is easy to get. There are many SEP’s and we can talk about them.