Jen Peppe Hahn Independent Insurance Agent

Making health insurance understandable, one customer at a time

Maryland and DC Licensed

HOSPITAL

MEDICAL

MEDICARE ADVANTAGE PLAN

PRESCRIPTION

COVERAGE

MEDIGAP/

SUPPLEMENT PLAN

Medicare Explained

Start with Part A and Part B. Create an account with the Social Security Administration to sign up for Part A and consider timing for Part B* https://www.ssa.gov/

Create an account with Medicare https://www.medicare.gov/

Medicare Part A and Part B

(red, white, and blue card)

Part A = Hospital Insurance

Coinsurance: days 1-60, 0%

Deductible: $1,676 (per benefit period)

Premium $0 for most people (see Medicare. gov Part A costs)

Inpatient Care in a hospital

Skilled Nursing Facility

Hospice

Some Home Health Care

example: (amounts are just for the example) You are admitted to the hospital for three days. Your bill is $5,000. Before Part A kicks in, you are responsible for the $1,676 deductible if you do not have a Supplement/Medigap Plan or Part C

*If you have an HSA you must stop contributing to it 6 months before attaining Part A or risk a penalty

Part B= Medical Insurance

(covers 80% of Medicare Approved Services)

Coinsurance: 20%

Yearly Deductible: $257

Monthly Premium: $185.00**

**(unless you fall into a higher income bracket): https://www.cms.gov/newsroom/fact-sheets/2024-medicare-parts-b-premiums-and-deductibles?mibextid=zxz2cz&mod=anlink

Doctor's Services

Outpatient Care

Preventative Care

Durable Medical Equipment

Some Home Health Care

example: (amounts are just for the example) Your first appointment of the year is $357. You pay the one time $257 deductible, the remainder of the bill is $100, Medicare covers $80, you are responsible for $20. Next time you go to a doctor and the bill is $100. Since your deductible is met Medicare pays $80, you pay $20.

Some people get a Medigap/Supplement Plan to cover the remaining 20% - see below "OPTION 1," OR

They enroll in Part C which has set copays per service rather than 20% coinsurance - see below "OPTION 2"

https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start

https://www.cms.gov/Outreach-and-Education/Find-Your-Provider-Type/Employers-and-Unions/FS3-Enroll-in-Part-A-and-B.pdf

Do I need Part B and when do I get it?

https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start

*Many people sign up for Medicare during their Initial Enrollment Period (IEP). This is the three months before you turn 65, the month your turn 65, and the three months after. If you sign up after your IEP you may be assessed a lifetime late penalty. An exception to this is if you or your spouse are still working allowing you to receive creditable health coverage through an employer. If this is the case, when that coverage ends, you will have a Special, 8 month Enrollment Period for Part B. Keep in mind, even though enrolling during that time will alleviate a late penalty, you only have 6 months after getting Part B for the first time to purchase a Medigap plan Guaranteed Issue (no underwriting and preferred rate), and just 63 days to get a Prescription Drug Plan penalty free. It is always best to resume coverage as soon as possible after losing employer coverage. You may also need to talk to your Human Resources department to see how your retirement benefits (if any) work with Medicare. https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/working-past-65/getting-medicare-when-you-retire

*If you are getting Social Security benefits, you automatically get Part A and B when you turn 65. If you wish to delay Part B because you already have creditable coverage, you must contact the Social Security Administration.

Most people take Part A when they are entitled to it (even if they delay Part B) because if you have worked full time and payed taxes on that income for ten years in your life in any order, it is free. You can sign up three months before you turn 65 for an effective date the first day of the month you turn 65. If you sign up after you turn 65 it is retroactive for 6 months (but not before the month you turn 65)

*If you are not getting Social Security Benefits, you can sign up for Part A and B during your Initial Enrollment Period which is three months before you turn 65, the month you turn 65, and three months after or upon losing creditable employer coverage. Sign up on www.ssa.gov

*If you have creditable coverage through an employer or spouse's employer, you may choose, with no penalty, to delay enrollment into Part B past your 65th birthday until you no longer have that coverage. During your IEP, however, you should compare the costs of your current coverage to Medicare to determine if the best path forward is to keep your employer based coverage, cancel it and transfer to Medicare, or have both. Check with your benefits department, they may have their own requirements. If you are self-employed or work for a company with less than 20 employees, sign up when you are first eligible at 65.

*The bottom line: When you are getting ready to turn 65, talk to an agent and your employer's benefits department to determine whether to start Part B or wait. If you delay Part B, sign up as soon as you lose other coverage or you risk a lifetime of late penalties

(See Medicare.gov for a complete list of scenarios)

Part B total cost, if in the standard income level category:

$185.00 a month premium**

$257 total deductible in 2025

PARTS A AND B DO NOT COVER EVERYTHING. A MAJORITY OF PEOPLE FILL THE COVERAGE GAPS OF PARTS A AND B ONE OF TWO WAYS:

Once You Have Part A and Part B

OPTION 1 Original Medicare:

A+B+D+Medigap/Supplement

There is a six month period right after you sign up for Part B in which you have a Guaranteed Issue (no underwriting and preferred rate) right to purchase a Medicare Supplement/Medigap Plan. After that, you will have to go through underwriting, costs can be higher, and it may be difficult to get a Medigap Plan.

Premium: Varies by plan, company, and area but remains fairly stable with low increases over time

No networks

Generally no referrals

You can go anywhere that accepts Medicare in the US

Generally no Prior Authorizations

Supplement Plans are a perfect compliment to Part A and Part B. Plans A-N are secondary to Part A and B and cover some or all of the costs that Original Medicare does not. For instance: Plan G covers the entire 20% of Coinsurance that Part B does not. So that $100 doctor's bill that Medicare Part B paid $80 for, and left you owing $20, is now 100% paid by insurance

Plan G example: Bill- $100, Part B paid $80, Plan G Paid $20, you owe $0.

Plan G also covers the entire Part A deductible ($1,676)

Plan N works similarly. It covers all of the things Plan G covers except you will owe a $20 copay to see your doctor or a specialist and a $50 copay to go to the ER. Plan N does not pay "excess charges." I have never known someone to incur these charges through a doctor or facility that accepts Original Medicare

Plan N example: Doctor's bill $1000, Part B pays $800, Plan N pays $200, you owe your doctor a $20 copay for the visit

The plans, REGARDLESS OF WHICH COMPANY SELLS THEM, have to offer THE EXACT SAME BENEFITS as the same lettered Plan sold by a different company. DO NOT choose your Medigap Plan by name brand, choose by most suitable letter of coverage, and then only by price

Configuring your Medicare this way has no out of pocket maximum, however, with a Supplement like a Plan G, your out of pocket expense for services is typically $0

*(See the chart below for the differences in Supplement Plans A-N)

Maryland has something called the Birthday Rule. Every year, for 30 days following your birthday, you can switch to an equal or lesser benefited Medigap plan if there is one with lower pricing.

example: You have a Plan G through Company A, who charges $150 a month. You call your agent and ask if there is another carrier that offers Plan G for less money. They find you a Plan G with Company B for $130 a month. You are able to switch to Carrier B in the 30 day period after your birthday. Your benefits remain exactly the same, because a Plan G is a Plan G regardless of the carrier and if your doctor's office accepts Original Medicare, they must accept all carrier's Plan G's because your Medigap Plan is secondary.

Part D is for Prescription Coverage. Medigap/Supplement Plans do not include prescription coverage, so you will need to add a stand alone Part D plan. Your Part D coverage will have to be reviewed every year during the Annual Enrollment Period (Oct 15-Dec 7) to assess whether it is still your most suitable option, determined by any changes in your medications and the respective carrier's changes in price and formularies. Just like Part B, whose premium is higher if you are in a higher income bracket, Part D also uses IRMAA, the Income Related Monthly Adjustment Amount that is assessed by the Social Security Administration and may add a surcharge to your Part D premium

Medicare Costs: https://www.medicare.gov/Pubs/pdf/11579-medicare-costs.pdf

OPTION 2 Medicare Advantage:

C+ (still pay B premium)

These Plans are described as wrapping Part A, Part B (MA) and sometimes Part D (Prescription Coverage) (MAPD) all into one plan issued by a private insurer, and therefore become your primary insurance rather than Original Medicare. Keep in mind you still have to have Part A and B and pay for your Part B Premiums. Instead of owing 20% coinsurance for Part B services, your cost sharing is a set cost/co-pay per procedure/visit/test

Part C Plans usually have low or zero premiums, require that you stay in network with an HMO, in network with a PPO, or pay more if you go Out of Network with a PPO and are run by private insurers. As opposed to Original Medicare (Part A and B with a Medigap policy) where you can go anywhere that accepts Medicare because Medicare is your primary insurance, because Part C plans are run by private carriers you have to make sure your doctors are in their network. In addition to that, Part C Plans generally require referrals to see specialists and prior authorizations for procedures. There are different types of Part C, Medicare Advantage Plans:

https://www.medicare.gov/health-drug-plans/health-plans/your-coverage-options/compare

Part C plans, their coverage, and their drug formularies can change yearly so if you opt into a Medicare Advantage Plan (Part C) instead of Original Medicare with a Supplement (Medigap A-N) plus Part D, you will have to be diligent every Annual Enrollment Period October 15- December 7 and review you current coverage's Annual Notice of Change to make sure it is still the most suitable and cost effective plan for you the following year.

Part C (Medicare Advantage) plans sometimes offer extra benefits such as some dental, vision, over the counter pharmacy costs, and/or other perks that can change, where as Original Medicare (Part A and B) with a Medigap Plan have predictable monthly premiums and benefits that will not change yearly, i.e.: Plan G's benefits in 2025 will be Plan G's benefits in 2030.

Because Medicare Advantage Plans (Part C) have costs per service, over time your expenses can add up. The good news is that your Part D (prescription coverage) is sometimes wrapped into the costs of Part C. It is very important when choosing a Part C that your agent makes sure the doctors and any hospitals or facilities you go to accept the plan you choose (before choosing it) since you will have to stay in network or pay more. It is equally important to confirm that your current meds will be covered if it is a MAPD (Part C).

Part C example: (noted that each plan has different cost structures this is a random example) You see your primary care Dr $0, they send you for an x-ray $15, it is determined you need a CAT Scan $150, you are sent for a biopsy $350, you are referred to a specialist $50, and you end up needing surgery ... As you can see cost is completely dependent on how much you use the plan.

Below is the same scenario, for comparison, with Original Medicare (Part A and B) and Medigap Plan G (from "Option 1"):

All costs are zero because you have paid your monthly Part B and Medigap Plan G premium, and your Plan G covered the 20% left on each of those visits, tests and procedures after Part B paid its 80%. In addition to that, you needed no referrals or prior authorizations and you went to any doctor you wanted that accepted Original Medicare for each respective part of the example (you may still be asked for a doctor's order so they know what to x-ray but they will not deny the x-ray if they accept Medicare).

I will caution you here... I have had clients ask their physician's offices if they accept their Plan G or if they accept the carrier that provides the Plan G. I have had clients told no and I have had to call the office back with my client on the line. No office that accepts Original Medicare can deny you coverage from your Original Medicare + Medigap/ Supplement Plan. Because your Medigap Plan is secondary. it does not ever need to be approved or disapproved by your office. It is the law. Unfortunately a lot of people at the front desks in offices confuse "Medicare," the very term, with "Medcare Advantage," (Part C), which is a whole other thing. With a Part C/Medicare Advantage Plan, you need to triple check that your preferred doctors will accept your specific Part C/Medicare Advantage Plan (this can also change yearly with Part C).

It may look appealing to grab a Part C/Medicare Advantage Plan when you turn 65 because you are in good health and want to save money now and consider changing back to Original Medicare with a Medigap/Supplement Plan later, but don't forget, it can be difficult to obtain a Medigap/Supplement plan once you are older and need to pass underwriting.

Configuring your Medicare via a Part C plan, comes with an Out of Pocket (OOP) Max. The threshold may be higher for plans that allow you to see out of network providers. Part D coverage and premiums through your Part C, do not count toward your OOP Max. Deductibles, co-payments, and coinsurance from in network providers all count toward your OOP Max.

See pages 5-6 of: https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf

Insurance is called insurance for a reason. As we get older, health concerns can increase. Choose the most suitable coverage taking your future needs into as much consideration as your current state of health. In contrast to your Medigap plan's carrier/brand not mattering, (again Plans A-F should only be compared amongst same letters by cost), the brand and reputation of Part C Plans are important. Make sure to pay attention to their Star Ratings which are determined by quality of care and customer service among other things. Agents/Brokers are very good resources for your evolving health insurance needs. If you live in Maryland, and would like to discuss your coverage, feel free to reach out with no pressure or obligation to get, or change plans. I look forward to speaking with you.

Yours in health,

Jen Peppe Hahn

Disclaimer: I do not offer every plan available in Maryland and DC. Any information I provide is limited to the plans I do offer in your area. If I do not sell the plan that would be the most suitable for you, I will tell you. To see all plans in your zip code, go to https://www.medicare.gov/ call 1-800-MEDICARE or visit your local State Health Insurance Program (SHIP). The options and examples presented on this website are not representative of a complete set of your choices. To personalize your options please fill out the contact form, call me, or send me an email.

301 698-8902 JEN@JPEPPEHAHN.COM