Medicare explained, Medicare made easy, Medicare made clear,
no matter how we word it in the title of all of these videos that you're watching
understanding Medicare is not always easy. I know that. I hope to solve that with this video. In this video
I'm going to help you learn about Medicare explained in an easy to follow format.
Medicare will be made clear to you. You'll understand how Medicare Works.
You'll understand about Medicare Part A and about Medicare Part B
and the choices that you have to make a once you've signed up for Medicare Part A and Medicare Part B.
Once you have signed up for Medicare Part A and Medicare Part B you'll have to make one of three choices.
We're gonna go over each of those choices. The pros and cons of each so that you can make
an informed decision once you sign up for Medicare. Stay tuned.
Medicare Explained by MedigapSeminars.org' an independent Medicare insurance broker licensed in 47-states.
Hi, I am Matthew Claassen with MedigapSeminars.org. I don't intend for this to be a long and boring video.
Medicare explained properly can make understanding Medicare easy, and can be done
in under 30 minutes. That's my goal for this video!
Once you understand the basics of Medicare Part A & Medicare Part B you will be faced with making one of three choices with your Medicare
This can be one of the most important decisions that you make in Medicare.
It will set you on a course that will impact the quality of the Medical Care that you get
and it could potentially be irreversible.
To keep this video brief I have done a separate video on how, when and where to sign up for Medicare. If you haven't signed up of for
Medicare yet and you would like to learn that first, I've linked it in the upper right of this video. There is a white circle with an "i"
You can click on that and go to the How To Sign-Up for Medicare video.
I will also have that linked at the very end of this video in the last 30-seconds when we link some videos on the screen for you.
First up in this Medicare Explained video is terminology.
Often when people start to learn about Medicare they trip up on the terminology.
Often it is common insurance terminology. So we're gonna cover this first, very briefly.
The first terms that you should be familiar with are Deductible, Copay, and Coinsurance.
The deductible is the amount of money you have to pay first, before your insurance pays a benefit.
A copay is a portion of the bill that you pay after you pay the deductible.
You'll pay the Copay upfront, often when you have the service itself. And the copay is always in a dollar amount.
For example; if you pay $20 every time you see a doctor, that's a copay.
Coinsurance is like a copay except it refers to a percentage. It is a percentage of the bill that you, the consumer, have to pay.
So, putting all this together; if you have a $200 deductible, a $20 copay and 20% coinsurance, it means that you're going to pay the first
$200 in services, that is your deductible.
If you are seeing a doctor and there is a $20 copay, you pay that $20 during the office visit.
If you have a 20% coinsurance it means that when you receive the bill, after you've paid the deductible and the copay
You're gonna pay 20% of the remaining Bill. It's very common for people to confuse a
deductible and a premium. The premium is also an important turn to understand.
With your Medicare Part B, we'll get into the moment, you have a premium. A premium is a monthly fee, your monthly cost to purchase the
insurance. A deductible as something that is paid when you use the insurance. The premium is what you pay to have the insurance.
It's important to understand this terminology, but don't get lost in the details of co pays and deductibles and co insurance
As I mentioned earlier, and we are going to get into detail here in just a bit, you're gonna have to make one of three choices. In two of the
three choices the deductibles, copay and coinsurance that you have in your Medicare & You guide book are rendered moot.
In two of those three choices, you do not need to understand those specific co pays and deductibles. So don't get lost in them.
Understand the big picture as we're gonna present here.
With terminology out of the way, next in this Medicare explained video is Medicare Part A & Medicare Part B.
Medicare Part A is that portion of your Health Insurance that covers you when you're in inpatient.
As soon as you are registered as and an inpatient and a hospital, or nursing facility, or a hospice
Medicare Part A takes over. Think of Medicare Part A is inpatient services insurance.
Whenever you're in inpatient hospital, nursing facility or in a hospice that's your Medicare Part A . Also the one exception
is if you're physically not able to get to a hospital or medical facility Medicare Part A also covers In-Home Health Care.
For most of us, we have paid for our Medicare Part A with a payroll tax. That's the 1.45% payroll tax that comes out of your paycheck
every paycheck when you're working. That covers Medicare Part A. As long as you have paid that tax, or I should say as long as
you or your spouse have paid that that tax for least 10 years, then Medicare Part A has no additional cost for you.
If neither you nor your spouse paid that tax for 10-years, Then you can still get Medicare Part A, but it will cost you a monthly premium.
So, for most of us Medicare Part A is already paid for.
Lets talk about Medicare Part B next in this Medicare Explained video.
Medicare Part B is your outpatient and Physician Services insurance.
if you're not an inpatient, obviously you;re an outpatient and that is your Medicare Part B Health Insurance coverage.
So Medicare Part B is the insurance you use when you see a doctor. When you have a lab test or wellness services. Medicare Part B
is that part of your Health Care insurance that people use most often. It's whenever you see a doctor outside a hospital in
even many of the hospital services and surgeries are now done on an outpatient basis, which would then mean they're covered under
Medicare Part B. Everyone has to pay for Medicare Part B. You have to pay a premium for it.
And everyone needs Part B unless you already have or are continuing with employer Health Insurance coverage and
your employer has 20 or more employees. Absent that, you will need Medicare Part B
and you're going to need to pay for it. How much you pay for your Medicare Part B
depends on your adjusted gross income as of two years ago, and going to depend on when you start your Medicare Part B as well.
in 2018, if your adjusted gross income two years ago was $85,000 or less filed individually, or $170,000 or less if you file jointly,
then you're Medicare Part B premium was $134 a month.
If your income was higher, your payments towards Medicare Part B are also going to be higher.
To find out exactly what is going to be for you in the year they are watching this video
simply go to Medicare.gov, the Medicare web site, and the search bar type in the "cost of Medicare Part B"
and that will tell you what you're gonna pay for your Medicare Part B. It's also called an income adjustment.
and just as an FYI, the same income adjustment that you have, if you are eligible for for your Medicare Part B
will also impact your prescription drug costs, your Medicare Part D prescription drug premium.
In my previous video on How To Sign-Up for Medicare I also cover how and when you can qualify for delaying your Medicare Part B.
Please see that video How To Sign-up for Medicare for those details.
So to recap; Medicare Part A is your inpatient hospital coverage. It's going to cover you if you're admitted as an inpatient in a hospital,
in a nursing facility, or in a hospice, or if you can't make it to one of those facilities and you need in Home Healthcare
Medicare Part A covers that. Medicare Part B is outpatient services and Physician Services.
That's the part of Medicare that you're gonna use most often
and it covers you when you see the doctor, it covers you for your lab tests and all the other outpatient services.
Together Medicare Part A and Medicare Part B are called Original Medicare. It's an important term that should understand.
We'll refer to it several times during this video. Original Medicare is Medicare Part A and Medicare Part B combined.
That's the pillar or the foundation of Medicare.
Your Original Medicare, Medicare Part A and Medicare Part B, is good in any state, in any territory, anywhere in the country.
You can see any doctor, you can go to any medical facility as long as they accept Medicare.
You don't have to ask permission to see a specialist. You have control over your Health Care
and you have freedom. That's if you have Medicare Part A and Medicare Part B.
Both Medicare Part A and Medicare Part B have co pays and deductibles. In addition to that, Medicare Part B also has coinsurance.
It has a 20% co insurance. That means that after you've paid the
deductible and after your co pays you still have to pay 20% of whatever the remaining portion of the bill is.
Rather than go through all the details of deductibles and copays, understand the bigger picture here that you're
going to have to make one of three choices. Now and two of those three choices you're not
going to have to know the specific co pays and deductibles in your Medicare & You guide book.
But no matter what choice you make, you will have to still pay for your Medicare Part B. Your Medicare Part B premium
will be there for you no matter what choice you make. Next in this Medicare Explained video are your choices. What are your three choices?
The first choice; do nothing. Just have your Medicare Part A and your Medicare Part B.
This is the only choice that you make that it's going to be important to understand all the details on those co pays and deductibles.
You're going to find when you look into them that there is no maximum annual out of pocket limit.
you are at substantial financial risk if you get ill.
Original Medicare, Medicare Part A and Medicare Part B alone was never meant to be your entire insurance.
Still it's a choice some people make and it's a choice you can make if you wish.
Your next choice, choice number two is to trade in your Medicare Part A and Medicare Part B for a Medicare Advantage Plan.
Medicare Advantage Plan's most people know as the HMOs and PPOs of Medicare. They are also called Medicare Part C.
Medicare Part C, aka a Medicare Advantage Plan
replaces Medicare Part A and Medicare Part B. You're replacing the co pays and the deductibles of Medicare Part A and B with the
copays and the deductibles of a private, for-profit insurance company.
With Medicare Part C, a Medicare Advantage plan, you still have co pays, you still have deductibles, you still have coinsurance.
It is just not the same co pays, co insurance that you have with Original Medicare. It's not less either.
It's just not the same. So instead of understanding the co pays and deductibles in your Medicare & You guidebook, you need to
understand those that are provided to you by the insurance company that you choose to work with.
I have an entire video on the details Medicare Advantage plans, but here are some of the pros and cons that you should consider.
First Medicare Advantage plans are NOT enhanced Medicare. In fact by rules or regulations a Medicare Advantage Plan is
designed to be actuarially equivalent to just having Medicare Part A and Medicare Part B.
What's that mean; actuarially equivalent?
It means that with all the people on the plan, half the people on the plan are going to pay
less for their Health Care than if they had just Medicare A & B.
Half of the people are gonna pay more for their Health Care than if they had just Medicare A & B.
Your experience is gonna be different from one person to another, and it's gonna depend entirely on your health needs.
Now on the positive side is many of these Medicare Advantage plans have a zero premium.
Matter of fact, in the southern half of the state's there often sold as a zero premium Medicare.
That's a little bit deceptive.
The truth is you're not paying any different if you have a zero premium plan than if you have original Medicare and
you're getting an actuarial equivalent.
So,it's not that you're getting enhanced coverage, and they all throw in something like dental or vision.
Be very careful with that. Often these are extremely limited dental or vision care that you could replace with $10.00 a month elsewhere.
Be very careful it's not enhanced Medicare coverage. So what's going on? What is this Medicare Advantage all about?
I mention with original Medicare that you have complete freedom and control you can see any
doctor, anywhere in the country. You can decide who you want to treat you.
With Medicare Advantage plans you're giving up that freedom and you're giving up that control for a maximum annual out of pocket limit
Original Medicare has no maximum out of pocket. You can be completely exposed financially.
A Medicare Advantage Plan sets a limit.
It might be a high limit. But it sets a limit on how much money
you are exposed to on an annual basis. So that's the tradeoff. You have to weigh for yourself whether or not it's worth it for you.
But you should also consider all three of your choices before you make that decision. Medicare Advantage plans will often also
include a bundled prescription drug plan. A bundled Part D plan. That could be a good thing if you have no or very few prescription
drugs that you're taking because it might save you that $20 premium that you would have to pay for prescription drug plan.
However, if you have a lot of prescription drug plans available, that is really what you want to look at because you could end up paying more
for your prescription drugs with the Medicare Advantage Plan than if you're able to shop for your own prescription drug plan as I show in
my other videos. Now this is very important; you're not allowed to have your own stand-alone prescription drug plan
when you have a Medicare Advantage HMO or PPO.
That's very important. If you were to go and get a standalone prescription drug plan
Medicare will actually cancel your HMO or PPO, cancel your Medicare Advantage Plan.
You cannot have both. You have to take the prescription drug plan that's bundled with your Medicare Advantage Plan.
It's also important to understand that Medicare Advantage Plan are local coverage. It's a trade off of choices. With Original Medicare
if there's a specialist you wanna go see in Texas and you're in New York, you can do that.
When you have a Medicare Advantage Plan you can't. You have a a local network that you typically have to stay within; local coverage.
If you a Snowbird and you live in two different or three different states, that should rule out a Medicare Advantage Plan as it is.
Or if you're an RV'er and you like to travel, that too should rule out a Medicare Advantage Plan. If you have a Medicare Advantage HMO
or PPO you're going to have a network, a select group of doctors that you are supposed to see. If you have an HMO
you can go out of that network without paying 100% of the medical cost yourself.
Other than an emergency, with an HMO outside of the networks, it's on you.
With a PPO you can still see other doctors in Medicare, other doctors that accept Medicare anywhere in the country.
But, it is gonna cost you more. In some cases that cost can be prohibitive. Lastly, Medicare Advantage plans change every year.
Anything about these plants can change. Your doctor may not be on it next year. Your hospitals can change. The copays and
deductibles the Part D drug coverage;
every feature of a Medicare Advantage Plan can change each and every year.
That's why there is the Annual Election Period. Some people call it open enrollment. It's technically an Annual Election Period.
That's from October 15 through December 7 of each year.
During that time, you can look at the plans that are available to you as they are for the year ahead and select
which one you want. You can keep the plan you have or you can select a new one.
Those are your options
Just remember, you have to do that each and every year because
the plans will change each and every year. And you should notice as your shopping through Medicare Advantage plans that
Medicare gives them a star rating from a low of one to a high of five.
That star rating is important. It shows you how old they have been rated by other users.
Other people in Medicare, how they've been rated on how the insurance plan treats you.
So that's very important and we're gonna get more into that the second. But when you're in evaluating
Medicare Advantage plans, that star rating is an important indicator. To recap your first two choices;
first there is do nothing. Just have Medicare A & B, Original Medicare.
You have the freedom to see any doctor in the country, you have control over your Health Care
But, you do not have a financial cap. You don't have a cap or limit on your financial exposure.
Choice number two is to trade Original Medicare in for the actuarial equivalency run by a private for profit insurance company.
You are going to give up your freedom and your control over your Health Care, but you're gonna have a limit financially.
You'll have a maximum annual out of pocket limit so that your financial exposure is capped on an annual basis.
Your third choice is to keep your Original Medicare. Keep Medicare Part A & B and add to it. Enhance it with a Medicare supplement.
A Medicare supplement will then pay the copays and deductibles that would have been left as your financial responsibility.
With the Medicare supplement plan you can limit your annual out a pocket expense
for medical bills to zero or just a couple $100. Medicare supplement plans are also called Medigap plans.
Same thing Medicare supplement or Medigap. Medicare supplement plans are subservient to Medicare.
Medicare supplement plans are administered by a private insurance company, but they are subservient to Medicare.
Here's how works; you go a doctor. The doctor will bill Medicare. Medicare pays its portion then Medicare will instruct the Medicare
supplement company what to pay and when to pay it. There's no debate, there's no argument.
There's nothing the Medicare supplement plan can do to ovoid paying something.
and it will never be in by something that you even look at. Medicare is the middle person so that you're never having to deal with the
insurance company other than paying your premiums and telling them when you've moved.
With Medicare supplement plans it's very important to understand it is completely different than the Medicare Advantage Plan
They are subservient to Medicare and they pay the claims Medicare tells them to pay.
There are no star ratings with Medicare supplement plans. That's important to understand, an important distinction.
Why are there no star ratings? There are no star rating for the supplement plan because your experience
with the supplement plan is actually your experience with Medicare.
Its original Medicare making those decisions, not the insurance company. The benefits of a Medicare supplement plan are standardized.
They are meant to be exactly the same from one company to another. In fact
those benefits are written into Social Security law. There are 10 different Medicare supplement plans. They are each designated
by letter. The most common are Medigap Plan F, Medigap Plan G, Medigap Plan N, Plan C etcetera.
Each and every one of those plans, if it's a Plan G it's identical from one company to another
Plan N's identical from one company to another
Because the benefits of those plans are written into law to be exact, to be identical. The only difference is your price and the pricing strategy
of the insurance company. With the Medicare supplement plan you still have Original Medicare
You can still see any doctor or go to any medical facility in the country that accepts Medicare.
You don't have to get permission. You have complete freedom, you have complete control of your Health Care and now you have a
financial maximum annual out of pocket that can be limited to down to zero or just a couple $100 a year.
It's also important to understand and when you have a Medicare supplement you don't need to
ask your doctor "Do you take insurance from company "X"? All your doctor or hospital has to do is take Medicare.
It doesn't matter which insurance company that you have your supplement plan with,
as long as they take Medicare they take the supplement. The easy way to word that is "Every doctor and every hospital that accepts
Medicare accepts every Medicare supplement from any insurance company.
Medicare supplement plans have their own premium, they have their own cost separate from Medicare.
For most people they find that the cost of a Medicare supplement is substantially less
than their under 65 medical insurance that they have been paying for.
When you have a Medicare supplement, you have Original Medicare you also will need to get
your own separate standalone prescription drug plan.
For some people that will be a good thing because when you can shop for your own prescription drug plan
you'll often save money over some of the alternatives with Medicare Advantage plans.
As long as the cost of a Medicare supplement can fit into your budget
the Medicare supplement and Original Medicare is some of the best Health Care that is available in this country.
This is very important -
in virtually every state in this country, all but a few states
there's only a six month window that you have are you can get the Medicare supplement plan of your choice
without having to go through medical underwriting.
You should be, by now, aware of your Medicare Initial Enrollment Period.
There is also a Medicare supplement Initial Enrollment Period. It's a separate period.
Your Medicare supplement an initial enrollment period
starts the day you start your Medicare Part B and extends for six months. It's a six month window of the very first six months
that you have Medicare Part B.
You can get any Medicare supplement plan available to you, at the best price that plan is offered. After that six0month period you can
still shop for Medicare supplement plan but in order to get one you'll have to qualify medically. To qualified medically
we will take a look at your medical history and your prescriptions. If you've had any significant
recent histories of heart attack stroke cancer dementia, very significant events
then you may not be able to get a Medicare supplement. This is something that I have seen all too often; people going with the Medicare
Advantage Plan thinking they will just save money 'cause they're healthy anyway.
A couple years go by, something happens and now they're looking and although the cost their associated with their Health Care and Medicare
Advantage Plan and they would rather have a supplement. So the call me up during the Medicare Annual Enrollment Period
and they want to get a Medicare supplement. But they can't.
They can't because their health history is now tainted and they are unable to qualify medically.
That's important to understand
the Annual election Period. Your annual open enrollment for Medicare is only for Medicare Advantage Plans and prescription drug plans.
You Medicare supplement has no annual enrollment. It doesn't change every year, so you don't need one.
After the first six months on Medicare, you can still change your plan any time. You can change it as often as you want.
You just have to qualify medically.
If you can't qualify medically then you will be unable to get a Medicare supplement plan. To put it simply you can always switch from a
Medicare supplement to Medicare Advantage Plan.
But you can't always switch from a Medicare Advantage Plan to a Medicare supplement.
To recap you three choices;
you can simply keep the Original Medicare you have freedom you have control
but you have unlimited financial exposure.
You can switch to a Medicare Advantage Plan where you
give up your freedom and your control but you have limited financial exposure.
Or you can build on your Original Medicare. Add a Medicare supplement to it. Your gonna pay an extra expense for that, but you maintain
your freedom to see any doctor anywhere in the country. You maintain your control to be able to
go to the doctor at your will and not have to get permission
and you've limited your financial exposure too much less than you would with the Medicare Advantage Plan.
Your next step is to you decide which of these three choices or areas that you wanna take a look at.
If you want to explore Medicare Advantage plans, at the very end of this video, in the last 30 seconds of this video
there are links to some of the other videos that you should see. One of those will be the Medicare Advantage Plans.
I will also have links to some specific Medicare supplements, the more common ones so you can see videos
on those as well. Again, it's in the last 30 seconds of this video.
Lastly, we have not covered Medicare Part D prescription drug plans.
Rather than drag this video on to a point where it puts everybody to sleep
I have the everything you need to know about prescription drug plans in two separate videos. The first being Medicare Part D Explained
which talks about the plan's the features of the plans that you should be aware of when
when deciding on shopping for a Part D plan. The second one is how to shop for a prescription drug plan. In that one I actually
take you step-by-step on how to get on the Medicare.gov site, input your prescriptions and let the Medicare.gov
website show you which Medicare Part D plan is best for you.
In those videos I also tell you why you should never take the recommendation for which
Medicare Part D plan to get from an agent or broker.
Never ask the agent or broker which Part D plan, which prescription drug plan should I get?
Always use the Medicare.gov website to figure out which plan is right for you.
I explain why in those videos. That too is linked you're just the second of the very end of this video.
I hope you found this video helpful and enjoyed our Medicare Explained video.
If you did, please give a thumbs up. When you do, you're actually signaling to YouTube
that "hey, this is a good video" and when other people searching
for a Medicare Explained video they are going to find this one too. It really does help. And if you subscribe to my channel you're gonna be
able to find all of my videos on Medicare very easily. They're on my channel under New to Medicare playlist and also All About Medicare
Now it's your turn. I make these videos for you. It's important for me to understand what your like or didn't like about the video.
Leave me a comment below. Let me know please what it is that you liked about the video
what it is you didn't like. It's gonna help me to make other videos that will be more beneficial to you.
If you have a question, I wanna hear from you. I'm really, really wanna know what you have to say.
Leave it in the Comment Section below and I will answer you.
I am Matthew Claassen with MedigapSeminars.org. Thank you for watching!
Independent Medicare insurance broker. Licensed in 47-states. Call us at 800-847-9680.
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