Gail Yoss, Authorized Independent Broker & Agent since 2010
Representing Top-Rated Insurance Companies
Local to the Richmond, VA Area and Surrounding Counties: (804) 240-0600
Richmond West End Office: 4905 Radford Ave Ste 110, Richmond 23230.

Medicare Solutions

Understanding Medicare


Medicare can be intimidating and confusing for some. Think of us as a personal assistant to navigate you through these muddy waters and the different parts of Medicare A – D.

 

The following information will help you decide if you want to keep your Original Medicare Parts A and B, pay the deductibles, co pays and coinsurance or  enroll into a:

1) Medicare Advantage Plan or
2) Supplement Plan and with a standalone Part D drug plan.

It is illegal to have a Medicare Advantage and a Supplement plan at the same time.

 

The following is an explanation of ORIGINAL MEDICARE and its parts:

 


Part A = Hospital Coverage

Monthly premium: Most people don’t pay a Part A premium if they paid Medicare taxes while working (40 quarters or 10 years). If you do not qualify for a premium-free Part A, you will pay up to $422 a monthly for this coverage.

 

This hospital coverage helps pay for your inpatient hospital, skilled
nursing facility stays if after a three day hospital stay. It also helps pay for some home health care and hospice care. Any provider that accepts Medicare patients will work throughout the U.S.

 

HOSPITAL STAY
In 2019, You Pay:

  • $1,364 deductible per benefit period of 60 days. If you go in and out of the hospital within this 60 day benefit period you will pay this amount once. But, if it has been past 60 days since you were last in the hospital then you must pay the deductible again.
  • $341 per day for days 61st – 90th of each benefit period.
  • $682 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)

 

SKILLED NURSING FACILITY STAY
In 2019, You Pay:

  • $0 for the first 20 days of each benefit period
  • $170.50 per day for days 21-100 of each benefit period
  • All costs for each day after day 100 of the benefit period

 


Part B = Medical Coverage

It helps pay some of the doctor’s visits, lab and some diagnostic screenings tests not covered by Part A. Preventative screenings are covered and annual physicals. Some medical equipment and diabetic supplies are covered. Not included are; dental, vision, hearing and prescription drug benefits. This is what original Medicare looks like:

  • You pay: Part B Yearly deductible (Year 2019: $185 out-of-pocket).
  • You pay: 20% out-of-pocket. Medicare generally pays 80%
  • You must continue to pay your monthly Part B premium to Medicare $135.50

 

The standard Part B premium amount in 2019 is $135.50 or higher depending on your income. However, most people who get Social Security benefits pay less than this amount ($130 on average). Social Security will tell you the exact amount you’ll pay for Part B in 2019.

 

You pay the standard premium amount (or higher) if:

  • You enroll in Part B for the first time in 2019.
  • IF you don’t get Social Security benefits now you will be billed directly by Medicare for your monthly premiums. If you will be receiving your Social Security then the monthly premium will automatically be taken out for Medicare.
  • If you have Medicare and Medicaid, and Medicaid pays your premiums.
    (Your state will pay the standard premium amount of $135.50 in 2019.)
  • Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount.

If you’re in 1 of these 5 groups, here’s what you’ll pay:

 

EXCESS CHARGES
Medicare pays $0 – You pay all costs

To learn more refer to Medicare & You 2019 the official U.S. government Medicare handbook.

 


Part C = Medicare Advantage Plan by Choice

Medicare Advantage Plans vs. Supplement Plans

Both types of plans are purchased and insured by private insurance companies.

Medicare Advantage Plans are contracted with Medicare and provides the same benefits as Medicare.

If you decide that you do not want to keep Original Medicare with parts A & B with all the costs it requires you may be interested in joining a Medicare Advantage Plan like (HMO or PPO). By joining a plan of this type you will still have Medicare but you will get your Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from this type of plan. Most include the Medicare prescription drug coverage and some may offer extra coverage, like vision, hearing, dental, and other health and wellness programs. These plans are offered by private companies that Medicare approves.

 

Original Medicare Part C Options

Medicare Advantage Plans

  • Combines Medicare Parts A, B & usually Part D Prescription drug plans
  • Monthly Premium $0–$$
  • May include a deductible
  • Provides Preventive Services
  • Copays – low
  • Some Services require 20%-30% coinsurance
  • Network – In or Out (HMO, PPO)
  • Referrals are needed
  • Additional Benefits – like vision, hearing, dental and other health and wellness programs – or rider $$
  • Part D – Prescriptions (usually)
  • Maximum out-of-pocket – $$ Cap

Supplement (Medigap) Plans

Ten plans to choose from in VA:
Some plans may pay:

  • Deductibles – Parts A & B
  • Pays 20% coinsurance
  • Pays copays
  • No Network – Freedom of choice of doctors / hospitals
  • Nationwide coverage – it moves with you
  • All plans are “standardized” in all states except Wisconsin, Minnesota, Massachusetts
  • Monthly premium to private insurance company
  • No Part D – must purchase standalone plan from private insurance company

 

Yoss Insurance has all of these plans to choose
from various private insurance companies.

You will generally receive your services from a plan’s network of providers. You must use the card from your Medicare Advantage Plan to receive services. Keep your Original Medicare card in safe place.In addition to paying your Part B monthly premium to Medicare, you might pay a monthly premium for the Medicare Advantage Plan.

 

During Open Enrollment between October 15 –December 7 you may enroll, switch or drop a Medicare Advantage Plan to be effective the first of January the following year.

 

Another option:

Purchase a Supplement Plan also known as a Medigap – these plans can pay the 20% for you that  is not covered by Medicare Part B.

Click to view medigap plans

 

To receive your Part A & Part B combined coverage but no prescription drug coverage. Plans begin at age 65. These types of plans from private insurance companies require monthly premiums from you and can be purchased through Yoss Insurance to compare costs.

 

The different benefits that these Supplement plans cover vary as well as the costs per plan. There are ten standardized plans to choose from available in Virginia all with monthly premiums. Supplement plans fill in the gap to pay in your place such as deductibles, coinsurance and copayments required by Medicare and to your providers.

 

It is illegal for anyone to sell you a Supplement (Medigap) policy unless you are switching back to Original Medicare. You may not have both plans at the same time.

 

The best time to buy a Supplement Plan is during your Initial Open Enrollment Period when you turn 65 or older and/ or enrolled in Part B. This 7-month period begins three months before your birthday month, the month of your birthday and three months after. This is known as a guaranteed issue time. Other Special Enrollments may apply.

To learn more refer to Medicare & You 2019 the official U.S. government Medicare handbook.

 


 

Part D = Prescription Drug Plan

To get Medicare prescription coverage you must join a plan approved by Medicare and offered through private insurance companies and you must live in the service area. A prescription plan could be embedded in a Medicare Advantage Plan or offered through an employer or union group plan. When you first become eligible for Medicare you can join during your Initial Enrollment Period without a penalty.

UNDERSTANDING THE COVERAGE GAP ( Stage 3) – aka “donut hole” $3,820
After your total costs reach this amount ( you plus the drug plan together) you will pay no more than 37% coinsurance for generic drugs or 25% coinsurance for brand name drugs for any drug tier during the remainder of the year. Stage 4 is the Catastrophe Coverage. Once you have met the out-of-pocket cost requirements of the coverage gap you automatically get “catastrophic coverage”. With this coverage you only pay a reduced coinsurance amount or copayment for covered drugs for the rest of the year.

 

During Open Enrollment between October 15 –December 7 you may enroll, switch or drop a Medicare drug plan to be effective the first of January the following year.

 

*PART D drug plans are run by private insurance companies that follow rules set by Medicare.

For more information refer to Medicare & You 2019 the official U.S. government Medicare handbook.

 

See if you qualify for Extra Help for prescription drug costs:
Save on drug costs


The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, co-payments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network premium and/or co-payments/co-insurance – may change January 1 of each year.