BBB Tip: Mystified by Medicare? Overwhelmed with choices? The BBB in New Orleans offers 7 tips

Michael Dunbar Insurance is a BBB Accredited Business in Metairie, Louisiana, and we thank them for partnering with us to provide this information.

Understanding Medicare can be overwhelming for first-time enrollers and those looking to change providers. The original version of Medicare began in 1966 and consists of two key parts: Part A for hospitalization (subject to a $1600 deductible in 2023) and Part B for outpatient medical care (subject to 20% coinsurance). “How much am I expected to pay?” and “When can I enroll?” are two of the most often asked questions. 

Below are 7 key questions you should consider prior to applying for Medicare benefits. 

QUESTION: How much will the government charge me for Medicare?

ANSWER: For 2023, the standard monthly premium will be $164.90.

• • • For individuals earning less than $1,529/month (or couples earning less than $2,060/month), Medicaid will pay this premium for you (note: these amounts may change on 3-1-2023).
    • For individuals earning more than $8,084/month (or couples earning more than $16,167/month), Social Security will assess an "Income Related Monthly Adjustment Amount" (IRMAA). More information on IRMAA.

QUESTION: When am I eligible for Medicare for the first time (and when do I apply)?

ANSWER: There are two primary ways to qualify for Medicare:

• • • Turning 65: You can apply three months prior to the month in which you turn 65. Your Medicare benefits will begin on the first day of the month of your 65th birthday.
    • Disabled prior to 65: If you qualify for Social Security Disability Income (SSDI), you will automatically be eligible for Medicare after 2 years from the onset of SSDI.

QUESTION: I already have Medicare. When am I eligible to review different plans or make a plan change?

ANSWER: The "Annual Enrollment Period" for 2023 is October 15-December 7. For some people, Special Enrollment Periods may be available year-round.  Find out if Special Enrollment Periods apply to you.  

QUESTION: How do I cover the gaps in Medicare?

ANSWER: There are two distinct strategies to consider:

• • Medicare Supplement combined with a Part D Prescription Drug plan: 
    • The monthly premium varies based on age, insurance company, and region. However, it will typically average $150-200/person between ages 65-70. These plans provide you access to any doctor or medical facility in the country that accepts Medicare. 
    • The benefits and structure of a specific Medicare Supplement are identical between all CMS approved insurance carriers. 
    • With Plan G, your Medical expenses would be covered at 100% after a $226 annual deductible (2023)
  • Medicare Advantage Plan
    • Most plans have a $0/month premium and a $0 deductible and include medical, prescription, and a variety of supplemental benefits (dental, vision, hearing, OTC credits, gym membership, and more). These plans are subject to a specific network of doctors and medical facilities, which vary by carrier.
    • While the schedule of benefits will be very similar between all carriers, the copays and supplemental benefits will often differ. 
    • Each plan has a specific "medical out of pocket maximum" expense for in network claims. This will also vary by both insurance carrier and region.

QUESTION: In choosing a Medicare Advantage Plan, how do I know which plan is best for me?

ANSWER: Michael Dunbar of Michael Dunbar Insurance reminds us, "Check that your preferred doctors and hospitals are in-network with the plan you are considering. Also, make sure you understand and compare the prescription copay tiers and formulary specific to each plan. Reviewing and confirming these two items will significantly help you identify which plan is right for you.” If you feel you cannot make the decision alone, a skilled independent agent should be able to help you compare your options.

QUESTION: What is a late enrollment penalty?

ANSWER: This relates specifically to prescription Part D benefits. Medicare beneficiaries may incur a late enrollment penalty if there is a continuous period of 63 days or more at any time after the end of the individual's Part D initial enrollment period, during which the individual was eligible to enroll, but was not enrolled in a Medicare Part D plan and was not covered under any creditable prescription drug coverage (such as on an employer group health plan).

QUESTION: What should I expect to pay to an independent licensed agent?

ANSWER: Some agents charge fees, and others do not. Michael Dunbar Insurance, the sponsor of this content, does not charge a fee. Make sure to find out, upfront, from any agent, any fees that they charge.  Fees may be charged for the initial consultation, ongoing service, annual reviews, changes, or assistance with claims. These fees, if the provider charges fees, may vary from one to another. 

Many providers are compensated by the carrier that they complete your enrollment with.  If this is important to you, make sure to ask.  

All independent agents do not carry every plan with every provider.  You can contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

For more information

Check out these resources for older adults.