Frequently Asked Questions

When do I actually need to do something?

Most people will need to act a minimum of 3-months before their Medicare takes effect (the 1st of the month in which you turn 65). While enrolling in Original Medicare (A and B) is often automatic if you are claiming Social Security benefits at or before your 65th birthday, that is only half of what you need to do.

Do I need to take Medicare?

If you are covered under a union plan, or an employer’s or a spousal employer’s health plan, you may be able to delay your Part B enrollment until the time you lose that coverage. If you are claiming Social Security and still covered by one of these plans, you may need to proactively decline Part B. Regardless, every situation is unique and requires an experienced professional’s guidance to avoid costly mistakes. If you are not covered by another credible policy and you do not enroll in Part B when first eligible, you may need to wait up to a year to enroll, and you may be charged a penalty for the rest of your life.

What does Medicare cover and how much does it cost?

Original Medicare comes in a few parts, Part A (your inpatient / hospital coverage) and Part B (your outpatient / primary care / specialist coverage). Most people have worked enough in their lifetime to get part A for free, and Part B comes at a premium of $135.50 per month for 2019. Part D is your prescription drug coverage, which we will address further down the page. If you have a high income or haven’t worked enough in the USA over your lifetime, these amounts may be adjusted higher.

What doesn’t Medicare cover?

As you may already know, Original Medicare has relatively large deductibles, copayments, and you are responsible for 20% of all Part B services. There is no out-of-pocket maximum under Original Medicare, so the potential risk of health costs is infinite. For this reason, those on Medicare most often choose one of two options in conjunction with their Medicare coverage: 1) enroll in a Medicare Supplement and a Prescription Drug Plan or, 2) enroll in an MAPD. To do nothing is a major financial risk.

What is a Medicare Supplement?

A Medicare Supplement is a supplementary insurance plan that can pay for what Original Medicare doesn’t. For example, the standard Plan G covers all Medicare copays, the full 20% of remaining services, and the Part A deductible ($1,364 for 2019). Medicare with a Supplement allows you to see any Medicare provider in the country with no referrals needed. There is no cap to how much a Medicare Supplement will pay out to cover your health costs. This approach would be paired with a stand-alone Prescription Drug Plan and is known as Option 1 when choosing how to supplement your Medicare.

Does it matter which Insurance Company I choose?

Medicare Supplements are standardized benefit plans mandated by the government. Effectively, these plan benefits cannot differ between insurance companies. However, you will find a wide range of prices for the same plans. This is why it is important to work with a broker like us, so that you don’t get tricked into paying more than you should for a given plan. On the MAPD side, plan benefits do differ between carriers, so it is important to choose the plan with the carrier that best meets your needs in your area.

What is an MAPD, Advantage Plan, or Part C?

In its most basic form, an MAPD (also known as Medicare Advantage or Part C) allows you to trade in your rights under Original Medicare to have a private insurance company effectively meet those same benefits. While many of these plans are offered at low to zero-dollar premiums and accompanied by a drug plan, the trade-off is a much smaller network of doctors you can see, similar service costs as if you had stayed on original Medicare, as well as a potential out-of-pocket maximum of $6,700 for the year. This is known as Option 2 when choosing how to supplement your Medicare.

What is Part D?

Part D of Medicare is your prescription drug coverage. This can be obtained by purchasing a stand-alone Prescription Drug Plan (PDP) alongside a Medicare Supplement Plan or by enrolling in an MAPD. When purchased alongside a Medicare Supplement, this combination is the most comprehensive way to cover your Medicare costs. Please note that if you do not enroll in Part D when first eligible, you may need to wait up to a year to enroll, and you may be charged a premium penalty for the rest of your life.

What if I’m on Medicaid or NJ Family Care?

Most often, Medicaid recipients become eligible for Medicare at 65 like everyone else. Medicaid income limits go down at 65 which means those on Medicaid under 65 may not be eligible for Medicaid over 65. For 2018, the Medicaid income limit for those over 65 was $12,144 for the year. If you continue to be eligible for Medicaid over 65, there are Dual Special Needs Plans (DSNP’s) available to you which combine the benefits of Medicare and Medicaid into a single plan with a private insurance carrier. These plans oftentimes offer more benefits than either Medicaid or Medicare offers on their own.

I already figured all this out, I don’t think I need help

You may have already done the research, perhaps even found the lowest price plan, but do you know about each carrier’s rate increase trends and the plans that are leaving the market? Gaining Medicare gives you a one-time Initial Enrollment opportunity to obtain supplemental coverage without underwriting (health questions), so be sure to work with a team that has your best interests in mind.

Can’t I just do this myself? Why do I need a broker?

Yes, you can feel free to try and handle this yourself, but the reality is that only a broker can offer you specialized Medicare guidance without a bias. By working with nearly every carrier offering insurance in NJ, we can show you all the prices, across every plan and every company. Additionally, working with a broker gives you piece of mind, as we will work on your behalf to ensure your policy works as intended. That means no tedious phone calls waiting on hold with the insurance company, we do all the work for you. Our clients are lifelong, as we keep in contact consistently to ensure they are receiving everything they need.

What do you mean this doesn’t cost anything? How can you offer your services to me for free?

Our services are completely free, and there is absolutely no difference in premium cost to work with an independent broker. We are compensated by the insurance carriers, which allows us to provide unbiased advice at no cost to you.

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NJ Life and Health Insurance Group, LLC is not affiliated with or endorsed by the Social Security Administration or the Federal Medicare Program