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Enrolling in Medicare and making some important decisions that may affect the rest of your life can certainly be daunting. There are different parts, different plans, then finding out what Medicare covers and what it doesn’t. Is there a way to get coverage for the things that Medicare doesn’t cover? How do you choose between all the plans? What if I get retiree benefits?


There are plenty of resources, and I’m sure you’ve been bombarded with mail, email and phone calls trying to persuade you to work with them, or sign up for a $0 plan. Some of these plans are great, others not so much. In my experience, it’s really about an individual’s needs both now and in the future.  Some people do well with original Medicare and a supplemental plan (Medigap Plan). Others do well with a Medicare Advantage plan.  And then some folks get retiree benefits from their employer. The idea is that there are many options available and to try and navigate this without help can leave you with more questions. That’s where we come in. We can help you sort through the noise and clarify all the information and misinformation.


In addition to these, you need to understand what Medicare does not cover.  Some of the things Medicare doesn’t cover are dental, hearing, and vision. Vision coverage gets complicated because vision correction isn’t covered, but things like glaucoma treatment and cataract surgery are covered.  Finding something that covers these benefits can be challenging, so call our office and we’ll see if we can find a solution that can help ease the burden of these costs.


What does Medicare cover? – the easiest way to answer this question is to visit and right along the top is a button that says “What Medicare Covers,” then search for what procedure you are curious about, and hit ‘Go.’  The website will then display the results showing whether it’s covered or not.  From what I’ve seen, it’s very likely that Medicare will cover your procedure as long as it is medically necessary.


Medicare 101


Medicare Part A is your hospital and hospice coverage. After a deductible ($1364 in 2019) Medicare will cover 100% of your costs for the first 60 days. The only other expense in those first 60 days is if you need blood. Medicare states you are responsible for the cost of the first three pints. Medicare will pay for any additional blood needed after those three pints.  After the 60 days, Medicare requires a daily copayment of $341/day for days for 61-90. For days 91-150, Medicare requires a $682/day.


If you need to go to a Skilled Nursing Facility (think rehab facility) after you are discharged from the hospital, Medicare pays 100% of the costs for the first 20 days. For days 21-100, Medicare requires a copay of $170.50 per day.


Medicare also provides coverage for Hospice care for the time when you are seriously ill or chronically ill and need to be provided with comfort (pain reduction) and with emotional and spiritual support.  Hospice does not necessarily mean ‘end of life’ but it is more about making the patient comfortable. Medicare pays for all but 5% of the cost of hospice and all but $5 for any medications administered during the hospice care.


Medicare Part A is free for most people. The qualification is that either you or your spouse have worked for at least 10 years (40 quarters) in your life. For other people, the cost will be $240 per month if you have worked for 30 quarters and $437 per month if you have worked less than 40 quarters.


Medicare Part B is optional (yet HIGHLY recommended) coverage for your regular doctor’s visits, whether those visits are to a general practitioner or a specialist. Medicare Part B has an annual deductible of $185 for 2019.  For many, this is typically met with your first or second doctor’s visit of the year. After the Part B deductible is met, Medicare will pay approximately 80% of the cost of the doctor’s visit, leaving you with the other 20%.


The typical cost for Medicare Part B is $135.50 per month. There are factors that could increase the cost, depending on your income and whether you have filed your taxes as a single or as a joint filer. These additional costs are known as IRMAA (Income Related Monthly Adjusted Amount).  Once you have applied for Medicare Part B, you may receive a letter from the Social Security Administration informing you that you are subject to IRMAA penalty.  Fortunately, you can certainly appeal this, as your circumstances may have changed.


How to Pay for What Medicare Doesn’t


The burning question remains “How do I get coverage for the 20% Medicare doesn’t pay?” – That’s where our office comes in.  There are Medicare Supplement plans (also known as Medigap) plans that pick up right where Medicare leaves off and covers the costs that Medicare does not.  The Medigap plans cover things like the Part A deductible if you go to the hospital, your Part B 20% copay, the copay for extended stays at the Skilled Nursing Facility after you are discharged from the hospital.  The big piece I’ve noticed and the reason that people get a Medicare Supplement plan is to make their medical costs very predictable. You know what you’re going to be spending each month. It’s unlikely that you will be caught with any ‘surprise’ bills like many of us have seen with traditional healthcare.

When you call our office, we will have a discussion and see which Supplemental plan (if any) is right for you. We won’t try and jam you into a plan if it doesn’t fit your needs and situation.  Oh, and our service for this is free.  IF we figure out that a Medicare Supplement plan is right for you, and IF you choose to work with us, the insurance company we choose pays us a ‘finder’s fee.’  The also does not affect the rate you would pay for that plan; it’s the same price whether you choose an agent or go directly to the insurance company for the plan. Call our office at 908-344-3931 or 888-658-9838 and we would be happy to answer any questions you have.


Paul Tullo –