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hi my name is stephanie apt and today i'm reviewing medicare explained for 2021 we will go over all of the basics that you need to know and talk about the important choices you have to make when you're new to medicare in 2021 so stay tuned stay tuned hi everyone my name is stephanie apt i am a licensed insurance broker and a medicare specialist and i help seniors all over the country to navigate the world of medicare and today's video is going to be medicare explained for 2021 so we're going to go over all that you need to know about medicare whether you're new to medicare this year or maybe you just need a refresher course that's what we'll talk about today so we're going to be reviewing the different parts of medicare we're going to go over when to enroll how to enroll in medicare we're also going to review all of the costs associated with medicare and we'll also be reviewing medicare supplement plans or medigap plans as well as medicare advantage plans and going over the decisions you're going to have to make when you transition to medicare so let's start by just reviewing the basics the different parts of medicare that you need to know so there's medicare part a which is your hospital insurance there's medicare part b your medical insurance and then there's part c of medicare that's also known as medicare advantage this is an optional part of medicare that you can elect and we'll talk more about that in a minute and then medicare part d is your prescription drug coverage component of medicare so your medicare enrollment period is a seven month window and this starts up to three months before the month you turn 65 and it goes up to three months after your 65th birth month that's also called your iep your initial enrollment period for medicare that's when you can sign up as long as you sign up before your 65th birth month your medicare coverage will start on the first day of the month that you turn 65 unless you're born on the first of the month that's a little tricky thing if you're born on the first of the month your medicare coverage will actually begin a month prior if you enroll in the latter part of this initial enrollment window then your medicare coverage could be delayed by a few months and i'm going to link some more information below about when your coverage will start depending on when you enroll if you're collecting social security benefits and you've been collecting social security benefits at least four months before you turn 65 you don't have to do anything to enroll in medicare the government automatically enrolls you in medicare parts a and b and they'll send you your medicare card in the mail a couple months before you turn 65 but if you're not collecting social security benefits then you do actively have to enroll in medicare and there's a few different ways that you can do this during your initial enrollment period you can enroll online it's a pretty simple way i'm going to link a video up here that talks a little bit more about how exactly to enroll in medicare online you can also call social security or you can go down to your social security office in person of course some social security offices are not scheduling very many appointments due to the covet pandemic so most people these days are either applying online or calling social security to get enrolled in medicare and when you go to sign up for medicare you'll be enrolling in medicare parts a and b medicare parts a and b are what we call original medicare or they may be known as traditional medicare so part a is your hospital insurance and that is usually free as long as you've been working in the united states for 10 years or 40 quarters and this part of medicare helps to cover your inpatient hospital stays it'll also help to cover things like skilled nursing facility care some types of home health care and hospice as well medicare part b is your medical insurance and so this is the part of medicare that will cover outpatient medical services doctor's office visits testing ambulance a whole slew of things are covered by medicare part b and medicare part b isn't free a lot of people are surprised to find out that they do have to pay to enroll in medicare part b in 2021 the standard medicare part b premium is 148 dollar per month however it may be more based on your income so there's something called irma or an income related monthly adjusted amount and you may be subject to irma or higher premiums for medicare part b and medicare part d if your income from two years prior fell above one of these thresholds whether you're married filing jointly or whether you file a joint tax return and there are ways that you can appeal irma if your life situation has changed but typically medicare will look at your tax return from two years prior to determine whether you will be subject to irma and they will usually let you know by sending you a letter in the mail if you're going to be subject to these higher charges and you can check out a video i've linked all about how to appeal irma if you don't think that you should be paying these higher charges if you've had a life-changing event so when you sign up for medicare parts a and b what exactly does it cover and what are your out-of-pocket responsibilities so that's what we'll talk a little bit about here medicare part a has an inpatient hospital deductible and this deductible in 2021 is 1 484 dollars so that's the amount that you have to pay before your medicare part a benefits kick in and this deductible is not an annual deductible it is per 60-day benefit period so if you have multiple hospital stays within a calendar year you may need to meet this deductible more than once if you have a long-term stay in the hospital after you've been in the hospital for 60 days you will be responsible for a co-insurance amount of 371 dollars per day additionally if you're in the hospital past 90 days your coinsurance is going to go up to 742 dollars per day and if you are in a skilled nursing facility medicare covers your first 20 days in the skilled nursing facility and then after that you're responsible for 185 and 50 cents per day for days 21 to 100. now on the medicare part b side of things which is again going to be everything doctor's office outpatient all the other medical services that medicare covers medicare part b also has a deductible an annual deductible that resets every january and this is the amount that you have to pay before medicare part b starts to kick in the deductible this year is two hundred and three dollars so that's what you're responsible for before medicare is going to kick in after you've met your part b deductible medicare is going to pay 80 and you have to pay the rest the other 20 um and this is where you're left really vulnerable right because there's no cap on that 20 so if you have something major happen to your health you are responsible for that full 20 and there is no cap or limit there so under traditional medicare parts a and b you do have potentially large out of pocket exposure so that's why a lot of people look at some type of gap coverage like a medicare supplement medigap plan or perhaps a medicare advantage plan to help cap these out-of-pocket costs that you would be responsible for under traditional medicare so that's what i'm going to talk about next so i've been using this flowchart for a while and i'm going to use it again in this video i think it can help you to visually understand what your options are and what your choices are when you enroll in medicare so you can kind of start at the top you know start here and decide how do you want to get your medicare benefits so the first choice that you have is original medicare or traditional medicare that's what we just reviewed parts a and b one of the benefits of going this route going with traditional medicare is that you can go to any doctor that takes medicare so you have your choice of doctors nationwide all over the u.s there are many many doctors that accept medicare patients so if you go this route you really do have your pick of your doctors and your hospitals because you are staying with original medicare from here you'll want to decide if you need drug coverage and if you need coverage for your prescriptions then you'll need to add on a standalone medicare part d prescription drug plan and medicare part d drug plans are administered through private insurance companies so you buy part d through a private insurance company like humana or silverscript that offers part d drug coverage and part d drug plans can vary quite a bit in cost in 2021 in most states plans are available starting at about seven dollars a month for a standalone part d drug plan and then the prices go up from there and then the next step will be deciding if you want to add supplemental coverage now if you're going this path of traditional medicare we've already reviewed all the potential out of pocket exposure that you have there so most people decide to add on some type of supplemental coverage to cap their medical out of pocket exposure and this is purchased through medigap or medicare supplement insurance so your medigap or your medicare supplement plan is going to fill in all those gaps it's going to pay all of those deductibles and coinsurance and all of those costs that we just talked about for you and we're going to talk a little bit more about how medigap medicare supplement plans work in just a moment here so again this is the one path that you do have i would say the benefits of doing this path are that you have the freedom to choose your own doctors in hospitals you don't need referrals and if you do add on a medicare supplement plan you have very comprehensive coverage very little out of pocket exposure because the medigap plan is covering all of those deductibles and coinsurance for you so you don't have to pay them the other option that you have is to go with a medicare advantage plan and this is also called part c of medicare that we mentioned briefly earlier in the video medicare advantage plans are an alternative way to receive your medicare benefits so if you go with a medicare advantage plan you still have to be enrolled in medicare a and b you still have to pay your medicare part b premium so you still have to be enrolled in traditional medicare but if you sign up for a medicare advantage plan then that managed care plan replaces your original medicare benefits and acts as your insurance so medicare advantage plans are managed care plans like hmos or ppos that you may have had in the past and these types of plans typically include medicare part d prescription drug coverage rolled right into the plan and medicare advantage plans have their own pros and cons they're a good fit for some people not the best fit for others and we're going to talk a little bit more about that in just a second so let's touch a little bit on medigap plans so the first column that we talked about you know one of the steps was deciding if you need supplemental coverage if you do then you're going to be looking at medigap also known as medicare supplement insurance and that's going to fill in the gaps in your original medicare a and b benefits so medigap plans are standardized the government regulates how these plans are offered and no matter what plan you choose you can still continue to go to any medicare doctor anywhere in the country this chart is a lot to look at it can be a little bit confusing and in fact there are some plans on here that are no longer available to people who are new to medicare or turning 65 in 2021 but for example i'm just going to talk a little bit about one of the most popular plans which is plan g right here and explain to you how that plan works so you can see that all of the potential out-of-pocket costs right here plan g covers pretty much all of them the only thing it doesn't cover is the medicare part b deductible so that's all that you would be responsible for and if you remember a moment ago we reviewed that the medicare part b deductible this year is 203 dollars per calendar year so if you have original medicare and a plan g medicare supplement you're responsible for the first 203 dollars of your medical expenses but after that everything else is covered at 100 percent so you have very very little out of pocket exposure if you go with a medigap plan like plan g again these plans have no network so you can go to any medicare doctor you choose and the way the plan works is your provider submits your claims to medicare and medicare either approves or denies them right so as long as medicare approves the claim then your medicare supplement plan must pay on the claim that medicare has approved so because of this your care is really determined by you and your doctor medicare is going to approve most things that are medically necessary so it's not up to an insurance company to decide whether or not your claim is going to be approved or denied any claim that medicare approves any medigap or medicare supplement plan must approve and pay on that claim as well one other important thing to know about medicare supplement plans that not everyone realizes is that in most states medigap plans are medically underwritten and what that means is that the insurance company can ask you a series of health questions on your application and based on your current health or your health history they could decide to decline you and and deny you coverage however everyone gets a one-time open enrollment window where they can choose any medicare supplement plan they want with any company and they're given the preferred rate without any medical underwriting and that is either when you're first turning 65 or when you are first going on to medicare part b so that's important to know because outside of that window you will have to typically pass through medical underwriting to get a medicare supplement plan in most states so now that we've talked about medicare supplement plans and the pros and cons of how they work let's look at the other side of the coin which is the medicare advantage plans and talk about the pros and cons there and if you want a deeper dive into the pros and cons of medicare advantage you can check out this video up here where we do a whole video all about medicare advantage pros cons and all that good stuff so what are the pros of a medicare advantage plan well one of the biggest is that they have very low monthly premiums these plans are funded by the government so the government pays these insurance companies when you enroll in their medicare advantage plan and because of that the insurance companies can pass on savings to you in the form of zero dollar premium or very low monthly premium costs so that makes these plans very attractive to people because they have low monthly premiums or in most areas zero dollar a month premiums available these plans also usually include your part d prescription drug coverage built in so you do not have to worry about buying a separate standalone part d drug plan additionally some medicare advantage plans include extra benefits that are not covered by original medicare so some things like dental vision or hearing services that traditional medicare doesn't cover may be covered partially on certain medicare advantage plans so a lot of people say well that sounds too good to be true what's the catch these plans of course do have a few downsides to them one of them is that you're typically working in a more limited doctor network so because these are managed care plans like an hmo or a ppo you have a set network of doctors that you really want to stay in um or else you may not have coverage at all or you're going to pay a higher cost for your services additionally the plans establish their own set of co-pays coinsurance and out-of-pocket costs that you are responsible for so you may have certain co-pays for office visits certain co-pays for hospitals today and in 2021 the maximum out-of-pocket that you could be responsible for is up to seven thousand five hundred and fifty dollars per year and that is for in-network services so it could be higher if you are out of network and again on a medicare advantage plan your claims are being submitted not to medicare but to the insurance company that you have your medicare advantage plan through right so you may see more need for things like prior authorization for certain services because the claims are submitted to the insurance carrier instead of to medicare so medicare has a lot of ins and outs a lot of rules and there really are a lot of choices that you have to make when you are turning 65 or going on medicare for the first time and we hear from our clients that it can be pretty overwhelming especially when you factor in all of the maybe phone calls that you're getting or mail that you're getting um it can be difficult to navigate what you need to do so i hope that this video helped give you a little bit more direction and information about the basics of medicare for 2021 if you would like information free no obligation quotes medicare assistance that is what we're here for you can give us a call anytime so i am an independent insurance broker and we're licensed in almost every state so if you have any questions please don't hesitate to give us a call our service is completely free of charge so we get paid when we help you apply for your medicare coverage so that's how i make my living and i would love the opportunity to assist you i hope you found this information helpful check out some more of our videos and thanks so much for watching we'll see you soon you