Medicare Part A & B

Medicare is a federal health insurance program for seniors with two fundamental components, Part A and Part B, automatically provided to all eligible individuals.

• Part A encompasses hospitalization services and is provided at no cost to most individuals.
• Part B is premium-based and covers medical services. Premium rates for Part B change each January, with the government setting the rates. On average, Medicare covers approximately 80% of your hospitalization and medical expenses, leaving a 20% gap for costs related to Medical and Hospital services along with full exposure to prescription drugs, dental and vision insurance, and SilverSneakers gym memberships.

You’ve probably received many advertisements in the mail, all designed to bridge this 20% gap left by Medicare and add extra perks like dental/vision and free gym. These plans typically fall into Medicare Supplement and Part C Medicare Advantage plan options.

Medicare Supplement

Medicare Supplement plans are identified by letters A through N. The federal government subsidizes these plans to cover the 20% balance remaining after original Medicare pays its share. When you seek medical care or hospitalization, two entities are responsible for payment: your Primary Medicare (red/white/blue) card and the Secondary Medicare Supplement card.

Medicare Supplement plans do not require referrals, specific network qualifications, or pre-authorization. This means minimal out-of-pocket expenses when you leave the hospital or visit your doctor. Moreover, these plans extend coverage to ambulatory care, ER visits, MRIs, and physical therapy.

Pros & Cons

Opting for supplemental coverage provides comprehensive benefits and the flexibility to receive care nationwide without worrying about network restrictions. Many individuals appreciate the predictability of monthly coverage costs. Care can be received nationally by any provider that opts into Medicare.

However, choosing a Medicare Supplement plan means paying additional premiums on top of your Part B premiums, which can fluctuate yearly, potentially increasing your overall healthcare expenses.

How Steinlage Can Assist You in Richmond, VA

At Steinlage, we collaborate with insurance carriers offering Medicare Supplement gap plans. Our extensive expertise enables us to help you navigate the various programs available. When you consult with us, we provide a Medicare overview in Richmond, guiding you through the entire enrollment process and ensuring you make an informed decision based on your specific circumstances and needs.

Medicare Overview: Part D

Medicare Part D is dedicated solely to prescription drug coverage, as neither Part A nor Part B includes this benefit. The federal government oversees prescription coverage under Part D, with the Centers for Medicare & Medicaid Services (CMS) responsible for rule creation and enforcement. Private Part D companies determine how they operate and generate revenue.

In Richmond, you’ll choose from Virginia’s 23 distinct Part D plans, each operating under a one-year contract with the government. Once you become a client at Steinlage Insurance Agency, we proactively review the Richmond Part D drug plans for clients during the Annual Enrollment Period (AEP), at no cost or headache.

How We Can Help

Our team will thoroughly assess your medications, pharmacy preferences, existing premiums, and whether a particular plan necessitates trying alternative medications first. Since each plan enters into an annual contract with the government, we review plans during the Medicare annual enrollment period, from October 15 to December 7, to evaluate any need for changes. This results in an Annual Enrollment Period (AEP), where we either adjust your prescription coverage or explore the second category: Medicare Advantage.

Medicare Advantage Part C

In contrast to supplemental coverage, Medicare Advantage Part C plans typically feature low to no monthly premiums. These plans come in two main types: Health Management Organization (HMO) and Preferred Provider Organization (PPO).

HMO plans often have lower premiums and reduced out-of-pocket costs. However, some private insurance companies may require pre-approval for certain services, and you might need to designate a primary care physician and obtain referrals.

Conversely, PPOs come with higher premiums but offer the flexibility to use providers in and out of the network without referrals. PPOs may entail higher out-of-pocket expenses, but the specific costs vary depending on location.

How It Works

If you opt for a Medicare Advantage plan, the federal government considers your location, such as your zip code and county, as these plans are region-specific. For example, Richmond residents may encounter different rates than other cities. The government calculates your region’s average Medicare Part A and B costs.

Instead of the 80/20 concept found in supplemental coverage, where claims are paid as they arise, the government subsidizes the private carrier of your choice when you select a Medicare Advantage plan. Although you still maintain Medicare Part A and B, you agree to receive all benefits through the private carrier, including drug coverage, dental, vision, hearing, and more. The company receives funding from Medicare, often resulting in little to no monthly premium cost for you.

Pros & Cons

The primary benefit of Medicare Advantage is the potential for a low or nonexistent monthly premium, thanks to government support. If you initially opt for an Advantage plan, you won’t need to contend with underwriting or health-related questions.

These plans operate similarly to employer-provided insurance, with copays for doctor visits and potential fees for emergency room visits or ambulance services. However, choosing an Advantage plan allows you to adhere to the private insurance company’s network. Furthermore, you may still be responsible for the remaining 20% of charges for services such as MRIs or chemotherapy.

Switching to a supplemental plan during annual or open enrollment may entail waiting periods and pricing adjustments based on age and health. If you’ve accrued substantial out-of-pocket expenses for services like chemotherapy on an Advantage plan, transitioning to a supplemental plan could result in less favorable rates or denial from the supplement carrier due to your current or prior health risk.

How Our Richmond Agency Can Help

If you believe a Medicare Advantage plan fits you, our team will provide comprehensive information through a detailed Medicare overview in Richmond, VA. We’ll then guide you through the process, helping you find a plan that includes your preferred doctors and hospitals in the network and covers prescriptions at the lowest possible cost.

How Steinlage Insurance Agency in Richmond, VA, Can Help

Steinlage Insurance Agency in Richmond, VA, boasts over 70 years of experience providing Medicare assistance to clients. Throughout the last seven decades, we’ve adapted to advances in medicine, longer lifespans, skyrocketing healthcare costs, and the birth of a national healthcare program.

When you seek assistance from us, you can be confident that our team will remain flexible and consistently meet your needs. We are a nationally recognized, award-winning Medicare insurance brokerage industry leader. We serve seniors in Richmond and throughout Virginia.

Get an Expert Medicare Overview in Richmond, VA

Steinlage Insurance Agency in Richmond, VA, boasts over 70 years of experience providing Medicare assistance to clients. We’ve adapted to medical advances, longer lifespans, skyrocketing healthcare costs, and the birth of a national healthcare program.

When you seek our assistance, you can be confident that our team will remain flexible and consistently meet your needs. We are a nationally recognized, award-winning Medicare insurance brokerage industry leader, serving seniors in Richmond and across Virginia.

Ready to get started with Medicare in Richmond? Schedule a consultation with our team today. We’ll provide a Medicare overview in Richmond, VA, tailored to your specific needs and ensure you have all the necessary information to make an informed decision.