Once you turn 65, you’re inundated with mail and phone calls regarding Medicare. However, many don’t know where to begin. Steinlage Insurance Agency in Charlottesville, VA, is here to help. Understanding your options and deciding the best plan for you is critical, which is why we aim to educate every client – starting with a Medicare overview.
Our agency exists to help you maneuver the process and avoid the frustrations and confusion associated with Medicare. The services we provide come at no cost to you, as we receive compensation from private insurance carriers. We work diligently each year to contract with all national insurance carriers.
Schedule a consultation with one of our team members today!
Medicare Part A & B
Medicare begins with two primary components – Part A and Part B – that everyone receives.
- Part A is free and includes hospitalization services.
- Part B is premium-based and includes medical services.
Part B’s premiums change every January, and the government determines them. On average, Medicare pays approximately 80% of the hospitalization and medical services you seek. As a result, a 20% gap remains regarding prescription drug coverage, dental and vision insurance, and SilverSneakers, a gym membership.
Many advertisements you receive in the mail aim to fill the 20% gap left by Medicare. Depending on the plan you choose, they will cover the remaining amount. These plans fall into two distinct categories: Medicare Supplement and Part C Medicare Advantage.
Medicare Supplement
Medicare Supplement plans range from letters A-N. The federal government subsidizes these plans, which pay the 20% balance left behind from original Medicare. As a result, two entities are responsible for payment when you visit the hospital or your primary care physician. You will show both your Primary Medicare (red/white/blue) card and the Secondary Medicare Supplement card.
Medicare Supplement plans don’t require referrals, specific qualifying networks, or pre-authorization. You will pay little to nothing out of pocket when you leave the hospital or doctor’s office. These plans also cover ambulatory care, ER visits, MRIs, and physical therapy.
Pros & Cons
Those who choose supplemental coverage enjoy its comprehensiveness. Seniors can go anywhere in the country, and the provider will accept their insurance. Individuals with supplemental plans also like knowing what they’ll pay monthly for coverage.
However, by choosing the Medicare Supplement route, you’ll have to pay premiums in addition to Part B premiums. Furthermore, the premium amount can change year-over-year and can increase.
How Steinlage in Charlottesville, VA, Can Help
At Steinlage, we work with insurance carriers that offer Medicare Supplement gap plans. Using our extensive knowledge, we help you determine which program is best for you. When you visit us for a consultation, we’ll provide you with a free Medicare overview and guide you through the process.
Medicare Part D
Medicare Part D is a standalone prescription drug coverage plan, as neither Part A nor B offers it. The federal government administers prescription coverage under Part D, and the Centers for Medicare & Medicaid Services (CMS) acts as the referee. They create and enforce the rules but let private Part D companies determine how to operate and make money.
There are 23 different Part D plans available for purchase, each state-specific, meaning that as a Charlottesville resident, you’ll choose from Virginia’s options. Each plan signs a one-year contract with the government.
How We Can Help
Our team will review all your medications and help you determine which of the 23 Medicare Part D plans is right for you. We’ll assess your medications, pharmacy, current premiums, and whether a specific plan will require you to try other drugs first.
Since each plan signs a one-year contract with the government, we’ll meet yearly during the Medicare annual enrollment period – October 15 – December 7 – to see if there’s any reason for change. The result is called an Annual Enrollment Plan, or AEP, where we either alter your prescription coverage or investigate the second category, Medicare Advantage.
Medicare Advantage Part C
In contrast to supplemental coverage, Medicare Advantage Part C plans boast little to no monthly premiums. There are two types of Medicare Advantage plans – Health Management Organization (HMO) and Preferred Provider Organization (PPO).
HMO plans typically have lower premiums, and you’ll pay less out of pocket. However, the private insurance company may require you or your doctor to undergo a pre-approval process for certain services. Every plan is different, but you’ll often have to designate a primary care doctor and get a referral.
PPOs have higher premiums than HMO plans, but you can use providers in and out of the network without a referral. PPOs also tend to have higher out-of-pocket costs. However, specific dollar amounts differ based on where you live.
How It Works
If you choose the Medicare Advantage route, the federal government will look at where you live, such as zip code and county, as the plans are regional-based. For example, Charlottesville residents may have different rates than those in Richmond. The government averages the Medicare Part A and B costs for your area.
Instead of paying the claim as it arises through the 80/20 concept found in supplemental coverage, the government subsidizes the private carrier you choose. It’s important to note that you still have Medicare Part A and B in this situation. However, by choosing an Advantage plan, you agree to get all benefits (including drug coverage, dental, vision, hearing, etc.) through the private carrier. That company takes the money from Medicare, and you have little to no premium.
Pros & Cons
The most significant benefit of Medicare Advantage is the low or nonexistent monthly premium, thanks to government subsidization. Additionally, if you choose an Advantage plan at the beginning, you don’t have to worry about underwriting and the associated health questions.
It works similarly to the insurance you receive from an employer. You can expect co-pays when you visit the doctor, and you may have an emergency room or ambulance fee. However, by choosing an Advantage plan, you agree to follow the rules and stay within the private insurance company’s network. Furthermore, you might still be responsible for the remaining 20% of the charges for services like MRIs or chemotherapy.
You will have to wait if you want to switch to a supplemental plan during annual enrollment or open enrollment. Your age and health determine your eligibility and the price you’ll pay. Therefore, if you’ve spent thousands out of pocket for chemotherapy on an Advantage plan, you’ll likely receive a less-than-desirable rate when you switch.
How Our Charlottesville Agency Can Help
If you think an Advantage plan is right for you, our team will ensure you have all relevant information by providing a Medicare overview. Then we’ll guide you through the process. We’ll help you find the plan that offers doctors and preferred hospitals in your network, and covers prescriptions for the lowest cost.
Why Choose Steinlage Insurance Agency in Charlottesville?
Steinlage Insurance Agency in Charlottesville, 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 Charlottesville and throughout Virginia.
Schedule a Consultation Today to Get Started With Medicare in Charlottesville
At Steinlage Insurance Agency, we are a trusted source of Medicare knowledge, trends, and news. We partner with the top insurance companies, so you receive the highest quality products. If you’re about to turn 65 and reside in Charlottesville, VA, we’d be happy to help you.
Schedule a consultation with our team today. We’ll provide a Medicare overview and ensure you have all the necessary information to decide confidently.
Medicare 101
Life is meant to be lived; cherish the exciting moments, and relish in those all too brief moments of relaxation. Steinlage Insurance Agency serves as a vessel to help our clients maneuver Medicare, and avoid the confusions and frustrations that come with senior health insurance. So, sit back, relax, and read on – we’ve got you covered.
Medicare Advantage plans offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Get extra benefits towards your plan now.
Purchase a Medicare Supplement insurance policy to cover the expenses left behind after Medicare pays. Learn how a Supplement Insurance policy can help you after doctor visits, ER, diagnostic tests, physical therapy, and other medical expenses.
Medicare Part D is the Prescription Drug benefit of Medicare. Enroll or join a Part D plan offered by a private insurers that contract annually with Medicare. Plans cover a wide variety of brand name and generic drugs. Plans also change annually in price, design, and covered drugs.
Medicare Advantage
Medicare Advantage plans offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Get extra benefits towards your plan now.
Medicare Supplement
Purchase a Medicare Supplement insurance policy to cover the expenses left behind after Medicare pays. Learn how a Supplement Insurance policy can help you after doctor visits, ER, diagnostic tests, physical therapy, and other medical expenses.
Part D
Medicare Part D is the Prescription Drug benefit of Medicare. Enroll or join a Part D plan offered by a private insurance company to be covered for the full retail cost of your prescriptions now.
