Senior Dental, Vision and Hearing, Telemedicine
We offer: Dental HMO, PPO, Indemnity, No Wait and Discount Plans
Vision HMO, PPO and Discount Plans
Hearing plans that are offered with Dental and Vision
Telemedicine with copays and without
Additional Ancillary Products
Term, Whole, Universal, Final Expense, Accidental Death & Dismemberment, Accident, Cancer, Critical Illness, Credit Lock, Hospital Indemnity, Legal Shield, Long Term Care, Short Term Care, Short Term Medical (ages 64 and younger) and Travel Insurance
Basic Medicare is the insurance program offered by the federal government.
Sometimes referred to as “Traditional Medicare,” it provides eligible individuals with coverage at the hospital and doctor’s office. To be eligible, you must be 65 years of age or older, or have a disability if younger. You can enroll in Basic Medicare through the government or by visiting the ssa.gov.
Basic Medicare benefits are comprised of two parts: 1) Medicare Part A, which is for hospital coverage, and 2) Medicare Part B, for doctor visits.
Part A is one of two parts that make up Original Medicare. It helps cover inpatient care in hospitals, care in skilled nursing facilities, hospice care, and some home health care.
Medicare Part A: Coverage and Costs
Medicare Part A covers inpatient hospital care, limited home health services, limited skilled nursing care facility services, and hospice care.
There are no monthly premiums for Medicare Part A if you paid taxes for at least 10 years. If you did not pay taxes, you will likely have to pay as much as $422 per month as of 2018.
Inpatient Hospital Care
Inpatient hospital care includes coverage for a room, nursing services, medications, medical supplies, and meals that are necessary for your treatment. You can receive inpatient hospital care at following facilities:
•Emergency or Critical Care.
•Long Term Care.
For inpatient hospitalization, you will face a deductible of $1,340 as of 2018. If your stay extends beyond 60 days, you will owe $335 per day for days 61-90, and $670 per day from day 91-150. You may be responsible for all costs after day 151.
Home Health Services
If your doctor has ordered home health care, and it is medically necessary, the following expenses should be covered by Medicare Part A:
•Skilled nursing care (part-time or intermittent).
•Medical social services.
•Durable medical equipment (80% of cost).
You will not be covered for 24-hour home health care unless it is medically necessary.
Skilled Nursing Facility Care
If your doctor recommends you transfer from inpatient hospital care to a Medicare-certified skilled nursing facility, Medicare Part A will cover the following expenses:
•Skilled nursing services.
•Medications while in the care of the skilled nursing facility.
•Medical supplies and equipment while in the care of the skilled nursing facility.
•Meals and dietary counseling.
•Medical social services.
Long-term medical or personal care is not covered if that is the only type of care you need.
If you have been diagnosed with a terminal illness, you may be eligible for hospice care, which will usually be provided in your home. To be eligible you must be (1) enrolled in Medicare Part A, (2) have been diagnosed by a doctor with a terminal illness with six months or less to live, and (3) agree to no longer receive medical treatment for your terminal illness.
The hospice care must be provided by a Medicare-approved hospice care provider and may include coverage for:
•Pain relief medications.
•Hospice aide services.
•Physical and occupational therapy.
•Short-term inpatient hospital care, as medically necessary.
You have the right to discontinue hospice care if you decide to seek additional treatment for a terminal illness at any time.
Part B is the second half of Original Medicare. It helps cover certain services from doctors and other health-care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
It’s important to note that Medicare beneficiaries can have Part A and Part B, or they can have one without the other. Either way, they have Original Medicare. Some people get both Parts A and B automatically, and others need to sign up.
Medicare Part B: Coverage and Costs
Medicare Part B is medical insurance that covers visits to your doctor, preventative health screenings, blood tests, medical equipment and supplies, outpatient hospital care, and more.
You will pay a monthly premium for Part B benefits, as well as a small annual deductible and doctor visit co-pays.
Medicare Part B monthly premiums are based on income. Generally speaking, the higher your income, the higher your premium. The income tiers are as follows:
Please note that if you are already receiving Social Security or Railroad Retirement Board benefits, your monthly premium will automatically be deducted from these payments once you are enrolled in Original Medicare.
The out-of-pocket costs for Medicare Part B include an annual deductible of $183 as of 2018. The insurance will cover 80% of outpatient and doctor visit costs, meaning you will have to pay for the remaining 20% out-of-pocket, or the coinsurance.
Gaps in Basic Medicare Coverage
Due to the lack of maximum out-of-pocket limits as well as the Part B coinsurance, many people seek to close the “gap” in Basic Medicare coverage with Private Medicare Insurance.
Additionally, Basic Medicare does not cover the following:
•Prescription drugs (unless hospitalized).
•Most dental care and dentures.
•Eye exams and contacts/eyeglasses.
•Hearing aids and exams.
•Foreign travel health care.
To cover the items that Basic Medicare does not cover, in addition to getting help for out-of-pocket costs, many people opt to purchase a Medicare Advantage, Prescription Drug Coverage or Medigap plans.
Part C covers all Part A and Part B benefits and services; may offer additional coverage, like vision, hearing, and dental; and may also include Medicare prescription drug coverage (most do). Medicare Advantage plans are offered through Medicare-approved insurance companies. You will find a number of options that may vary based on the county in which you live.
Medicare Advantage Plans
Medicare Advantage plans are offered by private health insurance carriers. Sometimes referred to a Medicare Part C, these plans help you get additional health coverage that is not available with Basic Medicare alone. They can help you save on out-of-pocket costs, and place an overall cap or maximum limit on these costs.
Medicare Advantage plans differ from Medigap in that they do not supplement Basic Medicare. Instead, you get both your Basic Medicare benefits and your additional benefits within the same plan. This could make plan management easier and more convenient. Think of Medicare Advantage plans like the health insurance you may have previously had through your employer at one point. You typically get medical services through a network of providers.
You can first enroll in Medicare Advantage during the Initial Enrollment Period. Initial Enrollment is the 7 months surrounding your 65th birthday – starting with 3 months before, continuing the month of, and ending 3 months after your 65th birthday. Those under 65 can enroll if they are disabled.
***Medicare Advantage plans offer both your Basic Medicare benefits and your additional Private Medicare Insurance in one convenient plan. For this reason, Medicare Advantage may feel similar to the HMO and PPO plans you may have previously had through an employer. Medicare Advantage plans help to lower your out-of-pocket costs, and have become a popular choice over the last few years. Many plans already include the cost of Basic Medicare’s deductibles. Additionally, and unlike Basic Medicare, Medicare Advantage plans place a limit on your total out-of-pocket costs. The maximum out-of-pocket limit is set by law and is around $6,700 in 2018, however, many plans can have substantially lower limits.***
***Medigap plans, also known as Medicare Supplement plans, are purchased in addition to your Basic Medicare coverage. These plans can lower your out-of-pocket costs. To begin, Medigap plans will pay for your Basic Medicare Part A deductible of $1,340 per hospital visit. Most Medigap plans will also pay for your out-of-pocket costs when visiting the doctor, or that 20% of costs that Basic Medicare Part B does not pay. Many Medigap plans offer additional benefits, such as long term care, or coverage for emergency medical services when traveling overseas.***
Medicare Advantage Continued
You can also enroll in a plan during the annual Open Enrollment Period, which begins on October 15 and ends on December 7. Open Enrollment is also a good time switch plans or make changes to your coverage. If you miss Open Enrollment, you can enroll during the Special Enrollment Period. You qualify for Special Enrollment if you have a life change, such as moving to a new state or losing coverage such as employer-based health insurance.
Lastly, all Medicare Advantage plans are given star ratings on a scale of 1 being the worst and 5 being the best. If you previously did not have a 5-star plan available in your state, and one suddenly becomes available, you can enroll in this new plan at any time.
Medicare Advantage: Coverage and Costs
Medicare Advantage plans can vary in coverage. Generally speaking, most Medicare Advantage plans cover out-of-pocket costs, such as Basic Medicare deductibles, copayments, and coinsurance. Additionally, many Medicare Advantage plans can include prescription drug coverage, dental insurance, and vision benefits. These benefits are not available with Basic Medicare alone.
Medicare Advantage premiums can start at $0* per month. These plans tend to only include very basic coverage, or primarily your Original Medicare benefits. On average, premiums tend to be around $34** per month, but can greatly vary from state to state and carrier to carrier.
•Generally speaking, the less coverage you purchase, the lower your monthly rate.
•Rates can vary across carriers and the state you live in.
•All plans by law must meet the same standard of coverage, no matter the carrier or the state.
•Medicare Advantage Plans can be purchased during Initial Enrollment Period, which is the 7 months surrounding your 65th birthday, or during the Open Enrollment Period, which begins on October 15 and ends on December 7. You can still get a plan if you miss these enrollment windows if you have certain life changes, such as moving, or if a highly rated 5-star plan become newly available in your state. Those under 65 can enroll if they are disabled.
Some Medicare Advantage plans offer free or discounted gym memberships, healthy workshops and chronic illness programs.
Prescription Drug Coverage
Like Part C, Part D is run by Medicare-approved, private insurance companies. It helps cover the cost of prescription drugs, and may help lower prescription drug costs and protect against future price increases.
Medicare Prescription Drug Plans
Basic Medicare does not provide prescription drug coverage at the pharmacy. It only includes coverage for prescription drugs while hospitalized. If you regularly take prescription medication, the out-of-pocket costs can be substantial if you only have Basic Medicare. Fortunately, private insurance carriers offer Medicare Part D plans to cover the costs of prescription drugs.
Enrollment in Medicare Part D is similar to Medicare Advantage. You can enroll during the Initial Enrollment Period, which is the 7 months surrounding your 65th birthday (starting with 3 months before, continuing the month of, and ending 3 months after your 65th birthday). Those under 65 can enroll if they are disabled. You can also enroll in a Medicare Part D plan during the Open Enrollment Period. Open Enrollment begins on October 15 and ends on December 7. If you miss Open Enrollment, you may still get a plan if you qualify for Special Enrollment. You qualify for Special Enrollment if you experience certain life changes, such as moving to a new state or losing health coverage.
Medicare Part D plans can be purchased as either (1) standalone coverage, which is in addition to Basic Medicare or a Medigap plan, or (2) as part of a Medicare Advantage plan.
Medicare Part D: Coverage and Costs
Though Medicare Part D plans are provided by private carriers, they are still regulated by the government. All Part D plan must cover the following:
•At least two different drugs from all categories of medications.
•At the least the majority of drugs from the following categories: ◦Cancer
Medicare Part D plans generally pay around 60% of brand-name and 49% of generic prescription drug costs. Once the plan pays for a total of $3,750 in costs for the year, you are in the “donut hole.” During the donut hole, the coverage drops to 50% for brand-name and 14% for generics. However, once you have spent a total of $5,000 out-of-pocket for the year, catastrophic coverage begins.
Under catastrophic coverage, you only will pay a small copayment, and the plan will pay for nearly all of your prescription drug costs. By 2020, the doughnut hole will disappear and Medicare Part D plans will pay for 75% of all prescription drug costs.
When shopping for a plan, it is best to check if the prescription drugs that you currently take -- or those that you think you might need at one point -- are covered as part of the plan. Each plan has a different list of covered drugs. This is known as the plan’s “formulary.” If a drug is not on the list, then you generally have to pay the full price.
You cannot purchase this type of plan if you have Medicare Advantage.
The premiums for Part D Medicare plans can vary from carrier to carrier and from state to state. Monthly premiums for MAPDPs start around $5***, while SPDPs start around $11.40***.
For those currently on Medicaid or Supplemental Security Income (SSI), you may qualify for the Medicare Extra Help Program. The Medicare Extra Help Program is government subsidy program that reduces your Part D premiums and deductibles. It can also remove the doughnut hole, giving you coverage with no limits.
You may also qualify for partial Medicare Extra Help if your monthly income is no more than $1,538 for individuals or $2,078 for married couples, and your “countable resources” (stocks, bonds, money in a savings or checking account) do not exceed $14,100 (individuals) or $28,150 (married couples). Please check with the government or visit medicare.gov to apply and learn more.
•You can buy a Medicare Part D plan separately or as part of a Medicare Advantage plan.
•Rates can vary across carriers and the state you live in.
•Plans by law are standardized to cover the most common medications. However, when shopping for a plan, it is important to check the plan’s formulary, or the exact medications the plan covers.
•Medicare Part D plans can be purchased during Initial Enrollment Period, which is the 7 months surrounding your 65th birthday, or during the Open Enrollment Period, which begins on October 15 and ends on December 7. You can still get a plan if you miss these enrollment windows if you have certain life changes, such as moving or losing health coverage. Those under 65 can enroll if they are disabled.
Click here to check drug pricing and create a list. This will allow you to check possible drug and plan prices.
Do you have more questions or would like to speak with someone? Click here to give us a call to learn more or schedule an appointment.
What Optional Medicare Coverage is available to me?
Medicare provides a lot of coverage, but it doesn’t cover everything. If you need supplemental coverage, then Medicare Supplement insurance may be for you.
Medicare Supplement (Medigap) Policies
Medicare Supplement (Medigap) policies supplement Original Medicare. They can help you pay for some of the health-care costs associated with Original Medicare, including co-payments, coinsurance, and deductibles. Some policies also cover services that Original Medicare doesn’t, like medical care outside of the U.S.
Medicare Supplement policies are sold by private insurance companies and have a monthly premium. In order to qualify for them, you must have Medicare Part A and Part B.
Medigap plans are offered by private health insurance carriers. They provide additional coverage and help close the “gap” between what Basic Medicare pays and what you would have to pay for out-of-pocket. Medigap plans are also known as Medicare Supplemental plans.
The best time to enroll in a Medigap plan is when you first qualify for Basic Medicare. The Medigap Enrollment Period begins on your 65th birthday and lasts for 6 months. During this time, private insurance companies are required by law to offer you a Medigap plan. They also cannot increase your premiums because of preexisting conditions. Those under 65 can enroll if they are disabled. If you miss the Medigap Enrollment Period, you can still get a Medigap policy, but carriers may require you take a physical exam. Based on the results, they can increase your premiums or even deny you coverage if you have a preexisting condition. If you face a higher premium or are denied coverage, it is important to shop around, since some carriers may still enroll you at a competitively lower rate.
Medigap: Coverage and Costs
There are 10 “letter” Medigap plans. They are Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan K, Plan L, Plan M, and Plan N.
In most states, each Medigap plan will have the same standardized coverage and benefits per letter category. For example, Plan N will have the same level of coverage in California as one in New York. Though the coverage is standardized, their availability can differ from state to state, and carrier to carrier.
Depending on the plan you select, most Medigap plans will help pay for:
•Basic Medicare deductibles, such as the $1,340 deductible for Part A.
•Coinsurance when visiting the doctor, such as covering the 20% of out-of-pocket costs that Basic Medicare does not pay for.
•Overseas emergency health care.
Medigap premiums tend to start around $89* per month. Higher coverage plans can cost $129* or more. Though the plans are standardized, rates can vary from state to state. Plan A tends to have the lowest premiums, however you may end up paying more out-of-pocket. By comparison, Plan F tends to have the highest premiums, but offers the most comprehensive set of benefits.
•Generally speaking, the more coverage you purchase, the higher your monthly rate.
•Rates and availability can vary by carrier and by state.
•The plans are all standardized into 10 “letter” plans, and their coverage does not vary by carrier and state.
•You must be enrolled in Original Medicare Part A and Part B to get a Medigap plan.
•The best time to enroll is during the Medigap Enrollment Period, which begins on your 65th birthday and ends 6 months after your 65th It may be harder to get a Medigap plan at a competitive rate after the enrollment period. Those under 65 can enroll if they are disabled.
Would you like more information on plan details, have questions or would like to enroll?
Click here or give us a call (918) 973.3304 or (918) 973.3304.
For additional quotes on Medicare Advantage, Part D and Medicare Supplements, click here.
The above quoted Insurance Companies or this agency are not connected with or endorsed by the U.S. Government or the federal Medicare program. Policies have exclusions and limitations. For cost, more plans, carriers and further details of the coverage and terms under which the policy may be continued in force, contact your agent or the company.
Ancillary Links and Brochures
My Benefit Comparison. Compare, get quotes for multiple products and enroll online.
Spirit Vision. Click here for details, pricing and online enrollment.
Ameritas Security Life Dental and Vision. Click here for more information on plans, pricing and to enroll.
Denali Dental and Vision. Click here for more information on plans, pricing and to enroll.
Dental Plans. Click here for more information on plans and discounts for Dental, Vision and Alternative Medicine discounts.
Magnum Dental and Vision. Click here for more plan information, pricing and to enroll online.
Ally Health Telemedicine. Click here for plan pricing, details and online enrollment.
Starmount ADD. Click here for plan pricing and online enrollment.
Starmount Accidental Death. Click here for plan pricing and online enrollment.
Ministry Health Share Plan. Click here for plan pricing, coverage and enrollment.