Caregiver Choices - Medicare Open Enrollment Questions


This topic can be overwhelming and frustrating for the growing number of Millennial and Sandwich generation caregivers. Knowledge is power, so learning more now will help your loved one and allow you to see what to expect during the process when your time comes to enroll. Aside from the fact that Open Enrollment is now between October 15th and December 7th, it is the best opportunity to review your health coverage to find new plans or change existing ones. Medicare Advantage enrolled min than 28 million people in 2022.

More plans were added to the Medicare Advantage plans during 2022 that received 4-star ratings. As more new enrollees approach this open enrollment, a few questions have been asked because Medicare is not a light subject. I checked back in with Barajas Insurance Group to help me pick these details apart. Today, licensed agent and co-owner Joe Barajas joins me to talk about Medicare changes for enrollees of the 2023 plan year.



For those new to this type of insurance, let's first recap on what Medicare is with the difference between Medicare and Medicaid.

>What is Medicare?

This government program began in 1966 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services (CMS.gov). It is a comprehensive program of health insurance designed to assist the nation's elderly and those with qualifying special needs in meeting hospital (emergencies and surgeries), medical (doctors and treatments), and other health costs (services and medicines). Medicare is available to most individuals 65 years of age, older, and younger people with disabilities.

>What is the difference between Medicare and Medicaid?

Part A is considered "hospital insurance." Part A also covers skilled nursing facilities and home health care. Most Americans who worked in the U.S. already paid for it through their payroll taxes over 40 quarters or ten years, so you do not have to pay for Part A premium. If you never worked, you may still qualify for premium-free Medicare Part A if married, through your spouse's work history, or based on specific medical conditions.

Part B, also called "medical insurance," is paid through monthly premiums. Part B covers the medically necessary services to treat illnesses, including doctor office visits, lab work, x-rays, and outpatient surgeries. It also covers preventative services such as cancer screenings or flu shots.

>What is a Medicare Advantage Plan?

Medicare Advantage is also referred to as Medicare Part C. It is an alternative to Medicare and not a replacement for Medicare. The Medicare Advantage plan is the "all-in-one" plan that bun


dles Medicare Part A, Part B, and commonly Part D (prescription drugs). The cost and plan will vary because Medicare Advantage plans are offered by private companies that have been Medicare-approved. These plans also offer dental, hearing, and vision benefits that Original Medicare does not cover.

Having Medicare does not mean everything is covered, though. Supplemental coverage helps with the cost of dental care, eye exams, hearing aids, acupuncture, and select cosmetic surgeries. Medicare does not cover long-term care expenses, which many find out when they need it most. Some confusion comes in because many pass on purchasing Long-term Insurance with a false understanding they don't need it if they have Medicare or can qualify for Medicaid, but that is not true.

Suppose you care for a loved one with a disability or meet the age requirements and struggle financially. In that case, it is beneficial to spend time with an agent like Monique and Joe Barajas to find out what you may qualify for or update your current coverage if needed. When Mom needed additional help through Home Health services for occupational therapy, it was a relief to know her appointments would be covered through her chosen coverage rather than having one more out-of-pocket expense.

Here are a few of the questions I asked Licensed Agent Joe Barajas, co-owner and founder of Barjas Insurance Group, LLC:

With Inflation being a financial pain point for everyone, are medicare premiums expected to rise in 2023? And can you break down the deductibles for Part A & Part B?



No, Medicare premiums will not increase for most recipients in 2023. The standard Medicare Part B premium is decreasing by about 3%. Federal officials expect the average premiums for Parts C and D, plans offered by private companies, to drop next year.

Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. The Standard monthly premium for Medicare Part B enrollees will be $164.90 in 2023, decreasing by $5.20 from $170.10 in 2022. The annual deductible for Medicare Part B beneficiaries is $226 for 2023, a decrease of $7 for $233 in 2022.

Part A for inpatient hospital deductible beneficiaries pay if admitted to the hospital will be $1,600 in 2023, an increase of $44 from $1,556 in 2022. This deductible covers beneficiaries for the first 60 days of Medicare-covered inpatient hospital care in a benefit period.

In 2023, beneficiaries must pay a coinsurance amount of $400 per day for the 61st through 90th day of a hospitalization ($389 in 2022) in a benefit period. Then $800 per day for lifetime reserve days ($778 in 2022). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $200.00 in 2023 ($194.50 in 2022).

If the premiums are not increasing for most recipients, then are Medicare premiums based on income?

Yes. If you have a higher income, you'll pay an additional premium amount for Medicare Part B and Medicare prescription drug coverage. We call the additional amount the "income-related monthly adjustment amount." Here's how it works: Part B helps pay for your doctor's services and outpatient care.

It also covers


other medical services, such as physical and occupational therapy and some home health care. For most beneficiaries, the government pays a substantial portion — about 75% — of the Part B premium, and the beneficiary pays the remaining 25%.

Suppose they determine you're a higher-income beneficiary. In that case, you'll pay a more significant percentage of the total cost of Part B based on the income you usually report to the Internal Revenue Service (IRS). You'll pay monthly Part B premiums equal to 35, 50, 65, 80, or 85% of the total cost, depending on what you report to the IRS.

Can Medicare be used as a secondary insurance?

Yes. According to Medicare.gov, Medicare and other health insurance (like from a group health plan, retiree coverage, or Medicaid), each type of coverage is called a "payer." When there's more than one payer, "coordination of benefits" rules decide who pays first. The "prima


ry payer" pays what it owes on your bills first and then sends the rest to the "secondary payer" (supplemental payer) to pay. In some rare cases, there may also be a third payer.

Here's how it typically works:

The insurance that pays first (the primary payer) pays up to its coverage limits.

The one that pays the second (secondary payer) only pays if there are costs the primary insurer didn't cover.

The secondary payer (which may be Medicare) may not pay all the remaining costs.

If your group health plan or retiree coverage is the secondary payer, you may need to enroll in Medicare Part B before they pay.

If the insurance company doesn't pay the Claim promptly (usually within 120 days), your doctor or another provider may bill Medicare. Medicare may make a conditional payment to pay the bill and recover any expenses the primary payer should've made.

You can imagine how in-depth talks about Medicare coverage can go. The reason to speak to a licensed and well-educated agent like Joe or Monique Barajas of Barajas Insurance Group, LLC.

Joe helps answer even more questions, such as the best Medicare or supplement plan to purchase next.




For more information, listen to the full podcast at www.proactivecaregiver.com/podcast.


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