Understanding Medicare: A Crash Course for RVers

Currently, 60 million Americans rely on Medicare. In the years 2011 through 2029, someone will turn 65 every eight seconds. Open enrollment is quickly approaching and it’s important for those approaching the age of 65 and older to know how to navigate the different components and often daunting realm of understanding Medicare. 

Navigating the complex road maps of Medicare isn’t easy. You can think of RVer Insurance Exchange as your Medicare GPS. The more you know about Medicare, the more you will be able to maximize your benefits and stay healthy. Shoot, you might even end up saving money too! Ask yourself, is that important to you?

Understanding Medicare Basics

In this article I am going to cover the basics of Medicare; What it covers, how it works, how to seek help, the changes to Medicare that occur in 2020 – 2021, what is Part C, and what is Part D.

With any kind of health insurance, it is never one size fits all. So, there are four things to consider; where you live, your current health status, income, and your lifestyle. When you turn 65, with Medicare, there are two different paths you can take. You can either go the Medicare Supplement route or the Medicare Advantage route, also known as Part C. Before I dive into the differences between the two, let’s first tackle the prerequisite for both, Medicare Parts A & B, also known as Original Medicare.

Understanding Medicare Part A

They call it original Medicare because back in 1965 when it was first turned into law that’s all there was. Part A of Original Medicare is hospitalization coverage, and most have paid into it while working and contributed to it over years of income tax payments. There is typically no premium for those who have worked in the USA for 10 years. Part A has deductibles and copays. 

Medicare Part B

Part B covers doctor’s visits and outpatient services. You will pay a monthly premium either through a deduction from your social security or monthly billing. This year the standard premium for Part B is $144.60. Part B also has deductibles and coinsurance of 80/20.

Medicare Part B covers Doctor visits and outpatient services

Medicare Supplement Plans

So now, let’s discuss the two paths that are in this fork in the road. The first path I will cover will be the Medicare Supplement route. Medicare Supplements work alongside original Medicare. You can think of them as filling in the gaps in coverage of original Medicare and what it doesn’t cover. They help to cover some or all of the out of pocket costs Medicare does not pay for. 

With Medicare supplements there is no network. As long as it is a Medicare approved service and Medicare contracted doctor the service will be covered. Supplements are also offered by private insurance companies. With Medicare supplements, there are 10 different options and the different options or plans are lettered A-N. They all have different premiums and cover different benefits. The most comprehensive plan that covers all of the federally regulated benefits, Plan F, is going away this year. 

Medicare Plan G

The next best plan is Plan G. The only difference between a Plan F and a Plan G is the $198 deductible. Once the $198 annual deductible is met then Plan F and Plan G are identical. There are numerous different companies all competing for your business offering these Medicare supplements lettered A-N. It is very important for me to note that they are indeed federally regulated, meaning that they are all required to include the same exact benefits that are designed to protect you, the insured. 

Since they are all federally regulated to be the same you will receive the same exact benefits with company X as you would with company Y. When shopping for a Medicare supplement, since they are federally regulated, you want to take into consideration two very important factors, today’s rate and how stable that rate is. It defeats the purpose in selecting if you were to go with company X who raises your premiums each year by $15-$30. The price may be attractive today but who’s to say it will still be in the coming years. Be sure you’re asking for the rate stability when speaking with your insurance agent. A good agent will be able to provide that information for you by showing the company’s rate history.

Medicare Advantage – aka Part C

Now onto the other fork in the road, Medicare Advantage, or some might know it as Part C. Just like with Medicare Supplements, you will need Original Medicare Parts A & B to join a Medicare Advantage plan. With Medicare Advantage the services replace original Medicare by private insurance companies so you can file away your red, white, and blue original Medicare card. These private insurance companies contract with Medicare to be responsible for all of your medical care. With Medicare Advantage plans, you must reside in the plan’s service area. You also cannot have end stage renal disease in 2020 and in most cases you will need to use the plan’s network. 

There are many different options of network for Medicare Advantage plans including but not limited to HMO’s, PPO’s, and POS’s. All Part C plans (Medicare Advantage plans) have a maximum out of pocket up to $6,700 annually. The insured will pay co-pays or coinsurance for services including hospital stays. Also, with most plans you must stay in network. Now that you’re an expert on Medicare from this article we can now cover the basics of Part D.

Understanding Medicare Part D
Understanding Medicare Part D is critical for managing your prescription drugs

Medicare Part D

Part D is going to cover your prescription drugs. It helps pay for medications not covered by Medicare. Part D is also through Private Insurance Companies. There are four phases to your Part D coverage. The first is the deductible phase, you’re responsible for the full cost of your medications until you pay the deductible amount set by your plan. The standard deductible for 2020 is $435, which is an increase of $20 from the previous year. The next phase is the initial coverage phase. In the initial coverage phase you pay 25% of retail drug cost before meeting the $4,020 limit. 

Once we’ve reached the $4,020 limit, the next phase we’re in is the coverage gap or also known as the “Donut Hole”. In the donut hole you pay 25% of generic or brand name retail drug prices. When you get to $6,350 in total out of pocket expenses, you’ve reached the limit of the donut hole and you have now entered into the catastrophic coverage phase. In the catastrophic coverage phase you pay approximately 5% of retail drug prices. Due to new changes in legislature, drug prices will soon appear in many TV Ads. Pharmaceutical companies will be required to disclose costs of medications on television if the price exceeds $35 per month.

RVer Insurance Exchange is Here To Help

I have covered a lot of information, so you’re welcome to call us if you ever have any questions. You don’t have to go it alone. Our agents are licensed in most states and can help you assess your needs. We also help with determining if you are eligible for other services besides Medicare that may save you money. 

Every year it’s important to reassess your needs and educate yourself on changes as the Medicare realm is continuously evolving. We are just a phone call or email away to help you with understanding your benefits.

Luke Martinez

Luke Martinez

Luke Martinez is a knowledgeable insurance agent for RV Insurance Benefits in both the Medicare and Under 65 markets.