Friday, January 15, 2021

Advantage Plans Deductibles

How can I avoid the Medicare deductibles? What's the MA deductibles? 

Medicare Advantage plans may or may not have a deductible. The ones that do not have a deductible are usually HMOs and the plan starts paying from day one (as long as you go "in-network). That means you have co-pays or co-insurance straight-away. This is one of MA's advantages.

Some Advantage plans have high deductibles, similar to what many people get from thru their employer. The deductibles can range from $500 to $4000 and typically there is some Part B Premium Rebate the higher the deductible. The other perk is the money you spend on healthcare will be exempt when you deposit money into and spend from a Medicare Spending Account (MSA). This is similar to Health Spending Account or Flexible Spending Account. There are contribution limits.

Medicare Spending Accounts (MSA) can be the best option for some people and those details with be in a future post.

Most Medicare Advantage Plans have a prescription coverage, and prescription coverage has its own deductibles. The deductibles will be based on medication tiers and most tier 1 will not have a deductible.

Thank you for reading. Please leave comments or follow.

Original Medicare Deductibles

What's that? How much? Isn't there usually only one deductible?

A deductible is the amount you pay for covered healthcare services and treatments before the insurance starts to pay. Private health plans will usually have only 1 deductible. More working Americans get to choose some version of a High Deductible Plan before the plan picks up the costs. The deductibles are often $1500 - $4000. Sometimes there are deductible tiers (or multiple deductibles) related to specific conditions, such as having a baby. 

Medicare has 2 deductibles. One for Part A and one for Part B. 

Part A (2021) - $1484
Part B (2021) - $203

After the deductible is met, Medicare picks up 80% of assignment or contracted payment. Medicare-approved doctors can charge up to 15% over assignment, which means Medicare isn't pay 80% anymore but only 73.5% and the consumer pays the rest, called co-insurance.


Part A-Hospital, hospice, skilled nursing facility and home health.
Part B-Out-patient, labs, medical equipment, limited medications, and mental health.

An individual on Medicare or a private health insurance is still covered by the terms of the plan. This means a few things. 1) Only money paid towards covered healthcare services and treatments will count towards the deductible. 2) The doctors and medical professionals need to be Medicare approved, or "take" the private insurance, and 3) the doctors will charge prices based on agreements with Medicare or the hypothetical  insurance company.

Medicaid plans don't have deductibles. They are designed to be zero-cost to super-low cost for needy individuals. If someone isn't "needy enough," but their Medicaid starts to pay after they pay a certain amount for covered healthcare, that's called spend-down. This may sound like a deductible, but because folks with spend down aren't restricted to the terms of Medicaid, doctor networks, etc, it's not a deductible. This means the doctors will charge patients with spend-down more than they would normally get paid by Medicaid. If the person with spend down is also on Medicare or a private insurance, the doctors have to charge based on the terms of the primary plan. Usually, only state-approved treatments and spending counts towards the spend-down, but not always. Medicaid can get really tricky, so it's best to get confirmation of coverage from the doctor's office and Medicaid office.

On Medicare, the doctors must treat you if you haven't met your deductible. On private insurance, or with a Medicaid spend down, the doctors might (but not always) refuse to treat you until they receive payment. 

There is a lot to cover with deductibles. In a future post I will talk about ways to eliminate the Part A and Part B deductibles. There are supplements, cost plans and MAs available that eliminate these for the consumers. Thank you for reading. Take care.

Wednesday, January 13, 2021

Medicare vs. Medicaid

What's the difference? Is Medicaid the worst and Medicare the 2nd worst?

MediCARE vs. MedicAID

Pronunciation and spelling are the first major differences. They are both government health insurance administered by the federal agency known as the Centers for Medicare and Medicaid Services (CMS).

Medicare is funded by payroll and self-employment taxes. Medicaid is funded by state and federal taxes.

Medicare is based on federal laws passed by Congress. The terms of how patients get care and doctors get paid is the same in all states. Private Medicare plans have to cover at least the same illnesses, treatments and services as Original Medicare.

Medicaid is legislated at the state level so every state Medicaid program is unique. This also means the terms of patient care vary among the different state plans. Also, you can only be in one state plan at a time. No doubling-up the benefits.

Now, many people can have both Medicare and Medicaid. In the insurance industry, this is referred to as Dual Eligible. When Medicaid coordinates with Medicare, the state picks up a lot of the costs that Original Medicare doesn't cover, like the Part B premium or the deductibles. 

In a future post, I will cover Medicare deductibles. Rest assured, there are options that make them non-issues. Thank you again for reading. Please follow.

Tuesday, January 12, 2021

Part B Rebate

Where do you sign up? How much can you get back?

The standard premium for Part B in 2021 is $148.50. There are 3 ways to pay less:

  • Qualify for Medicaid and the state will pay all or some of your premium
  • Get a Medicare Advantage (MA) plan that includes a rebate
  • Cancel your Part B enrollment.

If you want to try to get your state to pay your Part B premium, you will have to be approved for medicaid. This is a state benefit that is usually for the low-income, but not always. Some states accept anyone over 65. Some states will never pay the Part B premium. It's worth exploring if are living check-to-check. If order to apply, search your state's websites. In a later post, I will detail some of the general differences between Medicare and medicaid.

If you need to keep major medical insurance and Medicare is your best option, then there *might* be a Medicare Advantage (MA) plan in your area that offers a Part B "premium reduction" or "rebate." Most of the premium reduction or rebates are $15-$40. The plan may or may not include prescription drug coverage. If you have VA benefits, look for MA-only plans. Most areas have them, but not all. You can continue to get your prescriptions thru the VA pharmacies and still get the Part B reduction from the MA plan. Most of the MA-only plans have a Part B premium reduction or rebate upwards to $40. These plans are marketed towards Veterans and have names like Patriot or Honor. The reduction will usually come thru your monthly Social Security check.

For those who need creditable prescription drug coverage, there are MA (MAPD) plans with prescription coverage that offer a monthly rebate or Part B reduction. They will be based on where you live so not everyone, who see this, will be able to enroll in one.

Yes. Unfortunately, Medicare plans are designed for local markets and plans change if you move counties/major cities. These are called service areas. Sometimes nearby service areas have such similar plans no one know the difference. 

There is a link below that will take you to where you can search for local plans without logging in. 

From there, you will be asked other questions and eventually get a list of potential plans. There is no easy way to filter for plans that pay towards the Part B premium, but most of them are high deductible plans. Also, the MAPD plans tend to send a "rebate check," and the $148.50 (or more) will still get deducted from your Social Security check.

The Link:
You will be redirected.
Select Medicare Advantage Plan.
Enter your zip code.
Select "Plan Details" box for potential plan.
For for "Overview."
Look to see Row 5 "Part B premium reduction" Yes or No
Now you will have to search elsewhere or call the carrier for the exact amount.

The last option to save on the Part B premium is to cancel Part B. I only recommend this if you or your spouse currently have coverage thru a group employer plan.

This has been a longer post. Future posts will unwrap some of the generalities like some differences between Medicare and medicaid, or even - What's an Advantage Plan? Thanks for reading this far and please comment or subscribe.

Original Medicare - Part A and B

What is it? How much does it cost?

...Let's jump in.

Part A- Inpatient hospital stays, hospice care, and provides limited "skilled nursing" facility and home health benefits.

Part B- Professional services such as those provided by a doctor, and standard supplies that are needed to diagnose or treat medical conditions. It also covers ambulance, durable medical equipment like wheelchairs, limited out-patient drugs, and psych treatments.

Beneficiaries are said to be "entitled to Part A" and "Enrolled in Part B." This is because generally, most people get Part A at no cost and have to pay a monthly premium for part Part B. The standard premium in 2021 is $148.50.

Don't freak out. 

The money is drafted before you get your cut of Social Security. It's the almost the same premium for most retirees and disabled people, and a good majority will never realize or care that they "paid" a premium for Part B.

Now maybe you heard you get can get a reduction or a refund of your Part B premium. There are ways to pay less for Part B, and I will cover that in future posts.

I will eventually post a deep dive into Part A premium and why it's "usually no cost" but sometimes a cost, and the deductibles and co-insurance for Original Medicare, as well as some of the most common limits like the ones for nursing homes and out-patient drugs.

Thank you again for reading. Please leave any comments and come back often.

Sunday, January 10, 2021


What is Medicare? Who has it? How much is it? How do you enroll? 

Medicare is a government health insurance administered by the federal agency known as the Centers for Medicare and Medicaid Services. CMS for short. Unlike the IRS, they are easy to get a hold of on the phone. The customer service agents are friendly and knowledgeable. HOWEVER, they only help partners and people enrolled in Medicare.

Medicare is available to citizens of the United States and most legal permanent residents who are age 65 or older and those under 65 with certain disabilities, end-stage renal disease (ESRD), and Lou Gehrig's disease.

Yes! Medicare costs money. For most people, in 2021, the monthly premium for Part B is at least $148.50/month.

To enroll, you must apply through your local Social Security Benefits office. It's usually next door to the office issuing social security cards and dealing with your identity. It's best to call for an appointment.

Why do I said "at least"? And what's this about Part B?

Those questions will be answered in later blog posts. If you aren't already fluent with Medicare jargon, hopefully this blog will get you comfortable. Leave an encouraging comment. The more comments, the more motivated I'll be to keep posting. Thanks for reading and commenting.

Part D

 What's Part D? Is it required? Part D is drug coverage. Private insurance companies contract with the Federal government I order to off...