Tag: Medicare Part B

Categories
Medicare A & B

Your 2026 Medicare Part B and D Premiums

May Be Increased. Or Eliminated.

The 2026 standard monthly premium for Medicare Part B beneficiaries is $202.90.

However, your 2026 Medicare Parts B and D premiums could be higher or lower – based on your prior or current income.

  • Higher? Yes. If the Modified Adjusted Gross Income (MAGI) on your 2024 tax filing exceeded $109,000 ($218,000 joint) your 2026 Medicare Parts B and D premiums are increased. This will be withheld from your 2026 Social Security benefit. Here is more information about the Income Related Monthly Adjustment Amount (IRMAA) for Parts B and D
  • Lower? Yes. If your current annual income is below 186% of the Federal Poverty Level you will be eligible for the Medicare Savings QI Program, regardless of assets, and will not be paying any Part B premium.

 

  • If you are being charged IRMAA and had a life-changing event that resulted in a reduction in your income, you may be eligible for a reduction in IRMAA. Call Social Security at 1-800-772-1213 for instructions on how to file an appeal via the SSA-44 form.
  • Plan ahead. Assuming the law is not changed, check with your financial planner or tax preparer to confirm whether your 2025 tax filing will trigger a 2027 IRMAA.
  • Or, if your current monthly income is below $2,426 individual / $3,279 couple one of our agents listed below and we can review whether you are eligible for the Medicare Savings QI Program.

 

Questions?

Our licensed, independent and certified agents are available to answer your questions about Parts A, B, IRMAA and other Medicare topics. Send us a note below to request an individual consultation.

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Categories
Medicare supplement

Why Choose a High Deductible Medicare Supplement Plan?

Medicare Supplement Plan
reason 1:

Lower annual maximum co-pay responsibility ($2,950 in 2026) compared to most Medicare Advantage plans.

reason 2:

Lower annual cost (premium and out-of-pocket) compared to Medicare Supplement Plans F, G or N.

NY STATE RATES APPLICATION
Like with other deductibles, do I pay the first $2,950 in bills?

No. After you pay the Parts A and B deductibles, Medicare pays its share of claims (usually 80%) and you pay the 20%. Once your deductible and 20% share reaches $2,950, then your supplement plan pays 100% for the rest of the year. Think of it as a $2,950 cap on your out of pocket costs.

2026 2025
Part A deductible per period $1,736 $1,676
+ Part B deductible $283 $257
+ Part B co-share 20% 20%
= Maximum Out of Pocket $2,950 $2,870

Will hospitals and doctors will accept my High Deductible plan?

Yes, if your provider participates in Original Medicare for your primary coverage, they will accept your Medigap supplemental coverage; including plans with deductibles like Plans G, N and High Deductible. This way you have access to the nationwide network of doctors and hospitals participating in Original Medicare.

How does a High Deductible compare to Medicare Advantage plan?
      •  Medicare Advantage plans include a limit on out-of-pocket costs; ranging from $6,000 to $9,250 per year for in-network medical services. (Up to $13,900 for in and out of network)  Compare to a Medicare Supplement High Deductible plan with the annual maximum out-of-pocket cost capped at $2,950
      • Medicare Advantage plans manage your Medicare benefits through contracts with in-network providers and hospitals. As mentioned above, any provider accepting Original Medicare for your primary coverage will accept your supplement coverage – eliminating the “is my doctor in-network with my plan” questions.
      • Most Medicare Advantage plans, including those with a low monthly premium, include Part D prescription drug coverage. With Medicare Supplement, you will need to obtain separate creditable Part D drug coverage. during an Annual Enrollment, Open Enrollment or Special Enrollment  Period. VA drug benefits are considered creditable coverage.
      • Many Medicare Advantage plans include features like dental allowance, fitness membership, eyewear and hearing aid benefits not available with Original Medicare.

 Download 3 separate documents↓↓↓
Globe Life application Form 1 sign page 3 (and 5 for EFT)
Globe Life application Form 2 sign page 1
Globe Life application Form 3 sign page 1
About Globe Life Insurance of NY

Our agents are authorized to represent the Globe Life Insurance Company and Humana Medicare Supplement High Deductible Plans. Please call us at (518) 346-2115 or send any agent a quick note with your questions.

Categories
Medicare Medicare A & B Medicare supplement Part C Medicare Advantage Part D Prescription Drug

About the 2026 Medicare Annual Enrollment

Annual Enrollment Period

The Medicare Annual Enrollment Period, from October 15th through December 7th, is when Medicare beneficiaries can enroll in or change their Medicare Advantage (Part C) or Medicare Prescription Drug (Part D) plan to take effect January 1.

Some Important Tips to Consider if you are now enrolled in a Medicare Advantage (Part C) Plan:
  • You can leave your Medicare Advantage plan and enroll in another Medicare Advantage plan offered in your county. [We offer several]
  • Even if you decide to stay with your current Medicare Advantage plan, make sure your doctors and preferred hospitals are still in your network, especially if your plan is a HMO. 
  • You can leave Medicare Advantage and return to Original Medicare and purchase a Medicare Supplement (aka Medigap) policy. For New York State residents, acceptance is guaranteed and the continuous coverage transfer means no pre-existing condition limitations apply.
Some Important Tips to Consider if you HAVE ORIGINAL MEDICARE AND a Medicare SUPPLEMENT Plan:
  • The Annual Enrollment Period applies to your Part D drug plan only.
  • New York State residents can change their Medicare Supplement plan at any time of the year and without medical underwriting. An example could be changing from one company to another or changing from one plan (Plan F, Plan G, Plan N or High Deductible) to another. 
  • You can leave your Medicare Supplement (Medigap) plan and join a Medicare Advantage plan during the Annual Enrollment Period. There is no underwriting to move to a Medicare Advantage plan. You will be automatically accepted as long as your permanent address is within the coverage area.
  • Unless your prescription drugs are covered through the Veterans Administration, most individuals with Original Medicare and a Medicare Supplement plan also add a Medicare Part D prescription drug plan. We recommend updating your medication list and confirming – through your personal account at medicare.gov – which Part D drug plans will cover your prescriptions at the lowest annual out of pocket costs – that includes premium, deductible and prescription copay costs.

Our team of licensed, independent and certified agent advisors, from Long Island to the North Country, offer a no-obligation complimentary consultation to help you compare Medicare plans in your coverage area.

So, reach out to local agent by phone, an online note or book an appointment directly to his or her calendar and learn more about your Medicare plan options.

Categories
Medicare A & B Part D Prescription Drug

Changes to the NY Medicare Savings Program in 2025

If you are enrolled in Medicare Parts A and B and have limited income you may be able to get assistance with your health care costs through a Medicare Savings Program (MSP) 

If eligible, you will receive help paying the Medicare Part B premium, (currently $185.00) and automatically get Extra Help, the federal program that helps with prescription drug (Part D) costs such as monthly premium, drug deductible and prescription copays.

The two programs listed below offer separate benefits. You cannot choose which program to apply for – you will be enrolled in the program that corresponds to your income.

New Yorkers previously not eligible for MSP may now qualify effective January 1, 2025.

New 2025 New York Monthly Income Limits (*)
Program Individual Couple
QI (i) Up to $2,426 Up to $3,279
QMB (ii) Up to $1,800 Up to $2,433

(*) Eligibility is based on your income after subtracting for eligible health insurance premium deductions such as i) Medicare Supplement, ii) Part D drug plan, iii) dental, iv) vision, and iv) long term care premiums.

  • (QI) Once enrolled as a Qualified Individual with individual monthly income at or below $2,426 you will no longer have the Medicare Part B premium deducted from your Social Security check.  And you may receive up to three months of retroactive reimbursement for Part B premiums paid before your MSP effective date and within the same year of the effective date.
  • (QMB) If your individual monthly income is at or below $1,800 you would be enrolled in the Qualified Medicare Beneficiary Program and, like QI, will no longer have the Medicare Part B premium deducted from your Social Security check.
    • This program also pays for Medicare Parts A and B deductible and cost sharing however no retroactive Part B reimbursements are available to QMB enrollees.
    • Once enrolled in QMB, consider a Medicare Advantage DUAL (Medicare / Medicaid) plan. On top of the benefits described above, these plans include additional benefits like dental, vision and even an allowance for healthy food. Ask your local agent about the Medicare Advantage DUAL plans we represent for individuals in the QMB program. 

Your local agent can help you with the request. Start by downloading the form below. Then, along with a copy of your Medicare ID card, we’ll need documents to confirm your date of birth, residency and income. If you are paying another health insurance premium, such as i) Medicare Supplement, ii) Part D drug plan, iii) dental, iv) vision, and iv) long term care premiums, we’ll need some proof of that expense. Your local agent will work with you in getting this to your county’s Department of Social Services and follow up with you during the approval process which can takes up to 45 days.

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(i) Qualified Individual income eligibility at 186% of Federal Poverty Level
(ii) Qualified Medicare Beneficiary income eligibility at 138% of Federal Poverty Level
Categories
Part D Prescription Drug

Getting Ready for 2025 Medicare Part D

Passage of the Inflation Reduction Act (2022) has meant several changes to Medicare Part D, including these most frequently mentioned:
  • 2023: Insulin co-pay capped at $35 for 30 day supply.
  • 2024: Catastrophic Coverage Stage cost sharing eliminated.
  • 2025: Annual Out-of-Pocket Drug cost sharing capped at $2000.
  • 2026: Medicare and drug companies, for the first time, will negotiate price on the top ten drugs costing the Part D system the most in taxpayer money.
While millions of Medicare beneficiaries welcome these changes, the federal government is shifting more of the cost of these changes to the Part D drug plan carriers and the pharmaceutical companies. The 2025 drug plans, both standalone Part D and the Medicare Advantage plans including Part D, are published online at medicare.gov Changes to watch for in 2025:
    • Premium changes – with standalone Part D or Medicare Advantage.
    • Drug deductible change – can be as high as $590.
    • Cost sharing change – a prescription which may have previously been quoted a fixed copay may in 2025 be quoted a percentage of the drug cost.
Tips for Getting Ready Now!
   
enroll now in a New York program based on your Income 
Program Individual Couple
1. Medicare Savings < $2,426 mo < $3,279 mo
2. NY EPIC < $75,000 / yr < $100,000 / yr
  1. Medicare Savings Program. If eligible, you will receive help paying the Medicare Part B premium, and automatically get Extra Help, the federal program that helps with prescription drug (Part D) costs such as monthly premium, drug deductible and prescription copays.  Click for more information and MSP Application Form.
  2. For individuals with annual income greater than the above MSP levels, but under $75,000 (up to $100,000 for a couple) the New York State EPIC program is secondary drug coverage – meaning EPIC will, after meeting a deductible, help with your prescription copay.  If you take brand name medications and your 2025 cost sharing is based on percentage of the drug cost, you will want this EPIC secondary coverage in place to start the new year.  (Another benefit to being an EPIC member is having the ability to change your Part D plan one time per year outside of the Annual Enrollment Period.) You can now apply for NY State EPIC online or download, print, complete and mail the EPIC application to their office in Albany:
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3. Questions? Please feel free to contact any of our local, licensed and independent agents using the inquiry form below. We’ve even included a worksheet for you to use when researching which 2025 plans match your medications and providers.
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Provider-and-Medication-Worksheet:
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Categories
Webinar Reviews

Delaying Medicare Part B

Diane turned 65 in April 2023, however, declined the Medicare Part B coverage as she chose to remain working and insured through her employer’s group health plan.

In mid November, she decided her retirement date would be year-end and asked about Medicare Supplement plan to become effective in six weeks, January 1.

I advised that she would need to contact Social Security and activate Part B. And I also walked her through the form her employer would need to confirm she had been covered through the group plan since her 65th birthday. (That form prevents being assessed a Late Enrollment Penalty for going without coverage.)

Social Security expedited the Part B activation while I confirmed her primary care, specialist providers, and two medications were included in the Medicare Advantage PPO plan she chose.

On December 18th, her enrollment was all set for January 1, and I’m so appreciative of the kind words in her review posted a few days later.

Categories
Medicare Medicare A & B

Medicare Tips: Part B

Unlike Medicare Part A, which covers inpatient care in a hospital, skilled nursing or hospice facility, Part B covers through outpatient care, services from doctors and other providers, durable medical equipment and many preventative screenings.

  • Individuals already receiving Social Security benefits are automatically enrolled in Parts A and B effective the first day of the month you turn 65.
    • At age 65, individuals choosing to delay their Social Security benefit need to contact Social Security, online or your local office, to activate Parts A and B.
    • Individuals receiving Social Security Disability benefits are automatically enrolled in Parts A and B after 24 months.
    • At age 65, those covered through their individual or spouse’s currently employed group health plan (20 or more employees) may delay Part B WITHOUT PENALTY until they, or their spouse, are no longer employed and the employer coverage ends.
  • The standard Part B premium amount in 2023 is $164.90.
  •  Paying the Part B premium
    • If you receive Social Security benefits, your Part B premium (and the IRMAA adjustment, if applicable) will be deducted from your monthly Social Security payment.
    • If, like me, you are enrolled in Medicare Parts A and B and have deferred the Social Security benefit, Medicare sends a bill (sample below) for the Part B premium and, if applicable, any IRMAA adjustment, which can be paid by check or online.

 

Categories
Medicare

Get Questions Answered at “Medicare 101” Webinar

Are you going to be eligible for Medicare in the near future? Have you been enrolled in Medicare for awhile and want to better understand what it offers? Do you have a family member you help with Medicare issues?

If you answered yes, then “Medicare 101” is for you. This no sales-pitch educational webinar, led by multi-state licensed and Medicare Plan Specialist Dan Alcorn, will be held 9:30 am on the following days:

Monday – September 28, 2020 Register Here
Tuesday – October 6, 2020 Register Here
Sunday – October 18, 2020 Register Here
Monday – November 2, 2020 Register Here
Saturday – November 14, 2020 Register Here
Friday – November 20, 2020 Register Here

We’ll explore Medicare Parts A, B, C and D, the difference between a Medicare Supplement and Medicare Advantage plan, and more. After registration, you will receive the login instructions by e-mail. (The presentation is via GoToMeeting, a video conferencing platform. No video camera is necessary.)

For the GoToMeeting link and access code, register online at:
https://dgalcorn.com/dans-public-presentation-schedule/medicare-101/

Categories
Medicare supplement

What is a Medicare Supplement Plan G?

Medicare Supplement Plan

Medicare Supplement Plan G, also called Medigap, coverage is very similar to Plan F. It offers great value for beneficiaries who are willing to pay a small annual deductible. After that, Plan G provides full coverage for all of the gaps in Medicare. It pays for your hospital deductible, copays and coinsurance. It also covers the 20% that Part B doesn’t cover.

Plan G is an increasingly popular supplement for several reasons.

First, it has great coverage. For Medicare Part A in-patient hospital stays, it covers all of your expenses. That includes the Part A hospital deductible, which is $1,556 in 2022.

Second, Plan G covers each of the gaps in Medicare except for the $233 annual Part B deductible. We can often find a supplement Plan G that saves quite a bit in annual premiums over Plan F, substantially more than the $198 annual deductible.

Compare for Yourself! New York State Department of Financial Services publishes the Medicare Supplement monthly premiums by county.  Yes, it is as simple as that. I represent several of the insurance companies listed here and can assist you with the application process, please call (518) 346-2115 or book a telephone or video appointment directly to my calendar.

Attn: New York Residents. Did You Know?

  • Enrollment Calendar: New York State residents enrolled in Medicare can choose or change to a Medicare Supplement / Medigap Plan at any time. That’s because New York is a “guaranteed issue” state.
  • Health Underwriting? New York State residents enrolling in a Medicare Supplement / Medigap Plan are not subject to health underwriting.
  • Pre-Existing Conditions? The six month pre-existing condition claims exclusion can be eliminated for New York State residents changing to a Medigap plan from other creditable coverage.

Categories
Case Studies Medicare supplement

A conversation: Focus the fight against cancer instead of the HMO

Medicare Supplement Plan

In this nearly 16 minute conversation Greensboro North Carolina residents, Bob and Signe Foxworth, talk about their frustration and anxiety of trying, unsuccesfully, to obtain HMO approval for Bob’s preferred out of network prostate cancer treatment. Listen as Bob and Signe explain how peace of mind came when Dan counseled them to revert to Original Medicare and enroll in Medicare Supplement Plan N.
Signe: “As I recall, it was tremendous anxiety at the time. Because not being able to get the treatment sooner rather than later could have had fatal consequences … We had more anxiety fighting the (HMO) insurance company than we did about his illness… We were kind of at our wits end.”
Bob: “I got $20,000 worth of treatment for $20 … Everything was covered.”
Signe: “In this whole thing, the most precious thing is that peace of mind knowing that you are covered. Yes, you strain a little on your monthly budget But things happen unexpectedly and you are covered. It’s really beautiful.”

For a personal consultation regarding your Medicare choices, call Dan at (518) 346-2115