With the annual enrollment period ending in three days, many Americans are still wanting to make final changes to their coverage for the upcoming year.
Medicare can be a complex and overwhelming process, especially when it comes to evaluating plan options along with your own needs for doctors and drugs.
If you’re confused and unsure where to start, working with a licensed insurance agent may be the solution for you.
The Tampa Free Press sat down with Richard Sampson Insurance, a new insurance broker in Florida, to unravel the complexities and get some answers.
What Sets Your Agency Apart From Others?
“Our agency prides itself on not only our customer service but also our strong business ethics. Lots of agents are using the same carriers and tools, but in this landscape, there is now more of a need than ever for people to have a place to turn when it comes to their questions about Medicare benefits,” said Sampson.
“The Center for Medicare & Medicaid Services (CMS) has done a great job of putting safeguards in place to protect Medicare beneficiaries from false and misleading information, but people may still receive calls from 1-800 numbers and see infomercials on television .The truth is many people may not understand even the most basic aspects of what Parts A, B, C, & D are so when it comes to more complex concepts, people are lost. Our goal as an agency is to grow and be able to chat with our clients personally so that they know we are accessible whenever they need us–and we want to start with education as the foundation of everything we do. We don’t want to just put somebody in a plan. We want to walk them through what it all means step-by-step so they can make the best decision for them!” Frasure said.
Can Someone Already On Medicare Come To You During Open Enrollment For Help?
“There are two major enrollment periods every year. There can be other enrollment periods available under certain circumstances, but there are two big ones everybody knows about. AEP is known as the Annual Enrollment Period and lasts from October 15th to December 7th,” said Frasure.
“During this enrollment period, people can switch from one Medicare Advantage Plan or Prescription Drug plan to another, switch from Medicare Advantage to Original Medicare, from Original Medicare to Medicare Advantage, or enroll in a drug plan for the first time. Open Enrollment–although folks have a tendency to use those terms interchangeably is from January 1st to March 31st and it’s main purpose is to give individuals one more chance to change Medicare Advantage plans or change back to original Medicare in case the plan they signed up for during AEP didn’t meet their needs for one reason or another.
“We will be in AEP from now until December 7th, and our agency is always willing to work with people who need assistance with Medicare, whether they are brand new to everything or whether they are just looking to learn more about the basics and some of the options that may be available to them! AEP isn’t the only time we are available though. Our office is here to help our clients year-round,” Frasure concluded.
Understanding Medicare Part A, Part B, Part C, And Part D
Part A: Inpatient/Hospital Coverage
Medicare Part A provides coverage for inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services.
This coverage helps beneficiaries receive necessary medical attention when they require hospitalization or specialized care.
“Medicare Part A covers hospitalization, and it can also cover skilled nursing, home healthcare, and hospice if certain conditions are met. For most individuals, the premium is $0 if you filed taxes for the previous ten years. In 2024, the Part A deductible is $1,632 per benefit period,” said Frasure. “A benefit period starts the day you are admitted for inpatient hospitalization and ends when you haven’t had any inpatient hospital care for sixty days in a row.”
Part B: Outpatient/Medical Coverage
Medicare Part B offers coverage for outpatient and medical services to help prevent, diagnose, and treat medical conditions. This coverage includes doctor visits, preventive services, durable medical equipment, and more.
“Medicare Part B covers medical procedures for things like office visits, emergency rooms, surgeons, & radiology. The part B deductible for 2024 is $240 per calendar year and the base premium to keep your Medicare Part B active during 2024 is $174.70/ month,” explained Frasure. “Some folks may pay more than that if they made more than $103,000 as an individual or $206,000 jointly in 2022. This is known as an Income Related Monthly Adjustment Amount or IRMAA. The same thresholds also apply to Part D as well and as your income bracket increases there is a higher adjustment due on your Parts B & D.”
Part C: Medicare Advantage Plans
Medicare Part C, also known as Medicare Advantage, offers an alternative way to receive your Medicare benefits. These plans are offered by private insurance companies approved by Medicare, and they must provide coverage for everything provided by Original Medicare (Parts A and B).
However, Medicare Advantage Plans may have different rules, costs, and restrictions; and their availability varies by zip code.
“Part C is a privatized insurance plan that combines Parts A, B, & usually but not always part D. These are commonly known as Medicare Advantage Plans. The most well-known types are HMO (Health Maintenance Organizations) and PPO (Preferred Provider Organizations).
“Many people wonder what the major differences are between an HMO and PPO plan. HMO plans are plans that require you to stay in-network for coverage (unless it’s an emergency) and require referrals to see specialists. PPO plans are plans where you can stay in network for coverage and spend less but if you decide to go out of network they provide an extra layer of added flexibility if you’re willing to pay the extra cost.
“Depending on the specific plan–there are also additional added benefits in these plans that you won’t typically see under original Medicare but they greatly vary by plan. It’s important to discuss the coverages that are specific to your plan, in your area to get a comprehensive list of what is available,” Frasure explained.
Part D: Prescription Drug Coverage
Medicare Part D provides prescription drug coverage to beneficiaries. This coverage helps reduce the cost of prescription medications and ensures that individuals have access to necessary treatments.
“Regardless of whether you opt for Original Medicare, Original Medicare with a Supplement, or Medicare Advantage it’s important that you have “creditable” prescription drug coverage in force. Drug coverages are based on drug formularies that vary by company, and the lower the drug tier, the lower the prescription cost.
“Part D coverage can be purchased as either a stand-alone Prescription drug plan or as part of a MAPD (Medicare Advantage Prescription Drug Plan) and there is also extra help available through the government for individuals who need help with their prescription drug costs,” said Frasure.
Medicare Advantage
Frasure said that according to a recent article by the Kaiser Family Foundation, for the first time, roughly half of Medicare-eligible beneficiaries have opted for Medicare Advantage as opposed to Original Medicare.
“This is an important thing to note as for many years, Original Medicare was the usual route selected instead of the alternative. Blanket statements can never be made as to whether Medicare Advantage or Original Medicare is the better coverage because they both have their pros and cons for each individual but it is always important that individuals consider all of their options and do what they can to educate themselves on what is available to cater to their specific needs,” said Frasure.
About Richard Sampson Insurance
Richard is a successful and proven licensed insurance agent who has worked in the industry for more than 40 years. Most of his clients have been with him for decades and speak highly of not only his industry knowledge but also his ethical business practices and compassion for their needs and the needs of the community.
“After roughly 40 years of helping clients navigate auto, home, life insurance and more, I have become aware that many of my clients need help with understanding Medicare as well. Working with them has always been exciting and rewarding so I am eager to see our agency branch out so that we can help them in this regard as well!”
You can visit Richard’s website at https://www.richardsampsoninsurance.com to learn more.
Richard Sampson Insurance does not offer every plan available in your area. They currently represent 6 organizations which offer 2,352 products. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.”
Richard Sampson Insurance Agency is currently licensed and appointed in the states of FL, WA, KY, & TX.
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