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Medicare

Medicare

Know Your Options

Selecting the right Medicare plan is complicated. If you select the wrong plan you may have to wait an entire year to change to one that better meets your needs. We are here to help and our services are provided at no cost to our clients.

Whether you’re new to Medicare, getting ready to turn 65, or preparing to retire, you’ll need to make several important decisions about your health coverage. If you wait to enroll, you may have to pay a penalty, and you may have a gap in coverage.

Medicare Supplements

A Medicare supplement, sometimes called a Medigap policy, can help pay some of the costs that original Medicare doesn’t cover, like co-payments, co-insurance, and deductibles.

Enroll in a supplement plan when you’re first eligible. The best time to enroll is during your guaranteed acceptance period because you can buy any plan available, even if you have health problems. Your open enrollment period starts when you turn 64 1/2 or when you leave another group of medical coverage to join Medicare.

If you apply for Medicare supplement coverage after your guaranteed acceptance period, there’s no guarantee that an insurance company will approve your application if you don’t meet certain health criteria.

Long-term Care

Long-term care is a range of services and support for personal care needs. Most long-term care isn’t medical care but rather helps with basic personal tasks of everyday life, also called custodial care, and is not covered by Medicare. Sometimes, help to pay for long-term care is available through the Medicaid program, but only after your personal financial resources have been exhausted.

People who shift their Long-term care expenses to an insurance company are able to preserve their assets from a custodial care situation. Harvest Moon Insurance is fully licensed and certified to write long-term care insurance policies that include coverage for home health care, assisted living, and nursing home care.

Medicare doesn’t cover most dental care or cleanings, fillings, extractions, plates, dentures, or devices. However, affordable dental, vision, and hearing plans are available through Harvest Moon Insurance.

ABCs Of Medicare

Turning 65? Getting ready to retire? If so there are critical decisions you will have to make about your health coverage. Failing to do so within certain timelines could result in both penalties and gaps in coverage. Click read more to see an overview of the different parts of Medicare that we can help you with.

Medicare Part A

Medicare Part A Deductible for 2024 will be $1,600.00 an increase of $44.00 dollars from $1,556.00 in 2022.

The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,600.00in 2024, an increase of $44.00 dollars from $1,556.00 in 2022. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period.

In 2024, beneficiaries must pay a coinsurance amount of $400 per day for the 61st through 90th day of hospitalization in a benefit period and $800 per day for lifetime reserve days. 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 2024 ($194.50 in 2022).

Hospital Services

  • Days 1-60 $1600.00 deductible
  • Days 61-90 $400 per day
  • Days 91 and 150 (60 lifetime reserve days) $800 per day

Skilled Nursing Facility

(must be in the hospital as an inpatient 3 or more days)

  • Days 1-20 $0 per day
  • Days 21-100 $200.00 per day
  • Days 101 and beyond you pay all costs

Medicare Part B

Medical Services

Part B Deductible $226 yearly – After your deductible is met, you generally pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment. You will also pay for most doctor services while you are a hospital inpatient.

In 2022 the standard Part B premium is $170.10 per month.

Medicare Part C

Medicare Advantage Plans

Medicare Advantage Plans are offered by private insurance companies approved by Medicare. If you join a Medicare Advantage Plan you are still part of the Medicare program. However, your Part A and Part B benefits are provided by the Medicare Advantage Plan rather than Original Medicare.

These plans are required to cover all services approved by Medicare. Most Medicare Advantage Plans offer services in addition to Original Medicare and may also include Part D prescription drug coverage. Most Advantage Plans will be HMOs or PPOs.

Medicare Part D

Prescription Drugs

Medicare Part D plans are prescription drug plans offered by private insurance companies approved by Medicare. Each plan has its own list of covered drugs called a formulary. Within the formulary, there are different drug tiers. The cost of your drug will depend on the tier it falls under. Typically the lower the tier the lower the cost. Medicare Part D has a standard deductible of $505 in 2023 Some plans offer a lower deductible while others have no deductible at all. Part D Plans may also have discounts when using certain preferred pharmacies or mail-order services. You can enroll in Part D coverage by purchasing a stand-alone Prescription Drug Plan or by enrolling in one of the various Medicare Part C options (Advantage Plans) available in your service area.

2024 Defined Standard Medicare Part D Prescription Drug Plan Coverage Parameters.

Each year, the Centers for Medicare and Medicaid Services (CMS) releases the Medicare Part D drug plan benefit parameters for the “Defined Standard Benefit” plan and the Low-Income Subsidy (LIS) benefits. Medicare Part D plan providers then can use these standardized benefit parameters to determine drug plan coverage for the next plan year.

The CMS “Part D Benefit Parameters for Defined Standard Benefit” outline the minimum allowable Medicare Part D plan coverage. However, CMS allows Medicare Part D plans to offer a variation on the defined standard benefits (for example, a Medicare Part D plan can offer a $0 Initial Deductible instead of the standard deductible).

Accordingly, although an actual Part D drug plan’s coverage can vary from the CMS standardized benefits, you can use these parameters as a preview of how your Medicare Part D plan coverage may change in January, 2024. Actual Medicare drug plan options and benefit details will be available for your review beginning October 1, 2023.

Here are a few highlights of the defined standard Medicare Part D plan changes from 2023 to 2024. And the chart below shows the changes in defined standard Medicare Part D design for plan years 2020, 2021, 2022, 2023 and 2024.

    • Initial Deductible: will be increased by $25 to $505 in 2023 to $545 in 2024
    • Initial Coverage Limit (ICL): will increase from $4,430 in 2022 to 4,660 in 2023 to $5,030 in 2024.

    • Out-of-Pocket Threshold (or TROOP): will increase from $7,400 in 2023 to $8,000 in 2024.

    • The Catastrophic Coverage phase: The Catastrophic Coverage phase will remain the last phase of Medicare Part D coverage, however, starting January 1st, 2024, Medicare beneficiaries will no longer pay any cost for formulary drugs purchased in the Catastrophic Coverage stage (after exceeding the annual TROOP threshold).
    • Coverage Gap (Donut Hole): begins once you reach your Medicare Part D plan’s initial coverage limit ($4,660 in 2023) and ends when you spend a total of $7,400 out-of-pocket in 2023. Note: In 2025, the Coverage Gap or Donut Hole will be eliminated and a person who exceeds the 2025 annual out-of-pocket spending limit will not pay anything for formulary drugs through the remainder of the year.

    • 2023 Donut Hole Discount: Part D enrollees will receive a 75% Donut Hole discount on the total cost of their brand-name drugs purchased while in the Donut Hole. The discount includes a 70% discount paid by the brand-name drug manufacturer and a 5% discount paid by your Medicare Part D plan. The 70% paid by the drug manufacturer combined with the 25% you pay, counts toward your TROOP or Donut Hole exit point.

      For example: If you reach the Donut Hole and purchase a brand-name medication with a retail cost of $100, you will pay $25 for the medication, and receive $95 credit toward meeting your 2023 total out-of-pocket spending limit.
Medicare Part D beneficiaries who reach the Donut Hole will also pay a maximum of 25% co-pay on generic drugs purchased while in the Coverage Gap (receiving a 75% discount).

      For example: If you reach the 2021 Donut Hole, and your generic medication has a retail cost of $100, you will pay $25. The $25 that you spend will count toward your TROOP or Donut Hole exit point.

      Medicare Part D beneficiaries who reach the Donut Hole will also pay a maximum of 25% co-pay on generic drugs purchased while in the Coverage Gap (receiving a 75% discount). For example: If you reach the 2020 Donut Hole, and your generic medication has a retail cost of $100, you will pay $25. The $25 that you spend will count toward your TROOP or Donut Hole exit point.

    • Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit: beneficiaries will be charged $4.15 for those generic or preferred multisource drugs with a retail price under $83 and 5% for those with a retail price greater than $83. For brand-name drugs, beneficiaries would pay $10.35 for those drugs with a retail price under $207 and 5% for those with a retail price over $207.

    • Maximum Co-payments below the Out-of-Pocket Threshold for certain Low-Income Full Subsidy Eligible Enrollees: will increase to $4.15 for a generic or preferred drug that is a multi-source drug and $10.35 for all other drugs in 2023.

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