There are some options available to you if you can’t afford your Medicare or Part D premiums. For Part D, there is something called Extra Help or Low-Income Subsidy (LIS). LIS can help some low-income Medicare beneficiaries with their Part-D costs. To qualify for LIS, you must be enrolled in Medicare and be below certain income and assets limits. LIS extra help can reduce not only your Part D premiums but also your copays, coinsurance and even reduce or eliminate the Part-D late enrollment penalty. LIS applies to stand-alone Part-D plans and the Part-D segment of MAPD plans. To determine if you are eligible for LIS, contact an independent Medicare agent or call the Social Security Administration. In addition to these programs that help with premiums and out-of-pocket costs (deductibles, copays, coinsurance), other programs can help with the cost of individual prescription drugs. Call Kevin Leinum Medicare Agent – your local Medicare Expert about what Medicare covers or how enrolling in a Medicare Advantage or Medicare Supplement plan can improve your coverage and reduce your out-of-pocket costs.

Is there a premium I have to pay? At a high-level, Medicare Part A (Hospital Insurance) covers the following: Hospital care of inpatient. Conditioned home health services. Nursing facility care provided that custodial care isn’t the only care required. Hospice care. Medicare Part A covers hospital expenses that are critical for your inpatient care, including semi-private room, nursing services, meals, medications included in your inpatient treatment, and other related services and supplies from the hospital. Part A also has critical inpatient care provided through: Critical access hospitals. Acute care hospitals. Long-term care hospitals. Mental health care. Inpatient rehabilitation facilities. Participation in a clinical research study. In most cases, you won’t have to pay a monthly premium for Medicare Part A Hospital Insurance if you and your spouse paid Medicare taxes for at least 40 quarters (equal to about ten years of working). If you do not meet the qualifications for a premium-free Part A, you can buy it. Call Kevin Leinum Medicare Agent – your local Medicare Expert about what Medicare covers or how enrolling in a Medicare Advantage or Medicare Supplement plan can improve your coverage and reduce your out-of-pocket costs.

Several types of Medicare Advantage plans are available, and a Health Maintenance Organization (HMO) is one of them. If you join an HMO Plan, you will need to go to your Primary Care Physician (PCP) within the HMO’s network of doctors to get most of the routine care you will need. If you do need to see a specialist, you will need to get a referral from your PCP before you see them; otherwise, those services may not be covered. This process is much easier than it used to be, and most referrals are done electronically, so you don’t have to pick up a paper referral from your PCP’s office. There are some cases when you can receive services from doctors outside the HMO network, including the following: Emergency care Out-of-area urgent care Out-of-area dialysis There is also a variation of HMO plans called HMO-POS (the POS stands for Point-Of-Service). These plans allow you to go out-of-network for certain services. But, it usually costs more if you go to one of those out-of-network doctors. Kevin Leinum Medicare Agent – your local Medicare Expert – can help you understand the many parts of Medicare and determine what the right fit is for you. Give us a call to discuss the options available to you.

You are not required to enroll in a Part D prescription drug plan; however, you will not have coverage for most prescription drugs if you don’t. If you don’t enroll in a Part D plan when you first become Medicare eligible, you will also incur a late enrollment penalty if you enroll later. You will have to pay a late enrollment penalty for any period of 63 or more days in a row when you don’t have Medicare drug coverage or other creditable prescription drug coverage after your initial enrollment period. In most cases, you will have to pay the penalty for as long as you have Medicare drug coverage. The amount of the late enrollment penalty is dependent on how long you did not have Part D or creditable prescription drug coverage. The penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($33.06 in 2021) times the number of full, uncovered months you didn’t have Part D or other creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium. Call Kevin Leinum Medicare Agent – your local Medicare Expert about what Medicare covers or how enrolling in a Medicare Advantage or Medicare Supplement plan can improve your coverage and reduce your out-of-pocket costs.

Generally, Medicare Part B covers the services that may affect people who have diabetes. Part B also covers some preventive services for people who are at risk for diabetes. Part B covers services like the following: Diabetes Screenings Prevention Programs Self-management training Equipment and supplies Foot Exams and Treatment Glaucoma Tests Part D plans cover diabetes supplies used for injecting or inhaling insulin. Part D plans cover things like the following: Anti-diabetic drugs for maintaining blood sugar Certain medical supplies to administer insulin Insulin that isn’t administered with an insulin pump If you are enrolled in a Medicare Supplement or Medicare Advantage, your deductible, copay, or coinsurance may be different or less depending on the plan you have chosen. Medicare Advantage plans may also offer additional services related to diabetes. Please check your Medicare Advantage Summary of Benefits to see if your plan provides any supplemental benefits. Kevin Leinum Medicare Agent – your local Medicare Expert – can help you understand the many parts of Medicare and determine what the right fit is for you. Give us a call to discuss the options available to you.