Medicare is complicated – we’re here to help

Let’s review Your Medicare Insurance Options

Our team is standing by to help you get all the benefits to which you’re entitled.

Explor Your Options

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Yes. I can do that! HOWEVER what those commercials don’t tell you is that those plans are not offered in every part of the state (that’s why they need your zip code), AND it’s not available to everyone. You must meet eligibility requirements. I’ll need your zip code too.

Contact me and I can let you know if YOU’RE eligible.

Welcome. In order to get started on your insurance journey, we recommend that you read a few articles on our site that pertain to the type of insurance services that you’re looking for — so you can get better acquainted with the terminology, and get your questions written down and prepared for our staff. Once you’ve read over the information, we would encourage you to take the next step which is to call our office (the number is located at the top of this website) and book a consultation or you can fill out a contact form, here.  Read more at medicare.gov

Medicare is not FREE. There are some costs depending on your individual situation.  In almost all cases, you must continue to pay your Part B premium. Most people pay the minimum which changes from year to year.  People with higher incomes, pay a higher rate according to a scale.  Contact us to review your rate. Our staff is dedicated to finding you the best options at the most affordable prices for your budget. Our strongest advice would be to fill out a contact form and schedule a meeting with Howell Silverman, at your earliest convenience.  Read more at medicare.gov

Yes. You must sign up for some parts of Medicare even though you may have health coverage from your job.  If you don’t sign up when you’re first eligible, you may incur penalties for the rest of your life if you sign up later.  There is NO REASON NOT TO SIGN UP WHEN YOU’RE FIRST ELIGIBLE.  Whether you need or want all of what Medicare offers will depend on your particular situation and will vary according to your age and the number of employees in your company. For large companies (> than 20 Employees) Medicare will be the secondary provider and your work coverage will be your primary insurance. For small companies (< 20 employees), Medicare will be the primary and your work coverage will be secondary.  We would encourage you to take the next step which is to call our office (the number is located at the top of this website) and book a consultation or you can fill out a contact form.  Read more at medicare.gov

Yes.  You can have Medicare BUT NOT A Medicare Advantage or a Medicare Supplement plan if you have health coverage through your job. If you’d like to understand why, we’re happy to explain it.  You may only need Part A of medicare and not Part B. We would encourage you to take the next step which is to call our office (the number is located at the top of this website) and book a consultation or you can fill out a contact form.  Learn more about your situation at medicare.gov

Unfortunately, the answer is NO.  You can have Medicare but not a Medicare Advantage plan.  There are very important differences between your job health coverage, Medicare, Medicare Advantage and Medicare Supplement plans which you should completely understand. If you’d like to understand how it works, we’re happy to explain it. We would encourage you to take the next step which is to call our office (the number is located at the top of this website) and book a consultation or you can fill out a contact form. 

Learn more about your situation at medicare.gov

Medicare – aka Original Medicare is federal health insurance for people 65 or older, some younger people with disabilities and people with End-Stage Renal Disease. It has multiple parts, A, B, C, D and E.  It’s generally considered that Medicare will cover approximately 80% of the cost of your Medicare approved healthcare costs.  This leaves 20% for YOU to cover.  Unlike Medicare Advantage and to a large extent Medicare Supplement Plans, there is NO MAXIMUM OUT OF POCKET AMOUNT for the 20% you are responsible to pay with Original Medicare.  Having Original Medicare alone leaves you exposed to unlimted out of pocket costs.

Medicare Supplement Plans – aka Medigap, aka Part E, is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:

  • Copayments
  • Coinsurance
  • Deductibles

Some Medigap policies also cover some services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S., vision, hearing and dental.  If you have Original Medicare and you buy a Medigap policy, here’s what happens:

  • Medicare will pay its share of the Medicare-approved amount for covered health care costs.
  • Then, your Medigap policy pays its share.

Medicare Supplement Insurace generally does NOT include Prescription Drug Coverage so you’ll need a stand alone drug plan if you need/want prescription drug coverage.

Medicare Advantage Plans are another way to get your Medicare Part A and Part B and Part D coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Many Medicare Advantage Plans include drug coverage (Part D) and there are plans that don’t include drug coverage.  This is useful if you already have creditable drug coverage and you want to keep it. In many cases, you’ll need to use health care providers who participate in the plan’s network and service area for the lowest costs. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services, to help protect you from unexpected costs. Some plans offer out-of-network coverage, sometimes at a higher costs. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.

The most common types of Medicare Advantage Plans are: 

Other less common types of Medicare Advantage Plans that may be available include HMO Point of Service (HMOPOS) Plans and a Medicare Medical Savings Account (MSA) Plan.  

Contact me to see which plan is right for you.

Learn more at Medicare.gov

You don’t have be receiving social security benefits to get Medicare.  To get Medicare, you have to meet eligibility requirements and sign up.  Contact me and I’ll walk you through it from A-Z.  

Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance). You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

  • You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.

If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:

  • You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months. (Note: If you have Lou Gehrig’s disease, your Medicare benefits begin the first month you get disability benefits.)
  • You are a kidney dialysis or kidney transplant patient.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

Learn more at Medicare.gov

Medicare Part D and some parts of Part B deal with Prescription Drugs. 

All Medicare Part D (or MAPD) plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes, ” like drugs to treat cancer or HIV/AIDS”. Not every drug is covered. A plan’s list of covered drugs is called a “formulary,” and each plan has its own formulary. Plans place drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost and may or may not be subject to a deductible. A drug in a lower tier will generally cost you less than a drug in a higher tier. Contact me using either the phone number at the top of the page or via the contact form to see if the drugs you take are covered.

If you’ve received a notice that one or more drugs will no longer be covered, call me and I’ll try and find a plan in your area that will cover your medications.

One of my services is to research which plans in your area cover the drugs you’re already taking.  This valuable CONFIDENTIAL service will help you minimize the cost of your drugs.  All I’ll need to know is the name of the drug, the dosage (how many milligrams) and the number of doses you take per day.  I’ll even be able to estimate how much you’ll pay per month. Use the form to contact me and I’ll do the research and let you know.

Learn more at Medicare.gov

This varies by insurance carrier and plan.  In many cases there is ZERO Co-pay for seeing your primary care doctor.  Medicare beneficiaries pay nothing for most preventive services if the services are received from a doctor or other health care provider who participates with Medicare.  There is usually a co-pay to see a specialist and this varies by insurance carrier and by plan.  Along with Co-Pays, there can also be Deductibles, and Co-Insurance. These also vary greatly by insurance carrier and plan.

My job is to simplify the complex world of Medicare for you.  I’ll educate you on your options and you will make the decision on which plan and what options you want.  I will help you sign up for Medicare.  I make it SIMPLE!. Contact me

Sometimes, yes and sometimes no.  It depends on the plan and its features and benefits. Some insurance carriers offer a national network of providers, others are local or regional. Contact me and I’ll help answer your question.

Yes. Depending on your eligibility, you may qualify to have all, most or some of your costs for covered services paid for. This is a highly dependant on your specific situation and so you should Contact Me and I’ll get you a definitive answer.

In most cases, YES.

This varies by state so the answer is “it depends”.  For New York, you can not be denied coverage for a pre-existing condition  ALTHOUGH THERE MAY BE A WAITING PERIOD before coverage for your condition will begin. Under New York State regulation, the waiting period may be either reduced or waived entirely, depending upon your individual circumstances. If you are taking coverage for the first time during your Initial Coverage Enrollment Period, you can not be denied coverage for a pre-existing condition. See this link for more information for NY consummers. https://www.dfs.ny.gov/consumers/health_insurance/information_for_medicare_beneficiaries Learn more about Medigap policies at Medicare.gov

If you are signing up for Medicare for the fist time, it will take around three weeks to get your red, white and blue medicare card.  This card contains your Medicare ID and the month and year of your Part A and/or Part B effective dates.  Once you have that card, you can begin selecting a health plan. This is the BEST TIME TO CONTACT ME. 

I will simplify the complex world of Medicare for you.  I’ll educate you on your coverage options and you will make the final decision on which plan and what options you want.  I will help you sign up.  I make it SIMPLE!.

Contact me

Medicare limits when you can join. There are different parts of Medicare and you have options depending on your situation, if your working, already have private or group health coverage, considering retiring or already retired.  The first step is to visit SSA.GOV and click on the Medicare box to learn more.  If you want to make it simple for yourself, just complete the contact form and I’ll walk you through it from A-Z. 

Generally, you can join a plan when you first become eligible for Medicare. This is anytime beginning three months before the month you turn 65 and ends three months after the month you turned 65.

  • For example, if you turn 65 on May 5, your eligibility period starts on February 1 and ends on August 31.
  • If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after month 25 of your disability.
  • You can switch or drop your Medicare Advantage during an enrollment period between October 15 and December 7 of each year.
  • There are also special circumstances during which you are granted Special Enrollment opportunities. These chances to make changes are called Special Enrollment Periods (SEPs). Rules about when you can make changes and the type of changes you can make are different for each SEP. Some examples are: You move into or out of a coverage area; You stop or loose your employer healthcare coverage; You become eligible for Medicaid.  These are just a few of the special opportunities you have to make a changes.  Complete the contact form if you have questions or want to see if you can make a change now.

Learn more at Medicare.gov

There is no charge and no hidden fees for my service.

  1. Generally, you must sign up for Medicare when you’re first eligable. Some people get Medicare automatically, but most people have to sign up. You may have to sign up if you’re 65 (or almost 65) and not getting Social Security.
  2. There are ONLY certain times of the year and/or certain conditions placed on when you can change how you get your coverage.
  3. If you sign up for Medicare Part B and/or Part D when you’re first eligible, you can avoid a penalty. Learn more about Part B and Part D penalties below.
  4. You can choose how you get your Medicare coverage.
  5. You may be able to get help with your Medicare costs.

Use the contact form to let me know you have questions or want to sign up.

Learn more about Part B late enrollment penalties at Medicare.gov

Learn more about Part D late enrollment penalties and creditable coverage at Medicare.gov

Medicare

Also called Original Medicare is federal health insurance for people 65 or older, some younger people with disabilities, people with End-Stage Renal Disease.  Medicare is NOT health insurance and it is not FREE. 

  • Original Medicare includes Part A and Part B.
  • You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
  • You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
  • Part A Medicare will cover up to 80% of the cost of a hospital visit, but you are responsible for the remaining 20%. There are Deductibles and CoInsurance.
  • Part B Medicare 
    • Services from doctors and other health care providers
    • Outpatient care
    • Home health care
    • Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
    • Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits).
  • Part B Monthly Premium is set by the Government and may change from time to time. In 2021 the standard Part B Premium was 148.50/month. In 2022, the Part B standard premium will be $ 170.10.  You willl pay higher amounts depending on your income. This amount can be automatically deducted from your monthly Social Security payment (if you get one), otherwise it’s invoiced directly to you and must be paid quarterly. If you have private health insurance through and employer (or union), you may not need Part B. Consult with me to ensure you’re handling the Part B requirement correctly because if you don’t, you could face a penalty in the future if you don’t sign up when you’re first eligible.

Medicare Supplement

Medicare Supplemental Insurance (Medigap): Is extra insurance you can buy from a private insurance company that helps pay your share of the costs under Original Medicare. Recalling from above that Medicare (Original Medicare) will cover only up to 80% of the cost of your healthcare, you are responsible for paying the other 20%.  Medicare Supplement plans cover that 20% “Gap”.  Note that the 20% can be a very large amount.  For example, let’s say you have an extended stay in the hospital and your bill for that stay was $150,000.  Under Medicare (Original Medicare) your Part A will cover up to 80% of that bill which is $ 120,000. You would be responsible for the 20% difference or $ 30,000.  WIth Medicare (Original Medicare), you are financially exposed for that 20% with NO CAP. Your financial exposure is unlimited.

If you had a Medicare Supplement (Medigap) “safety net”, the insurance company will pay this $30,000 leaving you with little to no financial responsibility.  The catch is that there is a monthly premium that you must pay for a Medicare Supplement (Medigap) “safety net’.  The monthly premium varies among insurance companies and according to the Plan letter. 

Supplemental policies are standardized, and in most states named by letters, like Plan G, Plan N or Plan K. The benefits in each lettered plan are the same, no matter which insurance company sells it.

Medicare Advantage

  • Medicare Advantage is a Medicare-approved plan from a private insurance company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
  • In many cases, you’ll need to use doctors who are in the plan’s network but many plans allow you to see doctors outside of their network with a higher copay.
  • Plans may have lower out-of-pocket costs than Original Medicare.
  • Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
  • Some plans have no monthly premiums, no deductibles and no copays for seing your in-network primary care doctor. 

For a review of your situation, contact me.

Learn more here.

WE PUT YOU FIRST

We are in the business of helping people with their personal and business insurance needs.

We specialize in MEDICARE, Medicare Supplement Insurance (Medigap), Medicare Advantage & Prescription Drug Coverage Plans.

If you’re just turning 65, are already on a Medicare, Medigap, Medicare Supplement Plan or Medicare Advantage Plan, or a Prescription Drug Coverage Plan, or you simply want to know if you can save money, or learn about the extra benefits you may be entitled to, give us a call for a no obligation education discussion.

We help consumers save money, we help businesses reduce risk and we help families protect and preserve their financial future.

We offer all forms of insurance with personal service.