Not affiliated with or endorsed by the government or Federal Medicare program.
Medicare Workshop
Where Your Journey Begins
Annual Notice of Changes
- Insurance Carriers Will Be Sending Out a Letter to You of the Annual Notice of Changes
- Please Do Not Ignore This Letter
- Read It Thoroughly
- Recognize the Changes That Are Going to Affect You Next Year
- There Will Be Some Negative and Positive Changes in the new year.
- Meet With Your Trusted Broker
- If You Do Not Have an Insurance Broker, Please Call Me.
- Joe Louie Carbajal, (480) 332-7186 TTY: 711
Medicare information sheet with stethoscope and pen.
Understanding the Basics
Eligibility Requirements
Who is Eligible for Medicare?
Worked in the U.S. for at least 10 years with 40 work credits.
Medicare ABC & Ds
Part A: Hospital
- Hospital Stays
- Skilled Nursing Facility (SNF) --Not Long-Term Care
- In-Patient Surgery
- Hospice
Part B: Medical
Some Benefits Include:
- Doctor Visits
- Outpatient Services
- Diagnostic Labs & Tests
- Radiology
- Emergency Room
- Urgent Care
- Ambulance
- Durable Medical Equipment
Part C: Medicare Advantage
- HMO, PPO, PFFS, MSA
- HMO and PPO Plans Are the Most Popular
- Keep Your Original Medicare Card, but Your Primary Insurance is Your Advantage Health Plan.
- Most MAPD (Part C) Plans Include Prescription Drug Coverage
- Most Will Include Extra Benefits
- Medicare Pays Private Health Plans to Manage Care
- Lock-in and Enrollment Periods
Part D: Prescription Drugs
Prescription Drugs: Generic to Brand Name
Part D: Coverage Phases
Inflation Reduction Act
The lower-cost prescription drug law states your annual out-of-pocket costs will be capped at $2000 for people with Medicare Part D in 2025.
--US Dept. of Health and Human Services
Eliminates:
- Initial Coverage
- Coverage Gap (Aka Donut Hole)
- Catastrophic Coverage
What Original Medicare Does Not Cover
- Most Dental Care (Including Dentures)
- Routine Eye Exams
- Routine Foot Care
- Orthopedic Shoes
- Hearing Aids and Exams for Fitting Them
- Long-term Care (Also Called Custodial Care)
- Cosmetic Surgery
- Acupuncture
What is IRMAA, and How Does It Affect My Medicare?
IRMAA: Income-Related Monthly Adjustment Amounts
How to Enroll
Get Started With Social Security!
If you collect Soc. Security (prior to age 65):
- No action is needed
- At least 3 months before you turn 65, you automatically get Part A and B of your Medicare card sent in the mail.
If you do not collect Soc. Security (or wait after age 65) & want Medicare Part A & B:
- Contact SOC Security at ssa.gov/medicare, call (800) 772-1213 or go to the local SOC. Security office. Provide a payment method for Part B.
If you plan to keep working (past age 65):
No action needed! But…
- You CAN apply for Part A benefits (or WAIT) &
- Delay Part B (as long as you have creditable insurance coverage)
- 3 months before you retire, fill out form CMS-L564 with HR and submit to Soc Security with Part B application.
Create Your SSA Account
Make an account on https://www.ssa.gov/myaccount
To monitor your Soc Security benefits and apply for Medicare!
Your Official Medicare Guide
The 'Medicare & You' Handbook is Your Official Guide to Medicare.
- Medicare Households Receive an Updated Printed Handbook in Late Sep
- You Can Also Download a Copy Anytime, or Access It Electronically
Keep Your Handbook as a Reference. It Has Important Information About:
- Medicare Benefits, Costs, Rights, and Protections.
- Health and Drug Plans.
- Answers to Common Questions.
Inflation Reduction Act
Pros
- Donut Hole Eliminated
- Tier 3, 4, 5 May Decrease
- Capped Monthly Amount
Cons
- Tier 1 & 2 Most Likely Will Increase
- Part D Premiums Will Increase
- Part B Premiums May Also Increase
- Group Plans Will Most Likely No Longer Be Considered
- Creditable Coverage Due to the Cap Put on Part D Coverage Amount $2,000
What Our Partnership Entails
- Review all your doctors & medications
- Recommendations based on your individual needs. (Travel, access to providers, low copays/premiums, dental/vision, etc.)
- No cost for my services, I'm compensated by the insurance carriers.
- All compensation is regulated by CMS, and is the same with every MAPD carrier.
- Support throughout the year
- Complete annual reviews and/or when your needs change
JOE LOUIE CARBAJAL
TTY: 711
Counter Measures for Medical Expenses
- Hospital Indemnity Plans
- Cancer Plans
- Short-Term Living at Home Plans
- Critical Illness Plans.