Click the statement that represents your current status:
Part A
Part B
Form CMS-40B (To be completed by you)
CMS-L564 (To be completed by employer)
Next you’ll want to decide if a Medicare Supplement and Part D Rx plan or a Medicare Advantage Plan fits your needs.
Part B
Form CMS-40B (To be completed by you)
CMS-L564 (To be completed by employer)
Next you’ll want to decide if a Medicare Supplement and Part D Rx plan or a Medicare Advantage Plan fits your needs.
NextActive Employee Group Coverage
If Employer is Less than 20 Employees:
Medicare is Primary
We Recommend
Enroll in part A
If $0 premium and no contributions to Health Savings Account.
Consider Medicare part B & Coverage Options based on:
1. Group plan premium.
2. How does group plan pay AFTER Medicare pays?
If Employer is More than 20 Employees:
Medicare is Secondary
We Recommend
Enroll in part A
If $0 premium and no contributions to Health Savings Account.
Enroll in part B
Only if health care costs are more than part B premium
Compare Group Benefits/Premium
vs.
Medicare Benefits/Premium
Are you collecting social security income?
Part A
Part B
Part D
Once enrolled, you’ll want to decide if a Medicare Supplement and Part D Rx plan or a Medicare Advantage Plan fits your needs.
NextYou have two ways to lower your Original Medicare costs
Medicare Supplement (Medigap), Part D Rx Plan
Any Medicare Provider
Little Cost For Care
Rx Plan Choice
Portability
Higher Premium
Dental Not Included
Vision Not Included
Plan Will Not Change
Private Insurance Policy
No Value Added Benefits
Medicare Advantage
Provider Limitations
Point of Service Cost Sharing
Part D Rx Included
Not Portable
Low or $0 Premium
Dental Might Be Included
Vision Usually Included
Plans May Change or End
Government Funded
Value Added Benefits
First, let’s look at Medigap & Rx plans
NextTwo Popular Medigap Plans: G & N
Appx. monthly Premium:
Male | Female | |||
Plan G | Plan N | Plan G | Plan N | |
Age 65 | $135 | $115 | $125 | $100 |
Age 70 | $155 | $130 | $135 | $110 |
Age 75 | $185 | $155 | $160 | $130 |
Age 80 | $210 | $180 | $185 | $150 |
Non-smoker average premiums N-NV. Household discount not applied.
You Pay Medicare’s Part B deductible, that’s all for the year.
You pay Medicare’s Part B Deductible, then up to a $20 copay per doctor’s visit, $50 copay per Emergency Room Visit and 15% excess charges if you see an unassigned provider.
Part D Rx
Initial Stage
You pay Deductible, if applicable, then a flat Copay or percentage of the prescriptions cost up to the Government set amount in Rx purchased. ($5030 in 2024)
Gap/Donut Hole
You pay 25% of Negotiated Price.
Catastrophic
When the amount you’ve paid, plus brand discounts in the “Gap” total the Government set amount, $8000 in 2024.
You pay $0 the remainder of the year.
Starting in 2025 The Maximum Out-of- Pocket for all prescriptions will be $2000.
Part D Rx
Initial Stage Plan Examples
$0
Deductible, then
$0
Tier 1 Generic
$0
Tier 2 Non Pref Generic
$47
Tier 3 Pref Brand
50%
Tier 4 Non Pref Brand
33%
Tier 5 Specialty
Two Plan Examples. Monthly premiums vary by plan.
Higher premiums may not reflect greater coverage.
$0
Deductible, then
$0
Tier 1 Generic
$5
Tier 2 Non Pref Generic
$545
Deductible, then
25%
Tier 3 Pref Brand
47%
Tier 4 Non Pref Brand
25%
Tier 5 Specialty
Now, let’s look at Advantage Plans
Medicare Advantage Plan Types
Health Maintenance Organization (HMO) Plans
You must use doctors, other health care providers, or hospitals in the plan’s network except in an emergency.
You may also need to get a referral from your primary care doctor.
Health Maintenance Organization (HMO) D-SNP Plans
For people with Medicare and Medicaid.
Chronic Special Needs (C-SNP) Plans
Plans that are designed to help people with certain chronic illnesses: heart conditions, diabetes, etc. You must have a qualifying chronic condition to join this plan.
Preferred Provider Organization (PPO) Plans
You pay less using doctors, hospitals, and other health care providers “in” the plan’s network. You pay more if you use doctors, hospitals, and providers out-of-network.
Out-of-network providers are not required to accept the plan.
Private Fee-for-Service (PFFS) Plans
Medical Savings Account (MSA) Plans
HMO Point-of-Service (HMOPOS) Plans
Few plans available in Northern Nevada.
Call for Details.
Medicare Advantage
Cost Sharing Examples
Washoe County | HMO | PPO | |
---|---|---|---|
In Ntwk | Out Ntwk | ||
Monthly Premium | $0 | $20 | N/A |
Max Out-of-Pocket | $3,000 | $5,900 | $5,450 |
Ambulance | $300 | $300 | $300 |
Office Visit | $0/$35 | $0/$20 | $50 |
Inpatient Hospital | $0 | $300/1-5 days | 50% |
ER/Urgent Care | $125/$10 | $125/$30 | $125/$30 |
Routine Lab | $0 | $0 | 50% |
Outpatient Hospital | $350 | $350 | 50% |
Other considerations when comparing Supplements to Advantage plans
Medigap & Part D Rx
Medicare Advantage
Will Premiums Increase?
Medigap & Part D Rx
Medigap: Yes, but the birthday rule allows a plan change yearly
Part D: Depends on government funding & star ratings
Medicare Advantage
Depends on government funding & star ratings
If I Move, Can I Stay On The Plan?
Medigap & Part D Rx
Medigap: Yes
Part D: No, unless move is within the plan service area.
Medicare Advantage
No, unless move is within the plan service area.
Will Plan Change?
Medigap & Part D Rx
Medigap: Benefits never change
Part D: Plans may change yearly on Jan 1.
Medicare Advantage
Plans may change yearly on Jan 1.
Compare Your Options
Medigap & Part D Rx
Medicare Advantage-HMO or PPO
Use this chart to help you compare or give us a call at (775) 829-9600!
Group Plan
$_______ B
$_______ B-IRMAA
$_______ Group
$_______ Total
Annual Out of Pocket Max
$
Provider Choice
Determined By Plan
Rx Benefit
Included
Medigap & Part D
$_______ B
$_______ G or N-Sup
$_______ D-Rx
$_______ B-IRMMA
$_______ D-IRMMA
$_______ Total
Annual Out of Pocket Max
G & N: B Ded. | N: $20 Dr $50 Er
Provider Choice
Any Medicare Provider in USA
Rx Benefit
Multiple Plans
MA-HMO or PPO
$_______ B
$_______ Plan Premium
$_______ B-IRMMA
$_______ D-IRMMA
$_______ Total
Annual Out of Pocket Max
Copays for Care. Max Varies By plan
Provider Choice
HMO: Network Only | PPO: In/Out Unless Er
Rx Benefit
Included with plan
A&B Initial Election Period
The 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
If you enroll: | Part A starts: | Part B starts: |
---|---|---|
3 months before age 65 | 1st of the month you’re 65* | 1st of the month you’re 65* |
The month insured turns 65 | 1st of the month you’re 65 | 1 month after you sign up |
1 month after insured turns 65 | 1st of the month you’re 65 | 1 month after you sign up |
2 months after insured turns 65 | 1st of the month you’re 65 | 1 month after you sign up |
3 months after insured turns 65 | 1st of the month you’re 65 | 1 month after you sign up |
Apply online at:
Apply in person at:
Any Social Security Office
Call Social Security:
1-800-772-1213
Now you’ll want to decide if a Medicare Advantage Plan or Medicare Supplement and Part D Rx plan fit your needs.