Kevin Knauss: Health, History, Travel, Insurance
Post related to Medicare health insurance, Part A, Part B, Part C, and Part D prescription Drug Plans, Medicare Advantage and Medicare Supplement plans.
Not all plans include the SSBCI support. You can enroll in a Medicare Advantage plan that has the SSBCI even if you don’t qualify for the extra benefits. You can search on Medicare.gov for plans that include SSBCI. You can also ask your insurance agent to search for Medicare Advantage plans that include SSBCI that might support you.
It’s also important to learn if you or your family member will have any other coverage like an employer group retirement plan, VA (Veterans Administration) or Tricare for life. Sometimes you do not want to leave an employer group plan because once you leave you may not be able to get it back. Sometimes people will stay with VA for drug coverage but need additional help for healthcare services through a Medicare Advantage plan. Talk with those organizations to make sure that none of the changes you may be making such as enrolling in a drug plan or Medicare Advantage plan will for some reason terminate coverage in that existing group plan.
The copay for the GLP-1 drugs will be $50 under the Bridge program.
If your employer has less than 20 employees, Medicare is primary payor. This means the group plan may wait until Medicare pays their portion of the health care. If you don’t have Medicare then you may have a big health care bill to pay. If you have coverage through a small employer group, seriously consider enrolling in Medicare.
But does the High Deductible Plan G protect you from catastrophic Medicare health care costs? In the example below, the Medicare beneficiary has a medical event where they must be hospitalized for five days. They must then reside in a skilled nursing facility for 30 days to recuperate. The costs are 2026 and 2036 where a 5 percent inflation adjustment has been applied to the Medicare costs.
A few of the carriers will offer discounts on dentistry, optometry, pharmacy purchases, and hearing exams and hearing aids. These discount offerings are NOT insurance. Some of the carriers also offer dental, vision, and Part D prescription drug plans. It’s possible that those carriers would rather you enroll in their insurance plans instead of using a discount program. The discount plans may be valuable for some people who can leverage the programs to save money.
Covered California must perform periodic data matching between their enrolled members and federal databases. If they determine that a consumer is eligible for Medicare, and the individual is receiving subsidies for health insurance, they will be automatically discontinued.
You may have to pay an Income Related Monthly Adjustment Amount (IRMAA) if your income is greater than $109,000 for a single adult or $218,000 for joint tax filers. The income is the Modified Adjusted Gross Income which is comprised of your AGI plus tax exempt interest. The income year is 2 years prior. For 2026, Social Security uses the 2024 tax return to determine if you are subject to the IRMAA.
There are many different rules to determine if assets and personal property are exempt or counted. It quickly gets complicated if the applicant is married, but their spouse is not applying for the Medi-Cal extra help.
Under the leadership of Dr. Oz, Medicare is rushing to implement Artificial Intelligence (AI) to review, authorize, or deny health care services received by Original Medicare beneficiaries. The primary goal is to save money not necessarily improve patient outcomes. CMS calls the new AI health care initiative “Wasteful and Inappropriate Service Reduction (WISeR) Model.
