Jones Health and Benefits

In Medicare Advantage in many cases, you’ll need to use doctors and other providers who are in the plan’s network and service area for the lowest costs. Some plans won’t cover services from providers outside the plan’s network and service area.

Medicare Fast Fact: If you sign up for Medicare Part B when you’re first eligible, you can avoid a penalty.

Medicare Fast Fact: Some people get Medicare automatically, and some have to sign up. You may have to sign up if you’re 65 (or almost 65) and not getting Social Security.

When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get your Medicare coverageOriginal Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). Some people need to get additional coverage, like Medicare drug coverage or Medicare Supplement Insurance (Medigap).

Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).

Feeling overwhelmed by upcoming Medicare decisions? Make sure to contact us today for a no cost consultation.

COVID Special Enrollment Announcent 2021

Out of Network Coinsurance is the percentage (for example, 40%) you pay of the allowed amount for covered health care services to providers who don't contract with your health insurance or plan. Out-of-network coinsurance usually costs you more than in-network coinsurance.

Do I Owe Taxes on Social Security? You might, depending on your income. In 2020 couples who file a joint tax return and have a combined income between $32,000 and $44,000 will have to pay tax on up to 50% of their benefits. If their combined income is more than $44,000, they’ll be taxed on up to 85% of their benefits.

Turning 65 soon? Feeling overwhelmed by the amount of mail you get in regard to Medicare? Contact us today for a free consultation.

Fast Fact: Your eligibility for Social Security is based on the credits you earn during your working years. As of 2021, for every $1,470 you make, you earn one credit, up to a maximum of four per year.

Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).

Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

Preventive Services mean routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems. Getting prior authorization means, getting approval from a health plan that may be required before you get a service or fill a prescription in order for the service or prescription to be covered by your plan.

Fast Fact: As of 2021 workers pay 6.2% of their wages into Social Security on up to $142,800 of their income. Employers contribute another 6.2%. People who are self-employed have to pay both portions, or 12.4%.

A Medicare-approved amount is in Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference.

COBRA is a federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event. If you elect COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage, you pay 100% of the premiums, including the share the employer used to pay, plus a small administrative fee.

What do they mean when they say Coordination of Benefits? It’s a way to figure out who pays first when 2 or more health insurance plans are responsible for paying the same medical claim.

What is a non-preferred provider? A provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay more to see a non-preferred provider. Check your policy to see if you can go to all providers who have contracted with your health insurance or plan, or if your health insurance or plan has a tiered network and you must pay extra to see some providers.

What do they mean by having Credible Coverage? It’s Health insurance coverage under any of the following: a group health plan; individual health insurance; student health insurance; Medicare; Medicaid; CHAMPUS and TRICARE; the Federal Employees Health Benefits Program; Indian Health Service; the Peace Corps; Public Health Plan (any plan established or maintained by a State, the U.S. government, a foreign country); Children’s Health Insurance Program (CHIP); or, a state health insurance high risk pool. If you have prior creditable coverage, it will reduce the length of a pre-existing condition exclusion period under new job-based coverage.

The latest news for you from Nichelle

Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a "donut hole"). This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered drugs again.

A Medicare Savings Account (MSA Plan) combines a high deductible Medicare Advantage Plan and a bank account. The plan deposits money from Medicare into the account. You can use the money in this account to pay for your health care costs, but only Medicare-covered expenses count toward your deductible.

Medicare doesn’t cover everything. Some of the coverage gaps are particularly relevant to an aging population, such as hearing aids, podiatry, dental and vision care, and nursing home care In order to increase coverage for additional heathcare needs, some people choose to participate in a Medicare Advantage plan instead of traditional Medicare.