By Alison Nelson, Employee Benefits Account Manager
“I’m turning 65 and need to learn more about Medicare. What do I do?” This is a common and very valid question that I’m often asked. Medicare is daunting, and with 75% of Medicare beneficiaries worrying about affording costs beyond premiums, you’re going to want to understand all of your options.
I want to start by noting that I am not a Medicare expert. However, before you scroll away, I can provide some tools and resources that could be helpful in your Medicare journey.
A great first resource is medicare.gov. I know, I know. The government’s Medicare website for info on Medicare… revolutionary! But it truly is a great and underutilized site that breaks down the ins and outs of Medicare. In summary, there are four main plans with additional coverage available:
- Medicare Part A: Hospital Coverage
- This is often free and is automatic if/once enrolled in social security.
- Medicare Part B: Provider Coverage
- $170.10/month (or higher depending on income).
- We see most people waive Part B as long as they are enrolled in a qualified employer-sponsored health plan.
- Part B has no out-of-pocket maximum, so you would be responsible for 20% of expenses with no cap – this can add-up quickly. If employer coverage is terminated, we often recommend enrolling in a Medigap or Medicare Supplemental policy. This puts a “stopgap” or out-of-pocket limit to expenses. If this coverage is obtained following the loss or termination of qualified coverage, you can likely forego underwriting. If Medigap is waived at initial eligibility and obtained later, underwriting is likely – meaning if there are pre-existing conditions, you could be denied coverage.
- Medicare Part C: Medicare Advantage
- Part C is offered by Medicare-approved private companies that must follow rules set by Medicare. Medicare Advantage Plans include Part A and B coverage, and many include Part D drug coverage as well. However, it’s important to note that Part C is not available in Alaska.
- Medicare Part D: Prescription Coverage
- The costs vary by plan
- Medigap or Medicare Supplemental Coverage
- You are able to obtain supplemental coverage if enrolled in Part A & B.
- RISQ Consulting has a dedicated individual who is appointed by Medicare and is able to assist with Premera Medicare Supplemental Plans. There are no fees for her service.
- An additional popular Medicare Supplemental plan is with United Health Care through AARP.
Another resource, and one of the most comprehensive and digestible guides, is the Medicare & You 2023 Guide.
However, my number one recommendation is to reach out to the amazing folks at the Alaska Medicare Information Office! This is a free service for Alaskans by certified Medicare professionals. These pros are able to provide personalized recommendations and can walk you through the complexities of Medicare.
Becoming Medicare eligible can seem overwhelming, but with the right tools and resources, you’ll be able to navigate it like a pro. And, as always, if you have any questions or need to be pointed in the right direction, RISQ Consulting can help.
This article is from RISQ Consulting’s Zywave client portal, a resource available to all RISQ Consulting clients. Please contact your Benefits Consultant or Account Executive for more information or for help setting up your own login.
The U.S. Senate recently passed the Inflation Reduction Act, which includes provisions aimed at addressing climate change, reducing the high costs of prescription drugs and lowering the deficit by approximately $300 billion. The $750 billion spending bill passed through the budget reconciliation process, meaning all 50 Democrats and one tie-breaker vote from Vice President Kamala Harris were all that was needed.
How Will the Inflation Reduction Act Impact Health Care Policy?
The legislation includes provisions to lower prescription drug prices by allowing the federal health secretary to negotiate the prices of certain expensive drugs annually for Medicare. However, this will not impact every prescription drug and will not happen quickly. The negotiations will begin in 2026 for a maximum of 10 prescription drugs covered by Medicare, another 15 drugs in 2027 and 2028, and then 20 drugs in 2029. Additionally, pharmaceutical companies will be required to issue rebates if they raise drug prices beyond the rate of inflation.
The bill originally included a provision capping insulin at $35 per month for privately insured and Medicare patients. However, the Senate parliamentarian ruled the provision for privately insured patients out of order and removed it before the legislation was passed. The bill does cap out-of-pocket prescription drug costs at $2,000 for people on Medicare beginning in 2025.
Importantly, the bill helps millions of Americans avoid sharp increases in health care costs by extending enhanced Affordable Care Act subsidies for three years, one year later than originally proposed by the U.S. Congress.
What Else Does the Inflation Reduction Act Address?
The bill represents the largest climate change investment in U.S. history, with the goal of reducing U.S. carbon emissions by 40% by 2030. The bill contains tax incentives to reduce the cost of electricity by investing in renewable energy infrastructure and incentivizing Americans to switch to electric power for their homes and vehicles.
To boost revenue, the bill imposes a 15% minimum tax on the income of large corporations that earn at least $1 billion per year. This is expected to raise $300 billion in government revenue. The bill also levies a 1% excise tax on stock buybacks that will take effect in 2023. Some experts believe this will result in a rush on buybacks by some companies before the excise tax takes effect next year.
What This Means
The U.S. House plans to take up the bill at the end of the week. If the House passes the bill, which experts anticipate will happen, the legislation will be sent to President Joe Biden for signature. As this legislation is anticipated to impact large segments of the U.S. economy, employers will want to follow the process closely.
We will keep you apprised of any notable updates. Contact RISQ Consulting for more health care resources.