It is important to have a thorough understanding of Medicare when heading into retirement. Medicare is not an income producing piece of your retirement plan so unfortunately it gets overlooked by financial advisors. We believe at J.A. Lawrence Wealth Management that understanding our expenses is a vital step in retirement planning. Since healthcare is a substantial piece of our expenses in retirement, it is important to do your due diligence on this subject.
Medicare is a federal insurance program for the elderly. All our adult working lives we have been paying into the Medicare system via the FICA tax. The FICA tax is broken into two parts. The first part is known as OASDI (Old age survivor, disability, and insurance). OASDI is often referred to as social security. This portion of the FICA tax represents about 80% of the total FICA tax. The Hospital insurance (HI) makes up the remaining 20%. The HI portion is also referred to as Medicare part A.
There are four parts of Medicare everyone needs to be knowledgeable about. Parts A, B, C, and D. Each part is vitally important and needs to be included in your health insurance strategy.
PART A: Also known as Hospital Insurance or HI. This part simply gets you in the building and in a bed. This does not pay for the physician treating you. This part of Medicare is paid for via the FICA tax. Generally, everyone qualifies for Medicare at age 65 and above. At the very least you must sign up for this portion of Medicare. People have been paying into this their entire adult lives and its time to reap some benefit.
PART B: This part pays for the physician service. Things like blood tests, equipment costs, home health care, and outpatient care are just some of the services Part B covers. The proper way to look at it is Part A gets you in the door and Part B pays for the services inside the building. Part B is not paid for by FICA. This on average costs $135 per month. If adjusted income is higher than $170,000 year when married Part B becomes more expensive. In my opinion part B is just as vital as part A.
Medicare parts A&B, also known as original Medicare, consist of 80% of Medicare. Part C and D make up the other 20%.
PART C: Also known as Medicare supplement. This part allows you to see doctors/specialists for non-emergencies. There are two options for this part Medigap and Medicare advantage.
MEDIGAP: Medigap is between $100-200 per month. Any doctor that accepts part A/B also accepts Medigap. It is very important to know that you are always within issue for Medigap when signing up parts A and B. In layman’s terms, everyone qualifies for Medigap if they sign up when enrolling in parts A and B. However, if you decline Medigap and elect for Medicare Advantage, we’ll talk about that in a moment, than you have to be underwritten down the road. Please know that Medigap will be sold through insurance companies. The plans are listed as such: Plan N, Plan F, etc. No matter the insurance company, each “plan N” will be identical in coverage to another insurance companies “Plan N”. Therefor if one insurance company is charging more for their “Plan N” then always choose the least expensive option. They are identical Medigap plans.
MEDICARE ADVANTAGE: Medicare advantage is also operated by insurance companies. However, it is operated like what we are used to in private health care system. Medicare Advantage is operated on a network base. If the network is strong in your geographical area, this is a potentially good option because Medicare advantage is typically less expensive then Medigap. This becomes important especially in the case of travelling throughout the US. For instance, there is no Medicare Advantage network available in Alaska, therefor Medicare advantage patients cannot use their Medicare Advantage coverage there. Because Medicare Advantage is similar to health insurance before turning 65- there are a lot of changes year to year. These can be difficult to keep up with-especially in retirement as we age. Medigap is a much more stable network with less changes than Medicare Advantage.
PART D: This part covers prescription drugs. Some Medicare advantage policies will include part D. Medigap does not have part D. Part D on average can cost $35/month. If you are going the Medicare advantage route you need to go through a broker and not a captive agent. There is just a lot to it and its constantly changing. Do not do it on your own. Just like home/auto insurance brokers, these health brokers will shop for you through various companies and sell you the optimum policy. Captive agents can only sell you the company they work for. Obviously, you want to be sold the policy that benefits you the most and not just the insurance company.
Do yourself a favor and understand the true cost in regard to Medicare. If you have any questions feel free to reach out to John Lawrence with J.A. Lawrence Wealth Management.