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Miami Herald
2 days ago
- Business
- Miami Herald
Dave Ramsey sounds alarm for Americans on Medicare
One fundamental fact prevails and persists about Medicare: It's complicated. That said, Americans need to choose from several Medicare options, and one good place to start is to identify the highest priority tasks to understand. As a second step, one can move on to the many other lower-priority choices one must confront. Don't miss the move: Subscribe to TheStreet's free daily newsletter Dave Ramsey, the prominent personal finance author and radio host, emphasizes the complexity of Medicare's enrollment timelines, regulations, and choices. He warns individuals about a potential financial risk, encouraging them to fully understand the system to avoid unnecessary pitfalls. Medicare is divided into four distinct parts, each covering different aspects of healthcare. Part A, which covers hospital insurance, provides coverage for inpatient hospital stays, skilled nursing facility care, hospice services, and certain home health treatments. Medicare Part B, for medical insurance, helps cover expenses related to doctor visits, outpatient treatments, medical supplies, and preventive healthcare services. Unlike Part A, this portion of Medicare comes with a monthly premium, the amount of which is determined by an individual's income level. Related: Shark Tank's Kevin O'Leary sends strong message on Social Security Medicare Part C, often referred to as Medicare Advantage, is an alternative to Original Medicare and is offered through private insurance companies. These plans typically bundle coverage from Parts A and B while also providing additional benefits, such as vision, dental, and hearing care. Some Medicare Advantage plans even incorporate prescription drug coverage, creating a more comprehensive health care solution. Medicare Part D focuses solely on prescription medication costs, offering financial assistance for those who require ongoing prescriptions. These plans, administered by private insurers, come with varying premiums, deductibles, and covered drug lists, making it important to choose one that best fits individual healthcare needs. Ramsey explains that a thorough understanding of Medicare's structure - and enrollment periods - allows individuals to make informed decisions about their health care and to minimize financial burdens. Ramsey stresses that one of the most significant financial missteps individuals can make is failing to enroll in Medicare on time. He underscores the importance of keeping track of key enrollment periods, particularly the Initial Enrollment Period (IEP). Missing this window, unless one qualifies for a Special Enrollment Period (SEP), results in permanently increased premiums. This fact elevates understanding the IEP to priority number one. More on retirement: Dave Ramsey sounds alarm for Americans on Social SecurityScott Galloway warns Americans on 401(k), US economy threatShark Tank's Kevin O'Leary has message on Social Security, 401(k)s And Ramsey warns that the longer a person delays enrollment, the higher the financial penalties become. The Initial Enrollment Period is the first chance an individual has to sign up for Medicare, beginning three months before their 65th birthday and extending for three months afterward. If this timeframe is missed due to circumstances such as living abroad, a person may still be eligible for a Special Enrollment Period. Other situations that can trigger an SEP include leaving a job and losing employer-sponsored health coverage, losing equivalent prescription drug coverage, or relocating to an area where their current Medicare Advantage plan is unavailable. Ramsey emphasizes that understanding these enrollment rules is essential to avoid unnecessary financial penalties and ensure uninterrupted health care coverage. Related: Jean Chatzky warns Americans on Social Security, 401(k)s People who miss their Initial Enrollment Period (IEP) or Special Enrollment Period (SEP) still have the option to sign up for Medicare, Ramsey explains. However, he strongly advises against relying on the steps required to correct this mistake, as it can lead to significant financial consequences. Another opportunity to enroll is available during the General Enrollment Period (GEP), which occurs annually from Jan. 1 to March 31. Ramsey cautions that waiting until this time can result in a costly and long-term setback. He emphasizes that delaying enrollment to this extent is rarely a wise decision and should generally be avoided. "Using the GEP to enroll usually comes with a penalty in the form of higher premiums - and they last for the rest of your life," Ramsey wrote. The Open Enrollment Period (OEP) occurs from Oct. 15 to Dec. 7, but Ramsey clarifies that this is not meant for first-time Medicare enrollment. Instead, it allows current beneficiaries to modify their coverage, including switching plans or adjusting existing options. Additionally, the Medicare Advantage Open Enrollment Period runs from Jan. 1 to March 31, providing opportunities to change Advantage plans, revert to Original Medicare, or update prescription drug coverage. Related: Dave Ramsey sounds alarm for Americans on Social Security The Arena Media Brands, LLC THESTREET is a registered trademark of TheStreet, Inc.
Time Business News
7 days ago
- Business
- Time Business News
What Every Medicare Beneficiary Should Know About Filling Coverage Gaps
Navigating Medicare can feel like a maze for many beneficiaries, especially when it comes to understanding what's covered and what isn't. While Medicare Parts A and B provide essential coverage for hospital stays and medical services, they don't cover everything, leaving beneficiaries vulnerable to significant out-of-pocket costs. Filling these coverage gaps is critical to ensuring financial security and access to comprehensive healthcare. This article explores the gaps in Medicare coverage, options like mutual of omaha medicare supplement plans through Medigap Advisors, and alternative solutions such as Healthshare plans and HSA plans available via HSA for America. Here's what every Medicare beneficiary should know to protect their health and wallet. Medicare Parts A and B, often called Original Medicare, cover a range of services, including hospital stays, doctor visits, and preventive care. However, there are significant gaps that can lead to unexpected expenses: Deductibles and Coinsurance : In 2025, the Part A deductible is $1,632 per benefit period, and Part B has a $240 annual deductible with 20% coinsurance for most services. These costs can add up quickly, especially for frequent medical care. : In 2025, the Part A deductible is $1,632 per benefit period, and Part B has a $240 annual deductible with 20% coinsurance for most services. These costs can add up quickly, especially for frequent medical care. No Out-of-Pocket Maximum : Unlike many private insurance plans, Original Medicare has no cap on out-of-pocket expenses, leaving beneficiaries exposed to potentially unlimited costs. : Unlike many private insurance plans, Original Medicare has no cap on out-of-pocket expenses, leaving beneficiaries exposed to potentially unlimited costs. Limited Coverage for Certain Services : Medicare doesn't cover dental care, vision, hearing aids, or most long-term care, which are critical for many seniors. : Medicare doesn't cover dental care, vision, hearing aids, or most long-term care, which are critical for many seniors. Prescription Drugs: While Medicare Part D covers prescription drugs, gaps in coverage (like the 'donut hole') can result in high out-of-pocket costs for medications. A 2024 study estimated that the average Medicare beneficiary spends $5,460 annually on out-of-pocket healthcare costs, highlighting the need for solutions to fill these gaps []. To address these gaps, beneficiaries have several options, each with its own benefits and considerations. Here's a look at the most common solutions: Medigap plans, offered by private insurers like Mutual of Omaha, are designed to cover costs that Original Medicare doesn't, such as deductibles, coinsurance, and copayments. Through Medigap Advisors, beneficiaries can explore Mutual of Omaha Medicare Supplement Plans, which are known for competitive pricing and reliable coverage. Comprehensive Coverage : Plans like Medigap Plan G or Plan F (for those eligible before 2020) cover most or all of Medicare's deductibles and coinsurance, reducing out-of-pocket costs. : Plans like Medigap Plan G or Plan F (for those eligible before 2020) cover most or all of Medicare's deductibles and coinsurance, reducing out-of-pocket costs. Nationwide Acceptance : Medigap plans are standardized across most states, allowing beneficiaries to see any provider that accepts Medicare without network restrictions. : Medigap plans are standardized across most states, allowing beneficiaries to see any provider that accepts Medicare without network restrictions. Predictable Costs: With Medigap, beneficiaries can better predict healthcare expenses, as the plan covers many costs that would otherwise be out-of-pocket. Premium Costs : Medigap plans require monthly premiums, which can range from $100 to $300 depending on the plan, location, and age. Beneficiaries should compare plans through resources like Medigap Advisors to find cost-effective options. : Medigap plans require monthly premiums, which can range from $100 to $300 depending on the plan, location, and age. Beneficiaries should compare plans through resources like Medigap Advisors to find cost-effective options. No Prescription Drug Coverage: Medigap plans don't cover medications, so beneficiaries need a separate Part D plan. Medicare Advantage (Part C) plans are an alternative to Original Medicare, offered by private insurers. These plans often include additional benefits like dental, vision, and prescription drug coverage, addressing some of Medicare's gaps. All-in-One Coverage : Many plans bundle hospital, medical, and drug coverage, sometimes including extras like gym memberships. : Many plans bundle hospital, medical, and drug coverage, sometimes including extras like gym memberships. Out-of-Pocket Caps : Unlike Original Medicare, Medicare Advantage plans have annual out-of-pocket maximums, providing financial protection. : Unlike Original Medicare, Medicare Advantage plans have annual out-of-pocket maximums, providing financial protection. Low or No Premiums: Some plans have $0 premiums, though copays and deductibles vary. Network Restrictions : Medicare Advantage plans often require beneficiaries to use in-network providers, which can limit choices. : Medicare Advantage plans often require beneficiaries to use in-network providers, which can limit choices. Variable Coverage: Benefits vary by plan, and not all include comprehensive dental or vision coverage. For beneficiaries seeking alternatives to traditional insurance, Healthshare plans offer a faith-based cost-sharing model. Available through HSA for America, these plans involve members pooling funds to cover medical expenses, often at a lower cost than traditional insurance. Affordability : Monthly contributions are often lower than Medigap or Medicare Advantage premiums, making them appealing for budget-conscious beneficiaries. : Monthly contributions are often lower than Medigap or Medicare Advantage premiums, making them appealing for budget-conscious beneficiaries. Flexibility : Healthshare plans allow members to choose providers without network restrictions, complementing Medicare's nationwide coverage. : plans allow members to choose providers without network restrictions, complementing Medicare's nationwide coverage. Value Alignment: These plans appeal to those who prioritize faith-based, community-driven healthcare. Not Insurance : Healthshare plans are not regulated like insurance, and coverage isn't guaranteed for all expenses. Beneficiaries should review guidelines carefully. : plans are not regulated like insurance, and coverage isn't guaranteed for all expenses. Beneficiaries should review guidelines carefully. Limited Medicare Integration: While Healthshare plans can supplement Medicare, they may not cover all gaps, such as prescription drugs. For beneficiaries who enrolled in a high-deductible health plan (HDHP) before becoming eligible for Medicare, HSA plans can be a powerful tool. Through HSA for America, individuals can use HSA funds to pay for Medicare premiums (Parts B and D) and out-of-pocket costs like coinsurance. Tax Advantages : HSA contributions are tax-deductible, earnings grow tax-free, and withdrawals for qualified medical expenses are tax-free. : HSA contributions are tax-deductible, earnings grow tax-free, and withdrawals for qualified medical expenses are tax-free. Long-Term Savings : Funds roll over indefinitely, allowing beneficiaries to build a healthcare nest egg. : Funds roll over indefinitely, allowing beneficiaries to build a healthcare nest egg. Flexibility: HSAs can cover expenses like dental or vision care, which Medicare doesn't. Eligibility Limits : Once enrolled in Medicare, you can't contribute to an HSA, though you can use existing funds. : Once enrolled in Medicare, you can't contribute to an HSA, though you can use existing funds. Requires Pre-Planning: HSAs are most effective for those who built a balance before Medicare eligibility. To effectively fill coverage gaps, beneficiaries should: Assess Needs: Consider your health, budget, and lifestyle. Do you need dental or vision coverage? Are you comfortable with network restrictions? Compare Medigap Plans: Use Medigap Advisors to explore Mutual of Omaha Medicare Supplement Plans for comprehensive coverage. Explore Healthshare Options: For cost savings and flexibility, check out Healthshare plans via HSA for America. Leverage HSAs: If you have an HSA, use it strategically for premiums and uncovered expenses. Review Annually: Healthcare needs change, so reassess your plan during Medicare's Open Enrollment (October 15–December 7) to ensure it meets your needs. Filling Medicare coverage gaps is essential to avoid unexpected costs that can strain retirement savings. Whether through Mutual of Omaha Medicare Supplement Plans, Medicare Advantage, Healthshare plans, or HSA plans , beneficiaries have options to tailor coverage to their needs. By understanding these gaps and exploring solutions through trusted resources like Medigap Advisors and HSA for America, you can ensure comprehensive care without breaking the bank. For personalized guidance on filling Medicare gaps, visit Medigap Advisors for Medigap options or HSA for America for Healthshare and HSA plans. Taking proactive steps today can secure your health and financial future. TIME BUSINESS NEWS
Health Line
23-05-2025
- Health
- Health Line
Original Medicare (Parts A and B) vs. Medicare Advantage (Part C)
Original Medicare and Medicare Advantage (Part C) cover hospitalization, medical appointments, and other healthcare costs. Original Medicare is government-run, while Medicare Advantage plans are managed and sold by private insurance companies. Original Medicare and Medicare Advantage (Medicare Part C) are two insurance options for people 65 years and older living in the United States. Your medical needs, budget, and other personal lifestyle factors can all affect which coverage option is better for you. In this article, we'll explore the differences between Original Medicare and Medicare Advantage and how to decide which one is better for your medical needs. How does Original Medicare work? Original Medicare is a government-funded medical insurance option for people 65 years and older. Many older Americans use Medicare as their primary insurance since it covers: Inpatient hospital services (Medicare Part A): These benefits include coverage for hospital visits, hospice care, and limited skilled nursing facility care and at-home healthcare. Outpatient medical services (Medicare Part B): These benefits include coverage for preventive, diagnostic, and treatment services for health conditions. Original Medicare generally doesn't cover prescription drugs, dental, vision, or hearing services, or additional healthcare needs. However, for people who have enrolled in Original Medicare, add-ons such as Medicare Part D can provide prescription drug coverage, and Medicare supplement (Medigap) plans can help manage the out-of-pocket costs of Original Medicare. Original Medicare costs Although the government provides Original Medicare coverage, it is not free. You'll have certain set costs associated with your coverage under parts A and B. Here are some of the costs associated with original Medicare in 2025: How does Medicare Advantage work? Medicare Advantage (Part C) is an insurance option for people already enrolled in Medicare parts A and B. Medicare Advantage plans are offered through private insurance companies, and many plans cover hospital, medical insurance, and additional services such as: prescription drugs dental vision hearing fitness services, plus other health perks Medicare Advantage replaces Original Medicare add-ons, such as Part D and Medigap. Instead of having multiple insurance plans to cover medical costs, a Medicare Advantage plan offers all your coverage in one place. Medicare Advantage costs For some people, Medicare Advantage plans can help save money on long-term medical costs, while others prefer to pay for only what they need with Medicare add-ons. Below, you'll find an estimated cost comparison for some of the fees associated with Medicare Advantage in 2025: Cost Medicare Advantage amount Part B monthly premium $185 Medicare Advantage plan monthly premium varies (can start at $0) Medicare Advantage plan deductible varies (can start at $0) Medicare Advantage plan drug deductible varies (can start at $0) Medicare Advantage plan coinsurance /copayments varies (generally, $0 to $45+ per visit) maximum out-of-pocket yearly cost $1,000 to $10,000+ What to consider when choosing between Medicare vs. Medicare Advantage Original Medicare and Medicare Advantage differ in coverage, costs, and benefits. When comparing your options, there's no 'one plan fits all.' Medical services If you're someone who rarely visits the doctor, Medicare and Medicare add-ons may cover most of your needs. However, if you're someone who wants coverage for yearly dental, vision, or hearing exams, many Medicare Advantage plans offer this type of coverage. Health conditions If you have a chronic health condition, such as cancer, chronic heart failure, stroke, dementia, or others, it will affect your medical coverage. For example, Medicare may not cover all your needs, but a Medicare Advantage Special Needs Plan (SNP) could help with long-term costs. These plans are designed for people with one of several chronic health conditions. They offer: coverage for specialists and case managers access to medications specifically for your condition access to other benefits Research suggests that Medicare Advantage plans can help consumers save money on certain medical necessities, such as laboratory tests and medical equipment. Medications Original Medicare generally doesn't cover prescription drug costs. To receive coverage for prescription drugs, you need a Medicare Part D plan or Medicare Advantage plan with prescription drug coverage. No matter what option you choose, you're required to have some form of prescription drug coverage within 63 days of enrolling in Medicare, or you'll be required to pay a permanent late enrollment penalty. Budget If you have Medicare, you'll pay a monthly premium for Part A (if you don't qualify for premium-free Part A) and Part B, yearly deductibles for parts A and B, and other costs if you buy add-on coverage. If you have Medicare Advantage, you may need to pay additional costs, depending on the plan you choose. Before deciding on the type of Medicare plan you want, consider what out-of-pocket costs you can afford each year. Provider preference While Medicare offers the freedom to choose any provider within the Medicare network, most Medicare Advantage plans don't provide as much freedom. Depending on your Medicare Advantage plan, you may face additional costs for out-of-network services, specialist referrals, and visits. Travel frequency For some people, travel is a way of life. This is especially true for people who retire and choose to travel or live somewhere warmer during the colder months. If you travel frequently, consider what out-of-state medical needs you may have. In most cases, Medicare coverage is nationwide, while Medicare Advantage plans require you to stay in your local area for medical services. Enrolling in Medicare When to enroll Enrolling in Medicare is a time-sensitive process that you should begin roughly 3 months before your 65th birthday to ensure that you don't have a gap in coverage. If you receive social security benefits, you're automatically enrolled in Medicare parts A and B. You can also apply for Medicare 3 months before your 65th birthday and up to 3 months after. If you decide to wait to enroll until after that period, you may face late enrollment penalties. How to enroll When you apply for Medicare, you'll need to have some important personal information handy. This includes your place and date of birth, Medicaid number, and current health insurance information. Once you have this information, you can apply on the Social Security Administration website. You cannot enroll in a Medicare Advantage plan until you have been enrolled in Medicare parts A and B. Use the Medicare plan finder tool to find a list of Medicare Advantage plans or Part D plans near you. The takeaway Which health insurance plan covers all your medical needs depends entirely on your situation. Both original Medicare with add-ons and Medicare Advantage offer coverage, costs, and benefits to fit your needs. When comparing which option is better for you, be sure to consider: your medical situation monthly and yearly budget preference for providers other lifestyle factors that can impact your care and costs You don't have to wait until you apply for Medicare to begin shopping around for plans in your area. Get a head start on choosing the best health insurance plan right now. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Yahoo
23-05-2025
- Health
- Yahoo
Health Alliance Medicare Advantage plans set to end, impact over 33K people
CENTRAL ILLINOIS (WCIA) — Three months ago, Carle Health announced that its healthcare plans through Health Alliance will end by the end of the year. Now, the health system says Health Alliance Medicare Advantage plans will end by Dec. 31, 2025 as well. Carle Health said coverage for current Medicare Advantage members will remain unchanged through the end of the year. Insurance expert breaks down implications of Health Alliance's discontinued services 'This decision reflects the challenges facing provider-owned health plans in the current insurance and economic environment,' Carle Health said in a news release. Medicare Advantage replaces Original Medicare. It's sold and managed by private insurance companies. People who qualify for Medicare include people 65 or older, or those with a disability, End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant), or ALS (also called Lou Gehrig's disease), according to the Department of Health and Human Services. Carle Health previously said Medicare Advantage would continue. But, after they 'concluded their comprehensive strategic and financial analysis,' that decision changed. The decision impacts 33,332 Medicare Advantage members, according to Carle Health. 'Our decision to exit the insurance market comes at a time when market dynamics and plan designs have made it increasingly difficult for provider-owned health plans to remain sustainable,' James C. Leonard, MD, Carle Health president and chief executive officer, said. 'We're proud of the service our health plans have delivered for decades, and especially proud to have connected people to the care they've trusted through every stage of life. That legacy continues as Carle Health focuses our efforts on delivering exceptional care and positioning Carle Health for long-term strength and impact.' Carle layoffs set to begin in July on 'rolling basis' in Champaign WCIA has reached out to Carle Health to find out what services or help Carle Health plans to provide Medicare Advantage users when it's time for them to choose a new coverage option. The health system said they maintain relationships with other Medicare Advantage plans. And, when it's time to explore new coverage options, Carle said they will provide resources to help. 'For Carle Health patients wishing to stay connected to their care teams, we will be providing helpful enrollment information during the Annual Election Period at We are focused on a thoughtful and supportive transition for our members,' Carle Health said. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
USA Today
23-05-2025
- Health
- USA Today
10 Medicare myths you should know about
10 Medicare myths you should know about Show Caption Hide Caption DOJ criminal probe investigates UnitedHealth Group for Medicare fraud The Wall Street Journal reported the Department of Justice is investigating UnitedHealth Group for possible Medicare fraud. Here, we examine 10 of the most common myths associated with Medicare and separate facts from fiction. 1. Medicare is free for everyone Reality: Some parts of Medicare (Part A, hospital coverage) are free for individuals who worked and paid Medicare taxes, but most people are still required to pay premiums, deductibles and copays. Those copays cover other parts of Medicare, like Part B (medical coverage) and Part D (prescription coverage). 2. Medicare covers everything Reality: As mentioned above, there are different parts to Medicare, and the number of parts you carry determines how much you pay. If you want dental, vision or hearing coverage, you must choose Medicare Advantage or a supplemental plan that includes them. 3. You're automatically enrolled when you turn 65 Reality: You're required to enroll in Medicare, usually around three months before your 65th birthday. 4. You're automatically covered by Medicare if your spouse has coverage Reality: While this myth is an easy one to believe due to the way we often share a traditional healthcare plan with a spouse, it doesn't relate to Medicare. Your spouse's plan covers only them, and your plan will cover only you. 5. If you're on Medicare, you won't have coverage outside the U.S. Reality: Although Original Medicare doesn't typically cover care outside the U.S., Medigap may provide extra coverage for travelers. 6. Choose your Medicare plan carefully because you're stuck with whatever you choose Reality: If you don't like your plan, you can choose a new one during the annual enrollment period of Oct. 15 to Dec. 7. 7. Medicare will cover long-term care if you need it Reality: While Medicare typically covers short-term care in a skilled nursing facility following a hospital stay, it doesn't cover long-term care, assisted living or daily custodial care. 8. Doctors are required to accept Medicare Reality: Many doctors do accept Medicare coverage, but some choose not to do so. 9. Medicare and Medicaid are the same Reality: Although each program was initially designed to help Americans get the care they need, Medicare and Medicaid are very different. Medicare is a federal program for people 65 and older and younger people with disabilities. Medicaid is a state-administered program for low-income families and individuals. 10. There's only one way to get Medicare coverage According to the Social Security Administration (SSA), if you opt for Original Medicare coverage (Part A and Part B), you can buy a Medicare Supplement Insurance (Medigap) from a private insurance company. Many seniors find Medigap attractive because it covers some of the costs not covered by Medicare, including copayments, deductibles and coinsurance. In addition, if you choose Medicare Advantage, you can buy a Medicare-approved plan from a private company that bundles Part A, Part B and often Part D into a single plan. While most people refer to those signing up for Medicare this year as baby boomers, they're more accurately referred to as Generation Jones. Although Generation Jones may be a subset of baby boomers, their formative experiences had little in common with their older brothers and sisters. Now that they've slipped past middle age, Generation Jones can look to their boomer friends to learn how they handled the multitude of choices that signing up for Medicare requires. And hopefully, if they hear something about Medicare that doesn't sound "just right," they can ask a more experienced baby boomer for the real scoop. The Motley Fool has a disclosure policy. The Motley Fool is a USA TODAY content partner offering financial news, analysis and commentary designed to help people take control of their financial lives. Its content is produced independently of USA TODAY. The $ 22,924 Social Security bonus most retirees completely overlook Offer from the Motley Fool: If you're like most Americans, you're a few years (or more) behind on your retirement savings. But a handful of little-known "Social Security secrets"could help ensure a boost in your retirement income. One easy trick could pay you as much as $22,924 more... each year! Once you learn how to maximize your Social Security benefits, we think you could retire confidently with the peace of mind we're all after. JoinStock Advisorto learn more about these strategies. View the "Social Security secrets" »
