Newsletter

AARP VIDEO: WHAT MEDICARE DOESN’T COVER

This video from AARP explains some of the items that Original Medicare [Part A (hospital) and Part B (medical)] doesn't cover. Please click on the arrow to open.

Coverage for outpatient prescription drugs is provided by Part D plans, which can either be stand-alone plans (generally available for beneficiaries on Original Medicare with or without a Medicare Supplement plan) or plans that are included in Medicare Advantage plans (note: stand-alone drug coverage cannot be purchased by those enrolled in a Medicare Advantage HMO or PPO plan; in these cases beneficiaries must enroll in a Medicare Advantage plan that includes such coverage [these are called Medicare Advantage Prescription Drug (MAPD) plans].

If you have either a Medicare Supplement plan or a Medicare Advantage plan, some of these other items may be covered. Check your plan for details or contact us at 561-734-3884 if you have any questions.

For example, some Medicare Supplement plans contain foreign travel emergency coverage as well as payment for “excess” charges (i.e., up to 15% of the Medicare Allowable payment for providers who do not take Medicare assignment). Also, a few Medicare Supplement carriers provide discounts for various items such as dental, vision, hearing, and medications and several carriers offer fitness program coverage (with or without an additional premium).  

Many Medicare Advantage plans contain some coverage for dental, vision, and hearing; routine foot care; non-Medicare covered chiropractic and acupuncture benefits, etc.  

You should check your Medicare Supplement or Medicare Advantage plan to see what those plans cover.

Contact us at 561-734-3884 if you are interested in purchasing stand-alone dental, vision, and/or hearing insurance and/or supplemental coverage like hospital indemnity, cancer, or critical illness insurance.

WHAT IS A LATE ENROLLMENT PENALTY?

If you don’t enroll in Medicare Drug Coverage (i.e., coverage for outpatient medications) when you’re first eligible, you may be subject to what is called a Late Enrollment Penalty if you ever do enroll in a plan (e.g. a Medicare Advantage Prescription Drug Plan or a stand-alone Part D plan) that includes outpatient drug coverage at a later date.

You won’t be subject to this penalty if you’re enrolled in some other plan (like VA) that provides what is called “creditable coverage” (i.e., coverage at least equal to that provided by Medicare), if you’re enrolled in the Low Income Subsidy (also called “Extra Help”) program, or if you're without creditable drug coverage for a period of less than 63 continuous days.

The penalty is calculated by taking 1% of the “national base beneficiary premium ($36.78 for 2025) times the number of full, uncovered months a beneficiary did not have Part D or “creditable coverage.” For example, let’s assume a person goes 14 months without creditable coverage and then joins a Medicare drug program. The late enrollment penalty would be 1% of the national base beneficiary premium x 14 for EACH month the beneficiary is enrolled in a drug program.

Note that the “national base beneficiary premium” changes annually, but that increase is limited by law to 6% above the previous year’s number. For example, the national base beneficiary premium was $34.70 for 2024. That number is limited to $36.78 for 2025 (i.e.,$34.70 x 1.06 ).

READ AND CHECK YOUR SOCIAL SECURITY STATEMENT

Beneficiaries who are subject to income related monthly adjustment amounts (IRMAA) received letters from the Social Security Administration indicating how much their Social Security benefit with the 2.5% COLA increase and how much their deductions for Part B (including the $185 standard Part B premium AND the additional amount for Part B IRMAA) as well as Part D IRMAA will be for 2025. These letters were mailed the last week of November or in early December.

In addition, the letter includes information about the amount of any voluntary tax deductions.

This letter also includes instructions on what the beneficiary can do if their Modified Adjusted Gross Income has gone down at least one range from the table contained in the letter. Please contact us at 561-734-3884 if you need any help in applying to lower your IRMAA because of a change in life circumstances.

All other beneficiaries receive a Notice of Cost-of-Living Adjustment (COLA) in late December. This letter indicates the amount of the monthly Social Security benefit including the 2.5% COLA and 2025 common deductions: (1) premiums for Medicare Part B as well as premiums, if any, for Medicare Advantage (Part C) plans; (2) premiums for Part D plans; and (3) any federal tax withholding.

Both of these are very important letters, and you should be sure to retain copies of these with your other important financial records. The information can also be accessed by signing into your my Social Security account. These notices will be useful when you prepare your tax return and can be used as proof of your benefit amount if you need to apply for food, rent, or energy assistance. The notices can also be used to apply for bank loans or for other business.

Note: if you changed Medicare Advantage or outpatient drug plans after November 1, the information about any Part C or Part D premiums that will be deducted from your Social Security check for 2025 may not be accurate because the information concerning the new 2025 premiums may have been received by Social Security too late to have been included.

If you have any questions about the information contained in these notices, you can contact Social Security or check your my Social Security account. You can also call us at 561-734-3884 for help in understanding these notices.

About Paul Cholak

Paul is a licensed, independent health and life insurance agent and has over forty years of benefits experience and specializes in helping Medicare beneficiaries obtain health insurance. However, he offers a complete array of life and health insurance products to individuals of all ages.

He guides Medicare beneficiaries through the steps of getting insurance and is available to help clients both BEFORE and AFTER they've made their purchase decision.

Disclaimer for Part C and D plans: "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY: 1-877-2048) to get information on all your options."

Contact Us

Local: 561-734-3884 (TTY: 711)

Toll-free: 877-734-3884 (TTY:711)