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DON P. BAKER

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DON P. BAKER

DON P. BAKERDON P. BAKERDON P. BAKER
  • Home
  • Our Team
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  • Life Insurance
  • JUVENILE WHOLE LIFE
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Financial Consultant, Wealth Management, Real Estate, and Insurance

YOUR ONE SOURCE FOR YOUR ENTIRE MEDICARE INSURANCE NEEDS

We are here to assist you with Medicare

  

Medicare Parts A, B, C, and D Explained



Figuring out how Medicare works feels a little like learning the alphabet for the first time.

There are the four general parts of Medicare: A, B, C, and D. Then you have the 10 types of Medicare supplement plans: A, B, C, D, F, G, K, L, M, and N.


As confusing as that might seem, it's important to take the time to educate yourself. Medicare’s parts and supplement plans cover different things. They have different costs; participating doctor and hospital networks; availability; and other rules. You'll most likely be enrolled in multiple parts and/or plans at the same time. Getting familiar with them lets you choose the best health insurance for your needs.


Part A: Hospital Services

Medicare Parts A and B are run by a federal agency called the Centers for Medicare and Medicaid Services. Together, these two parts are known as Original Medicare. With Original Medicare, you can see any doctor or hospital anywhere in the country -- as long as they participate in the program and are accepting new Medicare patients. If you see a non-participating doctor, your out-of-pocket expenses go up.


Most people sign up for Original Medicare during their initial enrollment period. This is the 7-month period that starts 3 months before the month of your 65th birthday and ends 3 months after.


OK, how about Part A specifically? This is Medicare’s program for illness or injury serious enough to need care in a hospital or other health care facility. Generally, Part A covers:

A hospital stay that a doctor says is needed


A stay in a skilled nursing facility or nursing home when that care is short-term, ordered by a doctor, and follows a hospital stay


Home health care for services your doctor orders, like physical, occupational, and speech therapies


Hospice care when doctors certify that you're expected to die within 6 months


Most people can get Part A without paying a premium. If you or your spouse paid Medicare taxes for at least 10 years, you qualify for no-premium coverage. You also qualify if you get retirement benefits from Social Security or the Railroad Retirement Board.


Part A is not going to cover your long-term care costs unless they are really medically necessary.

If not, you can buy coverage. Your premium amount varies, depending on how long you paid Medicare taxes while you worked. You'll also pay a deductible. After that, you're responsible for a share of costs (this is called coinsurance).


While Part A is meant for inpatient care, don't make the mistake of thinking that it will pay for assisted-living care or long-term care that wasn't ordered by your doctor.


Part B: Medical Services

Part B is Medicare’s coverage for doctor visits, tests, and other outpatient services. It covers medically necessary services and some preventive ones, like checkups. It also may pay for:

· Participation in a clinical research study


· Ambulance rides (including some nonemergency trips)

· "Durable" medical equipment like walkers or oxygen tanks

· Mental health services

· Certain prescription drugs that are usually given by a doctor or at a hospital


With Part B, you pay:

· A premium that can increase with your income

· A deductible

· Typically, 20% of the costs for each medical service (as coinsurance)

· This raises an important point: Original Medicare may be run by the government, but that doesn’t mean it’s free to you.


Also, keep in mind that parts A and B don’t cover most dental care, eye exams, hearing aids or exams to fit them, cosmetic surgery, acupuncture, or routine foot care. Parts A and B also don’t cover most prescription drugs. You need to enroll in a Part D or Medicare Advantage plan for that.


Part C: Medicare Advantage

If you want extra services like those -- and are willing to pay more to get them -- Part C, or a Medicare Advantage plan, may be for you.


These plans are basically another way to get your Medicare benefits. They're sold by private insurance companies that are approved by Medicare.


The plans must at least offer you the same benefits as Part A and Part B. The private insurers then add extra services. In addition to vision, dental, and hearing services, these sometimes include things like:

· A wellness program

· Adult day-care services

· Transportation to doctor visits

· Most also offer the prescription drug coverage you'd otherwise get through Medicare Part D (more on that later).


With Part C, the government pays the insurance company a fixed amount per month for your care. But the company sets your out-of-pocket costs. You also deal with deductibles and coinsurance, just as you did with your employer’s insurance.

Some Medicare Advantage plans also charge monthly premiums. If you enroll in one of these, you may pay that on top of your Part B premium. Some plans, though, cover all or part of your Part B premiums. You might hear this called the "give-back benefit."


A few other things to remember about Medicare Advantage plans:

· You can choose among several types: Health maintenance organizations (HMOs), preferred provider organizations (PPOs), private fee-for-service (PFFS) plans, and special needs plans (SNPs). Each operates a bit differently.

· You may need a referral to see a specialist, or preauthorization for certain services.

· Medicare Advantage plans generally have smaller networks of doctors and hospitals than Original Medicare does. And people in rural areas may have fewer plans to choose from.

· Your Medicare Advantage insurer can make changes to your out-of-pocket fees as often as once a year.

· You can’t enroll in Medicare Advantage and buy a private Medicare supplement (Medigap) plan at the same time.


Part D: Prescription Drugs

Maybe you don't want to sign up for a Medicare Advantage plan, or the plans in your area don't offer the kind of drug coverage you need. You’ve got one more option to explore: a private insurance company’s Part D plan.


All Part D plans must offer a range of prescription drugs that people with Medicare often take, plus more specialized medications like cancer drugs and insulin. Each Part D plan publishes a list of its covered drugs, called a formulary. In each formulary, drugs are organized into different levels with varying costs.


Bear these points in mind about Part D plans:

· You must have Part A and Part B coverage to enroll in one.

· Drug coverage is optional. But if you don't sign up for Part D when you first enroll in Medicare, you may pay penalties for joining later on.

· If you get drug coverage through your Medicare Advantage plan, you don't need a separate Part D plan.


Medicare Supplement Plans (Medigap)

Medigap, or Medicare supplement, plans are extra insurance to pay for all or part of the deductibles, coinsurance, and copayments you have with Original Medicare. You buy them from private insurance companies.


There are 10 Medigap plans, which vary in what and how much they cover. Each is identified by a letter: A, B, C, D, F, G, K, L, M, and N. They're standardized, which means a Plan A offered by one company has the same benefits as a Plan A sold by another one. Your premiums may differ, though. To find out what benefits are offered under each plan, go to the Medicare website.

Each insurance company decides which Medigap plans it wants to sell, although some states’ laws require them to offer certain plans there.


A few things to know about Medigap plans:

· You'll still pay your Part B premiums, along with your Medigap premiums.

· Each policy covers just one person. Your spouse will need a separate one if you both want coverage.

· Those sold to people who are newly eligible for Medicare don't cover Part B deductibles. New enrollees haven't been allowed to buy C or F Medigap plans since Jan. 1, 2020.

· The best time to buy one is when you're first eligible. You'll likely face fewer choices and higher prices if you try to get one later on.

Learn More

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Financial Consultant, Wealth Management, Real Estate, and Insurance

MEDICARE SUPPLEMENT INSURANCE

Are you looking forward to retirement — but not to the decisions you’ll need to make about Medicare

 You’re not alone.


For over 50 years, we have offered Medicare Supplement insurance options to hundreds of thousands of Americans. People — like you — who feel overwhelmed by all their choices for coverage in retirement. We’ve been here for them. Listening. Answering questions. Empowering them with the guidance they need. 


You, too, can count on us to be by your side. So when it’s your turn, you can look forward to making decisions about your retirement with confidence.


Health care costs a worry? You’re not alone. 


Medicare is great, but it was never intended to pay all medical expenses.

Coverage you can count on.


Choose your own physician 

You’ll always have the freedom to choose your own doctor as long as they accept Medicare - it’s your doctor, your choice! You can also choose to get a specialist’s opinion, without a referral or prior approval. 


Choose the hospital you want 

You can go to the Medicare-approved hospital you want — it’s up to you! 


Get reliable lifetime coverage that keeps pace with Medicare 


You can feel secure with lifetime coverage that is guaranteed renewable as long as you make on-time premium payments. Only you can cancel your coverage! Plus, your coverage will increase to match rising Medicare deductibles and co-payments — so you have less worry. 


Preventive care — key to a happy retirement 


You can’t control everything. We get it. But, you can control how you take care of yourself. That means getting preventive care when and how you may need it. You don’t have to worry. 

As our customer, you can collect benefits for covered routine physical exams, immunizations and health screenings not paid for by Medicare.* Best of all, you’ll never pay anything for these covered preventive care services. 


We’re one of the few companies that covers preventive care — and doesn’t limit the dollar amount of preventive benefits you can receive. 


Immediate coverage 

Once your insurance policy is in effect, your coverage begins immediately. There is no waiting period for pre-existing conditions.


Exclusive second-chance option 

Choosing the right Medicare plan for you is important. That’s why we work hard to help you make the best choice at the time you sign up. But life changes — and your needs might, too. No problem! You have the option to switch to another insurance policy once in the first two years with no health questions. This option gives you a second chance you won’t get anywhere else. 


Strength, stability and quality service

For more than 117 years, we have helped Americans find the right coverage at the right price. Our reputation for honesty, financial strength, stability and security is recognized nationwide — and it guides us each day. As a mutual company, we are owned by our policy owners, so it is their interests that come first — not those of Wall Street. 


That’s just one of the reasons 95% of customers surveyed said they are satisfied with our service and 7 out of 10 Medicare Supplement customers have recommended us to a family member or friend..




Learn More

  

The decision of which insurance company you choose for Medicare Supplement insurance can come down to the company's financial strength, pricing options, personal service, customer service and experience. You can count on us for all of these.


Pricing Options

You want to make sure you can afford your coverage now and in the future. It's important you know insurance companies can set prices in different ways for Medicare Supplement insurance. The way prices are set determines how much you pay now and in the future. Our customers can depend on our long-term vision to help provide affordable premiums.


Personal Service

We know that insurance can be confusing. That's why we want you to be as educated as possible. Our experienced, professionally trained agents/producers take care to understand your needs, explain things clearly, and help guide you to an insurance coverage that's right for you.


Financial Strength

We consistently receive some of the highest financial strength ratings in the nation. Our strong financial base allows us to be there when you need us — so you can rely on us to service your insurance policy today and in the future.


Customer Service

Customers come first. We want ours to be happy and know they can contact us with all of their questions. Each and every day we work to create satisfied customers. You'll be glad to know that 95% of our customers are satisfied with us, according to our Customer Satisfaction survey conducted by Wiese Research Associates.


Experience

For decades, we have helped Americans find the right coverage at the right price. We're committed to helping seniors make some of the most important decisions they'll ever make. When you're ready to discuss insurance, you can rely on us for the straightforward guidance you need.

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Financial Consultant, Wealth Management, Real Estate, and Insurance

Medigap Policy

When’s the best time to buy a Medigap Policy?

  

The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. 

This period lasts for 6 months and begins on the first day of the month in which you’re both 65 or older and enrolled in Medicare Part B. 


During this period, an insurance company can’t use medical underwriting to decide whether to accept your application. This means the insurance company can’t do any of these because of your health problems:


• Refuse to sell you any Medigap policy it offers

• Charge you more for a Medigap policy than they charge someone with no health problems

• Make you wait for coverage to start 


Why is it important to buy a Medigap policy when I’m first eligible?


When you’re first eligible, you have the right to buy any Medigap policy offered in your state. In addition, you generally will get better prices and more choices among policies. It’s very important to understand your Medigap Open Enrollment Period. Outside of Medigap Open Enrollment, Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. 


However, if you apply during your Medigap Open Enrollment Period, you can buy any Medigap policy the company sells, even if you have health problems, for the same price as people with good health. If you apply for Medigap coverage after your Open Enrollment Period, there’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements, unless you’re eligible for guaranteed issue rights.


In most cases, it makes sense to enroll in Part B and buy a Medigap policy when you’re first eligible for Medicare, because you might otherwise have to pay a Part B late enrollment penalty and might miss your 6-month Medigap Open Enrollment Period. However, there are exceptions if you have employer coverage.


Employer coverage

If you have group health coverage through an employer or union, because either you or your spouse is currently working, you may want to wait to enroll in Part B. Benefits based on current employment often provide coverage similar to Part B, so you wouldn’t want to pay for Part B before you need it, and your Medigap Open Enrollment Period might expire before a Medigap policy would be useful. When the employer coverage ends, you’ll get a chance to enroll in Part B without a late enrollment penalty which means your Medigap Open Enrollment Period will start when you’re ready to take advantage of it. If you or your spouse is still working and you have coverage through an employer, contact your employer or union benefits administrator to find out how your insurance works with Medicare.

Learn More

 The Open Enrollment Period runs from, November 1 to  December 15, If you don't act by December 15, you can't get coverage unless you qualify for a Special Enrollment Period.  

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