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Medicare Extra Benefits By Zip Code

What Is A Zip Code And How Does It Work

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The ZIP Code full form is Zone Improvement Plan. A ZIP Code guides the destination post office or delivery area to which a letter or parcel will be sent for safedelivery of goods or mails. USPS delivery areas routes are directed by ZIP Codes in which goods are delivered.

ZIP Codes are basically 5-digit numbers developed by the United States Postal Service to identify and represent individual post offices across the United States.Most of the Countries has their own Postal systems developed in their country such as India, Czech Republic, Italy, Brazil, Germany, Switzerland etc.The United States Postal Service has segmented the country into 10 ZIP Code areas. Starting in the northeast, they are numbered 0-9.

Structure Your Income To Avoid A Premium Surcharge

The standard premium for Medicare Part B is $170.10 per month in 2022, and dropping to $164.90/month in 2023. But that assumes youre not a higher earner. Those with higher income levels are subject to higher premium costs. For 2022 heres what youll pay for Part B if your income falls into the level that triggers a surcharge:

2022 Medicare Part B premium costs by income level
Income level: individual tax filer Income level: joint tax filer Total monthly premium
$750,000 and above $560.50

If youre able to defer income strategically to future tax years so that you can report a lower total on your tax return, you might save yourself a higher premium charge for at least a year, since those surcharges are based on previous tax returns. For example, your 2022 tax return will determine whether you pay a surcharge in 2024 .

Medicare Benefits: How Does Your Zip Code Affect Your Ss Benefits

Everything you need to know

It might come as a surprise to you, but the Medicare benefits you receive can vary depending on the state in which you live.

The pricing, rules and availability of the plans for Medicare and Medicaid Services can vary by state, and sometimes even by zip code.

Here, we will explain how the prices can vary.

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How An Advantage Plan Works

With a regular Medicare plan, you get your Social Security check every month and an amount is deducted to pay for Medicare.

If you choose a Medicare Advantage Plan, money comes out of your check for the standard medicare amount, and then Medicare sends that money to the insurance company you have your plan with.

If you have a PREMIUM REDUCTION BENEFIT, then the insurance company sends some of that money back to your Social Security check. This sounds good, but it comes with changes to your out-of-pocket deductible.

“For example, the regular plans have an out-of-pocket of $3,600 but when you sign up for one of these programs, it’s not unusual to see these go up to $7,000 or $8,000 or $9000, ” said Edmonds.

Medicare enrollment ends on December 7, 2022.

Does Medicare Cost The Same In Every State

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The federal program that is Original Medicare costs the same no matter which state you reside in. But Medigap and Medicare Advantage plan options will change depending on your location.

Some states have a higher cost of Medigap than other states, some zip codes offer $0 Medicare Part C options. On the contrary, there are zip codes with fewer plan options or higher premium plans.

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Does My Zip Code Affect My Medicare Coverage

The Centers for Medicare & Medicaid Services reports that, with Original Medicare , you can use any doctor or hospital that takes Medicare, anywhere in the U.S. Medicare plans like Medigap and Medicare Advantage are a different story, though. The pricing, rules, and availability of these plans vary by state, and even sometimes by zip code. Here, we cover what you need to know about Medicare coverage based on where you live, using the official U.S. government website for Medicare as a guide.

What Is Medicare Part C

Original Medicare is made up of Medicare Part A and Part B . Medicare Part C plans are all-in-one alternative healthcare options to Original Medicare and include the same benefits as Medicare Part A and Part B plus additional coverage.

When you enroll in a Medicare Part C plan, the company you enroll with becomes your primary source of health insurance.

Medicare Part C coverage must at least match Original Medicare coverage. However, since there are several Medicare Part C plan types, costs for enrollees can vary widely.

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What Are Medicare Advantage Part B Buy Back Plans

Medicare Advantage plans are additions to your existing Medicare coverage. They can vary greatly in coverage amounts and premium prices. Some Medicare Advantage plans can come with a $0 premium or a low premium in addition to a Part B buy back .

If you pay your Part B premium automatically out of your Social Security check, this could feel like a bonus added to your monthly checks! Youll start seeing a bit more coming in, which is nice, assuming the plan you choose has the buy back option.

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Is Medicare Different In Each State

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Before we begin our discussion of Medicare coverage by state, letâs consider basic eligibility for Medicare. The Centers for Medicare & Medicaid Services reports that the following factors make you eligible for Medicare:

  • Age. If you are 65 or older, you qualify.
  • Disability. If you get disability income from Social Security or the Railroad Retirement Board , you’ll gain eligibility for Medicare once you’ve recieved your Social Security or RRB disbursements for 24 months. There are also special qualifying criteria for those with Lou Gehrig’s disease and end-stage renal disease which can eliminate waiting periods.

Assuming now that you are eligible, letâs address the questionâis Medicare different in each state? Since Original Medicare is a completely federal program, itâs equally available to residents in all U.S. states.

However, certain programs within Medicare vary from state to state in terms of rules, availability, and pricing. Two such Medicare plans are Medigap and Medicare Advantage. The coverage and features of these Medicare plans will vary depending on where you live.

Medigap

Medigap, sometimes called Medicare Supplement, is available to Original Medicare beneficiaries. It works like an insurance policy to cover the âgapâ between what Original Medicare pays and what you owe in out-of-pocket expenses .

Medicare Advantage

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How Much Do I Get Back With A Part B Give Back Plan

The amount you get back varies by plan. Amounts can range from $0.10 in some counties up to the full standard premium for the year.

The amount you get back will depend on the options available in your area. In some cases, policies of the same name will have different premium give back amounts depending on the county. Hence, it is important to understand your Medicare Advantage plan entirely before enrolling.

What Types Of Medicare Advantage Plans Are There

Coordinated care plans

Most Medicare Advantage plans are coordinated care plans. Coordinated care plans have a network of providers. If you use the plans network of providers, you generally pay less out-of-pocket for care.

Health Maintenance Organization plans

HMO plans use a network primary care provider to help coordinate care. HMO plans usually only pay for providers in the plan network.

Point of Service plans

POS plans have the benefits of an HMO plan, but with more flexible provider choices. Costs are generally lower if you use the plans network providers.

Preferred Provider Organization plans

PPO plans cover providers both in and out of network. These plans pay a portion of the cost for using an out-of-network provider.

Special Needs Plans

Special Needs Plans have benefits that cover special health care or financial needs. All SNPs include prescription drug coverage.

  • Dual-Eligible Special Needs Plans for people who have both Medicare and Medicaid
  • Chronic Special Needs Plans for people living with severe or disabling chronic conditions
  • Institutional Special Needs Plans for people who live in a skilled nursing facility
  • Institutional-Equivalent Special Needs Plans for people who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility

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What Ohip Covers And What It Doesnt

Before you can decide whether or not you need supplementary health and dental insurance, you should have an idea about the kinds of services OHIP does and doesnt pay for. The basic expenses covered by OHIP include:

  • Visits to doctors

For a full list visit What OHIP Covers.

What OHIP doesnt typically cover:

  • Prescription drugs/medicines provided outside of hospitals such as antibiotics, painkillers, and some cancer drugs
  • Specified elective medical services such as chiropractors or massage therapists
  • Semi-private or private hospital rooms
  • Some medical exams, tests and vaccinations

How Can Medicare Advantage Plans Afford To Offer So Many Extra Benefits

Medicare Additional Benefits By Zip Code

The extra benefits available from most Medicare Advantage plans have contributed to their growing popularity among people with Medicare.

Medicare Advantage plans typically have networks of hospitals, doctors, and other health suppliers that you must use to receive the full benefits of the Medicare Advantage plan.

Often the trade-off for Medicare Advantage plansâ use of provider networks are supplemental benefits that are not covered by Original Medicare.

Many Medicare Advantage plans offer the convenience of an âall-in-oneâ health insurance solution by providing coverage for hospital care, doctor visits, outpatient services, diagnostic tests as well as extra benefits like:

  • prescription drugs
  • routine hearing services.

If you choose to receive your Medicare benefits through government-administered Original Medicare, you will have to enroll in a separate insurance policies to receive Medicare prescription drug, dental, vision, and hearing coverage.

You may also want a Medicare Supplement Insurance policy in addition, to get benefits comparable to many Medicare Advantage plans.

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The Hold Harmless Provision Protects You If You Also Receive Social Security Benefits

Seniors who are enrolled in Medicare and Social Security simultaneously have their Part B premiums deducted directly from their Social Security benefits. Doing so isnt just a convenience, though in some cases, it can save you from rising premium costs thanks to Medicares hold-harmless provision.

This provision protects you from losing out on Social Security income when Part B premium increases surpass the cost-of-living adjustments that are applied to benefits each year. This means that if Part B increases by $30 a month in a given year, but your COLA only raises your monthly benefits by $24, you save yourself the extra $6 by not having to pay it.

In recent years, the COLA has been more than adequate to cover the full cost of the standard Part B increases, so the hold harmless provision hasnt been applicable . But its always there, just in case the Part B premium increase is more than a beneficiarys COLA for a given year.

When Does Your Special Enrollment Period Begin

According to Medicare, your SEP will begin depending on when you notify your plan provider of your move.

If you notify your plan provider before you move, your SEP begins the month before you move and lasts up to two full months after you move.

If you notify your plan provider after you move, your SEP to switch to another Medicare Advantage or Part D plan begins the month you tell your plan, plus two more full months thereafter.

You may choose to begin coverage any time between the first day of the month you moved , and up to three months after your Medicare Advantage plan or Part D plan receives the completed enrollment application.1

Contact your State Health Insurance Assistance Program if you need additional help in finding a Medicare plan or if you have general Medicare questions.

If youre planning to move in the near future, its a good idea to sort out your Medicare coverage as soon as possible and learn about all your available options for your new location.

Footnotes

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What You Pay With Original Medicare

For Medicare parts A and B, you pay monthly premiums, and deductibles, copays, and coinsurance. You also pay the full cost of any services that Medicare doesnt cover.

  • Premiums are amounts you pay to keep your Medicare coverage. Most people dont have to pay a Part A premium, but everyone must pay the Part B premium. The premium amounts may change each year in January.
  • A deductible is the amount you must pay for medical expenses before Medicare begins to pay.
  • A copayment is a set dollar amount you usually have to pay each time you see a doctor or go to the hospital.
  • Coinsurance is the percentage of the cost of a service that you pay after Medicare pays its portion of the cost. This means that if Medicare pays for 80% of the cost of a service, youll pay the remaining 20%.

How Does It Work

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Supplementary health and dental insurance policies are contracts between you and an insurance company. You agree to pay a yearly or monthly fee called a premium, and the company agrees to pay the benefits which are covered under your policy. Your policy will outline what is included and what is not.

Here are some common features of supplementary health and dental insurance:

  • Most policies do not cover 100 per cent of your medical expenses. You may have to pay some of the medical expenses you and your dependants incur. This is known as the deductible. Each policy is structured differently and you might have family deductibles or per service deductibles .
  • Some plans have a co-insurance feature in addition to the deductible. That means you have to pay a percentage, or co-insure, the medical expenses on top of your deductible. It could be 10 per cent of the eligible medical expense, or higher, and it may depend on the type of medical service required.
  • You may also have dollar or percentage limits, or maximums placed on the amount of benefits that you can receive. Maximums can apply to specific health benefits like eyeglasses or massage therapy sessions in a specified period typically a year, or during your lifetime.

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Medicare Advantage And Part D Plans When You Move

Medicare Advantage and Part D plans have geographic boundaries. Depending on where you move impacts what happens to your Medicare coverage and what you can do as a result.

If you move to a new city that is within your plans network, you can:

  • Keep your current Medicare Advantage or Part D plan
  • Enroll in or change to a different Medicare Advantage or Part D plan
  • Drop your existing Medicare Advantage plan and return to only Original Medicare

If you move to a new city that is outside of your plans network, you will lose your Medicare Advantage or Part D plan. In this case, if you have a Medicare Advantage plan, you either have to enroll in a new plan or opt to return to Original Medicare and also enroll in a Part D plan. In this situation you have the following options:

  • Enroll in a new Medicare Advantage plan
  • Enroll in a new Part D plan
  • Drop your Medicare Advantage coverage and return to Original Medicare when you move

We Can Make Understanding Your Options Easier

*You agree to have a licensed sales representative contact you via e-mail or phone to help you understand your Medicare options. You do not have to provide your information. Providence is proud to have local Medicare Advantage experts and by providing your zip code we will be better able to connect you with someone that is local to your area.

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What Is Pin Code Or Zip Code And Why They Are Used

PIN CODE is abbreviation for Postal Index Number, Pincode is a 6 digits combination code used for identifying unique post office used by India Post for the delivery of mails and goods. It is very difficult to process the mails or parcels on the basis of address, basically Postal Codes are used to speed up the routing process thegoods and mails to right direction.

How To Find Supplemental Medicare Plans In My Zip Code

Medicare Choices Made Easy 3 B

Whether youre moving a county over or across the country, its important to know the new options available to you. In some instances, like moving across the street, you wont need to change your plan. But its always nice to know if you can change plans.

Working with a licensed Medicare agent can save you time and money, our agents can help you compare all the plan options in your area.

Give us a call now at the number above to see the Medicare plans available in your zip code. Or fill out an online rate form to compare your options.

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Who Should Consider A Medicare Giveback Plan

You may want to consider a Medicare giveback plan if you:

  • Are already planning on enrolling in a Medicare Advantage plan
  • Live in a zip code covered by a plan that offers a giveback program
  • Understand that you may not get all your Part B premium reimbursed, and this program is not the only factor in choosing a plan

When you’re ready, a knowledgeable Medicare agent can help you understand your options.

Does My Zip Code Impact My Medicare Options

Zip code does affect which plan options are available to you. For example, Medigap and Medicare Advantage plans will vary in pricing as well as features depending on your location. Additionally, you must live in the plans service area to be eligible for enrollment.

Medicare Advantage plans are impacted most by zip code changes. Did you know Medicare Advantage plans dont cover you outside the service area? So, in many cases, when you leave the service area you no longer have coverage.

Also, Medicare Advantage plan premium costs are cheaper in metropolitan areas, and more expensive in rural areas. Some areas may offer policies with a larger network of doctors or more ancillary benefits.

Since Medicare Supplement plans are standardized, they have the same coverage in all states, except for Wisconsin, Massachusetts, and Minnesota. Pricing will vary greatly depending on your zip code.

If you want a policy that allows you to have coverage in another state, Medigap would be a good option for you.

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