” Helping people in Texas navigate everyday personal risks since 2000 “
” Helping people in Texas navigate everyday personal risks since 2000 “
Let us help you find the best plan to fit your health care needs.
Whether you are turning 65 and new to Medicare or have been on Medicare for years, we at Simple Senior Benefits will help you understand the world of Medicare.
When you have worked hard to enjoy what you have today, it is important to make sure you have the protection you need and deserve. In this confusing and ever-changing world of insurance benefits for people on Medicare, it’s good to have a specialist on your side.
We, at Simple Senior Benefits, will be your trusted resource for free and unbiased information on Medicare eligibility, coverage choices and plan enrollment. We are also trained to assist with various assistance programs through the State and Social Security, like Extra Help for Prescription Assistance and/or the Medicare Savings Program.
Our goal is to help Seniors get the exact coverage they need and deserve. We are independent advisors that represents many of the top insurance carriers that offer a wide variety of health and life products available to Seniors.
We have extensive experience and knowledge in the products we offer as well as an expertise on how to use those products to provide maximum benefit and protection to the clients we serve. It is our commitment and desire to establish trust and long-lasting relationships with our clients.
There are four basic parts of Medicare: A, B, C and D. Each part helps pay for certain health care services. Each part also has certain costs that you may have to pay. Your Medicare costs will depend on what coverage you choose and on what health care services you use.
Part A is hospital coverage. It covers care you receive while an inpatient in a hospital or skilled nursing facility.
In general, Part A covers:
Medicare Part A covers the hospital charges and most of the services you receive when you’re in the hospital. But it doesn’t cover the fees charged by doctors who participate in your care while you’re in the hospital. Medicare Part B helps pay those costs.
You usually don’t pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes for a certain amount of time while working. This is sometimes called “premium-free Part A.”
You can get premium-free Part A at 65 if:
You already get retirement benefits from Social Security or the Railroad Retirement Board. You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet. You or your spouse had Medicare-covered government employment.
If you’re under 65, you can get premium-free Part A if:
If you buy Part A, you’ll pay up to $422 each month in 2018. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $422. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $232.
In most cases, if you choose to buy Part A, you must also:
Timing is everything when you’re enrolling in Medicare, and a lot depends on your specific situation. That’s why we organized this enrollment information based on life circumstances.
Turning 65 is a big life event, and thousands of baby boomers are doing it every day.*Here’s what you need to know right off the bat:
Your first chance to sign up for Medicare is called your Initial Enrollment Period (IEP). It happens around your 65th birthday and lasts a total of 7 months. It includes your birthday month plus the 3 months before and the 3 months after. It’s best to sign up early to avoid gaps in coverage and late enrollment penalties.
You may be enrolled in Medicare automatically if you currently receive Social Security or Railroad Retirement Board benefits. You’ll receive your Medicare card in the mail a few months before your 65th birthday. You still have an IEP during which you may make Medicare coverage decisions.
A lot of people reach the age of Medicare eligibility and continue to work. Many have health insurance through their employers. What about Medicare?
Here’s what you need to know:
Retiring soon? Know the Medicare basics. Your Medicare health coverage choices can vary based on your age and whether you have retiree coverage through your employer or plan sponsor. Find out what you need to know and the questions to ask to help you retire with peace of mind.
Your SEP, if you qualify for one, begins when you retire or your employer insurance ends—whichever comes first.
Talk with your employer health insurance plan administrator before you make any decisions. You need to understand if, and how, your plan may work with Medicare. You may be required to take full Medicare benefits (Parts A and B) at age 65 in some situations, such as if your employer has fewer than 20 employees.
During your SEP, you may:
You are not eligible for this SEP when COBRA or retiree coverage ends. However, you may be eligible for a different SEP. Talk with your plan administrator or call the Medicare helpline for more information.
You may be eligible for Medicare before age 65 if you have a qualifying disability. Eligibility usually starts after you’ve received disability benefits for 24 months.
Here’s what you need to know:
Your IEP is 7 months long. It includes your 25th month of disability, the 3 months before and the 3 months after.
If you do nothing during your IEP, you will be covered by Original Medicare (Parts A and B). However, Original Medicare doesn’t cover everything.
Your IEP is when you may make other Medicare coverage choices based on your needs, such as adding a prescription drug (Part D) plan and Medicare supplement insurance or choosing a Medicare Advantage (Part C) plan. It’s best to act early to avoid gaps in coverage and possible late enrollment penalties.
If you have other coverage, such as through an employer, you may choose to delay Part B. Follow the directions on the back of your Medicare card to notify Medicare of your decision.
Note that you could be charged a Part B premium penalty if you decide to enroll in Part B later. Your employer must provide creditable coverage, so you may qualify for a Special Enrollment Period and avoid the penalty.
Medicare provides a General Enrollment Period (GEP) every year for people who missed signing up when they were first eligible. It’s like make-up time for Medicare enrollment.
The GEP is January 1 – March 31 every year. Here’s what you need to know:
Once you’re enrolled in Parts A and B, you have a chance to change plans once a year during Medicare Open Enrollment, Oct. 15 – Dec. 7. You may also qualify for a Medicare Special Enrollment Period (SEP). A SEP allows you to change plans outside of Medicare Open Enrollment in certain situations, such as if you move.
Missing your Initial Enrollment Period can be costly. Medicare Part A, Part B and Part D may charge premium penalties if you miss your initial enrollment dates, unless you qualify for a Medicare Special Enrollment Period.
Part A is premium free if you or your spouse worked and paid taxes for at least 10 years. If you have to pay a premium, the penalty for late enrollment is 10%.
The Part A premium penalty is charged for twice the number of years you delay enrollment. If you wait 2 years, for example, you would pay the additional 10% for 4 years (2 x 2 years). The penalty applies no matter how long you delay Part A enrollment.
The penalty for late enrollment in Part B is an additional 10% for each 12-month period that you delay it.
Let’s say your Initial Enrollment Period ended September 30, 2010, for example. Then you enroll in Part B during the General Enrollment Period in March 2013. Your late enrollment penalty would be 20% of the Part B premium, or 2 x 10%. This is because you waited 30 months to sign up, and that time period included 2 full 12-month periods.
In most cases, you have to pay the penalty every month for as long as you have Part B. If you’re under 65 and disabled, any Part B penalty ends once you turn 65 because you’ll have another Initial Enrollment Period based on your age.
The penalty for late enrollment in a Part D plan is 1% of the average Part D premium for each month you delay enrollment. You pay the penalty for as long as you’re enrolled in a Medicare Part D plan.
You may delay enrolling in Medicare Part D without penalty if you qualify for Extra Help or have creditable drug coverage. If it’s been more than 63 days since you’ve had creditable coverage, then the penalty may apply.
Medicare enrollment happens automatically for some people. Others need to enroll themselves when they first become eligible. It all depends on your situation.
After you are enrolled in Medicare, you need to take action if you want additional coverage, such as a Medicare Advantage (Part C) plan, a prescription drug (Part D) plan or a Medicare supplement insurance plan.
You will be enrolled automatically in Original Medicare Parts A and B if:
Keeping the card means you accept Original Medicare Part A and Part B coverage. You also agree to pay Part B premiums. (If you live in Puerto Rico, you need to enroll yourself in Part B; it’s not automatic.)
You must notify Medicare if you decide to refuse or delay Part B. You may want to do this if you have other health care coverage, such as through an employer or union. Follow the instructions on the back of your Medicare card.
You need to take action to sign up for Medicare if:
You can also enroll in Medicare by phone or in person at any Social Security office. Call 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday, 7 a.m. to 7 p.m. local time, to make an appointment.
If you live outside the United States and its territories, contact the nearest U.S. Social Security office, U.S. Embassy or consulate, or the Veterans Affairs Regional Office (VARO) in the Philippines.
You may choose to enroll in a private Medicare plan after you complete your initial enrollment in both Part A and Part B. You can choose a:
You can find out about plans offered where you live at Medicare.gov or directly from the insurance companies that offer them. You can apply online, by phone or through a local insurance agent.
Keep in mind that if you don’t get prescription drug coverage when you’re first eligible, you may be charged a premium penalty if you join a plan later. You could also be charged more for Medicare supplement insurance if you wait to buy a plan. In some cases, you could be denied this coverage entirely based on your health history.
There are several assistance programs available to help those on a limited fixed income with their medical and/or prescription drug costs through Social Security or your State welfare office. Please take the time and read about the programs below to see if you may qualify for any assistance program or the extra benefits and services often combined with various Medicare Advantage plans.
Medicaid is a state and federal program that provides health coverage if you have a limited fixed income.
Medicaid provides health coverage to people with low-income and asset levels who meet certain eligibility requirements. Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services.
Medicaid pays for “medically necessary” health care such as:
Medicaid will only cover these costs and services if you use providers that accept Medicaid. If you have both Medicare and Medicaid, Medicare is the primary payer (meaning Medicare will pay first for Medicare-covered benefits) and Medicaid is the secondary payer. If you qualify for Medicaid, it will also cover your Medicare Part A and B deductibles and co-payments, and pay your monthly Medicare Part B premium.
Medicare Savings Programs are federally funded program administered by each state. These programs are for people with limited income and resources and help pay some or all of the Medicare premiums, deductibles, co-payments and coinsurance.
Extra Help, also known as the Part D Low-Income Subsidy (LIS), is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage for eligible individuals who have a limited income.
Medicare beneficiaries receiving the low-income subsidy (LIS) get assistance in paying for:
You may qualify for the Extra Help available under Medicare Part D if:
Assets that count toward eligibility include:
There are programs available to help those on Medicare get extra benefits and services, like:
Although Medicare is a great program for covering your standard medical expenses, like hospital, doctor and prescription coverage, there are a lot of gaps that can end up costing you thousand of dollars out of pocket. These are some of the programs available to help you cover some of the expense and risk of what Medicare does not cover:
A hospital stay can be traumatic — to your health, wallet, and family. Even if you have other medical insurance, some costs won’t be covered. That’s when a Hospital Indemnity insurance plan can provide peace of mind by offering customized protection that pays benefits in your time of need.
Hospitalization is expensive on its own, but it’s easy to overlook the additional costs you can incur while you’re hospitalized. Deductibles and co-pays will start piling up, and you may require follow-up outpatient care or a stay in a nursing facility. That’s where Hospital Indemnity insurance fills in the gaps in a way other insurance plans don’t. You receive your benefit directly, and you may use the payment however you want — from deductibles to travel and lodging expenses.
Health insurance and Medicare cover some costs associated with a hospital stay, but not all of them. Hospital insurance acts as a supplemental plan to your existing primary insurance coverage to ensure you’re not dipping into your savings account or retirement income to pay for your hospitalization.
If you were diagnosed with cancer or suffered a heart attack or stroke, the last thing you would want to worry about is your finances. Cancer, Heart Attack and Stroke Insurance helps you receive the financial peace of mind that allows you to focus on what matters most – your recovery.
53% of the costs associated with cancer are non-medical, indirect costs.  Cash benefits from your policy can be used to help supplement lost income for you and your spouse, to pay for car and mortgage expenses and travel to and from medical facilities. It will also allow you to seek treatment that is out of network or not covered without worrying about costs. And, it will give you 24/7 access to Ask Mayo Clinic support services!
It’s usually difficult to plan for the unexpected, but Short-Term Care insurance makes it easier to prepare for unforeseen injuries or illnesses. You’ve likely heard about long-term care insurance, but you may be surprised to discover that a Short-Term Care plan could be a better fit for you.
When you suffer an illness or injury that requires a short stay of 12 months or less somewhere other than a hospital, Medicare doesn’t cover all the costs. That means, if you need care in a nursing home, assisted living facility, adult daycare, or hospice, you could face considerable out- of-pocket costs. A Short-Term Care plan not only fills in coverage gaps, but it may also give you the flexibility to receive home healthcare, depending on the benefits available in your state.
If you think a fall or a sudden decline in health can’t happen to you, the U.S. Department of Health and Human Services says seven out of 10 people ages 65 or older will require some kind of skilled care or custodial care in their lifetime. Medicare doesn’t cover custodial care, which is help with basic personal needs, such as getting in and out of bed, bathing, dressing, eating, and getting on and off the toilet. Short-Term Care insurance covers skilled and custodial care, so you don’t have to drain your savings account or retirement income to receive the recovery.
Dental and vision needs can be very costly if you don’t have the right insurance. Since most health insurance plans don’t cover routine checkups for your teeth or eyes, it’s important to find a supplemental insurance plan that fits your needs and budget.
A Dental insurance policy helps you pay for preventive dental care; diagnostic services; procedures, like root canals; and dental apparatuses, such as dentures and bridges. Dental Insurance generally include a mix of dental plans and an optional vision plan that can be added for an additional cost. The Vision insurance provides coverage for routine eye exams, frames & lenses or contacts.
Medicare and most health insurance plans do not cover basic dental and vision exams and services. Medicare only covers these types of procedures if you have a medical emergency or if your doctor orders them for medical treatment.
As you age, your teeth, eyes, and ears need more attention.
Having an insurance policy that covers regular exams and common procedures means you can maintain your health without draining your savings account or retirement income.
It isn’t easy to think about the end of your own life. But, if you consider it as planning for your family’s future when you’re gone, you realize it’s important to ease their financial stress by preparing now. Unfortunately, it’s easy to confuse what the differences are among Final Expense, Pre-need, and Term Life insurance plans.
The answer to that question will vary from person to person. Do you already have term or whole life insurance? If you do, that policy can help your loved ones pay for final expenses. However, if you have term life insurance and you outlive the policy term, it’s a different story. In that case, you may want to consider final expense insurance.
Alternatively, maybe your family will have plenty of assets to work with when you die. In that case, you could use what’s called “self-insurance.” “Self-insurance” is one of those terms that sounds more complicated than it is. To self-insure is just to use your own money rather than use a life insurance payout.
Could your family self-insure for your final expenses? It’s a good idea to assume around $10,000 for funeral expenses. But don’t forget to take into account whether you will want a catered party after the service. Or perhaps a trip abroad to scatter your ashes. Maybe you’ll end up leaving big bills behind. If situations like these sound like your situation, you may want to consider springing for final expense insurance. Additionally, it’s probably best not to count on the lump sum death payment from Social Security to pick up the slack. It’s only $255.