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Since this is a hot topic currently, I wanted to take the time to provide some education from our history.

Medicare has addressed funding issues through several strategies over the years:

  1. Payroll Taxes: Medicare is primarily funded through payroll taxes collected under the Federal Insurance Contributions Act (FICA). Employees and employers each pay 1.45% of wages, and higher-income earners pay an additional 0.9%.
  2. Premiums and Cost Sharing: Beneficiaries pay premiums for Medicare Part B and Part D, as well as deductibles and coinsurance for services. Higher-income beneficiaries pay higher premiums. 
  3. General Revenue: A significant portion of Medicare funding comes from general federal revenue, particularly for Part B and Part D.
    Legislative Adjustments: Congress has periodically adjusted Medicare funding through legislation. For example, the Balanced Budget Act of 1997 introduced measures to control costs, and the Affordable Care Act of 2010 included provisions to reduce spending and increase revenue. 
  4. Payment Reforms: Medicare has implemented various payment reforms to control costs, such as the Prospective Payment System for hospitals and value-based payment models that incentivize quality and efficiency. 
  5. Trust Funds: Medicare Part A is funded through the Hospital Insurance Trust Fund, while Parts B and D are funded through the Supplementary Medical Insurance Trust Fund. These trust funds help manage and allocate resources. 

Despite these measures, Medicare continues to face financial challenges, particularly with the aging population and rising healthcare costs. Ongoing efforts are needed to ensure its sustainability.

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Medicare-eligible individuals might use a discount card for several reasons:

In PA you can qualify for Medicaid based on a disability without considering the income limits.

In Pennsylvania, Medicaid eligibility for individuals with disabilities surpassing the Medicaid limit due to having income is still possible. This is called MAWD (Medicaid for-Workers with Disabilities).

MAWD allows individuals with disabilities to work and still receive Medicaid benefits, including any services and supports provided through waiver programs. There is a small monthly premium based on your income, typically around 5%.

However, there are specific programs and waivers that might offer some flexibility:

  • Medical Assistance for Workers with Disabilities (MAWD): This program allows individuals with disabilities to work and still receive Medicaid benefits. It has higher income and resource limits compared to standard Medicaid
  • Medically Needy Only (MNO): This category allows individuals with higher incomes to spend down their income on medical expenses to qualify for Medicaid 
  • Waivers: Certain waivers, like the Consolidated Waiver, provide services to individuals with disabilities and may have different financial criteria

It's best to contact your local County Assistance Office or visit the Pennsylvania Department of Human Services website for detailed information and to see if you qualify based on your specific circumstances.

Learn more: https://www.pa.gov/services/dhs/apply-for-medical-assistance-for-workers-with-disabilities-mawd.html

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Medicare-eligible individuals might use a discount card for several reasons:

  • Prescription Drug Savings: Medicare-approved prescription drug discount cards can help reduce the cost of medications by providing discounts of 10-25%. This is especially beneficial for those without comprehensive drug coverage.
  • Coverage Gaps: Some Medicare plans, like Original Medicare (Parts A and B), do not cover prescription drugs. Discount cards can help fill this gap until a more comprehensive plan is in place.
  • Financial Assistance: For individuals with limited income, discount cards can provide significant savings. For example, certain programs offer credits (e.g., $600 annually) to help cover prescription costs.
  • Additional Benefits: Some Medicare Advantage plans offer extra benefits, such as discounts on over-the-counter medications, healthy food items, and other essentials.

Using a discount card can help manage healthcare costs more effectively, ensuring that individuals can afford their necessary medications and other health-related items.

As an agent, you can make a small additional income each time your clients use this discount card. It’s a win-win! Watch the recorded training for more information.

Learn more: https://youtu.be/ZL-vj56wW4E

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Understanding Original Medicare (Part A and Part B) billing can be a bit complex, but I can help break it down for you.

Medicare Part A & Part B Billing 

  1. Automatic Deductions:
    1. If you receive Social Security benefits, your Medicare Part B premium is usually deducted automatically from your monthly Social Security payment
    2. If you don't receive Social Security benefits, you'll receive a bill from Medicare 
  2. Billing Frequency:
    1. Part A (Hospital Insurance): Most people don't pay a premium for Part A if they or their spouse paid Medicare taxes while working. If you do pay a premium, you'll be billed monthly
    2. Part B (Medical Insurance): You'll be billed every three months if you don't have it deducted from your Social Security benefits Payment Methods: 
  3. Payment Methods:
    1. Online: You can pay your Medicare premium online through your Medicare account using a credit/debit card, Health Savings Account (HSA) card, or checking/savings account 
    2. Medicare Easy Pay: This is an automatic deduction from your bank account. You can sign up online or by mailing a form
  4. Help with Costs: 
    1. If you have limited income and resources, you might qualify for programs that help pay your premiums and other costs like deductibles, coinsurance, and copay

It’s important to note that you may receive multiple first invoices from the Social Security office. The first one may not reflect any IRMAA charges. You will receive an updated invoice, so it’s fair to say that last one received is the most accurate. If you believe that the premium is incorrect, please complete a Redetermination Request Form.

Learn more: How to Pay Part A & Part B premiums | Medicare

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