Frequently Asked Questions

Providing answers to your Insurance FAQs

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Why Haven’t I Received my insurance card yet?

Medicare Red, White, and Blue Card

If you are drawing income from your social security benefit at the time you turn 65, you will automatically be enrolled in your Medicare and will receive your Red, White, and Blue card at least three months in advance. Those who are not drawing social security benefits at the time they turn 65, will need to apply for Medicare through social security.

Member ID Card

If you haven’t received your Member ID card for your selected plan, remember that it can take up to two weeks after your effective date for it to arrive. During the holidays, the mail is much slower and wait times are longer. If you have reason to believe that your card should have already arrived, you can always call here at the office. We will verify your address with what was added to your application, and then contact the company to ask them when your card was mailed. If needed, we can always order you a new card. While you wait, we can still access the information your healthcare providers need. Not having your card doesn’t mean you can’t use the plan.

Extra Benefit Card

If you haven’t received your Extra Benefit Card (OTC or Food Card) for your plan, it’s possible that you have it and don’t realize it yet. With some companies, there’s only one card that is all-encompassing while others have two cards. Make sure you know which method your plan uses before ordering a new card. If the plan does use two cards, it’s perfectly normal for the Member ID Card to arrive before the Extra Benefit Card. If this card doesn’t arrive two weeks after your plan’s effective date, call the office so we can contact the company and check to see if it’s been shipped, especially if the benefit doesn’t roll over to the next month. We always want to ensure that you receive all of your plan’s benefits.

What’s a Deductible?

A deductible is the amount of money you have to spend out-of-pocket on medical procedures or prescriptions before the insurance starts to pay. Each plan’s deductible is different, and each plan decides what procedures go towards the deductible.

What’s the difference between copayments and coinsurance?

Copayments are a fixed amount you pay for any covered service. Rather than paying the entire cost, you pay your insurance’s negotiated fee for in-network providers. Copays usually don’t count toward your deductible. You will still pay a copay after meeting your deductible.

Coinsurance is the percentage you pay for any covered service after you’ve met your deductible. Your insurance company covers part of care costs, and then you cover the rest. The coinsurance can vary by company and plan. In a plan’s terms, you’ll sometimes see coinsurance represented as a ratio. An “80/20” health insurance plan means your insurance will cover 80% of the cost. You’re then responsible for the remaining 20%. 

What’s my insurance out-of-pocket Maximum?

It’s a set amount that you’ll pay out-of-pocket for the year, determined by the plan. If you reach that maximum, then the insurance company will pay 100% of your medical costs for the rest of the year.

What Health Insurance do you offer?

We offer several options of health insurance for people under 65. Check out our ACA Health Insurance Frequently Asked Questions page to learn more about the available health plans.

What is Medicare Insurance?

Medicare is a government program that provides federal health insurance to those who are either 65 or older, younger people with qualifying disabilities, or anyone with End-Stage Renal Disease. It includes Part A and Part B. There are additional coverage plans you can purchase as well including Part C, Part D, and Medigap plans. To learn more about Medicare, check out our Medicare Frequently Asked Questions page.

What is IRMAA?

The Income Related Monthly Adjustment Amount (IRMAA) is an extra charge added to your premium if your modified adjusted gross income is above a certain amount. To determine if you’ll pay the IRMAA, Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago. The following chart contains the current (2024) figures for IRMAA.

Official IRMAA 2024 Brackets

SingleCouple MAGIPart BPart D
< $103,000< $206,000$174.70Premium (varies)
$103,000 to $129,000$206,000 to $258,000$244.60$12.90
$129,000 to $161,000$258,000 to $322,000$349.40$33.30
$161,000 to $193,000$322,000 to $386,000$454.20$53.80
$193,000 to $500,000$386,000 to $750,000$559.00$74.20
> $500,000> $750,000$594.00$81.00

What Is the medicare savings program (MSP)?

It’s a collaboration of Medicare and Medicaid. It allows individuals and couples with lower incomes to receive financial aid in regards to their Medicare expenses. The following are the three levels of Medicaid that individuals who already have Medicare can receive: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI or QI1). The level you receive is determined based on your income.

What is Extra Help?

It’s a federal program that lowers your Medicare Part D premium and any deductible, coinsurance, and copayments. If you don’t meet the requirements for MSP, you may still qualify for Extra Help, depending on your income. You automatically enroll in Extra Help if you do have MSP or another combination of Medicare and Medicaid.

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