(Courtesy of Medicare Done) As we welcome in the new year, there is a distinct sense of freshness in the air. We start on a clean slate. This extends to your health insurance policy, which, hopefully, you have securely in place Whether you’re covered by Medicare, your employer’s plan or a marketplace option, there’s a slew of jargon floating around. So, let’s do a quick rundown so you can be the knowledgeable standout at the office watercooler

Premiums: It’s the amount you pay to keep your plan active. Even if you never tap into health care services, you’re still footing the bill to uphold your coverage—a way of compensating the insurance company for shouldering the risk of potential health issues. Even after paying for your plan, there is usually additional cost-sharing to consider when you actually use medical services.

If your plan has a deductible, that’s the initial out-of-pocket sum before your coverage kicks in. Some services might be exempt from first reaching the deductible, like specific preventive care screenings. Once you surpass your deductible, copays and coinsurance come into play. Copays are fixed amounts you pay for services, like a $20 charge for a doctor visit. Coinsurance, on the other hand, is a percentage rather than a flat rate. For instance, with a 20% coinsurance, the insurance company covers 80%, and you’re responsible for the remaining 20%. Max out of pockets, sometimes referred to as the MOOP, is the most you will pay for covered services in a plan year. After that your insurance company will pay for any medical costs that come up.

Referrals: Some plans require you to choose a primary care doctor and get a directive from them to see a specialist. Occasionally a specialist office will require a referral regardless if the insurance company requires it, just to properly utilize the doctor’s time.

Authorizations: Before having a service done, your insurance company may have to authorize it to ensure it is medically necessary.

Do you want to retire, but have a spouse still under 65 and not eligible for Medicare? Would you like to compare COBRA with work coverage? Will you be subject to IRMAA (income-related monthly adjustment amount)? What type of long-term care is covered by Medicare? Are there network restrictions with Medicare? What is the difference between the different Medicare supplement companies? Do I need Medicare Part C and D? Is there a way to keep the same plan and lower my premiums? There are lots of questions. We have answers. Medicare is confusing! Work with Sarah Jeremias for a no-cost consultation or review to gain clarity and get solutions. Call 248-919-8193 or Email [email protected].