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Do You Qualify for Social Security Spouse’s Benefits?

by | Aug 1, 2024 | Social Security

Social Security benefits are a crucial part of the retirement income for millions of Americans. If you don’t have enough Social Security credits to receive benefits on your own work record or if your own benefit is small, you may be able to receive benefits as a spouse. For you to get benefits on your spouse’s work record, your spouse must be receiving their benefits. If your spouse is not yet receiving retirement or disability benefits, you’ll have to wait to apply on their record.

Eligibility for Spouse’s Benefits

To be eligible for spouse’s benefits, you must meet one of the following criteria:

  • Be 62 years of age or older.
  • Be any age if you have a child who is younger than 16 or has a disability and is entitled to benefits on your spouse’s record.

How the Spouse’s Benefit is Determined

Your full spouse’s benefit could be up to one-half of the amount your spouse is eligible to receive at their full retirement age. If you choose to receive your spouse’s benefits before you reach full retirement age, your payment will be permanently reduced.

If your spouse has postponed or plans to postpone their retirement to increase their monthly benefit amount by earning delayed retirement credits, your maximum spouse’s benefit remains 50% of their full retirement age benefit, not the higher amount including delayed retirement credits. However, your benefit as a surviving spouse would be based on the higher amount.

If you wait until you reach full retirement age to receive benefits, you’ll receive your full spouse’s benefit amount, which is one-half the amount your spouse receives. You may also get your full spouse’s benefit if you are under full retirement age but care for a child and one of the following applies:

  • The child is younger than age 16.
  • The child has a disability and is entitled to benefits on your spouse’s record.

Receiving Retirement and Spouse’s Benefits

If you’re eligible for both retirement and spouse’s benefits, you must apply for both. This requirement is called “deemed filing” because when you apply for one benefit, you are “deemed” to have applied for the other benefit as well. If you receive retirement benefits on your own record, that amount will be paid first. If your benefits as a spouse are higher than your own benefit, you will receive a combination of benefits that equals the higher spouse’s benefit.

Consider this example: Sandy is eligible for a monthly retirement benefit of $1,000 and a spouse’s benefit of $1,250. If she waits until her full retirement age to receive Social Security, she will receive her own $1,000 retirement benefit. Additionally, she will receive $250 from her spouse’s benefit, totaling $1,250 a month. Sandy only gets an additional spouse’s benefit because her own benefit is less than half her spouse’s full retirement age benefit.

Divorced Spouses Can Get Benefits, Too

If you are divorced from a marriage that lasted at least 10 years, you may be able to get benefits on your former spouse’s record. The rules for divorced spouse’s benefits are slightly different. You can find out more by visiting the Benefits For Your Family page on ssa.gov.

How Hilgerman Insurance Solutions Can Help

Navigating Social Security benefits can be complex and overwhelming. Hilgerman Insurance Solutions is here to help you understand your options and maximize your benefits. Whether you need assistance with determining your eligibility, understanding the application process, or managing your benefits, our team of experts is ready to provide the guidance and support you need. We specialize in helping individuals and families in Ventura County with their Social Security benefits, ensuring you get the most out of your entitlements.

Contact Hilgerman Insurance Solutions today to learn how we can assist you with your Social Security benefits and other insurance needs. Let us help you secure a stable financial future.

 

Hilgerman Insurance Solutions
(805) 279-5482
deb@hilgermanins.com  
www.hilgermanins.com

Prescription Drug Coverage (Part D): What You Need to Know

by | Jul 1, 2024 | Medicare

Navigating Medicare can be complex, especially when it comes to Prescription Drug Coverage (Part D). This part of the Medicare program changes frequently, almost every year, so it’s crucial to have your plan reviewed to determine coverage and costs for the upcoming year.

What is Medicare Part D?

Medicare Part D is prescription drug coverage that helps cover the cost of your medications. It’s available to anyone with Medicare and is provided through private insurance companies approved by Medicare. Part D plans can vary in terms of costs, covered drugs (formulary), and pharmacy networks.

Why is Part D Important?

Medications can be a significant part of your healthcare needs, and having the right Part D plan ensures you have access to the drugs you need without breaking the bank. Here are the key aspects of Medicare Part D:

  1. Formulary: A formulary is a list of drugs covered by a Part D plan. Each plan has its own formulary, which can change annually. It’s crucial to ensure that your medications are covered each year.

     

  2. Costs: Costs associated with Part D include premiums, deductibles, copayments, and coinsurance. These costs can vary widely between plans and can change every year.

     

  3. Pharmacy Network: Part D plans have a network of pharmacies where you can fill your prescriptions. Using an in-network pharmacy typically costs less than going out-of-network.

     

  4. Coverage Gap (Donut Hole): The coverage gap, commonly known as the donut hole, is a temporary limit on what the drug plan will cover for drugs. After spending a certain amount on covered drugs, you enter the donut hole, where you may pay higher out-of-pocket costs until you reach the catastrophic coverage threshold. In 2025 the coverage gap will be capped at $2,000.

Staying Up-to-Date with Part D Changes

Because Part D plans and formularies can change every year, it’s essential to review your plan annually to ensure it still meets your needs. Changes in your health or medication needs, as well as changes in the plan’s formulary, can impact your out-of-pocket costs and coverage. Hilgerman Insurance Solutions spends many hours each year learning and researching all the changes with Part D. This makes it very easy for you to get the correct information and help finding the best plan for you.

How Hilgerman Insurance Solutions Can Help

At Hilgerman Insurance Solutions, staying current with Medicare Part D changes is one of our specialties. We understand that keeping up with these changes can be overwhelming. That’s why we take care of it for you. Each year, we research all the changes and available plans to make sure you’re getting the best coverage for your needs at the best cost.

By working with us, you can be confident that you won’t overpay for your medications or lose access to the drugs you need. I, Deborah Hilgerman, am dedicated to helping you navigate the complexities of Medicare Part D, ensuring you have peace of mind and the right coverage.

Get the Help You Need

Let us help you make the best choice for your prescription drug coverage. Visit our website https://hilgermanins.com/ to request assistance. Together, we can make sure you have the coverage you need at a price you can afford, without the stress of keeping up with constant changes.

Hilgerman Insurance Solutions of Camarillo is an independent insurance agency that specializes in the senior market, while offering health insurance solutions for small businesses and individuals. We are contracted with most of the top insurance providers to offer you plans that best suit your needs, all with personal hands-on service and support. 

Our commitment is to provide expertise, friendly service along with a timely response. Please feel free to contact us today for a quote and/or no-cost consultation.   

 

Hilgerman Insurance Solutions
(805) 279-5482
deb@hilgermanins.com  
www.hilgermanins.com

 

Medicare Coverage for Hearing Aids 2024: What’s Covered?

by | Jun 24, 2024 | Medicare

Surprisingly, less than 15% of adults needing hearing aids actually use them, and it takes nearly nine years, on average, to purchase them after a diagnosis, according to a 2019 study. Kathleen Cameron from the National Council on Aging emphasizes that some older adults underestimate the impact of untreated hearing loss on overall health, viewing it as a normal part of aging.

Hearing exams and aids rank among the top five most postponed healthcare expenditures. A 2023 survey by the Senior Citizens League reveals that a quarter of respondents aged 65 and older delayed getting hearing exams and aids.

Medicare and Hearing Aids: Original Medicare (Parts A and B) doesn’t cover hearing aids or related exams. Medicare Part B covers diagnostic hearing and balance exams but not hearing aids.

Medicare Advantage plans (Part C) offer alternatives, with coverage varying by plan and state. Some plans cover hearing exams and aids, and from 2018 to 2020, the percentage of plans offering hearing benefits increased from 83% to 93%.

Medicaid and Hearing Aids: Dual-eligible individuals with both Medicare and Medicaid may have coverage for hearing aids, but specifics vary by state. Medicaid coverage details can be found in the Hearing Loss Association of America’s state-by-state guide.

Options for Hearing Aid Costs:

  • Private health insurance may cover hearing tests and aids.
  • Flexible spending accounts (FSAs) and health savings accounts (HSAs) can offset costs.
  • Some insurers like Aetna, Blue Cross Blue Shield, Cigna, Humana, and United Healthcare offer hearing aid benefits.
  • Veterans Administration (VA) benefits may provide free or low-cost hearing aids for eligible veterans.
  • Community-specific resources and charitable foundations, like the Miracle-Ear Foundation, offer assistance.

Alternative Options:

  • Over-the-counter (OTC) hearing aids, created in 2017, aim to be more accessible and affordable for mild to moderate hearing loss without a prescription.
  • Insurers may cover OTC options like Audien Atom Pro, Eargo, Go Hearing, MDHearing, and Otofonix.

When choosing hearing aids, consider factors like customer service, return policies, warranty coverage, and alternative options like OTC devices. Overall, addressing hearing loss promptly is crucial for overall health, even if Medicare doesn’t cover the cost of hearing aids.

Source: https://health.usnews.com/medicare/articles/does-medicare-cover-hearing-aids#expert-sources

Traveling with Medicare Prescription Drug Plan

Traveling with Medicare Prescription Drug Plan

by | Jun 24, 2024 | Medicare

Question: Can I use my Medicare Part D prescription drug coverage when traveling outside of my home state?

Yes. You can use your Medicare Part D prescription drug plan at any one of your plan’s network pharmacies across the country, and most Medicare prescription drug plans include 50,000 to 65,000 (or more) pharmacies in their network. Here are a few additional reminders about using a network pharmacy as you travel within the United States:

(1) You may pay more for your formulary drugs at a standard network pharmacy.

Please remember that your Medicare Part D plan may charge higher copayments at standard network pharmacies as compared to “preferred network” pharmacies.

(2) You may pay more (or less) for your formulary drugs as you travel since retail drug prices can vary between network pharmacies.

Please remember that retail drug prices can vary from pharmacy-to-pharmacy. So if your drug coverage is based on coinsurance (you pay a percentage of the retail cost – such as 25% of retail) – or you are in the Donut Hole – or in the
2023 Catastrophic Coverage phase you may find that you pay different prices at different pharmacies – although the pharmacies are still part of your Medicare Part D plan’s pharmacy network (or preferred pharmacy network).

Keep in mind that 2023 is the last year that Medicare Part D beneficiaries will pay cost-sharing in the Catastrophic Coverage phase. For plan year 2024 and beyond, the Inflation Reduction Act (IRA) of 2022 eliminates beneficiary cost-sharing in the Catastrophic Coverage phase, so plan members will not have any out-of-pocket costs for formulary drugs after reaching the plan’s 2024 $8,000 total out-of-pocket threshold (TrOOP); therefore, TrOOP becomes the RxMOOP in 2024.

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Question: How do we find a network pharmacy when we are in an unfamiliar area?

If your travels take you to a remote or unfamiliar area of the country, and you are having trouble finding a network pharmacy or preferred network pharmacy, you can always telephone your Medicare Part D plan’s Member Services department and ask them to help you find the nearest pharmacy. The toll-free number for Member Services is located on your Member ID card and most of your plan’s printed information.

If you cannot find your Member ID card or your Medicare plan’s contact information, you can telephone Medicare at 1-800-633-4227 and ask a Medicare representative to help find your plan’s contact information.

If you prefer to search for pharmacies and/or providers online, you can use our pharmacy and provider search tool articles for instructions and links to the online tools for a few of the more popular Medicare plans.

When all else fails: Asking for reimbursement when no network pharmacy is available

If, in the unlikely event that you find no network pharmacy in some area of the country, you should be able to purchase medications at a non-network pharmacy and submit the receipts to your Medicare plan for reimbursement. (You can also telephone your plan’s Member Services department to learn about the reimbursement process – the telephone number is on your Member ID card.)

Traveling when you have drug coverage through your Medicare Advantage plan

If you receive your Medicare Part D prescription drug coverage through a Medicare Advantage plan that includes prescription drug coverage (also called an MAPD), you will find that your MAPD has the same generous number of network pharmacies across the country (50,000 to 65,000 pharmacies) and you should be able to find a network pharmacy as you travel.

As a note, depending on your Medicare Advantage plan, you may pay higher out-of- network copayments for other healthcare needs (like doctor or hospital visits) as you travel away from home and outside of your Medicare Advantage plan’s established healthcare network or service area.

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