03 Jan Client Spotlight: James W. Simonds, CRIS®, CHRS® of Arroyo Insurance Services
Jim is one of the founding members of Arroyo Insurance Services since its inception in 1983. He is well versed both in Employee Benefits and Property & Casualty. He has developed specific Risk Management services for healthcare companies and has worked with several of the new emerging healthcare/bio- technology companies both within and outside of California. Helping clients to understand all aspects of Medicare, Healthcare Reform and other insurance products is one of Jim’s passions. He is able to help direct clients through www.Medicare.gov and navigate questions pertaining to their specific situation.
Jim holds multiple insurance designations, both the CHRS® (Certified Healthcare Reform Specialist) and CRIS® (Construction Risk and Insurance Specialist) along with a Bachelor’s degree. He serves as the Vice Chair of the Los Angeles Rotary Club Foundation and is an active Board Member of the Catalina Island Conservancy “Marineros”.
Q: I’ve heard Medicare has different “Parts” that I should be aware of, and I would like to understand the differences. Please explain.
Medicare has Parts A, B and D. Part A is for hospital services. Part B is for outpatient services such as doctor visits. Part D is the pharmacy benefit under Medicare.
Q: When should I start looking into Medicare? Do I need to apply before turning 65?
It’s best to review your options and apply with Medicare for Parts A & B and Part D (which is the pharmacy benefit of Medicare). Generally, 60 days prior to turning age 65 is a good time to apply. Apply directly online at http://www.medicare.gov/
Q: I am turning 65, but still working. Should I turn on Medicare or not, and why?
If you are covered with an Employer based health plan you don’t need to apply for Medicare Part A and B. But if you discontinue the Employer’s plan for any reason then it’s recommended that you apply for Medicare.
Q: What is Medicare Advantage Plan and how does it function versus a Supplemental Plan?
Medicare Advantage plans work much like HMO plans in that you select a Primary Care Physician. Medicare Supplement plans function in similar ways to PPO plans. You do not necessarily need to select a primary Doctor.
Q: Am I able to make Medicare plan changes each year, and should I? How often should I review and make changes?
Yes, you may make changes to your Medicare plan annually at open enrollment, which is the period of October 15 to December 7. Premium differences charged by each Plan offered can be a motivating factor to change. Or, if you have moved and are in a different geographical region, premiums and plans vary by zip codes.
Q: I have specific medications I want to continue when on Medicare. Will I be able to continue, and is there anything I need to know about supplemental plans to allow or not allow me to?
Yes, you can continue your medications under Part D of Medicare. But it’s best to first check with your pharmacist to make sure that your medications are on the Medicare formulary list.
Q: How are Medicare calculations done? Why would I pay more due to having capital gains one year, and how can I get this corrected?
The Part B premiums that Medicare charges each person monthly are based upon your annual income. The premiums may change if your total annual income does. The IRS reports your annual income to Medicare which in turn levies the maximum or minimum Part B premiums.
For 2023 the minimum Part B monthly premiums will be $164.90. Higher premiums are charged if individual income is above $97,000 and $194,000 for married couples. The higher premium costs for 2023 vary from $230.80 to $560.00 per month.
Jim is one of several Medicare specialists who has done a wonderful job serving our Bridge Advisory clients. You may contact him at email@example.com or call 818-399-7897. He would be happy to answer any questions. You may also view his profile here.