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MEDICARE

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What is Medicare?

Medicare is health insurance for two groups of people. The first is those age 65 plus the other group is those who are medically disabled by the Social Security Administration. People who are eligible for Original Medicare are eligible to pair it with either a Medigap (also known as Supplements)  and Part D plan or a Part C or Medicare Advantage. Along with being able to have extra layers of coverage with Dental, Vision, Hearing and Cancer coverage

We will discuss general information about Medicare and coverages available to go along with it. You can request a personalized one on one meeting with the form below.

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When do you enroll?

 Your Initial Enrollment Period (IEP) is seven months long and includes:

  • IEP refers to the time when you can enroll in a Part C or Part D plan
  • The three months before your 65th birthday, the month of your birthday and the three months following your birthday

 

For example: if your birthday is in March, you may enroll in Medicare for the first time anytime between December and June.

How do you enroll?

If you are already receiving your Social Security payments then your card will be automatically sent to you in the mail three months prior to your eligibility. You will automatically be enrolled in Part A when you turn 65, you can choose to enroll in Part B if you need medical coverage. If you or a spouse are employed and offered credible coverage then it is best to weigh the options and see whether it is in your best interest to take Part B.

If you are not receiving your Social Security payments then you will need to apply for Medicare on your own. There are several ways to do this. You can call into Social Security and schedule a phone appointment at a later date, you can go into a social security office and talk with an advisor or the most convenient is you can go to SSA.gov login to your account there and apply online.

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Orignal Medicare

Part A

As long as you have paid more than 40 quarters worth of Medicare taxes there is a $0.00 premium. If you have not worked enough quarters to qualify for premium free Part A then you can follow this LINK to find out what your costs may be.

Provides coverage for in patient hospital stays, Hospice services and some Home Health Care services.

Provides rehab in Skilled Nursing Facilities to recover after hospital admissions, as long as you were admitted to a hospital for Medicare’s minimum required time.

Part B

Is purchased at a premium of $135.50 (2019) no matter how many quarters you have paid into Medicare taxes. Some people with higher income may pay an extra cost called IIRMA.

Provides coverage for nearly anything that is not a hospital stay. Including Dr’s office visits,  labs, exams out patient X-rays, surgeries (in and out patient).

Provides coverage for certain prescriptions administered in a clinical setting. Primarily IV infusions and in office injections.

Part D

Covers Prescription drugs

Requires enrollment in Part A and/or Part B

Offered through private insurance companies who are contracted with Medicare. They are required to maintain coverages approved by Medicare yearly

There may be life time penalties for not enrolling when you are first eligible if you do not have credible coverage.

Medigap or Medicare Supplement

These go by either name, it really just depends on the person you are talking to.

Offered by private insurance companies for an additional Premium.

Helps to pay costs not covered by Original Medicare such as Co-insurances and Deductibles.

11 different plans to choose from. The most popular plans are F, G and N

What it doesn’t cover: Long Term Care, Routine Vision, Routine Dental, Hearing Aids, Eyeglasses (except in certain circumstances), Private duty nursing care, Prescription Drugs

Medicare Advantage or Part C

Requires enrollment in Part A and Part B

Requires payment of the Medicare Part B premium and in some cases additional premiums

Offered by private insurance companies as an alternative to Original Medicare

Heavily regulated and must offer at a minimum all the same benefits of Original Medicare

Generally lower premiums than a Medigap policy

Most plans have co-payments, co-insurance (the 80/20) and an annual out of pocket limit

*Medicare advantage is not a Medicare supplement insurance policy, and those with Medicare Advantage plans do not qualify for a “Medigap” or Medicare supplement

 

*Part D prescription coverage may be included as part of a Medicare Advantage plan, or it can be combined with Original Medicare and  Medigap policy

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