Medicare
Medicare is the federal health insurance program for people who are 65 or older. Certain people under 65 may qualify for Medicare with disabilities, or people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
For many elderly, costs are a major concern when it comes to choosing Medicare plans. There are premiums, deductibles, coinsurance, copayments, prescription drugs and provider networks to consider in calculating your total Medicare spending.
Primary Services
MEDICARE PART A - Hospital Insurance
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part A does not cover all hospital treatments. Medicare Part A also has other costs that you will need to account for, such as deductibles and coinsurance. You usually don’t pay a monthly premium for Part A. This is sometimes called “premium-free Part A.” Give us a call for more info.
MEDICARE PART B – Medical Insurance
Medicare Part B is the medical insurance that helps cover the certain services from doctors, other health care providers, outpatient care, home health care, durable medical equipment and most preventive services
You may automatically get Medicare Part B (Medical Insurance) but some may need to sign up for it. If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty. Give us a call for more info
MEDICARE PART D – Prescription Drug Coverage
Part D helps cover the cost of prescription drugs (including many recommended shots or vaccines). You must join a Medicare approved drug plan that offers drug coverage.
Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare. All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes. Many plans place drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier.
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Two options to get your Medicare Coverage:
ORIGINAL MEDICARE:
You get your benefits directly from the federal government. The benefits include two parts, Part A (Hospital Insurance) and Part B (Medical Insurance).
Some people with qualifying work history, your Part A benefits are premium-free. Medicare Part B premiums are set each year by the federal government and most people pay the same standard rate. You pay for services as you get them. You’ll pay a deductible at the start of each year, and you usually pay 20% of the cost of the Medicare-approved service, called coinsurance. If you want drug coverage, you can add a separate drug plan (Part D).
A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like: copayments, coinsurance, deductibles, depending on which plan you choose.
Medicare Supplement Insurance helps fill “gaps” in Original Medicare and is sold by private companies that helps pay your share of costs in Original Medicare.
MEDICARE ADVANTAGE (also known as Part C)
Is a Medicare-approved plan from a private insurance company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
In most cases, you’ll need to use doctors who are in the plan’s network.
Plans may have lower out-of-pocket costs than Original Medicare.
Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
Some plans may be premium-free, it vary based on your zip code and plan provider but you will still have to pay other costs, such as deductibles, coinsurance, and the Copays.
MEDICARE ELIGIBILTY
Eligibility begins on the 1st day of your 65th birth month and you can actually begin the enrollment process three months before that and ending 3 months after the month you turn 65.
Except, if your birthday is on the first of the month. Your 7-month period starts earlier. It starts 4 months before you turn 65 and ends 2 months after the month you turn 65. Your Medicare coverage starts the first day of the month before you turn 65.
A stay-at-home spouse with no work history may still be eligible for Medicare benefits depending on their spouse’s work history, your spouse worked and paid Medicare taxes for at least 10 years.
If you continue to work beyond age 65, things get a bit more complicated. You can delay filing for Part B without penalty, but you may be able to keep your company’s health insurance policy as your primary insurer.
If you miss your 7-month Initial Enrollment Period, you may have to wait till the annual enrollment period (AEP) and pay a monthly late enrollment penalty for as long as you have Part B coverage. The penalty goes up the longer you wait. You may also have to pay a penalty if you have to pay a Part A premium, also called “Premium-Part A.”
Regardless of how you qualify, you will need to enroll in Medicare during an enrollment period.
MEDICARE ENROLLMENT PERIOD:
Initial Enrollment Period.
Generally, when you turn 65. This is called your Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65. (except if your birthday is on the 1st of the month).
Open Enrollment Period.
From October 15 – December 7 each year
When you first become eligible for Medicare, you can join a plan, switch, or drop a plan. Your coverage will begin on January 1 (as long as the plan gets your request by December 7).
General Enrollment Period:
If you are unable to enroll during the initial enrollment period, you can sign up between January 1-March 31 each year. Your coverage starts July 1.
If you do not enroll in Medicare when you first become eligible, you could face late enrollment penalties and higher premiums, if you don’t qualify for a “Special Enrollment Period”. Some people are under the impression that if you delay Medicare, you can save money, but this depends on your circumstances.
Special Enrollment Period:
These periods are only granted to people who have qualifying life circumstances.
If you do not enroll during either of these periods above, or you happen to need insurance during a different time of the year, you may qualify for a Special Enrollment Period.
You can also use the 5-star Special Enrollment Period to switch from your current Medicare plan to a Medicare plan with a “5-star” quality rating carrier.
There is a broad range of reasons that can qualify you for a Special Enrollment Period, for lists of qualifying events, please give us a call, txt or send us an email.
Medicare can be confusing to understand. With so many plans to choose from, it can be very frustrating during the sign up process.
Let us help you navigate the complexity of choosing the right plan that works for you. Schedule a free educational one on one meeting.
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