Medicare

Medicare is federal health insurance for people ages 65 and over, under 65 with permanent disabilities, and anyone with End-Stage Renal Disease. Some people get Medicare automatically, others have to actively sign up -- it depends if you start getting retirement or disability benefits from Social Security before you turn 65. 

So you know how Medicare works for you and if you are eligible, let us help you understand it in a simple way.

What Are the Parts of Medicare?

There are 2 main ways to get your Medicare coverage: Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). There is also Medicare Part D.

  • Medicare Part A covers: hospital insurance covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care.

  • Medicare Part B covers, including doctor and other health care providers' services and outpatient care. Part B also covers durable medical equipment, home health care, and some preventive services.

  • Medicare Part C, If you have Part A and Part B, you can join a Medicare Advantage Plan, sometimes called “Part C”.

  • Medicare Part D only covers prescription drugs.

Part A - Inpatient Hospital Coverage

Any inpatient hospital care falls under Part A coverage. That includes:

Part B - Outpatient Medical Coverage

Part B covers 2 types of services: 1) Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. 2) Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

Part C - Medicare Advantage Plans

This type of Medicare health plan is offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D).

Part D - Drug Coverage

Parts A and B don’t cover prescription medications. Because of that, you can either pick a Medicare Advantage plan that merges with Part D to include prescription drug coverage or a separate Part D plan that solely covers prescription drugs.

Medicare - Eligibility

Most people are eligible for Medicare Part A and Part B when they turn 65. The rules can be confusing so we invite you to make a consultation with us. The criteria are usually essentially your age and your working status. It will also depend on whether you receive social security benefits.

And if I am not 65 years old, can I qualify for Medicare?

You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). 

Medicare - Enrollment

There are three enrollment periods in Medicare: Initial, Open and Special Enrollment. These three periods are specific and particular depending on your Medicare enrollment situation, so:

Initial Enrollment 

3 months before

65th Birthday Month

3 months after

Open Enrollment

From: January 1

To: March 31

Special Enrollment

There are certain situations when you can sign up for Part B (and premium-Part A) without paying a late enrollment penalty. A Special Enrollment Period is only available for a limited time.

What does Medicare cost?

Generally, you pay a monthly premium for Medicare coverage and part of the costs each time you get a covered service. There’s no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage, like a Medicare Supplement Insurance (Medigap) policy, or you join a Medicare Advantage Plan.

What’s a premium, deductible, coinsurance, or copayment?

Premium: A monthly amount you pay for coverage, whether you get services or not.

Deductible: An amount you have to pay for covered services and items each year before Medicare or your plan starts to pay.

Coinsurance: A percentage of the cost that you pay. In Part B, you generally pay 20% of the cost for each Medicare-covered service.

Example 
A Medicare-covered service costs $1000. Medicare pays $800 and you pay $200. ($1000 x 20% = $200.)

Copayment: A fixed amount you pay for a Medicare-covered service, like $30.

Talk to your insurance agent to figure out which option makes the most sense for you.

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Talk to your insurance agent to figure out which option makes the most sense for you. 〰️

Consult with us so you can choose your ideal MEDICARE plan!.

Let us evaluate your options so with the choice of your Medicare Plan. Many times the best fit option is not considered because there is no personalized attention. We accompany you throughout the process of having an adequate Medicare Health Plan. And remember, we are ''your ally in health insurance''.