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Medicare Basics

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While your options are many, gaining a good basic understanding of Medicare will help you feel better about your decisions, which is our main goal!

…Dave & Connie Hatch, Health Insurance Specialists

Understanding Medicare

What You Need To Know

The following information was retrieved from Medicare.gov and is presented in an easy-to-understand presentation for your convenience.
What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older. Medicare has 4 parts (not to be confused with plans). Each part of Medicare helps pay for different health care costs. Some parts of Medicare are FREE, some require an additional premium. 

Original Medicare (Parts A & B)

Medicare Part A (Hospital Insurance)
Part A is automatic and covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Most people get Part A for free.

Medicare Part B (Medical Insurance)
Part B is automatic if you do not have other coverage through an employer or spouse. Part B coverage resembles what you may think of as traditional health insurance and covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Most people will pay a standard Part B premium which varies depending on income.

What will Medicare cost you?  Click here for more.

Medicare Advantage Plans (Part C)

Medicare Advantage Plans are offered by private carriers and replace your original Medicare Parts A and B, as they are rolled into one plan.  You can select between an HMO or PPO, and most plans may cover more of your healthcare costs and have additional benefits, such as prescription drug coverage. Some may have dental or vision benefits, and even other benefits such as a healthy food allowance and more. Premiums vary based on coverage, carrier and geographical location.

Ultimately, the best Medicare Advantage Plan is one that is purchased from a quality carrier, has no or a low premium and leaves you with the least or no out of pocket expenses.

Note that you must be enrolled in Original Medicare to purchase an Advantage Plan.

Once your Initial Enrollment Period is over, if you wish to change or purchase Advantage or Part D Plans, you must act during the open enrollment period.  Open enrollment is from October 15th through December 7th annually.

Medicare Supplements (Medigap)

Medicare Supplement Insurance policies complement your Original Medicare Parts A and B. They cover some, if not all, of the expenses that Part A and B do not cover, like co-pays, deductibles and other charges.

There are many different types of Medicare Supplement policies available, however they are regulated so the benefits for these various policies (known as Plan A through N), are all the same regardless of the carrier. However, premiums can vary greatly among carriers.

Note you can purchase a Medicare Supplement plan anytime, however if you buy a plan during your initial enrollment period when you first become eligible, you can skip medical underwriting.

Note that because this plan provides benefits in addition to your original Medicare, you will pay the private insurance company a monthly premium for your Medicare Supplement policy in addition to the monthly Part B premium that you pay to Medicare.

Medicare Part D (Prescription Drug) Plans

Part D adds prescription drug coverage to Medicare insurance plans.  It is offered by private carriers that contract with Medicare. Because premiums vary greatly, you should carefully weigh your prescription costs against all variables of these plans. Selecting the wrong plan can wind up costing you thousands.  Some Medicare Advantage plans may offer prescription coverage as well.

Note that there is a separate premium you will pay for Medicare Part D in addition to your premium you pay for Part B.  For more on costs, click here.

Please note that you should sign up for Part D (even if you do not have prescriptions) when you first turn 65, as waiting may result in a costly monthly penalty added to your premium.

Medicare Eligibility & Open Enrollment

To sign up for original Medicare Parts A & B, along with Part D, most people will have an Initial Enrollment Period which is a 7 month period around the time they turn age 65. This period begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

Once your Initial Enrollment Period is over, if you wish to change or purchase Advantage or Part D Plans, you must act during the open enrollment period of October 15th through December 7th.

When open enrollment is closed, there are special circumstances in which one may qualify to enroll outside of the enrollment period. Listed below are the qualifying events:

  • You are turning 65
  • You move to a new area that is not in your current plan’s service area
  • Recently moved back to the US
  • You lose your current coverage (either Group or Medicaid)
  • You now need a SNP (Special Needs Plan) or you no longer need a SNP

Medicare is complex. We suggest you call our office for more information.

Disclaimer:

The above information on Medicare costs was retrieved from Medicare.gov.

Healthfirm Benefits, nor it’s agents, are not part of the Federal Government Medicare System. The content in on this page has not been reviewed or approved by Medicare.

We do not offer every plan available in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all your options.

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Getting Started with Medicare & Medicare & You

The following videos are provided by and copyright of The Centers for Medicare and Medicaid Services (CMS) and are for informational purposes.

Copyright The Department of Health and Human Services, and CMS

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Medicare Advantage replaces your original Medicare Parts A and B, as they are rolled into one plan. Some plans include prescription drug coverage, or dental and vision coverage, and more in some instances.

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A good NON-ACA option for times of transition or limited medical needs, i.e., you are healthy and do not expect to use a lot of health services. Less expensive than full coverage but does not provide coverage for preexisting conditions.

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