Medicare is the national health insurance program to which all Social Security recipients who are either over 65 years of age or under 65 and permanently disabled for 24 months are eligible. Also, individuals receiving Railroad Retirement benefits and individuals suffering from end stage renal disease are eligible to receive Medicare benefits.
There are four types of Medicare.
Medicare Part A helps cover inpatient care in hospitals, skilled nursing facilities, hospice and home health care. Generally there is no monthly premium if you qualify and paid Medicare taxes while working.
Medicare Part B helps cover medical care and services provided by doctors and other medical practitioners, home health care, durable medical equipment, and some outpatient care and home health services and other medically necessary services that Part A doesn’t cover.
Medicare Part A enrollment is generally automatic. You need to enroll in Medicare Part B and pay a monthly premium determined by your income, along with a deductible. Many people also purchase a supplemental insurance policy, such as a Medigap plan, or more commonly called a Medicare Supplement Plan to help with any Part A and B coverage gaps. These plans are permanent plans and allow you to go to any provider in the United States that accepts Medicare.
Medicare Part D is Prescription Drug Coverage, PDP, and is available to everyone with Medicare. It is a separate plan provided by private Medicare-approved companies, and you must pay a monthly premium. If you do not enroll in a Part D when you are first eligible, you may incur a penalty attached to your premium when you do decide to enroll and this penalty does not go away.
Medicare Advantage Plans, also known as Medicare Part C, are combination plans managed by private insurance companies approved by Medicare. They typically are a combination of Part A, Part B and Part D coverage, and must cover medically-necessary services. These plans generally require you to choose a Primary Care Physician and use network hospitals. Some allow you to go outside of network at a higher cost. All of these plans have co-pays, deductibles and coinsurance but the monthly premium is generally lower. There is some loss of freedom to choose with these plans and if you move to one, you may not be able to go back to a PPO Medicare Supplement Plan without medical underwriting.
Both the Medicare Part D, Prescription Drug Plans and Medicare Advantage Plans are yearly contracts and there is an Annual Open Enrollment Period for these plans, when you can move to another plan. The annual open enrollment period is October 15th through December 7th each year and the plan choices take effect January 1st of the following year.
For those individuals that qualify, there are programs to assist Medicare Eligible individuals with the cost of care. Many people are eligible for Medicaid based on their monthly income and assets. There is also help for prescription drug costs through a program called LIS for low income subsidy.
There are specific timelines to follow with Medicare and it’s important to follow these so that you don’t incur penalties, miss timelines where you can sign up without any medical questions or sign up that year.
We broker many carriers for Medicare Supplement Plans, Prescription Drug Plans, PDP and Medicare Advantage Plans that include Prescription Drug Coverage, MAPD. It is our goal to match you to the plan that best suits your needs.
Here are some very helpful links to better understand Medicare:
To Sign up: www.socialsecurity.gov
To see what is considered preventative care: http://www.medicare.gov/coverage/ preventive-and-screening-services.html
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