Medicare Options
Medicare can be quite confusing and complex. Let's break down the four basic parts.
4 Parts
original Medicare
Original Medicare is broken into two parts, Part A and Part B.
Medicare Part A:
When you apply for Medicare you will automatically be enrolled in Part A. Medicare Part A is all about your hospital coverage. Medicare Part A will help you pay for services such as Inpatient Hospital Stay, Home Health Care that you may need after being hospitalized for a stroke, a broken hip or any illness that requires rehabilitation it also covers Hospice. Most people do not have to pay a premium for Part A if you have paid into the system while working.
Original Medicare
Medicare Part B:
Medicare Part B is the second half of Original Medicare. Medicare Part B is all about your medical coverage. Medicare Part B covers doctors visits, lab tests, diagnostic screenings, medical equipment, ambulance transportation and other outpatient services.
Part B, unlike Part A of Medicare does require more costs. If you still have coverage through a spouse’s health plan you may want to delay signing up for Part B. If you do not have any other coverage and delay sighing up for Part B you could ay a higher monthly premium. The federal government sets the monthly premium. Depend on your income it could cost $174.70 or more. Part B does have an annual deductible of $240 for 2024 and you will have to pay 20% of the the doctor bills you incur for services. If you are currently collecting Social Security benefits these monthly premiums will be deducted from your monthly benefit amount.
Coverage under Medicare Part A and Part B will require you to pay a co-payment or co-insurance. Most often used for Medicare billing is the 20/80 co-insurance. You will be required you to pay 20% of your bill for services and Original Medicare is pay the remaining 80%. Remember this is only for covered services. If you have a healthcare service completed that is not covered under Medicare, you will be required to pay that bill on your own. Your provider must accept Original Medicare insurance to qualify for payment from Medicare. If your provider does not accept Medicare, you will be responsible for paying that bill. Original Medicare also does not cover prescription drugs, dental, vision or hearing except for a medical emergency. The great news is a private insurance companies work with Medicare to create a more complete coverage for you.
Part C
Now that we have covered the foundation to Original Medicare Part A and Part B, you can see that your responsibility for co-payments and co-insurance can be expensive. You have options to help support the portion of Medicare that you are required to pay but how do you know what plan to choose? All your healthcare plan choose should be based on your healthcare needs and budget.
What is a Medicare Advantage Plan?
Medicare Advantage plans are the most commonly type of private insurance plans that work with Medicare. Medicare Advantage plans or Medicare Part C is a combination of your Medicare Part’s A and B benefits with additional coverage such as prescription drug coverage. Medicare Advantage Plans are based on your county, state, and zip code, giving you options on the type of plan that would work for you. This allows your lower premiums that other private insurance options. Medicare Advantage plans are based on network, just like an HMO or PPO. Medicare Advantage plans will ask you to pay a co-payment or co-insurance based on your plan selected. Your co-payments or co-insurance under a Medicare Advantage plan can be lower than what Original Medicare may require you to pay. Medicare Advantage plans can also include benefits like vision, dental and hearing. If you are looking for a comprehensive plan, a Medicare Advantage plan may be an option for you. All your benefits are wrapped up into one plan for you with a Medicare Advantage plan.
Part D
Medicare Part D is a voluntary prescription drug benefit for people with Medicare that is obtained through private insurance companies. This coverage can help to cover the cost of some of your prescription drugs. You should enroll in Part D when you first enroll in Medicare to avoid coverage gaps or enrollment penalties. If you do enroll in Part D when you are first eligible, you will be able to access retail prescription drugs at a more affordable rate and enjoy protection against high costs in the event you need a very expensive medication.
Medicare FAQ's
You are eligible to apply for Medicare during your initial enrollment period which is a 7 month window. 3 months before turning 65, the month you turn 65 and 3 months after turning 65.
The easiest way to sign up for Medicare is online through SSA.gov or by Calling Social Security at 1-800-772-1213. You can also visit your local Social Security Office.
If you are already receiving Social Security Benefits you will be automatically enrolled into Original Medicare, otherwise you will be eligible to enroll during your initial enrollment period that starts 3 months before your 65th birthday.
If you miss your Initial Enrollment Period you can sign up during the General Enrollment period that occurs every year January 1st through March 31st. Coverage becomes effective the month following your enrollment date.
Yes, there are penalties for not signing up for Part B of Medicare and will be added to your premium.
If you need a new Medicare card you can order a replacement card by phone at 1-800-772-1213, or online at the Social Security Administration web site. Make sure you have your Medicare number ready when you call.
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We do not offer every plan available in your area. Currently we represent 14 organizations which offer 91 products in your area. Please contact Medicare.gov , 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
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