Medicare

Many people find Medicare complex and confusing and need help to sort out their options – especially those who are continuing to work beyond age 65 - Vasco Pickett

Medicare Overview

Medicare is a federal health insurance program for the following:

  • People 65 or older
  • People under 65 with certain disabilities
  • People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring
    dialysis or a kidney transplant)

The different parts of Medicare help cover specific services:

  • Medicare Part A (Hospital Insurance)
  • Medicare Part B (Medical Insurance)
  • Medicare Part C (also known as Medicare Advantage)
  • Medicare Part D (Medicare Prescription Drug Coverage)

When to Apply

You can apply for Medicare during the seven month period beginning three months before, the month of, and three months after your birthday month.

If you are already receiving Social Security you will be automatically enrolled and will receive your Medicare card about three months prior to your birthday and you will be given the option of turning down Part B coverage.

It is best to sign up early to avoid a delay in coverage. To get Part A and/or Part B the month you turn 65, you must sign up during the first three months before the month you turn 65.

Medicare Supplement Insurance

Original Medicare pays for many, but not all, health care services and supplies. Medicare Supplement Insurance is offered by private companies and can help pay some of the health care costs that Original Medicare doesn’t cover such as co-payments, co-insurance and deductibles. Medicare Supplement insurance is also referred to as “Medigap” insurance.

Insurance companies can sell only a “standardized” policy identified in most states by letters A – N. All policies offer the same basic benefits but some offer additional benefits so you can choose which one meets your needs. Different insurance companies may charge different premium for the same exact policy.

Things to consider in selecting a plan:

  • The amount of premium you are willing to pay.
  • The benefits you want.
  • The reputation and financial stability of the company offering the plan.
  • The acceptability of the plan by your healthcare providers.

View pdf chart comparing the currently authorized Medicare Supplement policies.

Medicare Parts A & B

Medicare covers certain medical services and supplies in hospitals, doctors’ offices and other health care settings. Services are either covered under Part A or Part B.

Medicare Part A- Hospital insurance

Part A helps cover the following although copayments, coinsurance and deductibles may apply in each case:

  • Inpatient care in a hospital
  • Inpatient care in a skilled nursing facility (but not custodial or long term care)
  • Hospice Services
  • Home health services (medically necessary , part time or intermittent skilled nursing care or therapy ) and only for those who are homebound

Medicare Part B – Medical Insurance

Part B helps cover medically-necessary services like doctors’ services, outpatient care, home health services, durable medical equipment and certain preventive services. In 2017, a deductible of $183 is applicable and various co-payments and coinsurance may apply in each case.

Part C- Medicare Advantage

Part C-Medicare Advantage is a type of Medicare health plan (like an HMO – Health Maintenance Organization) offered by a private company that contracts with Medicare to provide both Part A and Part B benefits. If you are enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid under Original Medicare.

Medicare Advantage Plans may offer extra coverage such as vision, dental or wellness programs and most include prescription drug coverage but may require you to only see doctor’s on the plan’s list. Medicare Advantage Plans can charge different out-of-pocket costs and have different rules for how you get services. These rules can change each year.

Part D- Prescription Drugs

Prescription Drug coverage is offered to everyone with Medicare. If you decide not to join a Medicare drug plan when you’re first eligible – or already have “creditable” prescription drug coverage – you will likely pay a late enrollment penalty. To get Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and specific drugs covered.

For The Part D Prescription Drug Plan Finder, click here.