What Is Medicare

General Medicare

If you are already receiving Social Security you will be automatically enrolled for Parts A & B and get your Medicare card 3 months before the month of your 65^th birthday and start receiving your benefits the first day of the month of your 65^th birthday or the previous month if your birthday is on the lst. If you do not automatically receive your Medicare card call Social Security at 1-800-772-1213.

U.S. government health insurance program for seniors 65+ and approved disabled individuals <65.

If you are already receiving Social Security you will be automatically enrolled for Parts A & B and get your Medicare card 3 months before the month of your 65^th birthday and start receiving your benefits the first day of the month of your 65^th birthday or the previous month if your birthday is on the lst.If you do not automatically receive your Medicare card call Social Security at 1-800-772-1213.
- If you do nothing you will keep Part B and Part B premiums will start coming out of your Social Security.
There are different rules for those that live in Puerto Rico or those that have serious health issues like end-stage renal failure and Lou Gehrig’s disease, please check with Medicare.gov or call 1-800-Medicare.
You must be a U.S. citizen or lawfully present in the U.S. to get Medicare Parts A &B.
If you meet certain requirements, you can delay Medicare Part B but you have to respond to their notification and have creditable insurance otherwise face penalty fees that will be added to your monthly Medicare premiums.If in doubt ask?
Your initial Enrollment Period is three months before the month of your 65^th birthday and three months after.

MEDICARE PLANS:

Medicare Part A:Everyone (who is eligible) receives Medicare Part A at age 65.Part A is your basic coverage for hospital, skilled nursing facility (not long-term or custodial)hospice care, and home health care it pays 80% after a deductible of $1,260 (2015) and covers 1-60 days and there is no premium. If you did not sign up during your initial enrollment period you can sign-up between January 1 and March 31 of each year but your coverage won’t start until July first and you may be assessed a penalty (if you did not have other creditable insurance).

Medicare Part B:This is coveragefor your Dr.and other out-patient medical services and the premiums vary depending on your taxable income and usually comes out of your Social Security check or for those not taking Social Security they may pay a premium.There is an annual deduction of $147 (2015).Part B pays 80% of the total Medicare approved charge. If you do not sign-up for Part B when you are first eligible for Medicare (and did not have creditable insurance) you will incur a penalty that will be added monthly to your premium for the rest of your life.

Medicare Part C:Medicare has sub-contracted Part C to private insurance companies called Advantage Plans.The government oversees these plans and decides which insurance companies can sell in which zip code.You are officially a client of the insurance companyand have to use their insurance card and cannot use your Medicare card (keep your Medicare card for use if you ever go back tooriginal Medicare).You still have to pay your Part B premiums but these are sent to the insurance company managing your Advantage Plan and you may also have an additional premium to pay to the insurance company for your Advantage Plan.Advantage Plans are either HMO’s which are usually free or PPO’s that usually have an additional premium.Advantage Plans include your drug plan Medicare Part D.

Medicare Part D:You have to have a separate drug plan (Part D) if you are on original Medicare(and have a Medicare supplement plan).If you have a Medicare Advantage Plan (Medicare Part C ) you do not need to buy a separate drug plan.Advantage plans usually include your drug plan.You need to purchase a Medicare Part D plan from an independent insurance company but if you do not purchase a plan when you are first on Medicare (and do not have an Advantage Plan or other creditable insurance) you will incur penalty fees if you sign up later.

Open enrollment for the above is October 15 thru December 7 each year, there are a few exceptions

When you are first eligible for Medicare (three months before your 65 birth month and three months after).
Move out of your plan’s service area. (Medicare Part C & D)
Lose other creditable insurance coverage

ALL INFORMATION CAN BE FOUND IN DETAIL IN YOUR ANNUAL MEDICARE BOOK OR ON-LINE AT MEDICARE.GOV.YOU CAN ALSO CALL 1-800-MEDICARE.

What is Medicare?

Medicare is a federal health insurance program specifically designed to cater to the healthcare needs of seniors aged 65 and older, as well as certain disabled individuals under the age of 65 who meet eligibility criteria. This program aims to provide affordable and comprehensive healthcare coverage, ensuring that these populations can access necessary medical services without facing financial hardship. By offering different parts of coverage, Medicare addresses various aspects of healthcare, from hospital stays to outpatient services, helping beneficiaries maintain their health and well-being.

Breakdown of Medicare Part A: What It Covers and Who Is Eligible

Medicare Part A primarily covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care services. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes while working. It is crucial for beneficiaries to understand that Part A only covers specific services, often requiring copayments, coinsurance, and deductibles. Eligibility for premium-free Part A generally depends on having worked and paid Medicare taxes for at least ten years or being married to someone who qualifies.

Medicare Part B: Explaining Doctor and Outpatient Services Coverage

Medicare Part B is designed to cover doctor visits, outpatient care, preventive services, and certain home health services. Unlike Part A, Part B requires beneficiaries to pay a monthly premium, which can vary based on income. This part of Medicare also involves additional costs such as deductibles and coinsurance. Preventive services under Part B include screenings, vaccinations, and annual wellness visits, all aimed at preventing or managing health issues. Understanding the specifics of Part B is essential for beneficiaries to effectively plan for their medical expenses and ensure comprehensive coverage.

Exploring Medicare Part C Advantage Plans Managed by Private Insurers

Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Part A and Part B). These plans are offered by private insurance companies approved by Medicare and often include additional benefits such as vision, dental, and hearing coverage. Medicare Advantage plans may also incorporate prescription drug coverage, similar to Part D. While these plans typically have networks of doctors and hospitals, they may offer lower out-of-pocket costs and additional perks. It is important for beneficiaries to compare different Medicare Advantage plans to find one that best suits their healthcare needs and preferences.

Understanding Medicare Part D: Prescription Drug Coverage and Its Importance

Medicare Part D provides prescription drug coverage to help beneficiaries manage the cost of medications. This coverage is offered through private insurance companies and can be added to Original Medicare or included in Medicare Advantage plans. Part D plans vary in terms of the drugs they cover, their premiums, and their cost-sharing structures. It is vital for beneficiaries to review and select a Part D plan that aligns with their medication needs, ensuring they can afford and access the prescriptions they require. Annual reviews of Part D plans during open enrollment periods can help beneficiaries adjust their coverage as needed.

Enrollment in Medicare Automatic and Manual Processes Explained

Enrolling in Medicare can happen automatically or manually, depending on the individual’s circumstances. Here are the key points to understand:

Automatic Enrollment: Those receiving Social Security benefits are automatically enrolled in Parts A and B at age 65.
Manual Enrollment: Individuals not receiving Social Security must enroll during the Initial Enrollment Period.
Initial Enrollment Period: Begins three months before turning 65 and ends three months after.
Special Enrollment Periods: Available for those who delayed enrollment due to other health coverage.
Avoiding Penalties: Timely enrollment is crucial to avoid late enrollment penalties.
Further Information: Visit Medicare.gov or call 1-800-Medicare for detailed guidance.