Providing our clients with the highest levels of professional insurance advice in the areas of MEDICARE, HEALTH INSURANCE and FINAL EXPENSE
OVERVIEW
Medicare is health insurance for people 65 or older, under 65 with certain disabilities, and any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or kidney transplant).
Medicare includes these parts:
- Medicare Part A – Hospital Insurance
- Medicare Part B – Medical Insurance (including Medicare preventative services)
- Medicare part D – Medicare prescription drug coverage
Medicare is managed by the Centers for Medicare & Medicaid Services (CMS). CMS is part of the Department of Health and Human Services.
WHAT YOU NEED TO DECIDE
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Enrolling in Medicare
If you want Medicare at age 65, you should contact Social Security during the 3 months before your 65th birthday. To enroll in Medicare, you can visit your local Social Security office, call Social Security at 1-800-772-1213, or visit www.socialsecurity.gov on the web. Medicare provides you with premium-free Medicare Part A (Hospital Insurance) and optional Medicare Part B (Medical Insurance) for which you will pay a monthly premium, if you elect to keep it.
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Decide if you want Medicare Part B
If you do not want to keep Part B, you must let Medicare know before the effective date of coverage shown on the front of your Medicare card.
You may be able to delay joining Part B without penalty if you or your spouse is working, and you are getting health insurance benefits based on that current employment. However, in certain circumstances such as company size, retirement status and disability, you may be required to maintain Part B.
If you do not keep Part B when you are first eligible, you may have to wait until the General Enrollment Period (January 1 – March 31 each year) to sign up, and your Part B coverage would start July 1 of that year. You may also have to pay a Part B late enrollment penalty.
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Decide how to get your Medicare coverage
If you keep Part B, you can choose how you get your health coverage. You can choose from Original Medicare (via the Government) or a Medicare Advantage Plan (run by a private insurance company).
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Decide if you want or need a Medicare Supplement (Medigap) policy
If you choose Original Medicare to provide your Medicare insurance coverage, you may want to buy a policy that helps pay some of the costs Medicare does not cover. You do not need and cannot use a Medicare Supplement if you choose a Medicare Advantage Plan
MEDICARE INSURANCE PRODUCTS
Medicare Supplement (Medigap)
These policies are a type of supplemental insurance to help pay some of the out of pocket costs in Original Medicare (like your deductibles and co-insurance). They also offer benefits not covered under Original Medicare (like emergency health care outside of the US). You need both Part A and Part B to buy a Medicare Supplement policy.
Medicare Advantage Plan (also called Medicare Part C)
Instead of Original Medicare (through the government ), you can join a Medicare Advantage Plan insured by a private insurance company, whereby you will get your Part A and Part B-covered services through the Medicare Advantage Plan. The plan may also offer extra coverage, such as vision, hearing, dental and/or health and wellness programs. Most include Medicare prescription drug coverage. Most Medicare Advantage Plans have provider networks. This means you probably have to see doctors who belong to the plan, or go to certain hospitals to get covered services (other than for emergency care), or else you may have extra costs. You may also need referrals to see specialists. Cost, extra coverage and rules vary by plan To join a Medicare Advantage Plan you must have both Medicare Parts A and B.
Medicare Part D Prescription Drug Plan
Medicare offers prescription drug coverage to everyone with Medicare, but you must sign up for it. You get Medicare prescription drug coverage by joining a Medicare Prescription Drug Plan or through a Medicare Advantage Drug Plan that offers drug coverage.
Medicare drug plans are run by private companies that contract with Medicare, and there may be dozens of different plans available where you live. These plans cover a variety of brand-name and generic prescription drugs, but costs and coverage are different in every plan.
You can join a Medicare drug plan when you first become eligible for Medicare. After this Initial Enrollment Period, you can change your plan every year during the Annual Enrollment Period (October 15 to December 7). If you make changes during this period, your new coverage will begin January 1 of the following year. If you do not join a Medicare drug plan when you are first eligible for Medicare, and you go without creditable prescription drug coverage for 63 days or more in a row, you may have to pay a late enrollment penalty to join a plan later. You may also have to wait for the next open enrollment to sign up.
Important Information and Disclaimer
This information supplied herein is intended as a summary only and is not intended to be a substitute for Official Medicare documents and regulations published by the Centers for Medicare & Medicaid Services. Official Medicare Program legal guidance is contained in the relevant statutes, regulations and rulings. This summary has not been approved by the Centers for Medicare & Medicaid Services.
