Medicare
Turning 65? Retiring soon? Too many options?
What is Medicare?
Medicare is provided by the federal government. It covers American citizens and others based on age, disability, or other qualifying medial conditions.
*Original Medicare includes Part A and Part B
* Medicare is tied to the Social Security system, and therefore only applies to the individual
Who is Eligible?
U.S citizens or legal residents with at least 5 years of residency.
Also, there are three qualifying categories;
*You are 65 or older
*If younger than 65, you have a qualifying disability
*If diagnosed with ALS or end-stange renal disease, you qualify at any age.
When Can I Enroll?
You can enroll 3 months prior to turning 65 and 3 months after turning 65. Some things to consider;
*Are you or your spouse still working?
*Do you wish to change your current plan?
*There are special enrollment periods available. Please visit the medicare website.
Part A
Covers inpatient hospital care, skilled nursing care, home health and hospice. It is premium free if you or your spouse made Social Security contributions for 10 years (40 quarters). If not, you may pay a monthly fee.
What is Covered by Original Medicare?
Part B
Covers non-hospital related expenses. Generally this includes; doctor visits, medically necessary services, and preventative services. Part B does include a monthly fee, which is based on your current income and can be covered by the state if you qualify financially.
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*Both Part A and Part B only cover up to 80% of your health care bill with no upper limit.
*Most prescription drugs
*Most care outside the United States
*Dental exams, cleanings or routine dental care
*Eye exams, eyeglasses or contacts
*Hearing exams or heading aids
*Long term care
*Custodial Care (Help with daily living)
*Hospital expenses such as TV and phone services
*Hospital and psychiatric hospital days beyond set limits
*Gym memberships and other wellness benefits
If you would like to explore options beyond Original Medicare, please see below.
We Offer The Following Plans That Provide Additional Coverage:
We will help you find the right solution for you.
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*Prescription Drug (part D) coverage
*Hearing exams or hearing aids
*Dental exams, cleaning, X rays and routine dental care
*Eye exams, eyeglasses or contact lenses
*Gym memberships and other wellness benefits
*Transportation to medical appointments and virtual visits
*Emergency services outside your plan
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*HMO- Health maintenance organizations
*PPO- Preferred provider organizations
*POS-Point of service plans
*PFFS- Private fee for service
*SNP- Special needs plans:
Dual eligible- those with Medicare and Medicaid
Chronic- for those living with severe and disabling chronic conditions
Institutional- for those living in contracted skilled nursing facility
Institutional equivalent- those is assisted living and need extra care
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You can enroll during your initial enrollment period and the medicare annual enrollment period. There is an open enrollment and special enrollment period where you can enroll or switch plans if you meet certain criteria.
Call us to find out when it’s time for you or visit the Medicare website for more details.
You must be entitled to Part A and Enrolled in Part B to qualify.
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*Medicare Advantage plans are often premium free. You will continue to pay your part B premiums, and part A if you have one. Some plans may charge premiums, deductibles, copays or coinsurance. These premiums can vary by year and costs vary based on the covered item or service.
*Where you get your care can affect your costs, many Medicare advantage plans are coordinated care plans and contract with a network of doctors and hospitals.
*Some plans may require you to select a primary care provider from their network.
*You can’t be denied coverage or charged more based on health status.
*Save now, pay for services later.
Medicare Advantage Plans (Part C)
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*Drugs commonly prescribed for by Medicare beneficiaries
*Specific brand name and generic drugs included in the formulary (list of covered drugs)
*Commercially available vaccines not covered under part B
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*Drugs not listed on the formulary
*Drugs prescribed for anorexia, weight loss or gain
*Prescriptions for fertility, erectile dysfunction or cosmetic purposes
*Prescription vitamins and minerals, and
*Non-prescription drugs (over the counter)
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You must be entitled to Part A or enrolled in Part B to sign up.
There could be late enrollment penalty if:
*You didn’t enroll when first eligible for Medicare and didn’t have other creditable drug coverage to qualify for enrollment during a special enrollment period
*You didn’t enroll within 63 days of losing your creditable drug coverage (usually from an employer health plan)
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Item description
Prescription Drug Plans (Part D)
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*Part A hospital coinsurance
*Part B coinsurance or copays
*Cost of blood transfusions (first 3 pints)
*Cost for 365 extra hospital days
*Hospice care coinsurance
Some plans may help pay for:
*Part A and Part B deductibles
*Cost of foreign travel emergency care up to plan limits
*Part A skilled nursing facility care coinsurance
*Additional services like vision, dental, hearing or gym memberships.
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You can get a Medigap Plan after you are 65 or older and enrolled in parts A and B. You can apply anytime, but the best time to buy this supplemental insurance is during your 6-month Medigap Open Enrollment Period beginning the month you turn 65 and are enrolled in A and B. It usually offers better prices and more choices even if you have health problems. After this enrollment period, your pre-existing health conditions may impact eligibility and costs.
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*There are a variety of supplemental plans labeled by different letters. Each plan sets their own premiums, which usually increase with the level of coverage.
*Pay for future services now, not when you use them.
Medicare Supplement Plans
Book an appointment.
We look forward to speaking with you. There is no cost to you for our services and no obligation. This is a solicitation for insurance.