Medicare
Health Insurance Solutions
Medicare
Medicare is a federal health insurance program that offers benefits to American citizens as well as permanent legal residents (of a minimum of 5 consecutive years) aged 65 and older, or those who have a qualifying illness or disability such as ESRD, ALS, and many other illnesses that usually take a few years to determine eligibility.
The majority of people are automatically enrolled in Original Medicare, Part A, and usually need to complete their enrollment into Part B when they reach eligibility if they are not already taking social security.
Medicare Part A is basically hospital insurance, whereas Medicare Part B is medical insurance like your doctors and outpatient services.
FAQ
Who is eligible for Medicare?
Generally, people that are Turning 65, are a US citizen or resident of 5 years (sometimes different rules apply depending on marriage status), and have worked more than 40+ working quarters are eligible for zero-premium part A.
Another way to become eligible for Medicare is to become disabled and receive SSDI for 24+ months, as well as automatic for ALS, and ESRD also known as end stage renal disease on the 4th month of receiving your dialysis treatments.
What does Medicare Part A Cover?
Medicare Part A Helps cover:
- Inpatient care
- Home health care
- Skilled Nursing Facility
- Hospice
What does Medicare Part B cover?
Medicare Part B helps covers your outpatient services:
- Services from doctors and providers
- Durable Medical Equipment
- Diagnostic Services
- Many Preventative services like screenings, shots and vaccines
What is Part D Coverage?
- Cost for prescription drug plans, shots and vaccines
- Plans that offer Medicare drug plans are run by private insurance companies that follow Medicare guidelines.
What is Medicare Part C or Medicare Advantage Plans?
There have been a few different ‘Plan C’s’ throughout the years, but the most common one is referred to as a Medicare advantage plan. Medicare Advantage Plans are a type of Medicare Health Plan or Medicare supplement used to help limit the out-of-pocket cost that Medicare doesn’t cover.
When you are enrolled into Medicare part A & B you are covered for 80% of your health care costs. So what’s left? 20%! That’s where I come into help. I am a licensed insurance broker that helps to educate the differences in a Medicare Advantage plan and a MediGap plan, as well as Prescription Drug Plans.
When you are enrolled into Medicare part A & B you are covered for 80% of your health care costs. So what’s left?
20%! That’s where I come into help. I am a licensed insurance broker that helps to educate the differences in a Medicare Advantage plan and a MediGap plan, as well as Prescription Drug Plans.
So what are Medicare Advantage plans and what do they cover?
The tricky part with MA’s, is there are literally 100’s of different options throughout the country. To be able to tell you exactly what the co-pays are for each plan is almost impossible as each carrier is different with different plans and different eligibility requirements. They also are determined on the area in which you live, some are income-based and others are qualified by different chronic conditions. However, to put it in a nutshell, they each come with a maximum out of pocket which protects you if you experience extensive health problems throughout the year. Generally, MAPD (Medicare Advantage also known as Part C) has very low premiums and the majority of them have a $0 additional premium. Some of the highlights of MA’s are they have enhanced benefits like dental, vision, hearing, fitness memberships, transportation, over-the-counter allowances, and part B givebacks that are appealing to a lot of the American population. MA plans can also include your PDP (Prescription Drug Plan) which is necessary when becoming eligible for Medicare to enroll into or else you could face having a LEP (late enrollment penalty).
What is a Medigap plan?
Medigap policy is an insurance policy that helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. Medigap policies are sold by private companies, and can help pay for some of the costs that Original Medicare doesn’t, like copayments, coinsurance, and deductibles.
Some Medigap policies also cover certain benefits Original Medicare doesn’t cover, like emergency foreign travel expenses. Medigap policies don’t cover your share of the costs under other types of health coverage, including Medicare Advantage Plans, stand-alone Medicare drug plans, employer/ union group health coverage, Medicaid, or TRICARE.
What Do I Need to Know About Medicare Part C?
- If you are enrolled in both Parts A and B, then you are eligible for C.
- Enrolment in Medicare Part C is voluntary.
- Many people choose to stick to their original Medicare A & B plans and instead, enroll in Medigap.
What is a late enrollment penalty?
A late enrollment penalty is a penalty that you are given when you do not use your election periods properly and enroll into the plans you are eligible for at that time. How does that apply to medicare? There are a few times you can encounter a LEP(late enrollment penalty). One of the ways is not enrolling into Medicare Part B once you become eligible. Becoming eligible is typically when you turn 65 or as stated early after you’ve been on SSDI (Social Security Disability) for 24+ months. If you are enrolled into SSDI then you automatically are enrolled into Medicare at your eligibility month. When you turn 65, unless you are taking social security you are not. So if you don’t enroll during your 7 month window, which is 3 months before the month of your 65th birthday, the month of, and 3 months after, then you will miss your enrollment for Medicare Part B and need to wait until the GEP(General Election Period) which is January 1st – March 31st of every year. The GEP is not to be confused with AEP (Annual Election Period) which is for plan changes of MA and PDP plans.
The next LEP is not enrolling into your Prescription Drug Plan when you enroll into Medicare Parts A and/or B. This is not something that is automatically done and you must contact a licensed insurance broker certified in Medicare Health plans (like us, Faith Insurance Solutions) to do so.
Medicare Supplement Plans- Medigap
What is Medigap Plan
Medicare Supplement plans cover 10 million Medicare beneficiaries. Also referred to as Medigap plans, these policies help pay for your share of Medicare expenses, such as your deductibles and coinsurance. Medicare supplement insurance plans are available for purchase in all 50 states and are very popular with people who want little to no copays when they access healthcare services.
Many people new to Medicare feel surprised to find that Medicare covers only 80% of your Part B expenses. The other 20% can be devastating to you financially if a serious illness arises. You can choose a Medicare Supplement that will pay some or all of that 20% for you, among other things. Supplemental insurance for seniors with Medicare essentially buys you peace of mind by eliminating that cost-sharing responsibility. You have a one-time open enrollment window, where you are guaranteed the right to purchase a Medigap. Your health status does not matter when you buy a plan during this six-month window.
Which MediGap plan should I purchase?
All MediGaps are the same no matter which private carrier you choose from, it’s the letters of the MediGap that determine the coverage. Above you will see a chart that explains, side by side, the differences in coverage based on the letter you choose.
The most popular plans to date in 2021 are going to be your Plan F, Plan G and Plan N. You will see in the chart above that there are only slight differences in the 3 plans. Plan F we will call your Cadillac plan, it covers every deductible and coinsurance. Plan G would be the second plan with top benefits, if you notice the only difference between the 2 are the Part B deductible.
Some Medigap policies also cover certain benefits Original Medicare doesn’t cover, like emergency foreign travel expenses. Medigap policies don’t cover your share of the costs under other types of health coverage, including Medicare Advantage Plans, stand-alone Medicare drug plans, employer or union group health coverage, Medicaid, or TRICARE.
How do I know when I should sign up?
For most people, your Initial Enrollment Period (A 7-month window in which you should enroll in Part A and Part B to avoid late enrollment penalties) is the best time to sign up for Medicare.
You can determine the dates of your exact Initial Enrollment Period using our IEP Calculator here.
How do I get Medicare?
Social Security offers you a quick online application for Medicare that can be completed in fewer than ten minutes. You do not have to be receiving income benefits to get Medicare. Just visit the Social Security website and follow the links about applying for Medicare.
Is it mandatory to go on Medicare when you turn 65?
No, but there are significant penalties for late enrollment unless you have other creditable medical coverage, such as from a large employer.
What age does Medicare start?
At age 65 you are eligible for Medicare, regardless of whether you are already taking Social Security income benefits. Some people also qualify for Medicare earlier than 65 due to a disability or illness.
FAQS – Medicare
How do I get Medicare?
Social Security offers you a quick online application for Medicare that can be completed in fewer than ten minutes. You do not have to be receiving income benefits to get Medicare. Just visit the Social Security website and follow the links about applying for Medicare.
Is it mandatory to go on Medicare when you turn 65?
No, but there are significant penalties for late enrollment unless you have other creditable coverage through an employer with more than 20+ employees. Please be advised that COBRA from your large employer does not count as creditable coverage and neither does the ACA or affordable healthcare act.
Why can’t I keep my Obamacare insurance? It’s CHEAPER!?
The fact is that you cannot have The Affordable Care Act (ACA/Obamacare) insurance through the federal marketplace if you have other creditable coverage like Medicare, Medicaid, or employer coverage. You also, cannot receive a subsidy if you are found eligible for any of these coverages and could face a penalty and pay back the entire amount when filing your federal tax return. What does that mean? That means, if you are getting a premium tax credit, which most people are when they get towards retirement age, you receive a “discount” on your health insurance through the federal exchange.
That discount is the form of a tax credit based on your income, so it’s essentially the government paying for your health insurance because of your income. You will pay that back if you do not follow the guidelines, one of them being eligible for Medicare.
What age does Medicare start?
Turning 65 is the magic number for becoming eligible for Medicare. Often times beneficiaries are confused with it being 62, which is when you can take your social security benefits. You may also become eligible if you are found eligible for SSDI which is Social Security Disability Income, and after your 24th monthly payment is when your Medicare will start. You also can be found eligible if you have ALS or ESRD. If you have ESRD then you are eligible for Medicare the 4th month after you receive dialysis.
How do I know when I should sign up?
For most people, your Initial Enrollment Period (A 7-month window in which you should enroll in Part A and Part B to avoid late enrollment penalties) is the best time to sign up for Medicare.
You can determine the dates of your exact Initial Enrollment Period using our IEP Calculator here.
How do I get Medicare?
Social Security offers you a quick online application for Medicare that can be completed in fewer than ten minutes. You do not have to be receiving income benefits to get Medicare. Just visit the Social Security website and follow the links about applying for Medicare.
