Medicare

What is Medicare and why is it important?

Medicare plays a key role in providing health and financial security to 60 million older people and younger people with disabilities. It covers many basic health services, including hospital stays, physician services, and prescription drugs.

Who is entitled to Medicare?

• People 65 or older
• Certain people under 65 with disabilities
• People of any age with End-Stage Renal Disease (ESRD

Do you have to pay for Medicare when you turn 65?

Most people age 65 or older are eligible for free Medical hospital insurance (Part A) if they have worked and paid Medicare taxes for at least 10 years. You can enroll in Medicare medical insurance (Part B) by paying a monthly premium.

I am still working do I need to enroll in Medicare when I turn 65?

If an employer provides Creditable Health coverage for someone that is turning 65

the 65 year old can opt to deferred Part B but is recommended to enroll in Part A.

What are the parts of Medicare? 

Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance).

What’s covered under Part A?

Hospital Insurance

• Inpatient care in a hospital
• Skilled nursing facility care
• Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
• Hospice care
• Home health care

You usually do not pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working for a certain amount of time. This is sometimes called premium-free Part A. If you are not eligible for premium-free Part A, you may be able to buy Part A.

What’s covered under Part B?

Medical Insurance. These are services that take place outside the hospital care.

• Services from doctors and other health care providers 
• Outpatient care
• Home health care
• Durable medical equipment (DME) (like wheelchairs, walkers, hospital beds, and other equipment) 
• Many preventive services (like screenings, shots, or vaccines, and yearly “Wellness” visits) Most people pay the standard Part B premium amount.

Most people pay the standard Part B premium amount.

What’s Covered under Part D?

Prescription drug coverage

• Helps cover the cost of prescription drugs (including many recommended shots or vaccines) 
• Run by private insurance companies that follow rules set by Medicare 
• May help lower your drug cost and help protect against higher costs in the future

What’s Covered under Part C Medicare Advantage

Are health plans provided by the Private Insurance carriers.

• An “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.
• Plans may have lower out-of-pocket costs than Original Medicare.
• Most plans offer extra benefits that Original Medicare does not cover— like vision, hearing, and dental services.

What is a Medicare Supplemental Plans (Medigap)?

This plans takes care of the 20% that Medicare does not.  There are various plans with different premiums.  These plans DO NOT include Prescription Drug Plans (PDP) with them, one will need to purchase a stand alone PDP.