Medicare Simplified
We are committed to ensuring you make informed decisions about your Medicare health insurance options. That's why we've developed this resource section.
Here, you'll find valuable information to educate yourself on various insurance choices and access resources that can assist you in selecting the ideal plan tailored to your specific needs.
If you require further assistance or have any questions, please don't hesitate to reach out to us. We're here to support you every step of the way.
Medicare: What You Need to Know
Medicare is a health insurance program for:
- Individuals aged 65 or older,
- Individuals under 65 with certain disabilities,
- Individuals of any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).
Medicare consists of:
- Part A (Hospital Insurance): Covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care. Most beneficiaries do not pay a premium for Part A.
- Part B (Medical Insurance): Covers doctor visits, outpatient care, and some preventive services. Most beneficiaries pay a monthly premium for Part B.
- Prescription Drug Coverage (Part D): Helps lower prescription drug costs and is provided by private companies. Beneficiaries choose a plan and pay a monthly premium. Delaying enrollment may result in penalties.
For more details, visit www.cms.gov or contact the phone number listed on the website to speak with a licensed agent.
Medicare Advantage Plans
Medicare Advantage Plans, also known as Medicare Part C, are comprehensive health plan options within the Medicare program. These plans provide all Medicare-covered health care services, including prescription drug coverage. Types of Medicare Advantage Plans include:
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Private Fee-for-Service Plans
- Special Needs Plans
When you join a Medicare Advantage Plan, you use the plan's insurance card for your health care needs. Most are managed care plans, requiring you to use plan doctors and hospitals for services.
To enroll in a Medicare Advantage Plan, you must have Medicare Part A and Part B and pay your Part B premium.
Enrollment periods are limited:
- Initial enrollment is around your 65th birthday or when first eligible for Medicare.
- Special enrollment periods apply for those with disabilities.
- Annual enrollment for changes runs from October 15 to December 7 each year.
For more details, visit www.medicare.gov or contact the phone number on the website to speak with a licensed insurance agent.
What is Medicare Supplement (Medigap) Insurance?
Medicare Supplement (Medigap) insurance, offered by private companies, helps cover out-of-pocket costs that Original Medicare doesn't, such as co-payments, coinsurance, and deductibles. When you have Original Medicare and a Medigap policy, Medicare pays its share of approved costs, and then your Medigap policy covers its portion.
Unlike Medicare Advantage Plans, Medigap policies only supplement Original Medicare coverage.
Key points about Medicare Supplement policies:
- You must have Medicare Part A and Part B.
- You can switch to a Medigap policy during specific enrollment periods or under certain conditions.
- You pay a monthly premium to the private insurance company for your Medigap policy, in addition to your Medicare Part B premium.
- Each individual needs their own Medigap policy.
- You can buy Medigap policies from any licensed insurance company in your state.
- Medigap policies are guaranteed renewable, regardless of health conditions.
- Policies sold after January 1, 2006, do not include prescription drug coverage; you need a Medicare Prescription Drug Plan (Part D) for that.
- You cannot have both a Medigap policy and a Medicare Advantage Plan at the same time.
For more information, visit www.medicare.gov or contact the phone number provided on the website to speak with a licensed insurance agent.
Part D Prescription Drug Plans
You can enroll in Medicare Part D Prescription Drug Plans three months before turning 65 or upon becoming eligible for Medicare under age 65. Timely enrollment is crucial to avoid permanent premium surcharges if you lack equivalent drug coverage from another source, like a retiree plan.
During the October 15 to December 7 annual open enrollment period, you can switch between Part D standalone plans or Medicare Advantage plans that include drug coverage.
For 2024, anticipate higher out-of-pocket costs:
- The out-of-pocket spending threshold increases to $8,000.
- The standard deductible rises to $545.
- The initial coverage limit is set at $5,030.
In the coverage gap phase, you'll pay 25% for both brand-name and generic drugs, with plans covering the remainder. Annual reviews of your Part D coverage are recommended, especially if you start new medications.
Explore Medicare.gov for plan basics and use the Part D Plan Finder to review coverage options and formularies including your drug list, revealing yearly out-of-pocket costs.
Financial assistance may be available for those meeting income and resource criteria outlined on Medicare.gov, including eligibility for Extra Help to cover Part D premiums and drug expenses.
For more details, visit www.medicare.gov or contact the provided phone number to consult with a licensed insurance agent.
Are You Eligible for Medicare?
You qualify for Medicare if you or your spouse worked at least 10 years in Medicare-covered employment and you're 65 years old and a U.S. citizen or permanent resident. If under 65, you may qualify with a disability or End-Stage Renal Disease.
For Part A coverage at age 65 without premiums:
- Receive retirement benefits from Social Security or Railroad Retirement Board.
- Eligible for Social Security or Railroad retirement benefits but haven't filed.
- You or your spouse had Medicare-covered government employment.
If under 65, Part A is premium-free if:
- Received Social Security or Railroad Retirement Board disability benefits for 24 months.
- Have End-Stage Renal Disease requiring dialysis or transplant.
Part B premiums are required unless deducted from your benefits. Otherwise, Medicare bills you quarterly.
Questions? Contact us for Medicare health insurance guidance. Call the number on this website to connect with a licensed insurance agent.
Different Types of Medicare Advantage Plans
Medicare Advantage is a private health plan contracted with Medicare to provide Part A and Part B benefits in one package. Plan options include:
- Health Maintenance Organization (HMO): Limits coverage to network providers, requiring referrals for specialists.
- Preferred Provider Organization (PPO): Offers lower costs within network; higher costs for out-of-network care.
- Private Fee-for-Service (PFFS): Determines fees for providers; differs from Original Medicare or supplements.
- Medicare Special Needs (SNP): Offers benefits that cover special health care or financial needs
For more details, visit www.medicare.gov or contact the phone number on the website to speak with a licensed insurance agent.
Compare Medicare Supplement Plans Side by Side
Medicare Supplement policies, also known as Medigap, are standardized under federal and state laws to ensure your protection. These policies are identified by letters in most states (see comparison chart), offering identical basic benefits across the board. When you compare plans, look at premiums, benefit levels, and out-of-pocket costs to select one that best fits your needs. As licensed insurance agents, we can clarify the differences between plans to assist you in making an informed decision.
In Massachusetts, Minnesota, and Wisconsin, Medigap policies follow different standardization rules.
Each insurance company decides which Medigap policies to offer, influenced by state regulations. They are required to offer Medigap Plan A if any Medigap policy is sold, and must include Plan C or Plan F if any Medigap plan is offered. Remember, Medigap policies cover co-insurance after deductibles are paid, unless the policy itself covers the deductible.
Here's a condensed version of the comparison of Medicare Supplement plans:
Medicare Supplement plans, also known as Medigap, are standardized under federal and state laws to ensure your protection. These plans are identified by letters and offer the same basic benefits across the board. Here’s a summary of the coverage:
- Plan A: Basic benefits including Part A coinsurance, Part B coinsurance, and more.
- Plan B: Similar to Plan A with additional coverage options.
- Plan C, D, F, G: Comprehensive coverage including deductibles and foreign travel exchange.
- Plan K, L, M, N: Varied coverage with different levels of cost-sharing and out-of-pocket limits.
Plans F and G also offer high-deductible options. Plans C and F have additional eligibility restrictions. For detailed benefits and to choose the right plan, contact a licensed insurance agent or visit www.medicare.gov.