Getting Started with Medicare: What I need to know?
It can be overwhelming when you first start learning about Medicare. Medicare is the government health care program for people 65 and over, and its coverage playsan important role in containing medical costs as you age. However, Medicare benefits do not pay for everything. As you approach age 65, you’ll need to decide how to deal with some of those coverage gaps.
Original Medicare will cover 80% of the medical costs as outlined in the Medicare coverage guidelines. To understand Medicare, let’s start at the beginning with the A, B, C’s, and D of Medicare. Medicare includes parts, Part A, Part B, Part C and Part D, that are the building blocks of your Medicare coverage.
(A)Hospital Insurance
(B) Medical Insurance
(D) Drug Coverage
(C) Supplemental Coverage
Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care and home health care.
Your Medicare options
When you first sign up for Medicare and during certain times of the year, you can choose which way to get your Medicare coverage.
Original Medicare (Part A & Part B) + Supplement/Medigap (also known as Part C) + Prescription Drug Plan (Part D)
Medicare Advantage (also known as Part C) (Includes Part A, Part B, Part C, and Part D)
See Chart Below to understand some of the differences in a Medicare Supplement vs Medicare
Advantage plan.
Medicare Supplement Plan
Medicare Supplement Plan
Docter and Hospitals
You can select your doctors and hospitals as long as they accept Medicare Patients
You will Normally Be Required to use doctor and hospitals in the plan network
Specialist Referrals
You can see specialists without referrals
You may need referrals and may be required to use network specialists
Networks
No network restrictions. Converage goes with you across the United States
You may have network restrictions. Emergency care is covered foe tracal within the United States ans sometimes abroad
Enorollment
You can apply to buy a Medicare Supplement plan any time after you turn 65 and join Medicare Part B
Generally, these are specific periods during the year when you can enroll or switch to another Medicare Advantage Plan.
Costs
You pay a monthly plan premium in addition to your part B premium. When you use services, your out-of-pocket costs are limited.
Generally, you pay a low or &0 monthly plan premium in addition to your part B premium, When you use services. you pay co-pays, co-insurance and Deductibles
Prescription Durg Coverage
Prescription drug coverage is not included. You will need to purchase a Medicare Part D Plan.
Prescription drug coverage is included in many plans. MAPD
Medicare Supplement Plan
Medicare Advantage Plane
1-You can select your doctors and hospitals as long as they accept Medicare Patients
Docter and Hospitals
1-You will Normally Be Required to use docter and hospitals in the plan network
2-You can see specialists without referrals
Specialist Referrals
2-You may need referrals and may be required to use network specialists
Networks
3-You may have network restrictions. Emergency care is covered foe tracal within the United Staates ans sometimes abroad
Enorollment
4-Generally, these are specific periods during the year when you can enroll or switch to another Medicare Advantage Plan.
Costs
5-Generally, you pay a low or &0 monthly plan premium in addition to your part B premium, When you use services. you pay co-pays, co-insurance and Deductibles
Prescription Durg Coverage
6-Prescription drug coverage is included in many plans. MAPD
How do I enroll in Medicare?
If you’re receiving Social Security benefits when you turn 65, you will be enrolled automatically in Medicare Part A, which covers hospital costs, and Part B, which covers doctor visits. If you want Medicare Part D prescription drug coverage, you’ll need to enroll yourself — that’s not automatic.If you’re not receiving Social Security benefits, you’ll sign up through the Social SecurityAdministration website. You typically should do so in the seven-month window around your 65th birthday (which includes the three months before the month you turn 65, your birthday month, and the three months after your birthday month) to avoid permanent penalties.
.If you want Medicare Supplemental Insurance (Medigap), you will sign up during thesix-month Medigap enrollment period, which starts the month you turn 65 and are enrolled in Medicare Part B. The private insurers who provide Medigap plans are required to take you if you sign up during that period. Otherwise, there is no guarantee they will sell you a Medigap plan.If you miss your initial window, or want to switch plans later, there are several annual Medicare open enrollment periods.
Is Medicare free?
You do not have to pay premiums for Medicare Part A if you or your spouse paid Medicare taxes for at least 10 years. Medicare taxes are part of the payroll taxes deducted from most working people’s paychecks.
You can see if you qualify by checking your Social Security statement, which is available through the Social Security website.Otherwise, eligible people pay monthly premiums for Part A of up to $471 each month. The other parts of Medicare, which cover things like doctor visits and prescription drugs, require monthly premiums.
Our Services are Free!
As licensed health insurance agents and Medicare specialists, Affordable Health and Medicare can help our friends and neighbors residing in the Woodlands, Magnolia, Conroe, Hempstead, and Tomball, find the best options in Medicare. We have online appointments available for scheduling at our office located in the Marcel Center on FM 1488 across from Del Webb retirement center and next to the 1488 XSCAPE movie theatre. We are in the same parking lot as the ENCLAVE retirement over 55+ living community.
We are happy to sit down for a free no obligation overview of the options to find the best plan that will fit your situation. We are independent agents and so we can present a variety of options. You will not pay for our services. Our fees are paid through the insurance companies that we represent.
