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What is Medicare?

 

Medicare is a health insurance program for:

 

  • People age 65 and over
  • People under 65 with certain disabilities
  • People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)

Since 1965, Medicare insurance has helped millions of Americans pay for the health care services they need. You likely have already paid into the program through Social Security

 

 

Am I Eligible?

 

 

 

If you’re turning 65

 

If you’re turning 65, you have an opportunity to enroll in Medicare. You can enroll three months before the month you turn 65, the month of your birthday or three months after your birth month. Eligibility requirements include:

 

  • You or your spouse have worked for at least 10 years in Medicare-covered employment, and
  • You’re a U.S. citizen or permanent resident for at least five years
  • Even if you’re not collecting Social Security yet, you’re eligible to join at age 65 or later

If you’re over 65

 

If you are over age 65, Medicare eligibility requirements include:

 

  • You or your spouse have worked for at least 10 years in Medicare-covered employment
  • You’re a U.S. citizen or permanent resident for at least five years
  • Even if you’re not collecting Social Security yet, you’re eligible to join at age 65 or later

If you’re under 65 with a disability

 

If you are eligible for Medicare due to disability, requirements include:

 

  • You’re a U.S. citizen or permanent resident for at least five years, and
  • You have a disability or End-Stage Renal Disease (ESRD) and you get disability benefits from Social Security or certain disability benefits from the Railroad Retirement Board (RRB) for 24 months

 

 

 

 

What is Medicare Part A & B?

 

Medicare Parts A and B are part of the federal government’s standard health plan for people age 65 or over, people under 65 with certain disabilities and people of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

 

Medicare works the same way throughout the U.S. with any provider that accepts Medicare patients. Parts A and B each help to pay for several types of medical costs, but they don’t cover everything.

 

First, you will learn “the basics” about what Medicare is and how the various parts of Medicare work. Next, you’ll learn what Medicare supplement insurance is, and how it may fit with your lifestyle. With this important information, you’ll be ready to make confident decisions about your Medicare coverage.

 

To get an idea of the coverage provided by Medicare Parts A and B, take a look at the information below.

 

Medicare Part A: Hospital Coverage

 

 

  • Inpatient hospital stays and skilled nursing facility stays
  • Hospice care and respite care
  • Home health care and religious nonmedical health care institution

Medicare Part B: Medical Coverage

 

  • Doctor visits
  • Outpatient care, such as lab tests
  • Services not covered by Part A, such as physical therapy
  • Some home health care services, in some cases
  • Some preventive services
  • Durable medical equipment

 

 

Medicare Parts A and B Pay:

 

  • Most fees for covered stays in the hospital except the Part A deductible and coinsurance amounts
  • About 80% of Part B-covered doctor and outpatient medical expenses (after the annual deductible is met)

You Pay:

 

  • The Part A premium if required, deductible and coinsurance amounts that apply
  • Usually a Part B monthly premium
  • The remaining Part B out-of-pocket expenses
  • Part B annual deductible

 

 

What is Medicare Advantage (Also known as Part C)?

 

Medicare Advantage (Part C) plans are Medicare-approved, but offered by private insurers. These Medicare plans combine hospital costs, doctors’ visits, outpatient care, and often Part D prescription drug benefits into one plan. Some plans may also offer vision, dental, hearing and/or health and wellness programs at an extra cost.

 

More About Medicare Advantage (Part C)

 

  • These plans often require you to pay copays
  • The doctors and hospitals you go to are usually a part of a network
  • You may also need a referral to see a specialist

Medicare Part C Pays:

 

  • Fixed dollar amount for covered services

You Pay:

 

  •  Part B premium and depending on your plan:
    • Part A premium
    • Part C premium (some plans have low or no premium)
    • Copayments and Coinsurance
    • Deductibles

 

 

 

 

What is Medicare Prescription Drug Coverage (Also known as Part D)?

 

If you have Medicare Parts A and/or B, Part D plans can be purchased separately to help cover your prescription drug costs. These plans are offered by Medicare-approved private insurers – so costs and covered drugs vary from plan to plan.

 

More about Medicare Part D:

 

  • Part D works with a Medicare supplement insurance plan, or on its own
  • You can also get Part D benefits through some Part C plans.

Each Year, Part D Pays:

 

  • Covered prescriptions included on the formulary (a list of covered drugs based on the plan selected)
  • Varying shares of other covered prescription costs until you reach the coverage gap
  • Most of the other covered prescription costs after you are out of the coverage gap

Each Year, You Pay:

 

  • Monthly premium
  • Varying shares of covered prescription costs, until you reach the coverage gap
  • Varying shares of the cost of generic and brand name drugs while in the coverage gap
  • Low or zero copays or coinsurance for prescription drug costs, after you are out of the coverage gap

 

 

 

 

 

What is a Medicare Supplement (Also known as Medi Gap)?

 

Medicare Parts A and B work together to provide basic medical coverage, but they don’t pay for everything. Expenses such as deductibles and coinsurance are still your responsibility.

 

Medicare supplement insurance plans could help pay for some of the out-of-pocket costs that Medicare Parts A and B don’t pay. Medicare supplement insurance plans are offered by private insurance companies and work with the coverage provided through Medicare Parts A and B. A variety of standardized plans are available to meet your budget, and each offer the same basic benefit structure. Benefits and costs vary depending on the plan chosen.

 

Medicare supplement insurance plans may also help you control your health care because there are no network restrictions. This means you can visit any doctor who accepts Medicare patients, and you can see a specialist with no referrals needed.

 

More about Medicare Supplement Insurance Plans:

 

  • In all states, Medicare supplement plans have the same basic benefits. So when shopping for a plan, you can compare one company’s “plan F” to another company’s “plan F.”

Note: Medicare supplement plan options available in Massachusetts, Minnesota and Wisconsin are standardized differently than plans available in the rest of the U.S.

 

Depending on the plan you choose,

 

 

 

Medicare supplement insurance pays:

 

  • Part A coinsurance, and most plans pay the hospital deductible
  • Some of the out-of-pocket costs not paid by Part B. Some plans also cover the Part B deductible
  • Cost of blood transfusions (first 3 pints)
  • Cost of 365 extra hospital days after you’ve used up your Part A benefits
  • Skilled nursing facility coinsurance
  • Hospice – Part A coinsurance
  • Respite care

Depending on the plan you choose, you pay:

 

  • Monthly premium
  • Limited out-of-pocket costs

 

How do I decide?

 

Understanding your options is important to deciding which type of Medicare or Medicare-related insurance might be right for you. Click or hover on the icons below for additional information on insurance options.

 

Option 1:     Medicare  Part   A & B

 

Option 2:      Medicare  Part  A & B    +     Medicare  Supplement

 

Option 3:     Medicare Part A & B       +   Part  D

 

Option 4:    Medicare Part  A & B       +   Medicare Supplement     +   Part D

 

Option 5:   Part C

 

Option 6:   Part C   + Part  D