Seniors
Need help finding the Medicare Plan that is Right for you?
That’s where we come in.
What Is Medicare, and What Does It Cover?
Medicare is the government health care program for people 65 and over, and its coverage plays an important role in containing medical costs as you age. But Medicare benefits don’t pay for everything. Knowing the basics of how Medicare works can help you understand some of the expenses you’ll face.
Turning 65 Soon?
What do I need to know?
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’re not receiving Social Security benefits, you’ll sign up through the Social Security Administration 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.
Who is eligible for coverage?
You’re entitled to Medicare if you’re at least 65 and a U.S. citizen, or a permanent legal resident for the past five years. Medicare also covers some disabled people under age 65. People who receive Social Security disability insurance usually become eligible for Medicare after a two-year waiting period, although those with end-stage renal disease (permanent kidney failure) are enrolled automatically upon signing up and those with Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease) are eligible the month disability begins.
Part A – Hospitalization
Medicare Part A covers inpatient care in a hospital or skilled nursing facility, although not custodial or long-term care. Part A also helps pay for hospice care and some home health care. Medicare Part A has a deductible and coinsurance, which means patients pay a portion of the bill
Part B – Physicians and Medical Treatment
Medicare Part B covers doctor visits and other medically necessary services and supplies. That includes preventive services or health care to prevent illness, as well as ambulance services, durable medical equipment, mental health coverage, and a few types of outpatient prescription drugs. Medicare Part B requires a monthly premium.
Part D – Prescription Drugs
Medicare Part D helps cover the cost of prescription drugs. Plans are offered by private insurers and require monthly premiums. Higher-income beneficiaries pay more. There typically is a late penalty premium if you don’t sign up when you are first eligible.
Medicare Advantage Plans (Part C)
Medicare Advantage, also known as Medicare Part C, is a type of health plan offered by private insurance companies that provides the benefits of Parts A and Part B and often Part D (prescription drug coverage) as well. These bundled plans may have additional coverage, such as vision, hearing and dental care. Unlike Original Medicare, Medicare Advantage plans have an annual limit on out-of-pocket costs. Medicare Advantage plans are typically HMOs or PPOs that may vary by zip code/county.
Which plans are right for me?
It’s good to have an expert in your back pocket.
That’s where we come in. First, we gather the facts.
For example:
Who is your primary physician, and/or specialist, and do you want to stay with him/her?
If yes, we will review the Provider Networks to search for your preferred providers.
Which prescription drugs do you take?
We will search plan formularies to find the plans that are most accurate and cost-effective.
Want to choose your own doctors/specialists or content to let your primary doctor make the referral?
We will point you to the plan design to fit your needs.