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MEDICARE BASICS

What is Medicare?

Medicare is health insurance for people:

  • 65 and older
  • Under 65 with certain disabilities
  • Any age with End-Stage Renal Disease (ESRD), permanent kidney failure requiring dialysis or transplant

Medicare is provided by the federal government and administered by CMS – Centers for Medicare & Medicaid Services.

What are the parts of Medicare?

Part A (Hospital Insurance) helps cover:

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care

Part B (Medical Insurance) helps cover:

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
  • Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

Part D (drug coverage):

  • Helps cover the cost of prescription drugs (including many recommended shots or vaccines)
  • Part D plans are run by private insurance companies that follow rules set by Medicare.

Part C (Medicare Advantage Plans):

  • Medicare Advantage is 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.
  • In most cases, you’ll need to use doctors who are in the plan’s network.
  • Most plans offer extra benefits that Original Medicare doesn’t cover— like vision, hearing, dental, and more.
  • Medicare Advantage Plans are sold by private insurance companies.

Medicare Supplement Plans (“Medigap”, “Medsups”):

  • Medicare Supplement Plans are sold by private insurance companies.
  • Medsups fill in the gaps of Original Medicare, helping limit your out of pocket costs.
  • These types of plans do no offer drug coverage or extra benefits such as dental, vision, hearing, and more.
  • You can visit any doctor who accepts Original Medicare.

Enrolling into Medicare

  • You will enroll into Original Medicare (Part A and Part B) through Social Security.
  • You will automatically receive your Medicare card if you are receiving:
    • Social Security Retirement
    • Social Security Income (SSI)
    • Social Security Disability (25th month on disability)
  • If you are not taking Social Security, you will need to contact Social Security to enroll in Original Medicare:

Call Social Security

Visit your local Social Security Office

Go online: https://www.ssa.gov/benefits/medicare/

  • If you do not enroll in Part B when you are first eligible you could incur a late enrollment penalty. Contact us for more information on this.
  • If you have a special circumstance to enroll at a later date, such as employer coverage through you or a spouse (employer must have 20+ employees), you may be able to delay your Part B without incurring a penalty.
  • For step-by-step help and assistance in enrolling in a Medicare plan, please call us: 843-848-8844