The Basics of Medicare

Medicare is a health insurance program for:

  • People age 65 or older.
  • People under age 65 with certain disabilities.
  • People with End-Stage Renal Disease.

What are the different parts of Medicare?

Medicare Part A (Hospital Insurance) helps cover your inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. When you enroll in Medicare, you receive Part A automatically. For most people, there is no premium for Part A.

Medicare Part B (Medical Insurance) helps cover medically necessary services from doctors and other health care providers, outpatient care, home health services and durable medical equipment. Part B also covers a wide range of preventative services such as vaccinations, screenings and an annual “Wellness Visit”. Additionally, Part B covers some other medical services that Part A doesn’t cover, for example physical and occupational therapy. The base monthly premium for Part B is $135.50 per month, but it could be higher based on your income. Once you begin receiving Social Security, the premium for Part B is deducted directly from your check.

Original Medicare is the name given to the benefits covered under Part A and Part B.

Medicare Part C Medicare Advantage Plans (like an HMO or PPO) are health plan options that are approved by Medicare and run by private insurance companies. They include all of the benefits covered under Parts A and B of Medicare as well as Part D prescription drug coverage. Many of these plans also have extra benefits such as dental, vision, hearing and fitness. There are several companies in our area which offer very competitive Medicare Advantage plans for a $0 premium.

Medicare Part D are Prescription Drug Plans offered by insurance companies approved by Medicare. There are many different companies offing prescriptions drugs, all with varying premiums and formularies. It is important to reevaluate your prescription drug plan to make sure you have the one that best suits your needs.

“We do not offer every plan available in your area. Currently, we represent 6 organizations that offer 48 products in your area. Please contact, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

During the Medicare Advantage Open Enrollment Period (MA OEP)- January 1 – March 31), Medicare Advantage plan enrollees may enroll in another Medicare Advantage plan or disenroll from their Medicare Advantage plan and return to Original Medicare. During MA OEP, unless you qualify for a Special Enrollment Period, enrollment in a new plan for existing Medicare Advantage enrollees is only permitted during MA OEP.”

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