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Medicare 101

Insurance can be pricey; Medicare offers different insurance options to help meet your healthcare needs. Medicare is a U.S federal government-funded health insurance program that covers medical care for people over the age of 65. You are also eligible for Medicare if:

  • You have a disability and a disability pension from Railroad retirement board
  • You are receiving social security disability benefits for two years
  • You have Amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease
  • You have end-stage renal disease, have undergone renal transplant or receiving dialysis

The program is currently being administered by the Centers for Medicare and Medicaid Services (CMS), extending its services to those with amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease and end-stage renal disease. Medicare is divided into four different type of services:

Medicare Part A

Medicare Part A covers costs that are billed by hospitals, inpatient, or similar settings, for example, some home-based healthcare, hospice and nursing facilities. However, this plan does not cover any long-term or custodial care. The coverage is for most people with a modest income with no premiums. People who have a higher income will be required to pay a small monthly amount for this plan.

Medicare Part B

Medicare Part B covers costs for medical and outpatient care, for example, doctor visits and mental health coverage. It also includes ambulance services, medical equipment, and a large portion of preventative services.

Medicare Part C

Medicare Part C, also known as Medicare advantage, is not a separate medical benefit and offers insurance plans to those enrolled in Part A and Part B. They may also offer extra benefits that Medicare patients would otherwise need to purchase through supplemental insurance. These benefits may include dental, hearing, vision care and even costs related to insurance while travelling outside the United States.

Medicare Part D

Medicare part D covers supplemental prescription drugs and out-of-pocket costs that otherwise original Medicare does not. You can enroll in Part D if you are already enrolled in Medicare Part A and Part B.

If you’ve been receiving social security benefits from the age of 65 then you will automatically be enrolled in Medicare Part A and Part B, covering hospital costs and doctor visits. However, if you want prescription drug coverage of Medicare Part D, you’ll need to enroll yourself. If you are not receiving social security benefits you will have to sign up through the Social Security Administration website. It is recommended that you do this in the seven-month window around your 65th birthday to avoid any permanent penalties. If you want to enroll for Medigap, private health insurance plans sold to supplement Medicare, you will have to sign up during the six-month Medigap enrollment period which starts in the month you turn 65. You are also required to be enrolled in Medicare Part B. the private insurers require you to sign up during the period – if you miss the initial window there is no guarantee they will sell you the Medigap plan.

Medicare Advantage

Understanding Medicare Advantage

Medicare Advantage is a private insurance alternative to Medicare. Although popular, it comes with its own pros and cons. Some Medicare Advantage programs offer saving that are better in terms of savings, flexibility, and care in the long-term. Whereas others offer few options with the added expenses and lifestyle changes. The programs offer hearing, dental, vision, prescription drug and other optional coverages that regular Medicare does not offer. The costs vary depending on the plan that you have signed up for, your medical needs and location.

Currently, more than 60 million Americans are registered in Medicare. Similarly, more than 37% of these people are registered in a Medicare Advantage plan or an alternative Medicare plan option.

The Advantage premiums are variable among different plans, whereas some plans do not charge any premiums. Average advantage premiums according to the Kaiser Family Foundation (KFF) were $29/month in 2019. Beneficiaries may also have to pay deductibles and copays which also vary for each plan. For example, there are some plants that may charge $10 or $20 as copay for each doctor visit. However, with original Medicare, the extra costs may be lower with the benefit of a yearly limit. After the beneficiary has reached the limit amount, the plan will not pay for any covered services.

How does one enroll in a Medicare Advantage Plan?

There are several ways you can find out about advantage plans.

  • You can call 1-800-MEDICARE to find out about the plans that are available in the area.
  • You can also opt for a paper enrollment form, once the form is complete, return it to the company.
When can you sign up for a Medicare Advantage Plan?

There are 3 set time periods of when you can join a Medicare Advantage plan and change or drop your current plan.

  • Initial enrollment – you can join a Medicare Advantage plan when you first get Medicare. The initial enrollment program begins 3 months before your 65th birthday month; it includes the birthday month and ends after 3 months of the birthday month.
  • General enrollment – you can sign up for original Medicare each year from January to March if you did not do so during the 7 months you were initially eligible. You can enroll in the program from April to June with the coverage starting in July.
  • Open enrollment – this enrollment period goes on from October 15th to December 7th. During this tenure you can switch Advantage plans, choose, and drop a plan. You can also make changes to a prescription plan (Part D). Medicare Part D gives you prescription drug coverage, whereas Medicare Part C refers “Medical Advantage”.

In summary, Medicare Advantage (Part C) is an alternative to original Medicare Parts A and B, offered by private companies with additional benefits. You will also have to cover copays and deductibles in addition to plan premiums. The costs vary among plans. Medicare Advantage allows you to join or change Advantage plans during various enrollment periods.

What is Medicare Supplement Insurance

What is Medicare Supplement Insurance?

Medicare is a federal government health coverage program that caters to people with certain disabilities and adults over the age of 65 years. However, it does not cover for all the costs of healthcare services and supplies. A Medicare Supplement insurance can (Medigap) policy can help pay for the remaining healthcare costs, for example, copayment, coinsurance, and deductibles.

Medicare Supplement Insurance Policies

About two-thirds of seniors and disabled beneficiaries of Medicare choose Medicare Part A and Part B which cover for medical procedures, doctors and hospitals. 81% of these beneficiaries choose to supplement their insurance with Medigap or Medical Supplement Insurance. Whereas 25 million beneficiaries also pay for stand-alone Medicare Part D prescription drug policy. While these options are expensive compared to the former, there are a few advantages. Both Medicare and Medigap insurance plans cover for hospitals and doctors that accept Medicare in the United States. This program also does not require any prior authorization or referral from a primary care doctor. Medigap’s coverage includes the entire U.S. which is important for anyone who is a frequent traveler or is in a different locale for part of the year. This is also a beneficial program for those who have particular hospitals and physicians they want to use.

Medicare Advantage Policies

Medicare advantage policies (Part C) are available from Medicare-approved, private insurance companies. The program is marketed to consumers under names including, Kaiser Foundation Medicare plans, Humana and Aetna. Compared to significant premiums for Medigap and insurance policies for prescription drugs, there may be no premium or lower one. Medicare Advantage plans cover services that are not covered by Medicare, such as prescription drugs, including hospitals and doctors. Statistics have shown that around one-third of Medicare beneficiaries choose on these plans. What’s more, most of these plans operate as either a health maintenance organization (HMO) or preferred provider organization (PPO). A drawback of HMOs is the fact that it limits members to using doctors and hospitals within their networks. On the contrary, PPO lets members get care from outside the plan’s network, however, members are required to pay more for such care. Some plans also have a prerequisite of prior authorization for referral from a primary care doctor, specialist care and procedures. The plan might not cover care outside the network’s geographical area. Extra benefits, such as, routine dental care, eyeglasses and gym memberships may be offered which are not covered by regular Medicare. There are more than 4,800 Medicare Advantage plans currently offered, therefore, it is important that you choose a plan that aligns best with your unique circumstances.

Medigap vs Medicare

Medicare supplement plans are very different from Medicare Advantage plans which are often used as an alternative to Medicare Part A and Part B. The plans are sold and administered by private companies, like Medicare supplement plans. The plans provided cover dental and vision care, also. Although a beneficiaries cannot have both parts A and B at the same time. Medicare supplement plans work in addition to Medicare parts A and B.


Who is eligible for Medicare?

Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance). You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years.

You can get Part A at age 65 without having to pay premiums if:

  • You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.

To find out if you are eligible and your expected premium, go the Medicare.gov eligibility tool.

If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A.

If you are under age 65, you can get Part A without having to pay premiums if:

  • You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months. (Note: If you have Lou Gehrig's disease, your Medicare benefits begin the first month you get disability benefits.)
  • You are a kidney dialysis or kidney transplant patient.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

Prescription Drug Coverage

Since January 1, 2006, everyone with Medicare, regardless of income, health status, or prescription drug usage has had access to prescription drug coverage. For more information, you may wish to visit the Prescription Drug Coverage site.