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Medicare

Helping you navigate Medicare solutions

Everyone unique, and so are our solutions. Here’s the options that we will overview.

Medicare
Part A

Medicare Part A covers your hospital expenses. This includes hospital stays, skilled nursing care, hospice, and home health-care services. You may have to pay various deductibles, coinsurance, and copayments. You earn Part A by paying taxes toward Medicare while working for 10 years (or 40 quarters). If you did not earn Part A, you will pay a premium.

Medicare
Part B

Medicare Part B covers services that treat illnesses or conditions such as doctor’s office visits, lab work, x-rays, and outpatient surgeries. It also covers preventive services like cancer screenings and flu shots. Part B also covers medically necessary durable medical equipment such as wheelchairs and walkers to treat a disease or condition. Most people pay a premium for Part B. Even if you are enrolled in a Medicare Advantage plan that provides your Part A and Part B benefits, you will still pay your Part B premium.

Medicare
Part D Prescription Drug Plans

Original Medicare doesn’t cover prescription drugs. Although Medicare Part D coverage is optional, it can be valuable if you take medications. You will pay a late-enrollment penalty if you don’t sign up for Medicare Part D Coverage when you are first eligible. You can get Medicare Part D prescription drug coverage either through an independent Prescription Drug Plan (PDP), or through a Medicare Advantage Plan that includes prescription drug coverage.

Additional Medicare Choices

01

Medicare Supplement Insurance Plans

A Medicare Supplement Insurance Plan is used with original Medicare. Any caregiver that accepts Medicare will take a Supplement because they only need to bill Medicare. Medicare pays their part (generally 80% of Medicare covered benefits) and sends the remainder of the bill to the Supplement which pays their part (generally 20%). It is important to note that Supplements do NOT include Prescription Drug Coverage (Part D, PDP) and for those that do not get a PDP when first eligible there will be a penalty when they do get a PDP. (there are exceptions to this) A Medicare Supplement does not change year to year (although the cost does generally go up the coverage does not change).

02

Medicare Advantage Plans

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are an “all in one” alternative to Original Medicare. They are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These “bundled” plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).

03

Medicare Prescription Drug Plans (Part D)

Medicare Prescription Drug Plan (Part D). These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.

Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost.

A drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.

Frequently Asked Questions

I’m turning 65 this year and I plan to retire. When am I eligible to enroll into Medicare?

Assuming you have met the work-related eligibility requirements, you may begin enrollment into Medicare 90 days in advance of the month you turn 65.

Can my dependent spouse be on my Medicare plan?
Medicare does not have spousal or dependent coverage. Medicare is individual. If your spouse has reached age eligibility (65), then they can enroll in Medicare of their own accord 90 days in advance of the month they turn 65.
Can I keep my employer coverage?
Maybe. If the employer group has 20 eligible employees or more, and you’re going to continue to work, then yes it’s an option. But there are many things to consider.
Do I need to enroll in Part “A” and Part “B” of Medicare?
Part “A” is typically in place, and a paid-up benefit when you turn 65. Part “B” is not, unless you have enrolled in Social Security prior to age 65. If you have not filed to receive Social Security benefits, then you need to proactively enroll in Part “B” benefits and begin paying for them.
Can I just have “Original Medicare” A+B as my health insurance at retirement?
Yes. However, you will not have prescription coverage, and you will face unlimited exposure to those costs due to the gaps in Original Medicare.
Can I keep all my same doctors when I’m on Medicare?
You usually can. It’s important to be sure your doctor accepts Medicare. Some don’t.
Does Medicare cover me if I’m in a nursing home?

Yes, for up to 100 days, after a required three-day hospital stay.

Does Medicare have dental plans?
No. But some Advantage plans offer limited dental coverage.
I am entitled to retiree benefits. Does that mean I won’t need Medicare?
No, a retiree plan will typically wrap around Medicare primary benefits.
What is Part “D”?
Part “D” is the Prescription Drug plan Medicare introduced in 2006.
What happens if I miss my designated enrollment window into Medicare?
In addition to having a huge gap in coverage, you will likely face a penalty from Medicare. A Part “B” penalty can be 10% of your Part “B” premium for each 12-month period outside of Medicare, and up to 1% of the national average of a Part “D” plan for each month absent Part “D”.
What is a Part “C” plan?
Part “C” is another name for Medicare Advantage. Also named MA, MSA, or MA-PD (when prescriptions are included).
Where do I go to get signed up for Medicare?

Online at SSA.gov or in person at a local Social Security office.

What is creditable coverage?
This is a Medicare term that establishes previous coverage being at least as good as Medicare’s. Typically is in play for Part “D” to avoid penalty.
Should I have both a Medicare Advantage Plan and a Medicare Supplement Plan?
No, that is not needed.

Still have questions?

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