WHAT IS MEDICARE?

MEDICARE, SIMPLIFIED

Medicare is the United States health insurance program that provides health services for people at age of 65 and older, or those under age 65 who have End-Stage Renal Disease, ALS, or have been collecting SSDI for at least 2 years. This national healthcare program is sponsored by the U.S. government and has administration under the CMS (Centers for Medicare ad Medicaid services).

It was created by the U.S. Congress as part of the Social Security Act amendments in 1965 to provide health insurance for people who were 65 or older and didn’t have any insurance policy.

There are four categories of Medicare coverage and each part covers different types of healthcare circumstances so it is important to know what benefits are included in each of those categories. These are known as Part A, B, C, and D.

What is Part A

Medicare Part A is half of "Original Medicare" (the half part is Part B). This coverage helps pay for bills for inpatient care like hospital stays and skilled nursing facility. Everyone who worked for at least 40 quarters (at least 10 years) and paid into medicare taxes will get this part premium-free.

Even if you get Part A Premium-Free, there is still a deductible that must be paid if you are hospitalized, which is why it's important to get a Medicare Supplement or Medicare Advantage to help cover these out-of-pocket costs

What is Part B

Medicare Part B (the other half of "Original Medicare") helps cover costs for doctor visits, preventative services like vaccines, cancer screenings, ambulance services, lab tests, surgeries, and durable medical equipment (like wheelchairs, walkers, or other medical devices)

The base monthly premium for Part B is $174.70 per month in 2024, which is usually deducted right out of your Social Security Check. This monthly premium could be higher if you earn over $103,000 annually, this is known as IRMAA (Income Related Monthly Adjustment Amount)

Part B also has a one time deductible of $240. And a coinsurance of 20% of the cost of your services without cap.

What is Part C

Medicare Part C is one way to help fill in the gaps of A and B. It is also known as "Medicare Advantage". Part C plans are sold by private insurance companies and must provide at least the same amount of coverage as Original medicare. If you decide to enroll in Part C, it will become your primary health coverage. You will still keep A and B, but will usually have part D included, along with added benefits such as Dental, Vision, Hearing, and Transportation

What is Part D

Part D is your Drugs. Medicare requires you to have a part D plan or other creditable coverage, or you will be penalized. If you do not have part C, this can be purchased separately. If you do have part C, it will be included in your Part C plan. If you are a Veteran, you have VA coverage, also known as "Express Scripts" which Medicare classifies as "Creditable Coverage" and you will not be penalized for not having a part D plan. As a veteran, there are specific plans designed for you, so reach out to see how we may be able to help

What is Medicare Supplements

Medicare Supplement Plans (also known as MediGap) are sold by private insurance companies and designed to help pay for additional costs left by Original Medicare, like coinsurance, copays, and deductibles. Before you can get a Medicare Supplement plan, you need to be enrolled in Original Medicare (Parts A + B)

Medicare supplement plans will have a cost to them, and do not include prescription drug coverage or Dental, Vision, Hearing. You will need to purchase them separately

Is Medicare Supplement or Advantage Better?

"Better" Is a subjective term, in fact it's one we don't use. What's important is which plan works for you. It will be based upon your health needs, your goals, and how much are you willing to spend for your healthcare. Reach out to talk to an expert today to see which path may be right for you