Basics of Medicare 101
Medicare 101 Made Easy
These are the basics of Medicare:
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). If you or your spouse have worked full time for 10 or more years over a lifetime, you are probably eligible to receive Medicare Part A for free. If you have to buy Part A, you’ll pay up to $471 each month.
Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. What Medicare covers is based upon, Federal and state laws, National coverage decisions made by Medicare about whether something is covered, local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.
Medicare Part B is available at a monthly rate set annually by Congress ($148.50 in 2021 for incomes of $85000.00 or less for an individual). Part B covers certain doctor’s services, outpatient care, medical supplies, and preventive services. Some seniors are eligible to receive the medical insurance portion (Part B) free as well, depending on their income and asset levels. For more information, inquire about the Qualified Medicare Beneficiary (QMB), Special Low Income Medicare Beneficiary (SLMB), and Qualifying Individual programs through your county social services office.
Medicare Part C (Medicare Advantage Plans) is a type of Medicare health plan offered by a private insurance company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPO’s), Private Fee-for-Service Plans (PFFS’s), Special Needs Plans (SNP’s), and Medicare Medical Savings Account Plans (MSA’s). If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and are not paid for under Original Medicare. Most Medicare Advantage Plans have prescription drug coverage included.
Medicare Part D (prescription drug coverage) adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare.
Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans. Keep in mind, you may owe a late enrollment penalty if you go without a Medicare Prescription Drug Plan (Part D), or without a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, or without creditable prescription drug coverage for any continuous period of 63 days or more after your Initial Enrollment Period is over.
You can make a decision about how to receive your Medicare coverage during certain periods. When you first become eligible for Medicare you may choose between Original Medicare and a Medicare Advantage Plan and may choose a Medicare Advantage Plan three months prior, the month of, and three months after you turn 65. During the Annual Election Period (October 15th – December 7th), you may move from Original Medicare to a Medicare Advantage Plan or a Medicare Advantage Plan to Original Medicare or you can switch from one Medicare Advantage Plan to another. During the Medicare Advantage Open Enrollment Period (January 1st – March 31st), you can make one move from a Medicare Advantage Plan back to Original Medicare or from one Medicare Advantage Plan to another Medicare Advantage Plan. In most cases, you are locked into your choice for the calendar year; however, some people qualify for a Special Election Period and can make a change during the lock-in period; this may include a move in or out of a service area, qualification for Low-Income Subsidy, or losing group coverage.
Are you new to Medicare? Not sure what plan to choose at the Annual Open Enrollment? Ashford Insurance is dedicated to helping you find a supplement, advantage plan, or drug plan that is right for you.
Whether an “all-in-one” Medicare Advantage plan or a standalone Part D plan suits you, Ashford Insurance can help. Get a quote at no cost to you. Let one of our licensed agents review your options, and find the best drug insurance plan for your unique needs. Just give us a call today at 817-952-3153.
Next, learn: How Medicare Works
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