Cooke County Medicare Plans

Cooke County Medicare Plans

Medicare is government-funded insurance for people 65 and older. It’s for individuals without access to healthcare either because they’re too old or they can’t afford it. Even though it’s sponsored by taxpayer dollars, it isn’t free. There are premiums, copays, and deductibles — but compared to private insurance, it’s very affordable.

More than 19 million Americans have signed up for Medicare, which was created in 1965. In the beginning, there were only 2 basic plans: hospitalization and medical services. Now, the program insures more than 63 million Americans, expanding to cover prescription medication, chronic illnesses, and the disabled.

Sign up When you are 64

Eligibility for Medicare coverage begins when you turn 65, but there’s no reason to wait until then to sign up. The initial enrollment period begins 3 months before your 65th birthday. The 7-month window lasts until 3 months after, but if you miss your initial enrollment period you may face financial penalties and decreased coverage. Everyone knows the wheels of government turn slowly, so signing up early is a good idea.

What happens if you wait until after you’re 65 to sign up for Medicare? While Medicare isn’t mandated by law, it’s required you sign up by the time you’re 65. If you don’t, your premiums will increase by as much as 10% per year. On top of that, Medicare may not cover pre-existing conditions.

Who is Eligible for Medicare?

If you’re 65, or about to turn 65, and you’re an American citizen or permanent resident, you’re eligible for Medicare. You qualify for Parts A and B. Part A is free if you’ve been working and paying your taxes or you and your spouse combined have been working and paying your taxes for 10 years or more. If not, you still qualify for Part A, it’s just not free.

The magic age is 65, but you also qualify if you’re disabled and receiving Social Security Disability Insurance (SSDI). If you believe you’re disabled and can no longer work, you need to apply for Social Security benefits.

Find out more about Social Security disability benefits at SSA.gov.

To see if you qualify, check out the Social Security Benefits Eligibility Screening Tool.

If you do qualify for SSDI, Medicare automatically enrolls you after 24 months and your Part B premiums get deducted directly from your disability check. In some cases, the waiting period is as low as 12 months.

How Many Parts Does Medicare Have?

Medicare plans cover everything from hospitalization to medical services, prescription drug medication to hospice, and home care. Medicare has 4 basic parts: A, B, C, and D. A supplemental insurance plan, Medicare Part G, also is available.

The different Medicare parts are:

Part A: Hospitalization – Part A includes basic hospitalization; all types of in-facility care from surgery and blood transfusions to chemotherapy and radiation.

Part B: Medical services – Part B includes doctor’s visits, ambulance services, durable medical equipment (DME), and mental health issues, both inpatient and out.

Part C: Medicare Advantage plan – Part C bundles all the services covered in parts A, B, and D and adds vision, dental, health and wellness, and hearing. Part C functions very much like a basic health maintenance organization (HMO) or preferred provider organization (PPO) with monthly premiums, deductibles, and copays.

Part D: Prescription medication – Part D includes coverage for most outpatient prescription drugs. Part D serves as either a stand-alone plan or as part of Medicare Advantage.

Is Medicare a Generous Insurance Program?

Few people would describe Medicare as generous. The program provides fewer benefits than most private insurance and covers only half the healthcare costs. Still, it gives people health insurance who otherwise might not qualify. Spending per beneficiary grows at a slower rate than with private insurance.

Medicare is, however, a blessing for many. Before Medicare came along, only 25% of senior citizens had adequate healthcare. After its implementation in 1965, that number rose quickly to 100%. Medicare filled the insurance void when it came to catastrophic coverage but still left holes for coverage like dental, vision, and hearing. Remember, in the beginning, there were only parts A and B. It wasn’t until later that Medicare introduced Part D — prescription medication coverage.

Medicare also doesn’t cover long-term nursing home care, a necessity for many seniors, or personal in-home care. The cost of an assisted-living facility can be upwards of $78,000 a year, all of which the individual now pays for with no financial assistance from Medicare. Medicare is not often called generous, but it does cover the basics.

What is Medigap?

Medigap, or Medicare Part G, is a supplemental plan that fills in the gaps where regular Medicare Parts A and B leave off. Medicare isn’t free. You need supplemental health coverage like Medigap to pay for many of the services regular Medicare does not. You must first qualify for Medicare Parts A and B to be eligible for Part G.

Medicare Part G covers 100% of coinsurance and hospital costs after Part A benefits run out. Part G coverage lasts for up to 1 year. While Part G does pay for Part A’s deductible, it does have a deductible itself. Part G also pays for hospice and home-care copayments and coinsurance.

When it comes to Part B, Medigap pays for all copayments and coinsurance. It pays for all costs incurred at a skilled nursing facility (SNF) and coinsurance as well. It even pays for up to 3 pints of blood.

Medigap pays many of the bills not covered by parts A and B. It does not, however, like a Medicare Advantage plan (Part C), pay for:

• Vision
• Dental
• Hearing
• Private nursing
• Long-term care

Most Medigap plans, unlike Medicare Advantage, don’t pay for prescription medication. If you sign up for a Medigap plan, you’re also going to need to have a prescription medication plan (Part D).

Medigap plans are sold by private insurance companies, so prices vary from state to state. While prices vary, benefits remain the same nationwide. Medigap plans are available to Medicare recipients in all 50 states and the District of Columbia.

When Should I Sign Up for Medicare?

Medicare is insurance for seniors 65 and older, people who otherwise wouldn’t qualify or can’t afford private health insurance. It’s sponsored by the federal government and partially paid for by the payroll taxes that come out of your paycheck. People who qualify for Medicare include:

Seniors 65 or older

People with disabilities and receiving Social Security disability benefits

People with end-stage renal or Lou Gehrig’s disease

If you’re 65, or about to turn 65, it’s highly recommended you enroll in Medicare. If you wait until after your initial enrollment period, you may not qualify for certain benefits. Medicare may not cover pre-existing conditions.

Your initial enrollment period begins 3 months prior to your 65th birthday and lasts until 3 months after (a 7-month window). If you miss your initial enrollment period, you can still apply during the general enrollment period, but there will be penalties, and you’ll pay higher premiums for as long as you have Medicare.

To see whether you are eligible for Medicare, check out the Medicare eligibility tool at Medicare.gov.