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Medicare Insurance Made Easy

Hillsboro Medicare Insurance

Medicare helps cover the costs of health emergencies and chronic conditions, but it can also be used to help maintain good health. Medicare beneficiaries have to pay premiums and a variety of other out-of-pocket costs and must make decisions about their coverage options.

Are You Eligible for Medicare?

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment, and you are 65 years old and a citizen or permanent resident of the United States.

If you are not 65, you might also qualify for coverage if you have a disability or with End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:

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

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

  • You have received Social Security or Railroad Retirement
  • Board disability benefits for 24 months. You are a kidney dialysis or kidney transplant patient.

While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.

What Does Medicare Part A Cover?

Medicare Part A covers hospital care and hospice. Part A will also pay for short-term stays at a skilled nursing facility if it follows a hospital stay of at least three days. Most retirees don’t pay a premium for Medicare Part A, but there is a $1,484 deductible in 2021 and additional charges for long hospital stays.

What Does Medicare Part B Cover?

Medicare Part B is medical insurance that pays for doctor’s visits and outpatient care. Part B provides a variety of free preventive services, such as an annual wellness doctor’s office visit, flu shot, and screenings for certain conditions. Beneficiaries can go to any doctor, specialist, or other health care provider that accepts Medicare and is taking on new patients.

Most beneficiaries pay the standard Medicare Part B premium of $148.50 per month in 2021, but higher-income retirees pay more. If your income is at least $88,000 or more, then you pay the income-related premium, which is indexed and rises with income, says Tricia Neuman, director of the Program on Medicare Policy at the Kaiser Family Foundation. Medicare Part B has a $203 deductible in 2021, after which beneficiaries are generally responsible for 20% of the cost of most doctor’s services.

What Does Medicare Part C Cover?

Medicare Part C or Medicare Advantage Plans are an alternative to original Medicare in which private insurance companies pay for Medicare-approved and sometimes other services but with different prices and restrictions than Original Medicare. You may be required to use doctors in the plan’s network and get a referral to see a specialist.

What Does Medicare Part D Cover?

Medicare Part D provides prescription drug coverage. Part D plans are private health insurance policies that follow rules set by Medicare. The premium for Medicare Part D prescription drug coverage varies depending on the plan you select. 

What Does Medigap Cover?

Retirees can purchase Medicare supplement insurance policies called Medigap to help pay for Original Medicare’s out-of-pocket costs and additional services Medicare doesn’t cover. Medicare supplement policies typically cover the copays, coinsurance, and deductibles of Original Medicare in exchange for a monthly payment.

It’s important to enroll in a Medigap plan during the six-month period that begins when you’re 65 or older and enrolled in Part B because after this enrollment period ends, you may not be able to buy a Medigap policy or could be charged significantly more.