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Hood County Medicare Plans
Medicare Insurance Made Easy
Hood County Medicare Plans
Healthcare costs had been a significant concern in the United States for many years. Many US citizens cannot afford to get medical insurance or pay for medical bills, which leaves them in a dilemma when making decisions regarding their finances and health.
The government saw the health struggles that its people were going through and came up with a Medicare Program to secure American citizens’ health. The program provides quality and affordable health services for millions of American citizens.
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.
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 just 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.
Medicare Part A – Original Coverage
Once you apply for Medicare, you get enrolled in Part A, also referred to as the original or hospital coverage. The plan covers your hospital admission, hospice, and professional nursing care for patients who need it after being ministered to for occurrences that need rehabilitation in a medical facility before they recover fully.
Part A is somehow free, and you need not pay for a premium since it is already covered in your tax deductions form on your paycheck as Medicare tax.
Medicare caters to all hospital services for the first two months of hospitalization but does not cater to a private room.
Who is eligible for Part A original coverage? You are eligible for Part A original coverage if you are aged sixty-five and over or if your partner or spouse worked and paid for the scope for more than ten years. However, you can still get Part A coverage premium-free if:
- You are entitled to acquire Railroad or Social Security benefits, but you are yet to file for them.
- You or your spouse worked for the government, which catered for your original cover.
- You are getting retirement benefits from Social Security or the Railroad Retirement Board.
You can still get Part A coverage if you and your spouse never paid Medicare care taxes while working by buying it. If you are below sixty-five years, you can get Part A range for free if:
- You are a kidney patient.
- You qualify for Social Security or Railroad Retirement Board disability advantage for twenty-four months.
Medicare Part B – Doctor and Outpatient Services
Part B’s program caters to doctor’s visits, medical equipment, laboratory tests, diagnostic screenings, ambulance services, and other outpatient services. Part B is more expensive than part A, and sometimes, people postpone signing up for the plan if they have work insurance or are covered by their spouse’s health scheme.
However, for people who don’t have medical insurance and are not covered in any way and still ignore signing up for part B, they are charged a higher monthly premium for as long as they first sign-up for the government medical program they stay in the scheme. You are eligible for part B Medicare if you:
- Are aged 65 years and above.
- You are a US citizen, or you are a permanent lawful resident who has resided in the US for more than five years.
Medicare Part C – The Advantage
The part C plan allows you to get Part A and Part B medical services from private insurance companies linked to Medicare. For the impatient care, it covers everything under Part A with an additional home care service.
However, Part C has divergent cost allocation for inpatient care and healthcare compared to the original plan. The good thing is that hospice care in plan C is covered by Plan A and B. For outpatient care, it substitutes for preventive services and medically essential services such as Occupational therapy, doctor visits, Emergency ambulance services, physical therapy, Lab test and x-rays, mental services, speech and language pathology, and preventive vaccines according to medicareusa.com. Plan C boasts of various advantage plans that include the following.
1. Health Maintenance Organizations (HMOs)
Employers cover it through an HMO Medicare Part C, and it boasts of provider networks that need you to approach the providers in the plans provider network for full coverage. It also asks you to choose a primary care provider and a referral when you need to see a specialist.
2. Preferred Provider Organizations ( PPOs)
Provided by some employer groups, and it typically has provider networks. It allows you to approach providers outside the provider network plan with higher charges. You can also choose a primary care provider and do not ask for referrals when visiting a specialist.
3. Private Fee for Service Plans (PFFS)
The plan comes up with its unique payment structure and settles on how much it will pay its providers and how much it will part with as a patient. It is a good pan as it allows you to visit any hospital that accommodates Medicare assignment and PFFS payment terms. Even better, it does not ask you for referrals or to choose a primary care provider. As for the plans Copayment and coinsurance, you can only meet their service time.
4. Special Needs Plans (SNPs)
It is a unique plan that serves people suffering from certain health conditions or with exceptional qualifications. The program needs you to use providers specified in its network except in emergency and kidney dialysis cases. It also requires you to choose a primary caregiver and referrals to specialists.
5. Medical Savings Account Plans (MSA)
A unique plan that charges a lot of money from your deductibles in a separate bank account specifically for you, for your medical care coverage. The plan allows you to visit any hospitals that accept the government project. Sadly, it does not cover prescription drugs despite allowing additional coverages such as frequent dental and optical services.
Part C plans are cheaper than parts A and B, with additional benefits depending on the patient’s insurance company and individual plan.
Medicare Part D
Part D covers prescription drugs, which you can sign up for alongside your Part A and B coverage. Every Medicare Prescription Drug Plan has a formula that lists the medications covered, which is available online. Part D requires you to pay a premium, accompanied by other costs that include coinsurance and copayments. However, the prices differ with different plans.
Part D coverage is optional, but it is advisable to enroll on it once you are registered for Medicare to avoid late enrollment penalties when you decide to sign up for it later.
Choosing Your Ideal Medicare Plan
Thanks to Medicare plans, millions of US citizens can today get affordable and quality medical care anytime they want, depending on the schemes they choose. If you’re not sure of which Medicare plan to go for, you should consult a professional so that you can make the right choice and get enrolled on time.
Need help? Call us for an appointment at (817) 952-3153
Ashford Insurance is an independent health insurance agency specializing in Texas Medicare insurance and has been helping seniors since 2005. Ashford Insurance is here to help you understand Medicare and health insurance in simple, plain terms that anyone can grasp. We specialize in assisting folks who are Medicare eligible to learn about the coverage options available through the Medicare Health Insurance Program.
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