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Medicare Basics

Medicare Made Easy

Medicare Basics

Medicare is the United States’ health insurance plan for citizens over the age of 65 and some others with certain health conditions. It covers many, but not all, of the costs of health care these populations.

Health care costs become increasingly significant with age or with certain health problems. These situations often coincide with an inability to work and earn income, so Medicare is an important part of long-term care plans for many Americans. Learn more about how the basics of Medicare and how you qualify.

If you are within three months of turning 65, you can apply for Medicare. Your basic Medicare options come in four types: Parts A, B, C, and D. Part C is also known as Medicare Advantage. Each part covers different items and comes with different costs. Original Medicare (Parts A and B) does not cover all your health care expenses, so most retirees will want additional coverage in the form of a Medicare Supplement policy or Medicare Advantage plan, as well as some form of long-term care insurance.

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 $85000.00 or less for an individual). Part B covers certain doctors’ 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.

Remember, in most cases, if you don’t sign up for Part B when you are first eligible, you will have to pay a late enrollment penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B, and coverage will start July 1 of that year. Usually, you don’t pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period.
 

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 (HMO’s), 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.

Next, learn: How Medicare Works

Need help? Call us for an appointment at (817) 952-3153

Sonia, “The Medicare Insurance Lady”,  has been helping folks eligible for Medicare in Texas with their Medicare Insurance now since 2005. Sonia is also licensed in Oklahoma. She has been married to John Ashford since 1982 and they reside in Bedford, Texas. They have six adult children and nine adorable grandchildren that they love to spoil. In Sonia’s limited spare time she enjoys quilting and crafting. 

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