Medicare Basics
Think of Medicare as a two step process:
Step 1: Enroll into Original Medicare consisting of Medicare Part A & Part B
Original Medicare is the government provided health care coverage for people that are 65 and over, have been on Social Security Disability for 24 months or more or have end of stage renal failure (kidney failure). Medicare covers hospital and medical costs. You have a 7 month period surrounding the month of your 65th birthday to sign up for Medicare. If you wait to sign up, you may have to pay a penalty when you do join. You may have special circumstances that allow you to enroll outside of the initial enrollment period without penalty. If you are receiving SSDI, you will automatically enroll into Medicare after being on Social Security Disability for 24 months.
Helps cover your hospital expenses, like being admitted into a hospital.
Original Medicare does not cover prescription drugs… Please see “Step Two” on this page or “Part D” on the Medicare Insurance page for more information about drug coverage. Generally you will be automatically enrolled into Medicare if you are receiving Social Security benefits…either retirement or disability. If you are not drawing your Social Security benefits you will need to contact your local Social Security office so they can explain the process to you & assist you with your enrollment. We recommend that you schedule an appointment to speak with a local Social Security worker or if transportation is difficult, you can be enrolled over the phone.
Step 2: If you feel you need more than Original Medicare Provides you.
Option 1: Original Medicare
PRESCRIPTION DRUG PLAN…MEDICARE PART D
- Helps pay for prescription drug costs.
- Average National Cost Usually Ranges between $30.00 & $40.00
- Avoid the Late Enrollment Penalty (LEP)…Enroll in Part D.
AND/OR MEDICARE SUPPLEMENT INSURANCE (MEDIGAP)
- Upsides
- Covers some or all of the costs that are not covered by Original Medicare…fills in the “gaps.”
- Downsides
- Monthly premiums are paid if you need to use your insurance or not.
- Monthly premiums generally increase every year.
Option 2: Medicare Advantage Plans
MEDICARE PART C…MEDICARE ADVANTAGE PLANS
Part C Plans are private health plans that are contracted with Medicare to manage your Medicare Part A and Part B benefits. Most plans are structured as a PPO or HMO…just like you probably had with your employer while working.
Since they manage your Medicare benefits, all Part C plans give you the same benefits as Original Medicare, plus more…
Many Part C plans also include Part D, Prescription Drug Coverage so you will avoid the late enrollment penalty.
Part C plans usually have a low or no monthly premium.
Additional benefits can include: dental services, vision services, hearing services, health screening tests, gym access and nurse helplines are some of the items that are often included in Medicare Advantage plans.
Plans also cap your out-of-pocket expenses for the year. The maximum out of pocket limit provides a financial “safety net” for members.
Overwhelmed? Lets Keep it Simple.
1) Purchase a stand alone prescription drug plan with a Medicare supplement policy to help cover the gaps in Original Medicare.
2) Enroll into a Medicare Advantage plan with a no or low monthly premium that also provides prescription drug coverage.
Simple…right?
For help on deciding on how to set Medicare up for you or to help a loved one, check out our Setting Up Your Medicare page for more information about how to decide what is the best fit for you…or you can contact us and speak to someone that is local, licensed and certified. We will be happy to help educate and guide you on your options and choices so that you can make an informed decision on what is right for you.
Note…If you have limited income & assets please take the time to visit the Extra Help With Medicare Costs page for information about programs that are built into Medicare to help you pay for your health & drug costs.