A look at Medicare benefits, including Original Medicare, supplemental coverage options, and Medicare Advantage plans.
Original Medicare (often just called “Medicare”) is a federal program that provides health insurance for people 65 and older and people with certain disabilities. Under Original Medicare, you can receive your services from any qualified health care provider in the US who accepts Medicare.
Original Medicare is made up of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance covering doctor visits and treatment).
Original Medicare does not pay 100% of the cost of covered services. There are also things Original Medicare does not cover at all, including prescription drugs, routine eye, dental, foot, and hearing care, long-term care, most care outside the US, and more.
Many people enroll in additional plans to help cover some of these costs.
Once you enroll in Original Medicare, you can choose to add plan(s) from private insurance companies to help fill some of the coverage gaps and reduce your out-of-pocket costs. These plans include Medicare Supplement/Medigap plans, Prescription Drug (Medicare Part D) plans, and Medicare Advantage (Medicare Part C) plans.
There is a wide range of Medicare Advantage plans, so costs, benefits, and your choice of health care provider can vary.
Medicare Advantage plans (also called Medicare Part C) are "all-in-one" plans. With Medicare Advantage plans, you can receive coverage for your Part A inpatient hospital stays, Part B doctor visits, and Part D prescription drugs all in one plan.
They cover everything that Original Medicare covers with extras - including dental, vision, hearing, over-the-counter, and fitness/wellness benefits. They may also cover urgent and emergency care while you travel.
A variety of plan types are offered, including PPO, HMO, HMO-POS, and HMO SNP plans.
Original Medicare does not include Part D prescription drug coverage (for drugs you would normally get at a pharmacy). If you want prescription drug coverage, you must either buy a standalone Part D Prescription Drug plan from an insurance company contracted with Medicare, or you can enroll in a Medicare Advantage plan that includes Part D benefits.
You pay a monthly premium, deductibles, and copayments or coinsurance with stand-alone plans and with some Medicare Advantage plans.
Medicare Supplement plans (also called “Medigap” plans) help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some also cover services Original Medicare doesn’t, like care outside the US.
Supplement/Medigap plans do not cover prescription drug costs, so you can also buy a Part D Prescription Drug plan. Monthly premiums for Supplement/Medigap plans are typically higher than those charged by Medicare Advantage plans.
There are two paths you can take to get additional coverage. Both begin with the first step of enrolling in Original Medicare. Here is a look at the steps you will need to take.
Enroll in Original Medicare when you become eligible.
The government-provided Original Medicare plan...
covers hospital |
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covers doctor and |
Then, choose from two paths to add more coverage:
Supplement/
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Medicare Advantage Plans
Medicare Advantage These plans include Medicare Parts A and B, plus more. The Part D Prescription Drug Plan is included with most plans.
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Learn the ins and outs of Medicare eligibility periods, enrollment, and assistance programs you may quality for.
There are specific times when you can sign up for plans or make changes to coverage you already have. Each year you'll have a chance to review your coverage and change plans.
Most people are first eligible to enroll in Original Medicare when they turn 65. Your seven-month-long “Initial Enrollment Period” begins three months before the month you turn 65 and ends three months after. You must be a US citizen or legal resident who has lived in the US for at least five years in a row.
Annual Enrollment Period for Medicare Advantage and Medicare prescription drug coverage: Every year Medicare offers an “Annual Enrollment Period,” from October 15 to December 7, when you can add, drop, or switch your enrollment for the following plan year.
Medicare Advantage Open Enrollment Period: Medicare offers a “Medicare Advantage Open Enrollment Period” from January 1 to March 31 each year. During this period, if you’re already in a Medicare Advantage plan, you can switch to another Medicare Advantage plan. You can also disenroll from your Medicare Advantage plan and return to Original Medicare and join a Medicare Part D Prescription Drug plan (if you choose to do so).
Medicare also offers “Special Enrollment Periods” when you can make enrollment changes if certain circumstances change (for example, if you lose employer coverage, move to a new service area, or would like to switch to a plan that has earned a 5-Star quality rating from Medicare.)
When you become eligible, begin the enrollment process with the Social Security Administration:
There are several state and federal programs that provide assistance with Medicare costs for Part A, Part B, and Part D. Eligibility varies by state and is determined by income and assets.
You can contact the Social Security Administration online, call 1-800-772-1213 (TTY/TDD: 1-800-325-0778), or visit your local Social Security office to see if you are eligible.
More people than ever before are deciding to delay their Medicare enrollment and continue to get their health insurance through their employer. While working past 65 can help you put away additional savings for retirement, you could inadvertently be penalized for not enrolling in Medicare at the proper time. Before you make this important decision, you should know what the impact could be.
We’ve put together the following information to help you better understand your options.
Speak with your benefits administrator to see how your employer’s plan works with Medicare. You may be required to enroll in Original Medicare Parts A and B when you turn 65. Many people only enroll in Part A (hospital coverage with no premium) and delay enrollment in Part B until they lose employer coverage. Contact your Social Security office to make sure your enrollment decisions are followed.
Keep records of any prescription drug coverage you receive from your employer after you turn 65. You may need proof of this when you eventually enroll in Medicare to avoid penalties.
Most people are first eligible to enroll in Original Medicare when they turn 65. Your seven-month-long “Initial Enrollment Period” begins three months before the month you turn 65 and ends three months after. You must be a US citizen or legal resident who has lived in the US for at least five years in a row.
You could save money if you switch to a Medicare plan with additional coverage.
If you want one health plan that includes Parts A and B, plus Part D Prescription Drug coverage and more, choose a Generations Advantage plan.
Let’s talk about your health needs and how our plans help you keep doing the things you love. Call us today to find out more about Martin’s Point Generations Advantage plans.