When you turn 65 you have to master a new health care system.
If you are still working, you may not have to enroll in Medicare Part B.
We’re here to help you every step of the way.
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Medicare was implemented by the federal government in 1966 and makes coverage available for more than 55 million people. While working, you pay payroll taxes which fund Medicare Part A. Medicare Part B is paid by you and is a monthly premium based upon your annual income for the prior 2 years.
Often, Medicare Parts A & B are referred to as Traditional or Original Medicare.
1. Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
2. Medicare Part B (Medical Insurance)
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
3. Medicare Part C (Medicare Advantage Plans)
A type of Medicare health plan offered by a private insurance company which contracts with Medicare to provide you with all your Part A and Part B benefits.
Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare.
Most Medicare Advantage Plans offer prescription drug coverage.
4. Medicare Part D (prescription drug coverage)
Part D 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.
On average Medicare Parts A & B cover about 50 percent of the costs (co-pays, co-insurance, deductibles) incurred by plan members. These out of pocket costs or “gaps” are borne by the plan member, most often in the form of supplemental coverage through private insurance carriers.
Because coverage is limited, many people seek out supplemental insurance options and prescription drug coverage – both at an extra cost.
This is either the health insurance portion of your coverage (Medigap) or your health insurance and drug (Medicare Advantage) combined coverage.
Medigap - Also referred to as a Medicare supplement - covers the gaps in traditional Medicare. There are 11 standardized plans to choose from and usually cover all or a portion of the cost of co-pays, co-insurance, and deductibles.
Medicare Advantage plans, at a minimum, cover everything offered by traditional Medicare Parts A & B. Many Medicare Advantage plans also include dental care, prescription drug coverage, health club membership, often at a minimal cost. You work within a network (PPO, HMO) of doctors, hospitals, etc. These plans change on an annual basis.
Prescription drug coverage plans are not provided within the traditional Medicare program. There are many available plans to choose from, and some plans’ formularies of covered drugs are broader than others. These plans change on an annual basis.
Most direct-to-consumer websites present Medigap or Medicare Advantage plans as straightforward proposition. Experience shows that may not be the case. Each plan is state specific so it’s advisable to seek the advice of an experienced advisor who can help you with your Medicare enrollment, selection of supplemental insurance, and do an analysis of your prescription drug coverage needs.
Working with an experienced advisor, will ensure that you have “peace of mind” in selecting the most cost effective and best coverage given your unique health care needs, both now and in the future.