Let us Help you Get Started with Medicare

 Medicare is health insurance for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). 

                                       Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

         Part B (Medical Insurance): Helps cover:

• Services from doctors and other health care providers
• Outpatient care
• Home health care
• Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
• Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits) 

Part D (Drug coverage): Helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to 

Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.

Medicare Supplemental Insurance (Medigap): Extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. Policies are standardized, and in most states named by letters, like Plan G or Plan K. The benefits in each lettered plan are the same, no matter which insurance company sells it.

• Original Medicare includes Part A and Part B.
• You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
• You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
• To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also buy supplemental coverage, like Medicare Supplement Insurance (Medigap), or have coverage from a former employer or union, or Medicaid.

• Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
• In most cases, you’ll need to use doctors who are in the plan’s network.
• Plans may have lower out-of-pocket costs than Original Medicare.
• Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.

Medicare Advantage Plans cover all Medicare services, except for:

• Clinical trials
• Hospice services
• Some new benefits that come from legislation or national coverage determinations (temporarily)

Plans must cover:

• All emergency and urgent care
• Almost all services that Original Medicare covers

Note: Original Medicare will still help cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies if you're in a Medicare Advantage Plan.

Medicare Advantage Plans may also cover things that Original Medicare doesn't, such as:

• Fitness programs (e.g. gym memberships or discounts)
• Some vision, hearing, and dental services (e.g. routine check ups or cleanings)

Plans can also offer additional benefits, such as:

• Transportation to doctor visits
• Over-the-counter drugs that Part D doesn't cover
• Services that promote health and wellness

Note: Check with the plan before you enroll to see what benefits it offers, if you might qualify, and if there are any limitations.

Plans can also offer benefit packages to certain chronically-ill enrollees to provide customized benefits for specific conditions. You can check with a Medicare Advantage Plan before you join to see if they offer these benefit packages, but you'll need to wait until you join the plan to see if you qualify.

Most plans include Medicare Drug Coverage (Part D). You will usually pay a monthly premium for the Medicare Advantage Plan in addition to your Part B premium. The standard Part B premium amount for 2022 is $170.10 ($164.90 in 2023) (or higher depending on your income).

If a service is not medically necessary according to the plan, you may have to pay all the costs for the service. However, you have the right to appeal this decision.

If you have a Medicare Advantage Plan, you have the right to request an organization determination (either orally or in writing) to determine if a service, drug, or supply is covered. Contact your plan to request one and follow the instructions to file a timely appeal. You may also receive plan-directed care, which is when a plan provider refers you for a service or to a provider outside the network without obtaining an organization determination in advance.

If you receive a service or supply that you reasonably thought would be covered, or if you are referred to an out-of-network provider for plan-covered services, you don't have to pay more than the plan's usual cost-sharing. 

Contact your plan or your agent for more information.

 Discover more differences between Original Medicare & Medicare Advantage. 

Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. Medicaid is a joint federal and state program that provides health coverage for some people with limited income and resources.  Medicaid offers benefits, like nursing home care, personal care services, and assistance paying for Medicare premiums and other costs.