As you approach the age of Medicare eligibility, it’s crucial to have a solid understanding of how Medicare works and the various options available to you. Medicare is a multifaceted program with multiple parts and coverage options, and a comprehensive understanding is vital for making well-informed decisions about your healthcare coverage.

Navigating the Parts of Medicare

Medicare is a federal health insurance program designed to provide coverage for individuals aged 65 and older, people with specific disabilities, and those with End-Stage Renal Disease (ESRD). To make informed decisions about your healthcare, it’s essential to comprehend the different parts of the Medicare program.

Part

A

HOSPITAL INSURANCE

INPATIENT CARE

  • Hospital Stays

  • Home health care

  • Skilled nursing facility

  • Hospice Care

  • Nursing home care

Part

B

MEDICAL INSURANCE

OUTPATIENT CARE

  • Doctor visits

  • Ambulance services

  • Durable medical equipment

  • Mental health services

  • Preventative services

Part

C

MEDICARE ADVANTAGE

PROVIDES SAME COVERAGE AS PARTS A & B

  • Prescription drugs

  • Vision, Dental and Hearing

  • Fitness memberships

  • Wellness programs

  • And more

Part

D

DRUG COVERAGE

DRUG COVERAGE

  • Each Part D plan must cover two drugs from each class

  • All Part D plans must also cover:

    • Immunosuppressants

    • HIV/AIDS drugs

    • Anticancer

    • Anticonvulsants

    • Antidepressants

    • Antipsychotics

Unpacking Medicare Supplement Plans

Medicare Supplement plans, commonly referred to as Medigap plans, are crafted to alleviate some of the out-of-pocket costs associated with Original Medicare (Part A and Part B). These plans are offered by private insurance companies and cover expenses such as copayments, coinsurance, and deductibles.

Medicare Supplement (Medigap) Coverage

BENEFITS

A

B

C

D

F

G

K

L

M

N

Part A

Coinsurance &

Hospital Costs

Part B

Coinsurance &

Hospital Costs

50%

75%

Blood

(First 3 Pints)

50%

75%

Part A Hospice

Care Coinsurance

or Copay

50%

75%

Skilled Nursing

Facility Care

Coinsurance

50%

75%

Part A

Deductible

50%

75%

50%

Part B

Deductible

Part B Excess Charges

Foreign Travel

Emergency Care

80%

80%

80%

80%

80%

80%

Understanding Your Eligibility

Medicare eligibility depends on various factors. To determine if you qualify for Medicare, you should meet specific criteria based on your age, citizenship,

or medical condition.

Eligibility varies as follows:

* You must be a U.S. citizen

If you are under 65:

* You may qualify if you are disabled and receive Social Security disability income benefits for

24 months.

* You have End-Stage Renal Disease (ESRD).

* You have amyotrophic Lateral Sclerosis (ALS).

Enrolling in Medicare: What You Need to Know

Once you qualify for Medicare, it’s essential to understand the enrollment periods available. Familiarizing yourself with these periods can help you make timely and informed decisions about your healthcare coverage.

Initial Enrollment Period

(IEP)

Once you qualify for Medicare, it’s essential to understand the enrollment periods available. Familiarizing yourself with these periods can help you make timely and informed decisions about your healthcare coverage.

General Enrollment Period

(GEP)

The GEP runs from January 1 to March 31 each year. It is an opportunity to enroll in Medicare if you missed your IEP. However, enrolling during the GEP may lead to late enrollment penalties.

Medigap Open Enrollment

The Medigap Open Enrollment Period spans six months, beginning when you turn 65 and your Part B coverage becomes effective. During this window, you can purchase a Medigap plan without the concern of being denied coverage.

Medicare Advantage Open Enrollment Period

(OEP)

The GEP runs from January 1 to March 31 each year. It is an opportunity to enroll in Medicare if you missed your IEP. However, enrolling during the GEP may lead to late enrollment penalties.

Annual Enrollment Period

(AEP)

The AEP takes place from October 15 to December 7 each year. During this period, you can review your Medicare plan and make changes if necessary. Any adjustments will become effective on January 1 of the following year.

Ready to Get Started with Medicare? Contact Us Today!

Medicare is a significant aspect of your healthcare, and making informed decisions about your coverage is of utmost importance. We are here to assist you through the process. If you have questions or need expert guidance regarding Medicare, don’t hesitate to contact us today. Our team is ready to help you navigate the complexities of Medicare and make the right choices for your healthcare needs.