If you are getting ready to turn 65 and are new to Medicare it can be very confusing. Trying to figure out what coverage is right for you can be a complicated because Medicare is different than traditional medical insurance. Medicare has four parts, Part A, Part B, Part C and Part D. Understanding each part and the difference between Supplemental Plans A-N (Medigap), Medicare Advantage Plans (like HMO or PPO) Insurance and Part D (prescription drug coverage) can be overwhelming. When nearing age “65” we will receive vast amounts of mail advertising numerous Medicare health insurance products but never letting us know which will fit our situation. This is where an agent from Coastal Benefits can help eliminate this confusion. We educate our clients so they have a better understanding of how Medicare works and can decide which plan suits their needs.

Original Medicare is Health insurance provided and regulated by the U.S. Government. To be eligible for enrollment:

You have to be 65 or older
Under 65 with certain disabilities, including end-stage renal disease
You or your spouse worked and paid Social Security taxes for at least 10 years
You are a permanent resident of the U.S. or a legal citizen who lived in the U.S. for 5 years in a row.
Enrollment for Original Medicare (Part A and B) is 3 months prior, the month of your 65 birthday, and 3 months after you turn 65.

If you’re automatically enrolled in Medicare, you will get a red white and blue card in the mail before your 65th birthday. In some cases you will have to sign up by calling the Social Security office to enroll.

Medicare Plan Parts:

Part A

PART A is paid for by taxes collected throughout your working career and is premium free if you or your spouse have worked and paid Medicare taxes for 40 quarters. Part A helps to cover inpatient hospital care, skilled nursing facilities, Hospice and some Home Health care services. Part A pays hospital costs subject to a deductible. Hospital stays longer than 60 days would be subject to a daily co-payment. Part A deductibles and co-payments are based on a per benefit period basis, not per occurrence.

Part A-Medicare pays all cost for first 20 days of Skilled Nursing Care, days 21-100 have a co-payment. Medicare does not cover costs beyond 100 days of Skilled Nursing Care.

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Part B

Part B pays for medical services such as doctor’s visits and other health care providers, outpatient services, diagnostics (laboratory services, x-rays, ect) some home health care, durable medical equipment and some preventive services. Part B has a monthly premium and is based on taxable income. You are eligible for this coverage when you turn 65.  Part B has an annual deductible that can change yearly. After the deductible Part B pays 80% of covered services and you pay the remaining 20% of cost. Original Medicare does not have an Out-of-Pocket maximum to protect against catastrophic expenses.

Medicare Advantage Plans (called Part C)

Part C Medicare Advantage Plans works like traditional major medical insurance and is offered through private insurance companies approved by Medicare to provide this coverage. These plans can be an HMO, PPO, or PFFS (Private Fee for Service) which determines what providers you can see for services. There are networks that provide services and out-of-pocket expenses such as premium payments, copays, deductibles, coinsurance and out-of-pocket maximums. You must be enrolled in Part A and B to be eligible for a Medicare Advantage plan. You’ll get your Medicare Part A (hospital) and Part B (Medical) coverage from the Medicare Advantage Plan, not Original Medicare. Some plans can cover extras such as dental, vision, hearing aids, pharmacy and wellness/fitness.

Medicare Advantage Plans must follow the rules set by Medicare. However, each Medicare Advantage plan can charge different out-of-pocket costs and have different guidelines for how you get services, like whether you need a referral for a specialists. The plan provisions can change each year but the plan must notify you about any changes before the start of the next enrollment year. Each year Medicare Advantage Plans can choose to leave Medicare, if this occurs you will need to choose another plan or return to Original Medicare. If you have this type of plan you can’t be sold a Medicare Supplement Insurance (Medigap). You can only enroll in a Medigap policy if you disenroll from your Medicare Advantage Plan and return to Original Medicare.

Medicare Supplement Health Insurance (Medigap)

Since Medicare Parts A and B do not pay all of your Hospital and medical expenses you might consider enrolling in a Medicare Supplement (Medigap). These plans can save you thousands of dollars (like copays, coinsurance and deductibles) in medical bills and provide a predictable outcome for out of pocket medical expenses. Medicare Supplement plans are policies issued by private insurance companies that are designed to fill in some of the gaps in Medicare. Medigap policies are guaranteed issued (cannot be refused or charged more for preexisting conditions) if enrolled within six months of taking Part B. These policies are standardized by the Federal Government and must meet certain requirements. The plans are labeled A through N and each one offers different combinations of benefits. Cost for premiums can vary for these plans according to the benefits and coverage you choose. This type of plan does not have networks so it can be used throughout the United States for Medicare approved services. This makes it easy for travel! You can go to any doctor or hospital you want that accepts Medicare! These plans are guaranteed renewable. Medigap plans do not cover prescription drugs so you will need to purchase a Part D plan for this coverage.

There are very specific rules for enrollment and it is important to speak with a professional at Coastal Benefits Group to be sure you receive maximum benefit by enrolling at the proper time. Our agents can help you choose a plan that fits your specific needs.

Part D

Part D is the outpatient prescription drug plan for Medicare. This insurance plan is provided through private prescription drug plans that contract with Medicare. To be eligible for Part D you must be enrolled in Medicare Part A or in Parts A and B. Each drug plan can vary in cost and drug coverage depending on the medications you take. The choices in plans include monthly costs, deductible options, copays and different drug tier options. Some plans offer lower out of pocket costs if you use a preferred network pharmacy. Enrollment guidelines can be confusing and can result in a penalty if you do not sign up at the right time. Our agents can help simplify all the parts of your drug plan and guide you to the coverage plan that fits your needs.

When you turn 65 and are faced with health coverage using Medicare it can be very complicated and overwhelming to figure out. At Coastal Benefits we take the confusion out of Medicare. We help educate and assist you to choose the plan that benefits your needs. Call us today and get a licensed professional to help understand you options to make sure you are not paying too much for your insurance. We are committed to getting you the appropriate policy for your needs and budget.