The Parts Of Medicare

Medicare Part A

Most people become eligible for Medicare at age 65, but eligibility for Medicare Part A can also come from having worked and paid taxes for at least 10 years in the US. If you have worked for at least 40 quarters (10 years) in the United States during your lifetime, you will qualify for Medicare at age 65.

Medicare Part A mainly covers hospital stays and is available without any premiums if you or your spouse has legally worked and paid taxes for at least 10 years in the U.S. If you have not worked for the required number of years, Part A may be available for you to purchase. This is known as the “buy-in” option. If you choose to purchase Part A, you will be required to pay a monthly premium. For questions on this please contact the Social Security Administration.

Medicare Part B

Medicare Part B provides coverage for outpatient benefits such as doctor visits, lab work, and surgery fees. You must pay a monthly premium for Medicare Part B, and you can enroll either online, by phone, or at a local Social Security office. If you are turning 65 and still have group health plan or insurance through an employer, you can delay enrollment into Medicare Part B in favor of your group health insurance without fearing a late penalty.

If you work for a smaller company, you must have both Medicare Part A and Part B to be covered by your company plan. You might need to evaluate whether the company plan makes sense for you or not. If you delay enrollment into Part B, consult with a local insurance agent who specializes in Medicare.

Once you are enrolled in Medicare Part A & Medicare Part B you can enroll in Medicare benefits such as Medicare, Advantage plan and Medigap plans. The Medicare premiums for Part B is currently $146.90 a month. If you are collecting social security, you will be automatically enrolled in Medicare Part A and Medicare Part B.

Medicare Part C

Medicare Part C, also known as Medicare Advantage, is issued by private insurance companies instead of Original Medicare. To be eligible for Part C, you must first be enrolled in both Medicare Parts A and B, and you must live in the plan’s service area. Medicare Advantage plans provide all the coverage offered by Original Medicare, but they may also offer additional benefits such as vision, dental, and prescription drug coverage. However, you may be required to pay additional premiums for these added benefits.

About Medicare Advantage (Medicare Part C)

Medicare Advantage (also known as Medicare Part C) is an alternative to Original Medicare, offered by private insurance companies. These plans must cover all of the same services as Original Medicare (Parts A and Part B), but they can also offer additional benefits like vision, dental, and hearing coverage, and may have lower out-of-pocket costs.

When you enroll in a Medicare Advantage plan, you still pay your monthly Part B premium, as well as any additional premium the health plan itself may charge. The insurance company receives a set amount of money from the federal government for each person they enroll in their plan, and they use this money to provide your healthcare benefits. Most Medicare Advantage plans cover prescription drug plans at no additional cost.

It’s important to note that Medicare Advantage plans may have different provider networks than Original Medicare and may require you to use providers within their network to receive coverage. Before enrolling in a Medicare Advantage plan, it’s important to review the plan’s provider network and make sure your preferred doctors and hospitals are included.

Original Medicare is accepted nationwide and all Medicare Advantage plans are required  to cover emergency care out of network but non-emergency care may not be covered. Many plans are now offering regional and some national networks. 

Medicare Advantage Enrollment Periods

It’s also important to note that Medicare Advantage plans have specific enrollment periods, just like Original Medicare. Please make sure you know when the Medicare enrollment periods are so you don’t get a late enrollment penalty.

The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year, during which time you can switch from Original Medicare to a Medicare Advantage plan, or vice versa. You can also switch between Medicare Advantage plans during this time.

Part D (Prescription Drug Coverage)

Finally, Medicare Part D provides coverage for prescription drugs. You are eligible for Part D as long as you are actively enrolled in either Part A and/or B, and you must also live in the Part D prescription drug plan’s service area if that’s service area. Part D is voluntary, but it is strongly recommended if you have no other prescription drug plan or coverage. It provides insurance against future catastrophic medication costs and gives lower copays on medications you take now.

It’s important to note that there are specific enrollment periods for Medicare, such as the initial enrollment period, which lasts for seven months, starting three months before your 65th birthday. Don’t wait until it’s too late to enroll in Medicare and risk facing penalties or gaps in coverage.

Choosing Your Medicare Benefits

When it comes to choosing the right Medicare plan for you, there are a few key things to consider, like your healthcare needs and. your budget. 

It’s important to note that while Medicare covers many medical services, it does not cover everything. For example, it does not cover most dental care, vision care, or hearing aids. It also does not cover long-term care, such as nursing home care, custodial care, or assisted living facilities.

Medicare Supplement Insurance (Medigap plan)

If you need additional coverage for these services, you may want to consider a Medicare Supplement plan, also known as Medigap plans. These plans are offered by private insurance companies and can help cover some of the out-of-pocket costs associated with Original Medicare. It’s important to note that you cannot have both a Medicare Advantage plan and a Medigap plan at the same time. 

Medigap plans, also known as Medicare Supplement plans, are designed to provide additional coverage to Medicare beneficiaries who have Original Medicare. These plans are sold by private insurance companies and can help fill the gaps in coverage that Medicare does not cover, such as deductibles, coinsurance, and copayments.

Medigap plans are only available to those who have paid Medicare taxes and are eligible for Medicare benefits. In Florida, like in other states, Medigap plans are standardized and labeled with letters A through N. Each plan offers a different set of benefits, but the coverage for each lettered medigap coverage plan is the same regardless of the insurance company that offers it.

While Medigap plans can be a good choice for those who want additional coverage beyond what Original Medicare provides, it’s important to note that they do not cover prescription drugs. Beneficiaries who want prescription drug coverage can enroll in a standalone Medicare Part D plan or a Medicare Advantage plan. 

Additionally, Medigap plans do not replace Medicare Part A and Part B, which provide hospital insurance and medical insurance respectively. Medicare beneficiaries who enroll in a Medigap plan must still pay their Part B premium, along with any premiums associated with the Medigap plan they choose.

Another thing to consider if you are choosing a Medicare Advantage plan is whether your doctors participate in the plan’s network.  Most Medicare Advantage plans have networks and you will pay more if you receive care outside the plan’s network unless it is for an emergency or urgently needed care.

Enrollment Periods for Medicare

Enrollment periods for Medicare refer to the times when eligible individuals can enroll in Medicare coverage or make changes to their existing coverage. There are several enrollment periods for Medicare, including the Initial Enrollment Period, General Enrollment Period, and Special Enrollment Periods.

The Initial Enrollment Period is the first opportunity most individuals have to enroll in Medicare, which typically begins three months before their 65th birthday and ends three months after their birthday month.

The General Enrollment Period, on the other hand, takes place between January 1 and March 31 each year and allows individuals who missed their initial enrollment period to sign up for Medicare Part A and/or Part B.

Finally, a Special Enrollment Period is available to individuals who experience certain qualifying events, such as moving or losing their employer-based health insurance.

It’s important to note that failing to enroll in Medicare during the appropriate enrollment period can result in late enrollment penalties, higher premiums, and gaps in coverage. Therefore, it’s important for individuals to be aware of the different enrollment periods for Medicare and to enroll or make changes to their coverage during the appropriate window of time. Medicare beneficiaries can find more information about enrollment periods and eligibility requirements on the official Medicare website or by contacting Medicare directly.

There are also annual enrollment periods for Medicare Advantage and Medicare Part D plans.

Medicare Eligibility

Medicare eligibility is determined by several factors, including age, disability status, and work history. Most people become Medicare eligible when they turn 65 and are eligible for retirement benefits, even if they are not retired. Individuals who have been receiving disability benefits for 24 months are also eligible for Medicare, regardless of age. Same with railroad retirement board benefits. 

Once an individual is eligible for Medicare, they will receive a Medicare card that shows their Medicare number and the dates when their coverage began. It’s important to note that Medicare eligibility does not automatically mean that an individual is enrolled in Medicare. They must actively enroll in Medicare Part A and Part B to receive coverage. Please make sure your Medicare plan with start when your health insurance ends. 

There are also insurance regulations that affect Medicare eligibility. For example, individuals who are eligible for both Medicare and Medicaid may have different eligibility requirements and may qualify for additional benefits. Additionally, individuals who are receiving railroad retirement benefits may be eligible for Medicare as well. Understanding Medicare eligibility and the associated regulations can be complex, but there are resources available to help individuals navigate the process and enroll in Medicare if they are eligible.

Medicare FAQ — Here’s what we are asked most frequently in Medicare

When can I initially enroll?

The initial Enrollment Period is the period when you are turning 65 or are first becoming Medicare Eligible that starts 3 months before the first month of eligibility, encompasses the first month of eligibility, and ends 3 months after that month. (A 7-month period)

Can I change from a Medicare Advantage to a Medicare Supplement later on?

Yes, this is possible however, it will be subject to medical underwriting and approval.

Can I change Part D plans?

Yes, during AEP individuals are allowed to change Part D plans. Part of what we do at Florida Healthcare Insurance is get back with you the client and review your medications and advise what plan will make the most sense.

If I am on an employer plan, can I delay my Medicare Enrollment?

Yes, if you are covered by an employer group health plan due to active employment (not a retiree plan), you may delay enrolling in Part B. When you do leave this plan, you will have a Special Election Period where you can get a guaranteed issue Medicare Supplement plan.

I’m on Obamacare and don’t want to switch to Medicare can I stay on it?

Unfortunately, this is not allowed. Once you are eligible for Medicare you must switch to that and unenroll yourself from Healthcare.Gov.

Is Medicare Mandatory?

No part of Medicare is mandatory, but if you choose to enroll in any part of Medicare after your Initial Enrollment Period, you could face financial penalties unless you qualify for a Special Enrollment Period with creditable employer coverage.

What’s the Difference Between a Medicare Advantage HMO and PPO?

A Medicare Advantage HMO Plan usually helps pay only for care you receive from providers in the plan network. A PPO plan will generally help pay for care received outside the plan network, but it may pay less than for the same care received within the network.

Understanding Your Medicare Eligibility

In summary, Medicare is a federal health insurance program that provides coverage for people over the age of 65, those with certain disabilities, and those with end-stage renal disease or ALS. It has several parts, including Parts A and a part B, which cover hospital stays and outpatient services, respectively. Medicare Advantage plans, Part C, are issued by private insurance companies, and Medicare Part D provides coverage for prescription drugs. There are costs associated with each part of Medicare, and it’s important to consider your budget when making a decision.

It’s also important to consider whether you want to keep your current doctors and hospitals, as well as the enrollment periods for Medicare. Consulting with a local insurance agent who specializes in Medicare can help you make an informed decision and ensure that you have the coverage you need.

Ready to get the Medicare Enrollment process started? Please contact one of our licensed health insurance brokers at 954-282-6891 or by clicking here!