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MEDICARE

Medicare is a federal health program for people age 65 or older. Medicare may also cover patients younger than 65 if you have a disabilities or permanent kidney failure. Medicare will aid with the cost of health care even though it may not cover all of a patient’s medical expenses, or long-term health care.

There are several choices for Medicare:

Original Medicare (Part A and Part B)

Medicare Part A

Assist with payment for:

A semi-private room
Hospital meals
Skilled nursing services
Lab tests and X-rays
Drugs, medical equipment and supplies used during your stay
Operating room and recovery room services
Care on special units, like intensive care
Rehab services after discharge, when qualified
Hospice care

Medicare Part A is hospital coverage. It covers care you receive while an inpatient in a hospital or skilled nursing facility. Medicare manages Part A coverage and costs based on a benefit period. The Part A does have a deductible.

Medicare Part B

Assist in paying for all or some of:

Doctor services, even when you’re in the hospital
Some preventive services
Clinical lab services
X-rays, MRIs, CT scans, EKGs and some other medically necessary tests
Outpatient surgery services
Ambulance services
Outpatient mental health care
Durable medical equipment (wheelchair, walker, etc.)

Medicare Part B covers doctor services and outpatient care. Outpatient care includes services you receive in a doctor’s office, a retail clinic, urgent care, or the emergency room.

Medicare Part C - Medicare Advantage

Medicare Part C

Medicare Part C combine the coverage of Parts A and B into one plan. They often include some prescription drug coverage.

May include coverage for:

Coverage for all benefits included in Parts A and B.
Dental, hearing and/or vision services
Health, wellness, and fitness programs
Prescription drug coverage for some drugs

All Part A Services and all Part B Services that are usually fully covered and can include: Wellness Services, Dental Exams, Vision Exams, Hearing Exams, and often partially covers: Dental Fillings and Crowns, Eyeglasses, and Hearing Aids.

Medicare Part D – Prescription Drug

Medicare Part D

Medicare prescription drug coverage is available to everyone with Medicare. To get Medicare prescription drug coverage, people must join a plan approved by Medicare that offers Medicare drug coverage. Most people pay a monthly premium for Part D

Medicare Supplement Insurance Plans - Medigap

Medigap

A Medicare Supplement Insurance Plan works with Original Medicare, cover some of the costs. Medigap, helps to pay some out-of-pocket costs associated with Original Medicare.

Enrollment Periods

Initial Enrollment Period (IEP)

If you aren’t receiving Social Security and don’t have health insurance through an employer (either your own or your spouse’s) upon turning 65.
The IEP is a seven-month period; the fourth month being the one in which you turn 65.
You can enroll in Medicare starting up to three months before your 65th birthday and your window to sign up ends three months following your 65th birthday.

Special Enrollment Period (SEP)

If you delayed Medicare enrollment after turning 65 because you were insured through an employer for whom you or your spouse was still actively working.
The SEP allows you to sign up for Medicare starting at any point before your or your spouse’s employment draws to an end, up until eight months following your (or your spouse’s) retirement.

Annual Enrollment Period

October 15th through December 7th you can enroll in a Medicare Advantage or Medicare Supplemental plan or make changes to your existing Medicare Plan

Medicare Supplement Open Enrollment Period

The Medicare supplement open enrollment is 6 months long. It begins the month you are 65 or older and are enrolled in Medicare Part B. You cannot be denied coverage or charged more based on your health history if you enroll during your open enrollment. Some states may allow for additional Open Enrollment Periods.

Special Enrollment Period: Working past 65

You may qualify for a Special Enrollment Period (SEP) to enroll in Original Medicare – Part A, Part B or both without penalty for up to 8 months after the month your (or your spouse’s) employment or employer coverage ends, whichever comes first. You can also join a Medicare Advantage plan (Part C) or prescription drug plan (Part D) up to 2 full months after the same event, if you are eligible.