About Medicare

Understanding Medicare

Medicare provides affordable health insurance for tens of millions of people. As a federal program, Medicare is run by an agency within the U.S. Department of Health and Human Services.

However, the Social Security Administration (SSA) determines your Medicare eligibility. Whether you’re enrolling in Medicare for the first time or re-evaluating your existing plan, our experienced Medicare advocates can provide you with peace of mind that you are enrolled in the best, most affordable plan based on your unique treatment profile and financial needs.

Medicare is a federal health insurance program that consists of several different parts. The insurance is available for people age 65 or older, under age 65 for Social Security Disability recipients, and any age with permanent kidney failure.

Part A

Medicare Part A covers hospice care, home health care, skilled nursing facilities, and in-patient hospital stays.

Most people age 65 or older who are citizens or permanent residents of the United States are eligible for “free” Medicare Part A. You can get Part A at age 65 without having to pay premiums if:

  • You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.

Although you don’t pay a premium, there are some co-payments and a yearly deductible.

Part B

Medicare Part B covers doctors’ bills, outpatient hospital care, home-based physical therapy, lab tests and X-rays, chiropractic care, durable medical equipment, ambulance services, and a limited number of prescription drugs. Part B is optional and there is a monthly premium and an annual deductible.

Part B monthly premium depends on cost of living and when you enrolled. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every three months.

Part B helps cover doctor services and outpatient care.

  • Helps cover some preventive services to help maintain a person’s health and to keep certain illnesses from getting worse.
  • Generally pays 80% of the Medicare-approved amount for covered services.

If you didn’t sign up for Medicare Part B when you first became eligible, you may be able to sign up during the General Enrollment Period. This period runs the first 45 days of every year.

Part C

Medicare Part C is designed to close some gaps in Medicare coverage. There are two main types of policies: Medigap and Medicare Advantage. Medicare Advantage is often called “Medicare Part C,” because people with Medicare Parts A and B can choose to receive all of their health care services through a private insurance company under Part C. you must purchase these benefits through private companies approved by and under contract with Medicare.

Anyone enrolled in a Medicare Advantage plan can switch to Original Medicare during the first 45 days of the new year. Medigap policies may help pay certain fees, such as copayments and deductibles, as well as the portion of doctor bills that Medicare does not cover.

Part D

Medicare Part D is optional prescription drug coverage that is available to all people who are eligible for Medicare. Plans are offered through insurance companies and other private companies. There is a monthly premium, a yearly deductible, and a co-payment.

The official Medicare website has a useful a tool that helps you determine whether or not you or your loved one is eligible to receive Medicare benefits. You will be asked to answer a series of questions and the tool will determine if you might be able to receive Medicare. Click here to go to the Medicare Eligibility Tool.

What makes Medicare so complex?

While it would be nice if the Medicare system was less complex, we focus on understanding and navigating the current system to maximize your benefits.

  1. The application process which involves many choices, decisions, and deadlines that can be confusing and overwhelming
  2. Private health insurance is often needed to supplement or replace Medicare coverage
  3. Failure to enroll in a timely fashion can result in costly penalties and surcharges to your monthly premiums
  4. Coordination of benefits with other health insurance providers is complex and has serious financial consequences
  5. Choosing the proper prescription drug coverage is dependent on your unique treatment profile