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Medicare

What is Original Medicare and Medicare Supplemental Insurance?

Original Medicare is the federal health insurance program for people who are 65 and older and a U.S. Citizen or legal resident who has lived in the U.S. for at least five years. People under 65 can qualify on the basis of disability or other special situations, including people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). The different parts of Medicare help cover specific services. The best place to obtain a wealth of information about Medicare is through the official U.S. Government Site for Medicare at www.Medicare.gov.

Medicare Supplemental Insurance is a policy that works with Original Medicare coverage to help pay some of your out-of-pocket costs, such as copayments, coinsurance, and the yearly Medicare deductible. The policy also pays for the “gaps” in Medicare coverage.

Who is Eligible?

People 65 or over, disabled individuals with permanent kidney failure, or individuals with amyotrophic sclerosis (Lou Gehrig’s disease).

Customization of Medicare

Your Medicare plan can be customized to meet your needs utilizing Supplemental Insurance, Replacement Insurance, and Prescription Coverage (aka Medicare Part D).

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What are the Four Parts of Medicare?

Medicare Part A (Hospital Insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance) covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Medicare Part C, or Medicare Advantage Plans, are a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Medicare Part D (prescription drug coverage) adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

When Can I Enroll or Change My Medicare plan?

There is an Initial Enrollment Period once you turn 65 or otherwise become eligible. You have three months prior to your 65th birthday and three months after to enroll.

The Open Enrollment Period begins on October 15th and ends on December 7th. During this time, you can add, drop, or change your Medicare plan coverage.

Special Election Periods are for individuals who qualify under certain circumstances, such as if you have moved, retired, receive assistance from the state, or if you have been diagnosed with a specific chronic health condition.

When do I begin receiving Medicare?

  • If you are receiving retirement benefits when you turn age 65, you will automatically become enrolled.
  • If you are not receiving retirement benefits when you turn age 65, you should enroll for Medicare before your 65th birthday even in you don’t yet want to file for retirement benefits.
  • Disabled individuals become eligible for Medicare once they have received 24 months of disability benefits.

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