Medicare Explained

Medicare is the federal health insurance program for people aged 65 or older, those under 65 with certain disabilities, and people of any age with permanent kidney failure, aka End-Stage Renal Disease.

There’s a lot of information to learn when it comes to Medicare. At Southeast Insurance Group, we give you what you need to make the best decision to protect you and your family. Doing some basic research will help you know what questions to ask so you can get a better understanding of your options and avoid common mistakes made by people who are new to Medicare. Being informed can also keep you from paying any late enrollment fees.

The Basics

With Medicare, you often think of letters of the alphabet. There are four parts: A, B, C, and D.

Medicare Part A

Medicare Part A is inpatient hospital coverage. Most Americans qualify for Part A premium-free because they or their spouse paid Medicare taxes for 10 or more years. Part A includes:

Hospital care
Skilled nursing
Hospice
Home health care (in some cases)

While 99% of Americans don’t pay premiums for Part A, there’s currently a $1,408 deductible when you’re admitted into hospital care.

Parts of Medicare

Medicare Part B

Medicare Part B is medical coverage. This includes:

Doctor visits
Lab tests
Outpatient surgeries
Mental health services
X-rays
Flu shots
Durable medical equipment

Part B has a monthly premium and a deductible. Under Part B, the government pays 80% and you pay 20% of your medical bills. However, there’s no cap on how much you could pay.

Together Parts A and B make up the Original Medicare Plan.

Medicare Part C

Medicare Part C is better known as Medicare Advantage, MA, or Medicare replacement plans. These “all-in-one” insurance plans are meant to maximize your Medicare coverage and offer additional benefits not covered by Parts A and B. For example, many Advantage plans include prescription drug coverage, dental and vision benefits, over-the-counter supplies, transportation services, and more.

We can tell you about the benefits available in your area and help you find a program with a monthly premium as low as $0!

Medicare Part D

Part D adds prescription drug coverage to:

Original Medicare
Some Medicare Cost Plans
Some Medicare Private-Fee-for-Service Plans
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.

Medicare Supplement Insurance

Medicare Supplement and “Medigap” are the same types of health insurance plan. This is additional coverage that helps fill gaps in Original Medicare Parts A and B. The plans are identified by letters A – N and sold by private insurance companies.

Original Medicare pays for about 80% of your costs for covered services and medical supplies. A Medigap policy can help pay some of the leftover costs, like copayments, coinsurance, and deductibles. Some policies also cover medical care when you travel abroad.

If you have the Original Medicare Plan and you purchase a Medigap policy, here’s what happens:

Medicare will pay its share of the approved amount for covered health care costs.
Then, your Medigap plan pays its share.

Medicare Supplements (Medigap Plans)

This chart shows the percentages that these plans cover of what Medicare does not.

When Does Your Medicare Coverage Start?

For most people, Medicare begins the first day of the month you turn 65 years. If you’re getting Social Security before 65, you’ll automatically be enrolled in Parts A and B.

If you’re not getting Social Security, you must enroll yourself. Your Initial Medicare Enrollment Period is a 7-month window around your 65th birthday. It starts 3 months before and ends 3 months after the month you turn 65.

How to Apply

The following are options to enroll in Medicare: You can enroll online at www.SocialSecurity.gov, call Social Security at 1-800-772-1213, or show up in person at your local office. However, with long lines, it may be quicker to enroll via phone or online.

Once you have received your Medicare card in the mail, you may enroll in other Medicare options, such as:

Medigap
Medicare Part D
Medicare Advantage

Whatever option you decide on, you must continue to pay your Medicare Part B premiums.

For more information or to discuss your Medicare options with an agent, call us today!