Medicare Basics

Medicare Basics

For those who are new to Medicare, enrolling can be a confusing time… What plan should you choose? What are your out-of-pocket expenses expected to be? What is the difference between Part A and Part B? Naturally, with so many different components and coverage options, things can become overwhelming. This is where we come in. As a licensed insurance agent, we go through a rigorous amount of training, education, and dozens of certifications each year so that we can help you navigate this thing we call Medicare! Below, we break down and provide a simplified explanation to the different Plans and what they all mean for you. Below is a little chart that provides a basic outline for the Plans and how the process works…

Medicare Comparison Chart

Who Qualifies For Medicare?

According to HHS.gov, Medicare is generally available for people aged 65 or older. With that said, people under 65 may also be eligible with a qualifying disability or medical condition such as End Stage Renal Disease.

There are two main plans or “Parts” of Medicare, Part A which is your hospital insurance, and Part B which is similar to a major medical insurance plan. Medicare Part A is free of charge as long as you are age 65 or older and you or your spouse paid into Medicare for at least 10 years or 40 quarters. Other circumstances may also grant you eligibility such as you are receiving or eligible to receive retirement benefits from Social Security or the Railroad Retirement Board. Another circumstance that would provide you eligibility would be if you or your spouse had Medicare-covered government employment. If you would like more information on Medicare qualifications, feel free to give us a call today!

If you would like to find out if you’re eligible to receive Medicare or would like to calculate your premium, click here

Medicare Enrollment Periods

Understanding the various Medicare Enrollment Periods is very important! Partially because there are penalties for not signing up for various plans by specific dates, but more so, if you are unhappy with your current plan or your circumstance changes, you need to know when and how to switch things up.

The first enrollment period we are going to talk about is the Initial Enrollment Period. This only applies when you first become eligible to receive Medicare. This period starts 3 months before you turn 65 and ends 3 months after you turn 65. Whether you intend to sign up for Medicare or not when you turn 65, there are steps you need to take to prove that you are receiving credible coverage, or you may face a late enrollment penalty for Part B.

Next up is the Annual Election Period. For those that have already signed up for Medicare and have a Medicare Supplement or Medicare Advance Plan can sign up, change, or disenroll from their plan every year between October 15th and December 7th for the next year. During this period, you can change to a Medicare Advantage plan from Original Medicare (Part A and Part B) or vice versus, enroll in a Medicare Supplement Plan (for those on Original Medicare), or enroll in a Part D prescription drug plan. No matter what you decide to do, these changes don’t go into effect until January 1st of the following year.

Medicare Services Mesa Az

Then you have the General Enrollment Period or Open Enrollment Period which runs from January 1st through March 31st. We like to refer to this period as the “test drive” period where you can test out the plan changes you made during the Annual Election Period. If you don’t care for your plan or something just isn’t working out, this is your last chance to change until the next AEP. Again, during this period, you can change just about anything you would like to change. You can switch to a Part C or Medicare Advantage Plan, unenroll from a Medicare Advantage Plan and enroll in a Medicare Supplement Plan, or anything in between.

Lastly, you have your Special Enrollment Period. This period would start in the months following the Open Enrollment Period should your circumstance change, such as new employment, disability, addition/subtraction of a group health plan, or other qualifying circumstance.

For more information on the various enrollment periods, don’t hesitate to give us a call! We are a wealth of information and can truly guide you through the Medicare process. No sales pitches, no pressuring you to sign up for a plan. Just good honest customer service!

Medicare Part A

Now, let’s talk about Medicare Part A. Medicare Part A is essentially your Hospital insurance. It covers hospital charges and most of the services you receive when you are in the hospital. It does not cover the fees charged by the doctors who participate in your care while you are in the hospital. Those are typically billed separate and a portion of that is normally covered by Part B if you are enrolled.

Unfortunately, Medicare Part A does not pick up the entire bill… There is a deductible! Medicare Part A shares some of the costs with you if you need be hospitalized. The important thing to remember is that there are NO “Out-of-Pocket” maximums or caps with Original Medicare! This is why it is so important for you to understand how these plans work to minimize your out of pocket risk!

You can see based on the chart below how the charges can really start to accumulate!

Certified Medicare Specialist For Seniors Mesa Az
Medicare Part A Mesa Az

Medicare Part B

Medicare Part B is a little different from Medicare Part A. Think of Part B as your insurance for most routine medical visits and emergency medical services. It also covers some preventative care like the flu shot, annual checkup, and more. With that said, Medicare Part B is not free. Not only is there a monthly deductible that must be paid, but Part B only covers 80% of a qualifying medical service. Think of it like an 80/20 plan. Medicare Part B covers the first 80% and you are responsible for the remaining 20%. The standard Part B premium in 2020 is $144.60 each month (or higher depending on your income level). The payment is deducted from your monthly check if you receive Social Security benefits. Otherwise, you need to send a monthly premium payment to Medicare.

The most important thing to remember is that there are no out of pocket maximums with Original Medicare! The chart below provides a brief example of how Part B works…

Medicare Part B Mesa AZ
Medicare Part B Comparison Chart Mesa Az

FAQ

What is Medicare?
Medicare is a national health insurance program in the United States. There are two main plans or “Parts” of Medicare, Part A which is your hospital insurance, and Part B which is similar to a major medical insurance plan.
If I am eligible for Medicare, how do I enroll?
Medicare Part A is free of charge as long as you are age 65 or older and you or your spouse paid into Medicare for at least 10 years or 40 quarters. Other circumstances may also grant you eligibility such as you are receiving or eligible to receive retirement benefits from Social Security or the Railroad Retirement Board. Another circumstance that would provide you eligibility would be if you or your spouse had Medicare-covered government employment. If you would like more information on Medicare qualifications, feel free to give us a call today!
What does Medicare cover?
Medicare Part A is essentially your Hospital insurance. It covers hospital charges and most of the services you receive when you are in the hospital. It does not cover the fees charged by the doctors who participate in your care while you are in the hospital. Those are typically billed separate and a portion of that is normally covered by Part B if you are enrolled.

Medicare Part B is a little different from Medicare Part A. Think of Part B as your insurance for most routine medical visits and emergency medical services. It also covers some preventative care like the flu shot, annual checkup, and more. With that said, Medicare Part B is not free.

How much does Medicare cost?
Medicare costs can range based on a few factors. Reach out to go over your options to discuss customized plans for you.
How Do I Know What Medicare Coverage Is Right For Me?
For those who are new to Medicare, enrolling can be a confusing time… What plan should you choose? What are your out-of-pocket expenses expected to be? What is the difference between Part A and Part B? Naturally, with so many different components and coverage options, things can become overwhelming. This is where we come in. As a licensed insurance agent, we go through a rigorous amount of training, education, and dozens of certifications each year so that we can help you navigate this thing we call Medicare!
Is Medicare Mandatory?
Medicare Part A is mandatory once you enroll in Social Security, but Part B, C, and D are all optional.

Know Your Options, Call Us Today for More!

Our advice is built upon no agenda – just pure guidance when it comes to life insurance coverage. With 40 plus years of experience, David Petersen is the one you can count on. Let us help ensure you gain coverage the way you want to. For more information, call us at 480-694-2470