Medicare

              WHAT IS MEDICARE?    

Medicare insurance is for people 65 and older and people under 65 with certain disabilities. Medicare will also help people with End-Stage Renal disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig's disease.

Original Medicare: Doctor and Hospital Choice

You can go to any doctor or hospital that takes Medicare, anywhere in the U.S.

Original Medicare: Cost

Medicare does not cover everything!

For Part B-covered services, you usually pay 20% of the Medicare-approved amount after you meet your deductible. This is called coinsurance.

The Part A deductible for 2025 is $ 1,676  for each benefit period. The Part B deductible is $257.00.

You pay a monthly premium for Part B. If you choose to join a Medicare drug plan, you'll pay a separate premium for your Medicare drug coverage (Part D).

There's no yearly limit on what you pay out-of-pocket unless you have supplemental insurance (Medigap).

You can get Medigap to help pay your remaining out-of-pocket costs (like your 20% coinsurance). Or, you can use coverage from a former employer or union, or Medicaid.

When! When do you sign up for Medicare?

This is one of the more important questions about Medicare, "when do I sign up?" Another is, "what if I move?" Yet another, "I am on SSDI (Social Security Disability Income) and am on original Medicare, what is next?"

Click here to learn more about when.

             PARTS OF MEDICARE     

The ABC's and D of Medicare

Part A:  Hospital Insurance, Premium-free for most people and helps cover:   

Inpatient hospital stays, including rehabilitation hospital and psychiatric hospital care. Skilled nursing facilities. Hospice. Home Health Care (in some cases).    

Part B: Medical Insurance 

The standard Part B premium for 2025 is $185.00 (or higher depending on your income) and helps cover: Most medically necessary doctors' services. Preventive Physician care. Outpatient hospital care and surgery, home health care, durable medical equipment. Mental Health Care. 

Part B coverage is optional, though you may be charged a penalty fee if you are without coverage and later want to enroll in Part B 

Part C: Also Known as "Medicare Advantage"  

Medicare Advantage is another way to get your Medicare benefits: Combines Part A, Part B, and often Part D. Run by private approved insurers. Benefits through Medicare Advantage instead of Original Medicare (parts A and B).    

Part D: Prescription Drug Coverage 

Part D helps cover prescription drug costs:  Run by private approved insurers. May help lower prescription drug costs. 

Part D coverage is optional, though you may be charged a penalty fee if you are without prescription drug coverage and later want to enroll in a Part D plan.    

Medicare Supplement (Medigap)   

Medigap plans are supplemental insurance plans sold by private insurance companies to fill "gaps" in Original Medicare coverage. You can choose from a range of standardized plans, each offering different coverage. These plans are designed to "supplement" your original Medicare plan and can help pay Part A and B co-payments, Part A and B Coinsurance, and Part A and B deductible.

           SSDI: DID YOU KNOW?

According to the law, your SSDI (Social Security Disability Insurance) payments cannot start until you have been disabled for at least five full months. Your payment will usually start with your sixth month of disability. And, if you have been approved for SSDI, you must wait a full two years after that period passes for your Medicare coverage to start. A total of 24 months.

What Medicare coverage is available to people with disabilities?

Simply stated, Medicare coverage is available to those who qualify based on disability as those who qualify based on age. For all those that are eligible for Medicare, you can get the full range of benefits. Health care services do not have to be related to one's disability in order to be covered. Coverage will include certain hospitals, nursing homes, home health services, your doctors, and community-based services.

Can I sign up for a Medigap (Supplemental) Plan or a Medicare Advantage Plan?

Some insurance companies may elect to sell Medigap (Supplemental) policies to people under age 65, even in states that do not require this policy.     

If you do not have prescription drug coverage from another source that is comparable to Medicare, you should enroll in a Medicare Part D (PDP) Plan.    

Alternatively, you can look into receiving your Medicare-covered benefits, including prescription drugs, through a Medicare Advantage Plan offered through private insurance companies. For example, an HMO or PPO. However, access to providers, in general, is more limited.

Medicare Advantage Plans are not allowed to turn down people with Medicare based on their health status or pre-existing condition.

Confused?  

Call. The consultation is all at no cost to you!