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medicare overview

Medicare is a national health insurance program started by the federal government in 1965 under President Lyndon Johnson.  It helps cover your medical and prescription drug expenses if you are age 65 or older, have a disability or end stage renal disease.  While there are different parts to Medicare which cover different things, and a couple of Medicare related choices each person must make along the way, our goal is to educate you and help you come to the right decisions for you.

medicare costs and coverage

medicare costs and coverage
Medicare Part A:

Medicare Part A is for inpatient hospital coverage. Most people qualify for premium free Part A because they or their spouse have paid their Medicare payroll taxes for 10- years. Coverage includes hospital facilities, nurses, food, and anesthesiologists. Surgeons are not included. There is also coverage for skilled nursing, hospice care, and at home health care (in certain circumstances) is also included.

Medicare Part B:

Medicare Part B is your Medical portion. This includes doctor visits, lab tests, surgeries, ambulance services, durable medical equipment and mental health. There is limited outpatient prescription drug coverage. There is an annual deductible of $185 and it is an 80/20 co-insurance plan with no maximum out of pocket. The standard 2019 Part B premium is $135.50. If your annual income is over $85,000 you will pay a higher Part B premium.

Medicare Part C:

Medicare Part C is a private Medicare plan from an insurance company that replaces Medicare Part A and Part B. In other words, you are replacing your government provided Part A and Part B with equivalent or better benefits from an insurance company. When you choose to do this the government pays a monthly stipend to your insurance company to subsidize the cost of your care. It is commonly called a Medicare Advantage Plan (or an MA plan), and usually includes Part D drug coverage (then called a Medicare Advantage Prescription Drug plan or MAPD). When you have Part C you still pay your Medicare Part B premium.

Medicare Part D:

Medicare Part D is prescription drug coverage. It is highly regulated and subsidized by the government, but you buy your plan from a private insurance company. You pay a premium for Part D, along with copays, deductibles, and coinsurances.

how to enroll in medicare

how to enroll in medicare
How to enroll in Medicare

For most people your Medicare coverage begins the first day of the month when you turn 65. If your birthday is the 1st of the month you are eligible for the first of the preceding month. If you have a certain qualifying disease (for example kidney disease or ALS) or if you are on social security disability you may be eligible for Medicare much earlier.

Automatic Enrollment in Medicare. If you are receiving Social Security Income prior to 65 your Medicare part A and B will be started automatically. You will receive your Medicare card in the mail with both part A and B effective dates approximately 90- days prior to your start date.

If you are not receiving Social Security, you must enroll in Part A and Part B Medicare.

  • Go online at www.SocialSecurity.gov
  • Call Social Security at 1-800-772-1213, M – F, 7 am to 7 pm.
  • Visit your local Social Security Office

What if I want to delay my Medicare enrollment because I still have employer based group health insurance?

People generally accept Medicare Part A because it is premium free for most people, even if you are on group health insurance. If you’re automatically enrolled in Medicare Part B, but do not wish to keep it because you will have to pay a premium, you have a few options to drop the coverage. If your Medicare coverage hasn’t started yet and you were sent a red, white and blue Medicare cared, you can follow the instructions that come with your card and send the card back. If you keep the Medicare card, you keep Part B and will need to pay Part B premiums.

your decision: advantage plans vs supplement plans

your decision: advantage plans vs supplement plans
Your decision: advantage plans vs supplement plans

While Medicare Part A and Part B (sometimes referred to as Original Medicare) covers many healthcare expenses, it doesn’t cover everything. Beneficiaries are still responsible for a number of expenses which can easily add up. For example, in addition to various copayments and deductibles, vision and dental care, prescription drugs and overseas emergency health services are not covered.

As a result, most people with Medicare enroll in one of two types of plans to cover these gaps in coverage: These two types of plans are called Medicare Advantage Plans and Medicare Supplement (aka Medigap) plans.

Medicare Advantage Plans offer coverage all of your Medicare services through a private insurance company instead of through government provided Medicare Part A and Part B. When you choose this option, you must still enroll in Medicare Part A and Part B. Then the federal government pays a monthly stipend to your insurance company on your behalf, whether you have medical claims or not. Many Medicare Advantage plans will have a network of contracted providers and facilities. Many Medicare Advantage plans include Part D drug coverage, and then are referred to as MAPD plans (Medicare Advantage Prescription Drug plans).

Medicare Supplement Insurance helps fill the gaps when you decide to stay on regular Medicare Part A and Part B. Your Medicare Supplement (aka Medigap) plan will pay many if not all the costs that the government does not pay such as Medicare Part B excess charges or emergency medical coverage when you’re traveling outside of the country. If you have a Medigap plan, you should also have a stand alone Part D drug plan. Keep in mind that Medicare Supplement insurance plans can only be used to pay for Original Medicare costs and can’t be used with Medicare Advantage plans.

prescription drug coverage

prescription drug coverage
Prescription Drug Coverage

Medicare Part D is a prescription drug plan (PDP) which you buy from a private insurance company that contracts with Medicare. PDP plans have premiums, as well as co-insurance, deductibles, and or copays for medications. The formulary (list of covered drugs) on each PDP is different. When choosing a plan, you want to be sure your prescriptions are on the formulary. This is something you can check yourself on www.Medicare.gov, or a Benafica representative can do this check on your behalf.

If you have Original Medicare (Part A and Part B), Medicare Part D isn’t automatically included and you will need to choose stand-alone Part D plan to work alongside your Original Medicare and your Medicare Supplement.

If you have Medicare Part C, also known as Medicare Advantage, your Part D plan can be bundled in so that you have your Medicare health and prescription drug benefits covered under a single plan.

initial enrollment period

initial enrollment period

Initial Enrollment Period
You can sign up for Medicare over an initial 7-month period. 3 months before your 65th birthday, the month of your birthday, and during the following 3 months. If you miss your enrollment period, you may face a late enrollment penalty.

annual enrollment period

annual enrollment period
Annual Enrollment Period

Each year from October 15th to December 7th, people enrolled on Medicare can revisit the available Medicare plans in their area and decide if a different selection is more suitable for them. Not everyone is eligible to enroll in every available plan. Be sure to talk to a licensed Benafica Medicare representation to understand your options.

let us help

let us help
Let us help

Call 651.259.9000 for Medicare help today or fill out the form on the contact page.