If and when you end up in the hospital because you have a major medical need the bulk of your Medicare insurance coverage falls under Medicare Part A. Most people consider Part A hospital insurance coverage, however it provides more coverage than just hospitalization care.
In addition to your hospital coverage, Medicare Part A hospital insurance also cover you for you for the following medical needs:
All of these coverages and more are provided to you for you when your Doctor determines you have a medically necessary need.
Part A of your Medicare coverage is a vital hospital insurance coverage you will one day need, as it provides you with life saving coverage. Some of your largest medicare bills happen when you are dealing with a health concern that falls into one of these categories of coverage.
While many believe that Medicare coverage as a whole is completely free this is not actually the case. In some instances you may be required to pay a portion of your Part A premium if you have not paid enough into Medicare throughout your years of working.
Most Medicare beneficiaries will not be required to pay any additional premium towards their Medicare Part A coverage. As long as you have worked for 10 years (which is equal to 40 quarters) in your lifetime, you will generally pay no additional premium towards your Part A Medicare insurance coverage.
You might be asking why is so a few people pay for Part A and most do not. For those who do not pay anything, these are for those individuals whom they or their spouse paid their payroll taxes into Medicare each time their employer paid them their salary. You may not have known that a portion of the payroll taxes you paid covered your Part A insurance premiums.
If you do not have 40 quarters, you can pay for Part A in order to have this important coverage. Premiums in 2021 are $471 per month if you have less than 30 quarters or $259 per month for people with 30 – 39 quarters. This information is available on Medicare.gov as well for your review.
Read more about the cost of Part A on our Medicare costs page
If you have not already done so, I would recommend going to our Start Here tab. This page will be your best place to go for how to enroll into Medicare.
That being said, if you are already taking Social Security income, you should be enrolled into Medicare Part A automatically. Two to three months prior to turning 65 you should receive your red, white, and blue Medicare card showing your Part A effective date.
If you plan to keep working past the age of 65, you may or may not need to sign up for Part B medical insurance and Part D prescription drugs coverage. If your card does not show a Part B effective date next to it like your Part A coverage you will need to have this added if you will not have creditable medical insurance coverage in place through an employer sponsored plan.
If you already receive Social Security benefits and your Medicare card does not show up in the mail automatically, we highly encourage you to call the Social Security office at 1-800-772-1213 to find out why.
Medicare no longer uses your Social Security Number as your Medicare Number. This is to help prevent Identity theft. You will be assigned a specific number from Medicare that looks similar to the picture next to this information.
If you are part of another large majority of Medicare Beneficiaries who are not receiving Social Security income benefits or Railroad Retirement income benefits, you will need to be proactive and sign up for Part A, Part B, and Part D prescription drug coverage three months before age 65. One of the easiest ways to sign up is through the Social Security website.
Once the Social Security Administration receives your Medicare application for Part A and Part B outpatient care coverage, they will
Next you will need to decide on a few more housekeeping items. This includes the following:
Talking with a Medicare expert is highly recommended as they can help you navigate between these housekeeping items. They can also recommend a private insurance company that is best for you.
Never sign up for a Medicare advantage plan or Medigap plan without first talking with a local Medicare insurance agent.
We recommend that you go enjoy a little time outdoors while you wait for the your local Social Security office to send you your approval letter.
Under Original Medicare (with no Medicare Supplement / Medigap or Medicare Advantage Plan in place) Your Medicare Part A coverage will pay for the majority of the cost. However, you will have some cost-sharing as well that you are responsible for. Not matter how much you plan writing these checks to cover this cost is always painful.
The Centers for Medicare and Medicaid Services (CMS) has the responsibility of calculating our portion of the cost for Medicare Part A. This includes the cost associated with your deductible and coinsurance. Please keep in mind these figures are only dealing with your Part A Medicare coverage benefits. In 2021, your portion that you will pay:
For skilled nursing facility stays, Medicare covers day 1 – 20 at 100%. Starting on day 21 you will be charged a daily copay in plan year 2021 for days 21- 100 of $185.50. On day 101 and beyond you will be responsible for 100% of the cost.
Fortunately, both Medigap policies and Part C Medicare Advantage plans will help cover most of these costs. If you purchased a Medigap policy Plan G your skilled nursing facility cost would be covered at 100% for all 100 days. While a Medicare Advantage plan can have lower daily co-pays than the $185.50 amount. It is important that you review your specific plan summary of benefits to ensure you know your true cost. Unfortunately neither the Medigap or Medicare Advantage plan will provide any additional coverage beyond day 100.
To get help with your Medicare insurance needs or learn more about Medicare hospital coverage, call our insurance experts at (562) 735-3553 for a FREE consultation!
Long Term Care medical Insurance is not included as part of your Medicare coverage. You are highly encouraged to consider exploring this coverage well in advance to actually needing it.
90% of the time clients reach out to us a day, week, or month before they are faced with putting their loved one into a long term care facility. At this point we have to tell our clients that unfortunately we do not have a insurance carrier that will provide this needed coverage based on your current situation.
We encourage our clients to explore this coverage option at the same time they are signing up for Medicare coverage. You will need to be healthy and have no major medical. conditions at the time of application. This will also help you obtain a more competitive price when we shop for your Long Term Care insurance coverage.
Because we are a full service Insurance Agency we can help you find an medical insurance option that makes sense for you to explore and obtain. Let us know how we can help you with your Long Term Care needs.
Many of our clients are only enrolled into Part A when they first come to us. One of the main reasons they don’t enroll into Medicare Part B medical insurance is because they still have credible health insurance coverage through an employer health plan.
Once you are ready to enroll into Medicare Part B of Original Medicare, we recommend going to the Social Security website and downloading their enrollment application. Following is a link to this form CMS Form 40B a federal government website.
Once you receive your new Medicare Card showing your Date of Enrollment into Part B medical insurance, you are now able to give us a call and sign up for either a Medicare Supplement Plan / Medigap plan or a Medicare Advantage Plan.
Medicare Part B covers many of your preventive services to help keep you out of the hospital.
You’re required to be enrolled into both Part A and Medicare Part B coverage before you can sign up for either a Medigap plan or a Medicare Advantage plan.
Want Medicare Insurance Agent to explain in a one-on-one setting? Get help from our Medicare insurance experts today at (562) 735-3553.
While obtaining your Medicare Part D prescription drug coverage through a reputable health care company is important, there are many insurance companies that we work with that are just as trustworthy.
There are also some Medicare Part D health care companies we tend to avoid as they have not proven to be trustworthy as of today.
Unlike group health plan coverage, there are many more insurance companies that provide health insurance for older adults.
It is highly recommended to sign up for Part B coverage once you turn age 65. Coverage begins on the first of your birthday month. If you are still covered by a group health plan that offers creditable coverage, then you can delay your enrollment into this part of Medicare.
When you sign up for Part B, Social Security may ask for sensitive information to verify your identity.
Once you are about 60 days from losing your group health insurance, you will qualify for a special enrollment period. During the special enrollment period, you are able to enroll into a Medicare health plan even through you are outside of the general enrollment period.
A group health plan offered by your employer will typically satisfy the requirements of delaying signing up for Part B. However, if your company is part of a “Health Sharing Ministry” that is not considered a real insurance company, this will not satisfy the requirements.
Eligibility for home health care services under Medicare is based on the need for skilled nursing care or therapy services, which are provided by a Medicare-certified home health agency.
A patient’s attending physician must certify that the patient is homebound, and that the home health care services are medically necessary.
In general, Medicare will cover up to 20 hours per week of skilled nursing care and 40 hours per week of physical, occupational, or speech therapy.
Some additional home health services may also be covered, including medical social services, durable medical equipment, and intravenous therapy. However, Medicare will not cover long-term care or personal care services, such as help with bathing, dressing, and eating.
For patients who require these types of coverages, the federal government provides Medicaid services to low income families or a private long-term care insurance policy may be a better option.
Preventive services are not typically covered under Medicare Part A hospital insurance, as these types of health coverage are included under your Medicare Part B medical services.
If you forgot to enroll into Part B, you may have an opportunity to be covered during the general enrollment period.
Medicare Part C is more commonly known as Medicare Advantage plans. Many of these plans do not have additional monthly premiums. It is an alternative health coverage to Original Medicare and are typically HMO plans.
Before enrolling into a Medicare advantage plan, it is important to understand their benefits and limitations.
Most Advantage plans include prescription drugs as part of their health insurance program. These health insurance plans will typically include copays, deductibles, coinsurance, and max out of pocket costs.
Unlike Original Medicare with a Medigap plan, you will typically be locked into a medical provider network. Many Medicare beneficiaries prefer staying on Original Medicare and purchasing a Medigap plan, so they have the freedom to see any doctor throughout the US.
Another benefit to Medigap plans is the United States Government approved and standardized Medigap plans. This means they do not change from year to year, like a Medicare advantage plan.
Medigap plans are offered by private insurance companies and should be purchased through an independent Insurance agent. This will ensure you obtain multiple insurance quotes from all available private insurance companies.
Medigap plans do have a monthly premium for each of their plans. The monthly premium is based on the level of coverage purchased. To keep your monthly premium low, select the best Medigap plan option that you feel the most comfortable with.
Original Medicare with a Medigap plan will provide health benefits for all services covered at no additional cost.
Medigap Plan F has higher monthly premiums and if you qualify for this plan we recommend, obtaining the Plan G as their monthly premiums are more sustainable for most people.
Coverage begins on the first of the month following the date you request coverage.