What is Medicare and How Does Medicare Work?
Medicare is a health insurance program for people 65 and older and some younger people with qualified disabilities. Getting started early when enrolling in Medicare is vital as it is a multi-step registration process.
Contacting a Medicare Agent for assistance is critical to ensure you get Medicare and do not fail to enroll in the required parts. Missing a coverage part or secondary insurance policy can cost you thousands in uncovered health care costs and lifetime penalties.
Integrity Now Insurance Brokers is certified in Medicare and licensed throughout the United States to help older adults sign up for Medicare plan that suits their healthcare needs best.
What is Medicare?
Medicare is a federal health insurance program established in 1965 by Congress to provide health care coverage and support to individuals over 65, disabled individuals, and those with End-Stage Renal Disease (ESRD). It consists of four parts: Medicare Part A (hospital insurance), Medicare Part B (medical insurance), Medicare Part C (Medicare Advantage), and Medicare Part D (Medicare prescription drug plan).
Medicare also offers the option of a Medicare Supplement Insurance plan (Medigap) to help pay for out-of-pocket costs that Medicare Parts A and B do not cover.
Medicare covers many of the costs associated with medical care but does not cover all expenses. Individuals need to understand their coverage and what out-of-pocket costs they may be required to pay. It is also essential to understand the differences between Original Medicare, Medicare Advantage, and Medicare Supplement plans so they can make the best choice to fit their health needs and budget.
With the help of Integrity Now Insurance Brokers, individuals can compare plans to find the right coverage.
What Medicare covers
Medicare covers a wide range of services related to hospital care, doctor visits, preventive care, and prescription drugs. Original Medicare is broken down into three main categories that include:
- Medicare Part A covers many health care services received in the hospital setting,
- Medicare Part B covers doctor appointments and outpatient medical care.
- Part D (Prescription Drug Coverage) helps cover the cost of prescription drugs.
Many Medicare beneficiaries prefer this structure because it provides the most flexible health insurance option. They can see any doctor and medical facility that accepts Medicare without restrictions.
Private insurance companies offer a secondary policy to fill in the gaps of Medicare Part A & B. These are known as Medigap Plans. Medicare beneficiaries can have zero out-of-pocket costs for a small insurance premium when these secondary plans work alongside Original Medicare.
Congress later allowed a new plan offered by private insurance companies, Part C (Medicare Advantage). Unlike Medicare Supplement plans, which fill in the gaps of Original Medicare, Medicare Advantage plans replaces Original Medicare when beneficiaries enroll in a Medicare Advantage plan.
The intention of allowing Medicare Advantage plans was to provide an alternative low-cost health insurance option for seniors. It is critical to understand what you may gain or lose when enrolling in a Medicare Advantage plan by talking with one of our Medigap insurance agents.
What are the Different Parts of Medicare (Parts A, B, C, and D)
Medicare consists of four parts – Part A, Part B, Part C, and Part D – offering different coverage and costs.
- Part A covers hospital care and related services
- Part B covers doctor appointments and outpatient medical care
- Part C is offered by private insurers and covers the same benefits as Parts A and B, plus extra benefits such as vision, hearing, and dental care.
- Part D covers prescription drugs.
Understanding the four parts of Medicare is essential when choosing the right coverage to know how to get your Medicare coverage and the benefits you deserve.
Who is eligible for Medicare
If you are new to Medicare, you may be confused about how to sign up for a Medicare plan and what Original Medicare covers. You might also wonder if you are eligible to receive your Medicare today or not.
Medicare program for people age 65 and over, as well as certain individuals under 65 with disabilities, are eligible for Medicare benefits.
Those who receive Social Security disability insurance usually become eligible for Medicare after a two-year waiting period. Additionally, those with end-stage renal disease (permanent kidney failure), amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease), and certain other disabilities are eligible the month their disability begins.
Those who qualify for both Medicare and Medicaid are called “dual eligible” and will have both Medicare as their primary plan and Medicaid as their secondary plan.
Finally, those approaching age 65 can enroll in Medicare during an initial enrollment period that starts three months before their 65th birthday and ends three months after their birthday month. Private insurers may also offer Medicare plans.
What are the Benefits of Having Medicare?
Having Medicare has many benefits once you become eligible for Medicare coverage. These benefits include the following:
- Excellent health coverage that can be customized to fit one’s health needs and budget.
- Free preventive benefits and cancer screenings.
- Discounts on brand-name prescription drugs.
- Broad access to medical doctors and medical facilities.
- Access to Medicare Advantage plans, which include prescription drug coverage.
- Low to zero-cost copays, deductibles, and coinsurance options with Medigap plans.
- The ability to choose your own doctor or healthcare provider nationwide (Original Medicare with a Medigap plan ONLY).
- Financial assistance for those with limited incomes, disabilities, or chronic illnesses.
- Peace of mind knowing that you have quality health coverage tailored to your specific needs.
- The assurance of knowing that you won’t face financial hardship should you require emergency care or long-term medical treatments.
Medicare Insurance Coverage Options
1. Original Medicare
Original Medicare is a health insurance program sponsored by the federal government for people ages 65 and over or those under 65 who may qualify due to specific disabilities or conditions. Original Medicare consists of Part A and Part B and is managed by the federal government. Part A covers hospital expenses, and Part B covers medical services.
Original Medicare provides coverage for most approved healthcare services and supplies, although you’ll pay a share of the cost after meeting your deductible. Medicare covers medically necessary services, preventive services like shots and screenings, and some not covered services, such as long-term care.
When enrolling in Original Medicare, buying a secondary Medicare Supplement Plan G is recommended.
2. Medicare Advantage Plans
Medicare Advantage Plans, also known as Medicare Part C, are health plans offered by private health insurance companies that provide the same coverage as Original Medicare. They can offer additional benefits like vision, hearing, and dental care but are not required to include these additional benefits.
Many Medicare Advantage plans also include Medicare Part D drug plan (prescription drug coverage.
Unlike Original Medicare, Medicare Advantage plans have an annual limit on out-of-pocket costs and typically offer HMOs or PPOs with coverage only in some local regions. Doctors and medical facilities seen outside of the Medicare Advantage plan network are not covered by many of these plans, and Medicare beneficiaries would be responsible for the full cost.
3. Medicare Part D Prescription Drug Coverage
Medicare Part D prescription drug coverage options include stand-alone plans from private insurance health companies. These plans provide coverage for your prescription medications and some vaccines. Depending on the plan, prescription drugs may be divided into coverage tiers with different copay amounts for generic, preferred brand-name, non-preferred brand-name, and expensive drugs.
Original Medicare beneficiaries must enroll in a stand-alone Part D plan to have coverage for prescription drugs. It’s essential to check each plan’s formulary to ensure your medications are covered.
Enrolling in Part D can also help protect you from expensive medication costs if your health changes. Those who don’t enroll in Part D during their initial enrollment period may have to pay a late-enrollment penalty.
Medicare beneficiaries who enroll in a Medicare Advantage plan cannot enroll in a standalone Part D plan and must accept the prescription drug coverage in their program.
4. Medicare Supplement Plans
There are several options for Medicare supplement plans, also known as Medigap. These private insurance policies help pay for out-of-pocket costs not covered by Original Medicare.
Depending on where you live, you have up to 10 different Medicare Supplement policies to choose from A, B, C, D, F, G, K, L, M, and N (Wisconsin, Massachusetts, and Minnesota policies may have different names).
Each policy offers standardized benefits, such as covering the costs of the copayments, coinsurance, deductibles, and care received when traveling abroad.
It is critical to select a health insurance program that provides health care coverage you must have, not only while you are healthy but also when you become sick.
How to Enroll in Original Medicare?
Before one of our licensed insurance agents can enroll you in a Medicare Advantage plan or Medigap plan, you must first enroll in Medicare Parts A&B. Here is how to enroll in Original Medicare:
- Determine your initial enrollment period. This is a 7-month period that starts three months before and ends three months after your 65th birthday – including your birthday month.
- Sign up online: Go to Social Security’s website and apply for Medicare online. The online application is quick and easy to complete, typically taking less than 15 minutes.
- Call Social Security at 800-772-1213: You can also contact Social Security by phone.
- Come to your local Social Security office: Make sure to call to check about in-person appointment availability.
Once you receive your new Medicare card, call Integrity Now Insurance Brokers to complete the next steps of fully enrolling in Medicare.
How to enroll in a Medicare Supplement Plan: Medigap Plan
Once you receive your red, white, and blue Medicare card, follow these steps to enroll in your Medicare Supplement plan.
- Step 1: Determine the best time to enroll in a Medicare Supplement plan: The best time to buy a Medigap policy is during your initial sign-up period around your 65th birthday. During this period, you are guaranteed coverage regardless of your health status. If you wait until after this window, you must pass medical underwriting first. This means the insurer will ask you questions about your health now and in the past and medications.
- Step 2: Research the 10 standardized Medigap plans: The National Association of Insurance Commissioners develops 10 standard Medigap plans. They pay most, if not all, of Medicare coinsurance, deductibles, and copay amounts based on the plan selected.
- Step 3: Work with Medigap insurance Brokers to obtain quotes from different insurers: Once you have decided which type of Medigap plan you want, you can obtain quotes from different insurers. Compare the quotes and choose the one that best meets your needs.
- Step 4: Fill out the application: Once you have chosen the plan, you must fill out the application. You will need to provide information about yourself, your health, and your medical history. You must also provide proof of your Medicare Part A and Part B coverage.
- Step 5: Make the payment: Once the application is approved, you will be required to pay for your Medigap policy. Depending on the plan, you may also have to pay an annual or monthly premium.
- Step 6: Start using your Medicare Supplement plan: Now that the Medicare insurance company approves you, verify the effective date of coverage and start using your health insurance.
How to Enroll In a Medicare Advantage Plan: Medicare Part C
Here are the Step-by-Step Instructions for Enrolling in a Medicare Advantage Plan:
- Sign up for Original Medicare Part A and Part B
- Choose a Medicare Advantage Plan that meets your needs. Consider the plan coverage, cost, and network of providers.
- Gather the necessary documents for enrollment, such as proof of identity, Social Security number, and any other documents required by the plan.
- Contact Integrity Now Insurance Brokers and inquire about enrollment. You may be able to enroll over the phone or may need to complete an electronic enrollment form.
- If approved, you will receive a membership card from the private insurer that will be used to access your Medicare Advantage plan benefits.
- During the enrollment process, you will be asked to choose a primary care provider. Find a provider in the insurer’s network to ensure the maximum coverage for your benefits.
- Verify your prescription medications are covered by the Medicare Advantage plans and costs.
- Once enrolled, you will pay a monthly premium to the private insurer and the Part B premium that you pay to the Centers for Medicare and Medicaid Services.
- After enrollment, you should receive a copy of the plan’s benefits explanation to understand what is and is not covered.
How to Enroll in A Prescription Drug Plan: Medicare Part D
Depending on the Medicare plan you choose, you need to ensure you have prescription drug coverage. By working with our Medicare insurance agents, we will guide you every step of the way to ensure you have all of the required health coverage in place.
Here are the steps you will need to follow when enrolling in a Part D Medicare plan:
- Step 1: Determine your eligibility for Part D. You must be enrolled in Original Medicare Part A or B to be eligible for Part D prescription drug coverage.
- Step 2: Review your current prescription drug coverage. If you have creditable drug coverage from an employer, Veterans hospital, or retiree plan, you don’t need to enroll in a Part D plan until you lose this coverage.
- Step 3: Review the formulary. Each Part D plan includes a list of covered drugs, so make sure your medications are included in the plan you’re considering.
- Step 4: Compare plans. Compare the coverage, premiums, deductibles, and co-pays of different Part D plans to find the one that best meets your needs.
- Step 5: Enroll in a plan. If you decide to enroll in a Part D plan, provide the required information to our licensed insurance agents to get enrolled.
- Step 6: Monitor your coverage. Please pay attention to changes in the formulary and review your plan each year to ensure it’s still the best one for you.
How to Qualify for Medicaid?
To qualify for Medicaid, you must contact your Medi-Cal office, social service office, or welfare office to see eligibility. Once eligibility is determined, there are two Medicaid programs that you can qualify for – the Qualified Medicare Beneficiary (QMB) and the Specified Low-Income Medicare Beneficiary (SLMB) programs.
If you qualify for the QMB program, your state will pay your monthly Medicare premiums, any Medicare deductibles, and coinsurance.
On the other hand, if you are eligible for the SLMB program, your state will only pay your medical insurance (Part B) monthly premium. You can request information from your local Social Security Administration office to learn more about both programs.
Get Help Today From Our Medicare Agents
If you’re feeling overwhelmed by the complex world of Medicare insurance plans, don’t worry – you’re not alone. With so many different options and regulations, it can be difficult to know where to start.
That’s where Integrity Now Insurance Brokers comes in. Our team of experienced Medicare agents is here to help guide you through the process, answer your questions, and find a plan that fits your unique needs and budget.
We understand that every individual’s situation is different, so we offer personalized one-on-one support to ensure you make the best decision for yourself and your loved ones.
Whether you’re looking to enroll in a new plan, make changes to your current coverage, or need help navigating Medicare Part D prescription drug plans, we’re here to help.
Contact Integrity Now Insurance Brokers today for the support and guidance you need.