Medicare Overview
[/fusion_text][fusion_separator style_type=”default” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” sep_color=”” top_margin=”5%” bottom_margin=”” border_size=”0″ icon=”” icon_circle=”” icon_circle_color=”” width=”” alignment=”center” /][/fusion_builder_column][fusion_builder_column type=”1_3″ layout=”1_3″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” border_radius=”” box_shadow=”no” dimension_box_shadow=”” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”true” element_content=”” first=”false”][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container][fusion_builder_container hundred_percent=”no” hundred_percent_height=”no” hundred_percent_height_scroll=”no” hundred_percent_height_center_content=”yes” equal_height_columns=”no” menu_anchor=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” status=”published” publish_date=”” class=”” id=”” background_color=”” background_image=”” background_position=”center center” background_repeat=”no-repeat” fade=”no” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ video_mp4=”” video_webm=”” video_ogv=”” video_url=”” video_aspect_ratio=”16:9″ video_loop=”yes” video_mute=”yes” video_preview_image=”” border_size=”” border_color=”” border_style=”solid” margin_top=”” margin_bottom=”” padding_top=”5%” padding_right=”” padding_bottom=”3%” padding_left=””][fusion_builder_row][fusion_builder_column type=”2_3″ layout=”2_3″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” border_radius=”” box_shadow=”no” dimension_box_shadow=”” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”false” first=”true”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]What’s Medicare?
Medicare is the federal health insurance program for:
- People who are 65 or older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
The different parts of Medicare help cover specific services:
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
For a hospital stay, after you pay a deductible of $1,600 per admission for 2023, it covers the cost of your semi-private room. This covers you for days 1 thru 60. Copays apply after that.
The cost of Part A for most people at age 65 is $0. This is because during your working years you have paid taxes to pre-fund the premiums for your hospital benefits. If you don’t automatically qualify for premium-free coverage, most individuals can still apply for it. For 2023 the cost is $506 per month.
Medicare Part B (Medical Insurance)
Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Part B has an annual deductible of $240 for 2024. After that you will pay a 20% coinsurance for all Medicare approved services. Medicare Part B has No Out of Pocket Maximum.
Part B has a monthly premium. The cost of Part B is set by Social Security and it changes from year to year. For 2023 the standard cost is $164.90 per month. You may pay a higher or lower premium based on your adjusted gross income reported to the IRS in recent years.
Medicare Part C (Medicare Advantage Plans)
Medicare Advantage, also known as Part C, is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D (see below). Medicare Advantage plans are offered by private insurance companies. You will pay co-pays or co-insurance for various medical services. Some co-pays could be as little as $0.
If you’re in a Medicare Advantage Plan or other Medicare plan, you may have different rules. But your plan must give you at least the same coverage as Original Medicare. Medicare Advantage Plans can include extra benefits such as; routine vision exam and hardware, routine hearing exams and hearing aids, fitness programs, and OTC benefits.
To enroll in a Part C plan, you must first be enrolled in both Parts A and B of Medicare. Even if you find a Part C plan with a very low premium or no premium, you will still pay the Part B monthly premium. You must also live in the plan service area. Once you enroll, your Medicare coverage will be from the Medicare Advantage plan itself, not from the government.
Part C is voluntary. Many people prefer to get their Medicare coverage from Original Medicare and a traditional Medicare Supplement Plan or Medigap. These people do not want a Part C Medicare Advantage plan, so they simply don’t enroll in one.
Medicare Part D (Prescription Drug Coverage)
Part D adds prescription drug coverage to Original Medicare. Medicare Part D is a federal program administered through private insurance companies. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
It covers retail prescription drugs that you pick up yourself at the pharmacy or order via mail order. You choose a carrier and enroll in their drug plan, and that’s how you sign up for Part D drug plan. Most states have about 30 drug plans to choose from, and the best way to determine which one is the right fit for you is to have your agent run a Part D analysis using Medicare’s prescription drug finder tool.
Call Progressive Concepts Insurance for a free consultation and quote for your Part D prescription drug plan.
[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_3″ layout=”1_3″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_image_id=”” background_color=”#ffffff” background_image=”” background_position=”left top” background_repeat=”no-repeat” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” border_radius_top_left=”” border_radius_top_right=”” border_radius_bottom_left=”” border_radius_bottom_right=”” box_shadow=”no” box_shadow_vertical=”2px” box_shadow_horizontal=”2px” box_shadow_blur=”10″ box_shadow_spread=”7″ box_shadow_color=”#e0e0e0″ box_shadow_style=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”true” first=”false”][fusion_button link=”#ab” text_transform=”” title=”” target=”_self” link_attributes=”” alignment=”” modal=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” color=”custom” button_gradient_top_color=”#00426b” button_gradient_bottom_color=”#00426b” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” accent_hover_color=”” type=”” bevel_color=”” border_width=”” size=”xlarge” stretch=”yes” shape=”” icon=”” icon_position=”left” icon_divider=”no” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]How to Get Parts A & B[/fusion_button][fusion_separator style_type=”default” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” sep_color=”” top_margin=”30px” bottom_margin=”” border_size=”0″ icon=”” icon_circle=”” icon_circle_color=”” width=”” alignment=”center” /][fusion_button link=”/contact” text_transform=”” title=”” target=”_self” link_attributes=”” alignment=”” modal=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” color=”default” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” accent_hover_color=”” type=”” bevel_color=”” border_width=”” size=”xlarge” stretch=”yes” shape=”” icon=”” icon_position=”left” icon_divider=”no” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]Contact us for a one-on-one presentation of Medicare 101, Parts & Pieces[/fusion_button][fusion_separator style_type=”default” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” sep_color=”” top_margin=”30px” bottom_margin=”” border_size=”0″ icon=”” icon_circle=”” icon_circle_color=”” width=”” alignment=”center” /][fusion_widget_area name=”avada-slidingbar-widget-1″ title_size=”” title_color=”” background_color=”#e4e4e4″ padding_top=”7%” padding_right=”7%” padding_bottom=”7%” padding_left=”7%” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” /][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container][fusion_builder_container hundred_percent=”no” hundred_percent_height=”no” hundred_percent_height_scroll=”no” hundred_percent_height_center_content=”yes” equal_height_columns=”no” menu_anchor=”ab” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” status=”published” publish_date=”” class=”” id=”” background_color=”” background_image=”” background_position=”center center” background_repeat=”no-repeat” fade=”no” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ video_mp4=”” video_webm=”” video_ogv=”” video_url=”” video_aspect_ratio=”16:9″ video_loop=”yes” video_mute=”yes” video_preview_image=”” border_size=”” border_color=”” border_style=”solid” margin_top=”” margin_bottom=”” padding_top=”5%” padding_right=”” padding_bottom=”3%” padding_left=””][fusion_builder_row][fusion_builder_column type=”2_3″ layout=”2_3″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” border_radius=”” box_shadow=”no” dimension_box_shadow=”” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”false” first=”true”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]How do I get Parts A & B?
Some people get Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) automatically and other people have to sign up for it. In most cases, it depends on whether you’re getting Social Security benefits. If you are receiving Disability Benefits from Social Security for 24 months you will automatically get Part A and Part B.
You Initial Enrollment Period (IEP) is a 7-month window around the month you turn 65.
- 3 months before your 65th birthday
- The month of your 65 birthday
- 3 months after your 65th birthday
How do I sign up?
- Apply online at Social Security: www.socialsecurity.gov
- Visit your local Social Security Office
- Call Social Security at 1-800-772-1213
Should I get Parts A & B?
Most people should enroll in Medicare Part A (Hospital Insurance) when they’re first eligible, but certain people may choose to delay Medicare Part B (Medical Insurance) if they have qualifying group health insurance from their employer or their spouse’s employer.
If you’re on an Employer Sponsored Plan the size of the employer determines whether you may be able to delay Part A and Part B without having to pay a penalty if you enroll later.
The employer has fewer than 20 employees
You should sign up for Part A and Part B when you’re first eligible. In this case, Medicare pays before your other coverage.
Note: If you don’t enroll when you’re first eligible, you may have to pay a Part B lifetime late enrollment penalty, and you may have a gap in coverage if you decide you want Part B later. The lifetime penalty is 10% for every 12-month period in which you didn’t enroll. When you do choose to enroll you can only do so during the General Enrollment Period between January 1 to March 31st of each year. Your Part B coverage would begin on July 1st of the same year.
The employer has 20 or more employees
Ask your benefits manager whether you have group health plan coverage (as defined by the IRS). People with group health coverage based on current employment may be able to delay Part A and Part B and won’t have to pay a lifetime late enrollment penalty if they enroll later. If you want to delay both Part A and Part B coverage, you don’t need to do anything when you turn 65.
If you’re eligible for premium-free Part A, you can enroll in Part A at any time after you’re first eligible for Medicare. Your Part A coverage will go back (retroactively) 6 months from when you sign up (but no earlier than the first month you’re eligible for Medicare).
If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, you may have to pay a penalty.
When the employment or employer/union coverage ends
Once the employment (or your employer/union coverage) ends, 2 things happen:
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- You may be able to get COBRA coverage, which continues your health insurance through the employer’s plan (in most cases for only 18 months) and probably at a higher cost to you.
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- You have 8 months to sign up for Part B without a penalty, whether or not you choose COBRA. If you choose COBRA, don’t wait until your COBRA ends to enroll in Part B. If you don’t enroll in Part B during the 8 months after the employment ends you will incur a lifetime penalty as long as you have Part B and you will have a gap in coverage because you won’t be able to enroll until January 1-March 31 for a July 1 effective date.
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