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Applications & Resources for applying for Medicare

Social Security Benefits Application

Medicare Part B Enrollment Application

Medicare.Gov

What is Medicare?

Medicare is the United States federal health insurance program for people who are 65 or older. It’s also available for people who are younger than 65 and have been diagnosed with certain disabilities or health conditions such as End-Stage Renal Disease (ESRD) or Lou Gehrig’s disease (ALS).

That’s a pretty straightforward definition, but there is a lot to the Medicare program, and many beneficiaries are still confused about it long after their enrollment. Our goal is to simplify your Medicare for your peace of mind!

Medicare was originally created in 1965. President Lyndon Johnson signed the Medicare and Medicaid Act into law. The act established Medicare as a way for retired individuals to get health insurance. It also created Medicaid, which is often confused with Medicare. Medicaid is also a health insurance program, but it is designed for people with limited incomes rather than based solely on age.

The Medicare program consists of four parts, plus some other options for additional coverage. While everyone starts with Parts A and B, the rest of your coverage options will be a personal decision based on your healthcare needs and budget.

How Does Medicare Work?

Let’s start talking in more detail about each part of Medicare and the supplement coverage offered to Medicare beneficiaries.

Original Medicare

Original Medicare includes Part A and Part B. It’s sometimes called Traditional Medicare. Original Medicare is where everyone starts. You must enroll in both Parts A and B before you can choose any additional coverage.

Medicare Part A is also called inpatient or hospital insurance. It covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Most beneficiaries don’t pay a premium for Part A. As long as you or your spouse have worked and paid taxes for ten years (40 quarters), you won’t pay a premium for Part A. If you haven’t met that requirement, your premium is based on the number of quarters you’ve fulfilled. Premiums typically change (increase) every year.

Even though Part A doesn’t have a premium, it does have other out-of-pocket costs. First, it has a deductible. The Part A deductible works differently than other health insurance deductibles you might be used to. Instead of an annual charge, it goes by benefit periods. A benefit period begins on the first day you become an inpatient and ends when you’ve been out of the hospital (or other facility) for 60 consecutive days.

Part A also has copays, which are based on the number of days you’ve been hospitalized. The first 60 days of a hospitalization are covered by Medicare. Copays begin on day 61.

Medicare Part B is also called outpatient or medical insurance. It covers visits to your doctor, imaging, lab tests, surgeries, durable medical equipment, and many preventive care services.

Part B does have a monthly premium. The Centers for Medicare and Medicaid Services (CMS) sets a standard premium each year. Most people pay the standard amount, but people with higher incomes will pay more. On the other hand, beneficiaries with limited incomes are eligible for Medicare Savings Programs, which can help cover the Part B premium.

Part B also has a deductible, but it is a smaller annual fee. Once you meet that deductible, Part B pays for 80% of covered services, leaving you with a 20% coinsurance amount.

Unlike traditional group health insurance, there is no out-of-pocket maximum under Original Medicare. While it does offer great coverage, it can leave beneficiaries with a large financial burden.

This is where we come in to fills the gaps where original Medicare leaves off to ensure you are protected for all of your health and wellness needs!