An Introduction to Medicare

What is Medicare insurance?Medicare insurance is a health insurance program that’s offered by the federal government to anyone who’s 65 years old or older. Younger people who are living with certain disabilities or illnesses and receiving Social Security disability insurance (SSDI) for at least two years are also eligible. Those who have end-stage renal disease (permanent kidney failure) and amyotrophic lateral sclerosis (ALS, a.k.a. Lou Gehrig’s disease) are automatically enrolled. This insurance helps contain medical costs as you grow older, but Medicare Advantage doesn’t pay for everything.

What is Medicare insurance?

There are four parts that you should know about because each offers specific coverage. These include:

  • Part A is sometimes referred to as “hospital insurance“ because it covers inpatient hospital care and related services (e.g., care in a skilled nursing facility that isn’t custodial or long-term). It also helps pay for some hospice and home health care services.
  • Part B pays for your outpatient medical care (e.g., doctor appointments, some medical supplies, preventive services, ambulance services, mental health coverage, some prescription drugs, and durable medical equipment) and therefore is sometimes referred to as “medical insurance.”
  • Part C is offered by private insurers. Known as Medicare Advantage, it covers the same benefits of Parts A and B as well as some additional benefits from Part D for things like vision, hearing aids, and dental care.
  • Part D covers prescription drugs, both generic and brand names.

What is Medicare Part C?

In order to participate in Medicare Part C (a.k.a., Medicare Advantage), you need to pay your Part B premium and possibly another premium for the insurer if there is one (many have a $0 premium). Unlike your typical Medicare insurance, Medicare Advantage plans have an annual limit on out-of-pocket costs ($7,550 in 2022 and possibly $8,300 in 2023). These plans are typically HMOs or PPOs, which means that they’ll only provide coverage in certain local areas. You’ll also need to have pre-authorization and referrals. Another important thing to understand is that with Medicare Advantage, most healthcare services will charge copays.

What is a Medicare enrollment period?

Unless you’re automatically enrolled in Medicare insurance, you’ll need to be proactive about enrolling yourself. Some times when you’ll need to do this include:

  • The initial enrollment period lasts for 7 months, around the time when you turn 65 years old. This period starts three months before your birthday month as well as three months after your birthday month, and it also includes your birthday month. So, for instance, if your birthday month is July, you’ll be eligible to start at the beginning of April and end at the end of October.
  • The general enrollment period runs from January 1 to March 31 each year. Anyone who doesn’t apply for Medicare insurance during their initial enrollment period will need to wait until this period to enroll. Your coverage will then begin on July 1, but you may owe late penalties. This means that you must pay an additional amount for any medications that are covered by Medicare Part D.
  • The special enrollment period is a period when you can join Medicare and make any changes that you want to make to your coverage due to events that have happened in your life (e.g., leaving a job or moving out of your plan’s coverage area).
  • The annual Medicare open enrollment period allows you to make any changes you want between October 15 and December 7. Medicare Advantage also has its own yearly open enrollment period, which is from January 1 through March 31.

Where can you learn more?

To learn more about Medicare insurance, contact Gemini Insurance Company in Palm Harbor, FL. We have the knowledge you need to make an empowered decision so contact us today.

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