Need Help? Call Grand Valley Senior Benefits Now: (970) 773-0220 info@yourmedicareguy.com

Medicare is a federal health insurance program that helps pay for hospital and medical care for people age 65 and older and, in certain cases, people under 65 with specific disabilities.

Medicare consists of two main parts, (usually referred to as original Medicare) hospital and medical insurance, along with two additional parts that provide some flexibility and prescription drug benefits.

Medicare Part A helps cover:

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Home hospice care
  • Some home health care

You may go to any provider that accepts Medicare.

For most people, there is no premium for Part A as long as they or their spouse paid Medicare taxes for 40 quarters or 10 years. In 2016 there is a $1,288 yearly deductible for in-patient hospital care.

Medicare Part B helps pay for:

  • Services from doctors and providers
  • Outpatient care
  • Lab fees and X-rays
  • Durable medical equipment (wheelchairs, walkers, oxygen equipment, etc.)
  • Some preventive services

You may go to any provider that accepts Medicare.

In 2016 people new to Medicare will pay a $120.80 monthly Part B premium. There is a $166 annual deductible and 20% copay for all Medicare approved services. As you can see, Medicare does not cover all your medical expenses.

Medicare Supplement Plans (also known as Medigap insurance)
Medicare supplement plans are standardized plans offered by private insurance companies and approved by Medicare that can help pay some of the cost not covered by original Medicare.

There are ten standard Medigap policies: A, B, C, D, F, G K, L, M and N. The different lettered policies offer different benefits and have different costs. All policies with the same letter must offer the same basic benefits. Even though the basic benefits are the same for each standard policy, the insurance companies may charge different premiums for the identical policy. The only difference in any Plan F is the monthly premium charged by the different insurance companies.

A plan may not cancel your coverage as long as you continue to pay your premium. They also cannot single out a person for a rate increase. You may go to any provider that accepts Medicare.

When you purchase a Medicare supplement you must also purchase a Part D prescription drug plan.

Medicare Part C (Medicare Advantage plans)
Medicare Advantage plans are offered by private insurance companies that are approved by Medicare. All Medicare Advantage plans are not created equal, as benefits, copays, deductibles and availability vary by county and state. In order to control costs, Medicare Advantage plans are allowed to limit a patient’s choices of doctors, hospitals, etc., to only members of their networks. This can be a major disadvantage if a patient’s favorite doctor, specialist, or hospital is not a member of a plan’s network.

Medicare Part D (prescription drug coverage)

  • Prescription drug plans are run by Medicare-approved private insurance companies and help cover the cost of prescription drugs.
  • Deductibles vary by plan
  • Costs vary from plan to plan
  • Drug lists (know as formularies) vary by plan

Enrollment Period for People Turning 65
The Initial Enrollment Period (IEP) for Medicare is a seven-month period that starts three months before you turn 65 and ends three months after you turn 65.

Late Enrollment Penalties
If you or your spouse plan to work past age 65 and you have insurance through an employer, contact your local social security office to ensure you do not incur any late enrollment penalties.

Medicare and the Affordable Care Act (Obamacare)
If you have health insurance through the Marketplace and are getting ready to turn 65, you can cancel the marketplace plan once your Medicare coverage starts.

Enrolling in the right Medicare plan is an important decision, and by understanding the facts, you can navigate the process with ease.