MEDICARE BASICS

If you are overwhelmed by all the information that you have been inundated with now that you are or will be Medicare eligible, don’t worry, you are not alone. There are many resources to help educate you on your Medicare options, including the Medicare & You book, however, we are here to help you. Call us today, so we can help answer your questions.

STEP 1

ENROLL IN ORIGINAL MEDICARE

Original Medicare is provided by the federal government and consists of Part A (hospital stays) & Part B (doctor and outpatient visits). Original Medicare pays for some of your expenses, but not all. There is also no out of pocket maximum, or safety net with Original Medicare.

 

PART A:  Helps pay for inpatient hospital care such as room and board, skilled nursing care, limited home health, hospice and inpatient medication. Generally, if you or your spouse have made payroll contributions to social security for at least 10 years or 40 quarters, you will most likely not have to pay a premium for Part A. There is a deductible of $1364 (2019) per stay in the hospital, as well as certain daily co-pays that you are responsible for. 

 

PART B: Helps pay for doctor visits and outpatient care. This can include outpatient medical services, some preventative care such as annual flu shots, emergency room services, and mental health care as an outpatient. Generally, most Medicare recipients will pay a monthly premium for their Part B coverage. For 2019, the standard Part B premium amount is $135.50 (or higher depending on your income). However, most people who get Social Security benefits will pay less than this amount ($109 on average). There is also a deductible of $185 (2019) that needs to be met before Medicare coverage will start to pay.  After the deductible is met, you typically pay 20% of the Medicare approved amount for most doctor services. 

ELIGIBILITY:  To be eligible for Medicare, you must be a U.S. citizen, or legal resident for at least 5 years and be 65 or older, or younger than 65 with a qualifying disability, or any age with a diagnosis of end-stage renal disease or ALS.

ENROLLMENT: Generally you will automatically be enrolled in Part A  and B if you are receiving social security benefits. Your Part B monthly premium will be deducted from your social security income. This will usually take place after you are 64 years and 9 months of age, or otherwise Medicare eligible. Many people who work beyond 65 choose to enroll only in Part A so they don’t have to pay the Part B premium due to them having employer-sponsored coverage. Your Initial Enrollment Period (IEP) is your first chance to enroll in Medicare and is 7 months long. This includes the three months prior to your birthday month, your birthday month, and three months after your birthday month. If you enroll in Medicare before the month you turn 65, your coverage starts the first day of your birthday month. If you enroll during your birthday month or the three months following, your enrollment could be delayed. If you are 65 and still working, contact your benefits administrator to compare your options. For enrollment questions, contact your local social security office or visit www.ssa.gov.

There are four different enrollment periods for Medicare:

Initial Enrollment Period is a seven-month period when you first become eligible for Medicare coverage. It begins three months before – and ends three months after – the month you turn 65. This enrollment period allows you to enroll in a Medicare Advantage Plan, or Prescription Plan.

Open Enrollment occurs every year from October 15 – December 7. Other than your initial enrollment or special circumstances, this is the only time you can make changes to your Medicare Advantage or Prescription Drug Plans.

Special Enrollment can only occur when you have a qualifying life event that allows you to enroll, disenroll, or change your Medicare coverage.

General Enrollment in Original Medicare, from January 1 – March 31, is for those who didn’t enroll in Medicare Part A (if they have to buy it) and/or Part B (for which they must pay premiums) when they first became eligible.

STEP 2

ADDITIONAL COVERAGE OPTIONS

Once you have determined you are eligible and will be or are enrolled in Original Medicare Parts A & B, you can decide on what additional coverage options will best suit your individual health needs. This is when an independent broker can help you navigate the different plans available. You can either select a Medicare Supplement (Medigap) plan that will help cover some of the costs not paid for by Original Medicare, and add a Part D prescription plan, or add a Medicare Advantage plan that combines Part A and B, and usually includes the Part D prescription coverage as well. Keep in mind a Medicare Supplement and Medicare Advantage plan are two completely different plans. You must continue to pay your Part B premium if you select either of these options. Contact your local broker today at 541-505-6864 to decide what plan is right for you.

OR

OPTION 1

OPTION 2

Add one or both of the following
to Original Medicare:

Choose a Medicare Advantage plan:

Medicare Supplement Insurance

Offered by private companies

Covers some of the costs not paid for by Original Medicare Parts A and B

Medicare Part D

Offered by private companies

Part D covers prescription drugs

Part C combines
Part A (hospital) and Part B (doctor)

Medicare Advantage (Part C)

Offered by private companies

Most plans cover prescription drugs

Provides additional benefits