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Eva Valdes
What We Cover
What is Medicare?
Medicare is a federally health insurance program. It is a program for individuals 65 and older and individuals under the age of 65 that have certain disabilities, such as permanent kidney failure (End-Stage Renal Disease).
Part A - Hospital Insurance Medicare
Hospital insurance covers inpatient hospital care, critical access care, short-term care in skilled nursing facilities, hospice and home health care. Medicare typically does not pay for assisted living facilities, nursing homes or long-term care at home. Typically there is no monthly premium for most Medicare beneficiaries if the beneficiary or their spouse paid Medicare taxes while they were working. If you don't qualify for premium free Part A, you can buy Part A.
Part B - Medical Insurance
Is part of Original Medicare and covers medical services and supplies that are medically necessary to treat your health condition. This can include outpatient care, preventive services, ambulance services, and durable medical equipment. It also covers part-time or intermittent home health and rehabilitative services, such as physical therapy, if they are ordered by a doctor to treat your condition. Everyone pays a monthly premium for Part B.
There Are 2 Main Ways To Get Medicare Coverage
Original Medicare and Medicare Advantage
Part C - Medicare Advantage Plan
Medicare Part C plans are private Medicare plans which pay instead of Medicare. Think of Medicare Advantage plans as a package where you will have Part A, Part B and usually Part D together in one plan. You will have one ID card that you use at hospital, doctor’s office and pharmacy. Most Advantage plans include a built-in Part D drug plan, although in some areas you can find them without Part D. Medicare C plans resemble group insurance benefits you may have had through former employers. Generally, there is a local network of providers that you will use. You will pay copays for many routine services like doctor’s visits, lab-work, ambulance, surgeries, hospital stays, urgent care and more.
Part D - Prescription Drug Coverage
Medicare prescription drug plans (Part D) help pay for medications. You can get a standalone Part D plan or get a Medicare Advantage plan that includes drug coverage.
Medicare Supplement Insurance
A Medicare Supplement Insurance (Medigap) policy is one health insurance option that can help pay some of the health care costs that Original Medicare doesn't cover, like coinsurance, copayments, or deductibles. Private insurance companies sell Medigap policies. A Medigap policy is different from a Medicare Advantage Plan. Medicare Advantage plans are ways to get Medicare benefits and a Medicare Supplement plan fills in the gaps left by Original Medicare (Parts A & B). The best time to buy a Medigap policy is the six-month period that starts the first day of the month you turn 65 or older and enrolled in Part B. Medigap policies do not over prescription drug plans, vision, dental, and hearing aids.
Your medicare options-Original medicare & Medicare advantage
Enrollment Periods
Enrollment Periods
Enrollment Periods
When can I join, switch, or a plan?
You can join, switch, or drop a
Medicare Health Plan or a Medicare Advantage Plan (Part C) with or without drug coverage during these times:
- Initial Enrollment Period. When you first become eligible for Medicare, you can join a plan.
- Open Enrollment Period. From October 15 – December 7 each year, you can join, switch, or drop a plan. Your coverage will begin on January 1 (as long as the plan gets your request by December 7).
- Medicare Advantage Open Enrollment Period. From January 1 – March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. re
Original Medicare
Enrollment Periods
Enrollment Periods
ADD EXTRA COVERAGE
- Medicare Supplement Insurance (Medigap)
- Drug plan (Part D)
THIS COVERAGE INCLUDES
- Hospital (Part A)
- Medical (Part B)
- Use of any doctor or hospital that takes Medicare, across the U.S
THIS COVERAGE DOES NOT INCLUDE
- Drugs
- Vision, hearing, dental, and more
- Help with out-of-pocket costs
- Covers 80% of cost for most medical bills
- You pay the remaining 20% of costs, with no yearly limit on what you pay out-of-pocket
- You can buy a Medicare Supplement Insurance (Medigap) policy to help pay your share of costs
- If you want drug coverage, you can join a separate Drug plan (Part D)
- Can use any doctor or hospital that takes Medicare, anywhere in the U.S
Medicare Advantage
Enrollment Periods
Medicare Advantage
Alternative to Original Medicare.
- These "bundled" plans include Part A, Part B, and usually Part D.
- Most plans offer extra benefits—like vision, hearing, dental, and more.
THIS COVERAGE INCLUDES
- Hospital (Part A)
- Medical (Part B)
- Drugs
- Help with out-of-pocket costs
- Vision, hearing, dental, and more
THIS COVERAGE DOES NOT INCLUDE
- Use of any doctor or hospital that takes Medicare, across the U.S.
- You use the plan's network (for non-emergency or non-urgent care)
- If you don't join a Medicare Advantage Plan when your first get Part A & B, you may have to wait for the next yearly Open Enrollment