What is Medicare?
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD), or Lou Gehrig’s Disease. The program helps with the cost of health care but does not cover all medical expenses or the cost of long-term care. Medicare has four Parts: Part A, Part B, Part C, and Part D.
Who is eligible?
In general, individuals who are United States citizens, who are 65 years old and who have worked at least 10 years in this country, or individuals deemed disabled for 24 months may be eligible for Original Medicare Part A at no cost and Part B by paying a premium based on income.
How do I enroll in Medicare?
An individual can enroll in Medicare at a Social Security office, by calling Social Security (800-772-1213) or online at www.Medicare.gov. There are specific timeframes involved when enrolling.
Why is it important to enroll?
There are regulations surrounding enrolling in Medicare that can result in a financial penalty. If you are working, you may or may not need to enroll in Part A and/or Part B. Other regulations involve COBRA, HSA health plans, creditable and non-creditable plans, and other types of plans. Ortolani Services, Inc. can help you understand whether you need to enroll in Medicare. If you are working, we can compare your current plan to Medicare to determine which plan best meets your needs.
What are the Four Parts of Medicare?
Part A covers inpatient hospital room and board, skilled nursing care, hospice, and some home healthcare costs.
Part B covers medically necessary doctor visits, outpatient surgery, physical therapy, home care, and medical equipment.
Part C, also known as Medicare Advantage, provides the same coverage as Part A, Part B, and often Part D, but coverage is provided by private health insurance carriers that have a contract with Medicare. Medicare Advantage plans may have no or low monthly premiums, copays, and annual out-of-pocket maximums to protect a person from catastrophic illness. These plans can include more benefits than Original Medicare (Part A and Part B). Additional benefits may include coverage for prescriptions, a comprehensive physical, dental, vision, routine foot care, and gym membership.
Part D provides outpatient prescription drug coverage. Plans can be purchased on a standalone basis or be included in a Medicare Advantage plan. Plans vary in price, copays, and the drugs included in their formulary (prescription drug list).
What is Medicare Supplement (Medigap)?
Medicare Supplement, or Medigap, plans cover the “gaps” in Original Medicare (Part A and Part B). These gaps include items like copayments, coinsurance, and deductibles. Medicare Supplement plans are provided by private insurance companies.
What is Medicare Advantage?
Medicare Advantage is offered through private insurance plans. Its popularity comes from low or no premiums and a cap on total out-of-pocket expenses. Medicare Advantage plans may include drug coverage and additional benefits not covered by Original Medicare. These plans have copays and possibly other costs.
What questions should I ask when considering which plan to enroll in?
Can I keep my doctor if I enroll in Medicare?
If you enroll in Medicare Part B and your doctor does not accept Medicare, you would be responsible for the bill. Doctors may take an employer plan but may not take Medicare.
Am I taking prescription drugs?
Part D plans and Medicare Advantage plan have formularies (lists of covered drugs). The drugs on these lists vary and change from year to year. A review of the formularies would be needed to determine the best plan for you. Ortolani Services, Inc. can assist you with this.
Do I plan to travel inside or outside the United States?
Medicare does not cover a person outside the country. Some supplements and Medicare Advantage plans cover a person for worldwide emergencies.
What if I am still working?
If your employer still offers health insurance to you, you may be able to keep your employer group insurance plan and choose to delay enrolling in Part A, Part B and/or Part D until you retire and lose your group coverage. There are specific considerations to consider when making this decision, including size of employer, type of employer coverage, and your own personal circumstances. Ortolani Services, Inc. can assist you with this decision.
What does Medicare cost?
Costs for Medicare vary from year to year. Generally, you will need to pay a Part A deductible, Part B premium, and Part B deductible. Most people don’t pay a premium for Part A since they have paid into the system during their working years. Part D also has a monthly premium, as do Medicare Supplement plans. Medicare Advantage plans often have low or zero premiums, which vary by plan type and geography, and often include prescription drug coverage at no extra cost.
Can I qualify for extra help?
People with limited income and resources may qualify for Extra Help programs that pay the Part B Original Medicare premium and/or lower the costs of Medicare prescription drug coverage. You can get more information about assistance by going to a Social Security office, calling 1-800-772-1213, visiting www.ssa.gov, or call us at Ortolani Services, Inc. and we can help.
What if I have more questions?
Medicare.gov offers many helpful resources for you to learn more about Medicare. You can also contact us at Ortolani Services, Inc. we are highly trained insurance professionals who will guide you through the complex task of choosing appropriate coverage at an affordable cost. We are dedicated to serving your long-term interests. We are ready to help you review your choices and make an informed decision. There is no fee for this service.