MEDICARE Plan COVERAGE
Original Medicare is the federal health insurance program for people aged 65 and above, and under 65 with End-Stage Renal Disease (ESRD) or certain disabilities.
Enrolling in the right Medicare Parts plan is an important decision to make. Your lifestyle, budget, and health are key considerations. You’ve worked hard to get to Original Medicare and now you want the freedom to pursue your interests without worrying about health insurance. That’s where we come in. As an independent agency, the pros at SBHS will help you understand your Medicare Plan coverage options and provide FREE no obligation advice so you can feel confident in your decision!
Medicare is the federal health insurance program for people aged 65 and above, and under 65 with End-Stage Renal Disease (ESRD) or certain disabilities.
Enrolling in the right Medicare plan is an important decision to make. Your lifestyle, budget, and health are key considerations. You’ve worked hard to get to Medicare and now you want the freedom to pursue your interests without worrying about health insurance. That’s where we come in. As an independent agency, the pros at SBHS will help you understand your Medicare coverage options and provide FREE advice so you can feel confident in your decision!
Medicare Part A
Medicare Part A is hospital coverage. If you or your spouse paid Medicare taxes for a decade or more, you qualify for Part A premium-free. Medicare Part A includes hospice care, skilled nursing, hospice, and sometimes home healthcare. There’s currently a $1,408 deductible when you’re admitted into hospital care.
Medicare Part B
Medicare Part B is medical coverage. This includes doctor visits, lab tests, outpatient surgeries, mental health services, x-rays, ambulances, flu shots, and durable medical equipment (like oxygen tanks and wheelchairs).
Part B has a monthly premium and a deductible. Under Part B, the government pays 80% and you pay 20% of your medical bills. But there’s NO cap on how much you could pay.
Together, Parts A and B make up what’s known as Original Medicare.
Original Medicare Is Not Full Coverage
While Original Medicare covers your basic healthcare expenses, it doesn’t cover everything. And the costs can add up quickly!
Original Medicare does NOT cover hearing, vision, dental, prescription drugs, gym membership, or medical emergencies overseas. Because of the gaps and expenses, about 85% of people with Original Medicare sign up for additional coverage.
Medigap Plans
One of these supplementary coverage options is Medigap or Medicare Supplement plans. With a Medigap policy, you keep Original Medicare and your Medigap plan covers many — if not all — of the costs that the government does not pay, such as deductibles, coinsurance, and excess charges.
Here are some key points to know about Medigap plans:
- You can use your plan anywhere in the U.S. that accepts Medicare, and if you move, you can keep your plan.
- They are guaranteed issue when you’re first eligible for Medicare and in limited scenarios, meaning you cannot be denied coverage.
- Once you have a Medigap plan, the benefits cannot be changed or taken away.
Medicare Part C
A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.
If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer additional coverage. Medicare Advantage / Prescription Drug Plans (MA-PD) include Medicare prescription drug coverage (Part D).
The Medicare program pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare program. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.
Medicare Prescription Part D
Medicare Part D provides coverage for prescription drugs. It’s important if you’re taking regular medications for conditions like high blood pressure and diabetes.
Unless you qualify for a subsidy, you’ll pay premiums for your plan, and depending on your plan, you may be responsible for copays, deductibles, and coinsurances for the medications you need. The formulary, or list of covered drugs, on each Part D plan may be different.
However, Part D plans are required to cover at least two drugs from each category. They also must cover all drugs in six specific categories:
- Immunosuppressants
- Anticancer
- Antidepressants
- Antipsychotics
- Anticonvulsants
- HIV/AIDS drugs
When choosing a Medicare drug plan, make sure your preferred pharmacy is in-network and all your prescriptions are on the formulary. A licensed sales agent associated with SBHS can help you with this.
When Does Your Original Medicare Coverage Start?
For most people, Original Medicare begins the FIRST day of the month they turn 65. If you’re receiving Social Security before age 65, you’ll automatically be enrolled in Medicare Parts A and B.
If you’re not receiving Social Security, you must self-enroll. Your Initial Original Medicare Enrollment Period is a 7-month window around your 65th birthday. It starts 3 months before and ends 3 months after the month you turn 65.
You can enroll online at www.SocialSecurity.gov. You may call Social Security at 1-800-772-1213, or show up in person at your local office. However, with long lines, it may be quicker to enroll via phone or online.
Once you have your Original Medicare card, you may enroll in other Medicare Plan options, such as:
- Medigap
- Medicare Part D
- Medicare Advantage
Whatever option you choose, you must continue to pay your Medicare Part B premiums.
What If You Miss Initial Enrollment?
If you miss your Initial Enrollment Period, you can enroll in Original Medicare during the General Enrollment Period — from January 1 to March 31 — although you may be subject to a late enrollment penalty.
Get FREE No Obligation Medicare Plan Review
Medicare Plans can be confusing and overwhelming, but don’t let that keep you from finding a plan that fits your needs. Reach out to SBHS, and get FREE no obligation plan reviews from licensed sales agents who can check your eligibility to enroll and review your plan options. You’ve got nothing to lose.
FAQ's
Initial Enrollment Period
Who Needs: Turning 65
Purpose: Enroll in Original Medicare and possibly a Medicare Advantage Plan
When: 3 months before 65th birthday, birthday month, and 3 months after 65th birthday month;
Medicare Advantage & Prescription Drug Plan Annual Enrollment Period
Who Needs: Medicare Parts A & B Enrollees
Purpose: Reevaluate coverage & make changes
When: October 15
December 7; and
Special Enrollment Period
Who needs: Aging-in, recently moved, lost health insurance coverage or have other Special Enrollment Period qualifying conditions
When: Special Enrollment Period eligibility varies by qualifying conditions.
“Speak with a licensed insurance agent to review your plan options and possibly enroll in a Medicare Advantage Plan during one of these enrollment periods
- Call Today: 1 (877) 292-7204
- TTY Users should call 1-877-486-2048 or for accommodation of persons with special needs call 711
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For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, 7 days a week or consult www.medicare.gov.
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ATTENTION: If you speak Spanish, language assistance services, free of charge, are available to you. Call 1-800-633-4227 (TTY: 1-877-486-2048).
FCS disclaimer: Participating sales agencies represent Medicare Advantage [HMO, PPO and PFFS] organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
SEP/ROY Disclaimer: Enrollment in the described plan type may be limited to certain times of the year unless you qualify for a Special Enrollment Period.
