ORIGINAL MEDICARE

Original Medicare: Your Guide to Coverage

You need health insurance, but as your budget shrinks in retirement, you might worry about affordable coverage. The good news is that most senior citizens qualify for Medicare. It provides quality insurance to millions of Americans. It’s one of the easiest ways for senior citizens to afford their health care.

Let Senior Healthcare Solutions help you get the Medicare plan that’s of the most benefit to you today.

What is Medicare?

The U.S. government recognizes that senior citizens and other vulnerable populations need health insurance. However, many senior citizens struggle to afford the costs of private plans. To remedy this problem, the government Medicare program helps qualifying individuals get effective coverage.

Over the years a portion of your federal tax payments go into the Medicare fund. When you eventually qualify for Medicare, you’ll be able to get health insurance at relatively low costs.

What Services Does Medicare Cover?

Medicare is a big system, but it has a core component called Original Medicare. It is the option available to all Medicare enrollees. It contains two central pieces of coverage:

• Medicare Part A: All Medicare recipients receive this coverage. It will cover inpatient hospital services, such as surgeries, drug treatments and other hospitalization costs.
• Medicare Part B: This coverage applies to outpatient services like doctors visits, lab testing, certain therapies and more. Part B coverage is optional for Medicare enrollees. However, you still should enroll in Part B as soon as you qualify for the program. If you decide to get it later you might face enrollment penalties.

In most cases, you will pay no premium for your Medicare Part A. However, most people pay a premium for their Part B coverage, which is income sensitive and starts at $135.50 in 2019. Other costs, like deductibles, co-payments and coinsurance will also apply.

Who Can Get Medicare?

Only certain individuals can qualify Medicare for it at this time. These are:

• Individuals who are age 65, or about to turn 65
• Those with qualifying disabilities
• Americans with End-stage renal disease (ESRD)

Keep in mind, if you want any additional coverage, such as Medicare Part D, Medigap coverage or Medicare Advantage plans, you might face other coverage qualifications.

When Can You Apply for Medicare?

In most cases, you qualify for Medicare around the time you turn 65. At this time, you enter what is called your Initial Enrollment Period (IEP). This is a seven-month period around your 65^th birthday.

• The IEP starts the first day of the month, three months before your 65^th birthday. So, if your birthday is August 16, for example, the IEP will start on May 1.
• It will last the entire month of your 65^th birthday. In this case from August 1 – August 31.
• The IEP ends the last day of the third month after your 65^th birthday. Again, if your birthday is August 16, the IEP will end November 30.

Please note, if you do not enroll in Medicare during the IEP, you might face late enrollment penalties. In some cases, you can choose to delay your Medicare enrollment until later. In other cases, you might be able to enroll before your 65^th birthday. Talk to one of our agents to learn more about your needs.

What are the Different Medicare Plans?

Private insurers work with the Medicare program to offer additional plans that pay costs not covered by Original Medicare. Ask your agent if you qualify to:

• Medicare Part D Prescription Coverage: This coverage will pay a portion of your standard medication costs that you pick up from your pharmacy. More Info
• Medicare Supplementals (Medigap Insurance): Medigap plans cover outstanding costs not covered by Original Medicare. Multiple plans exist and they will cover copayments, deductibles and coinsurance costs not provided by Original coverage. More Info
• Medicare Advantage Plans (Medicare Part C): Advantage plans are similar to Original Medicare but also covers additional services. They will cover all Medicare Part A & Part B costs, except for hospice care. However, they will also cover things like prescription drugs, dental care, hearing services and vision care. More Info

Because these are private plans, the services they offer will vary. They will differ in how they interact with Original Medicare coverage. Ask one of our agents to help you determine your eligibility for each.

Who do You Call with Medicare Questions?

To get help with all your Medicare questions and needs, call Senior Healthcare Solutions today at 631 539-6351. We can help you get covered today!

You can also contact the Medicare system directly at:

• www.medicare.gov/forms-help-resources
• National Phone Number: 1-800-MEDICARE (1-800-633-4227)
• TTY Phone: 1-877-486-2048
• Medicare Contact Center Operations
  PO Box 1270
  Lawrence, KS 66044

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