Medicare Insurance In Surprise AZ

What is Medicare?

This is a common question we get asked by a variety of individuals. To put it simply, Medicare is a federal healthcare insurance program for people who are 65 years of age or older, certain younger individuals with a qualifying disability, or people End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Medicare is a little different from your traditional major medical health insurance plans because it is broken up into several different sections, or Parts. You may have heard the term Medicare Part A, Medicare Part B, Medicare Part C, and so on… We’ll talk about those below, but before we do, let’s talk about eligibility.
Medicare Medical Insurance Surprise AZ
Generally speaking, you are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:
  • You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to receive Social Security or Railroad benefits, but you have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.
To find out if you are eligible and your expected premium, go the Medicare.gov eligibility tool.

Now, if you didn’t work for 10 years or and don’t meet the qualifying factors, you still may be able to buy into Medicare. If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A.
If you are under age 65, you can get Part A without having to pay premiums if:

  • You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months. (Note: If you have Lou Gehrig’s disease, your Medicare benefits begin the first month you get disability benefits.)
  • You are a kidney dialysis or kidney transplant patient.
While most people do not have to pay a premium for Medicare Part A, Medicare Part B is a little different. Together, Medicare Part A and Part B make up what is known as Traditional Medicare or Original Medicare. For more information on Medicare Part A and B, see below.

Let’s talk about Medicare Part A

Medicare Part A is often referred to as “hospital coverage”. That is because it is designed to cover hospital visits and similar services. Generally speaking, Medicare Part A covers:
  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
  • Hospice care
  • Home health care
Keep in mind, each item covered may have rules, limitations, co-pays, co-insurance and more so it is important to work with an Independent Medicare Insurance Agent to know what your out-of-pocket risk looks like in a year. Most importantly, Medicare Part A does not cover things like routine doctor visits. That is where Part B comes into play.
The last thing we will cover is deductibles, co-pays, and co-insurance. Unfortunately, Medicare Part A doesn’t cover everything so it is important to know what you may be liable for in the event of an emergency room visit. In 2021 for example, you pay the following:
  • $1,484 deductible for each benefit period
  • Days 1-60: $0 coinsurance for each benefit period
  • Days 61-90: $371 coinsurance per day of each benefit period
  • Days 91 and beyond: $742 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: all costs

What is Medicare Part B?

Medicare Part B makes up the other portion of Traditional or Original Medicare. This is commonly referred to as your medical insurance. Generally speaking, it covers things like doctors visits, preventative services, certain vaccines, mental health care, and more. While this is not a complete list, working with an independent Medicare insurance agent will really help you better understand how Medicare Part B coverage works.
Unlike Medicare Part A, there is a premium for Medicare Part B. In 2021, that premium is $148.50. Depending on your income, that amount may be higher or lower based on your individual circumstance. In addition, you have a co-insurance amount of 20%. So think about Medicare Part B like an 80/20 plan. Medicare covers 80% of your qualifying medical expenses and you are responsible for 20%. There is also a deductible of $203.
For more information on Traditional Medicare or Medicare Part B, give us a call to schedule a phone, virtual, or in-person meeting. Together, we can review your individual circumstance and help guide you to a plan that will provide the coverage you need and limit your out of pocket expenses.

Medicare Part C

How does Medicare Part C work?

Medicare Part C plans are commonly referred to as Medicare Advantage Plans. Medicare Part C is an alternative to traditional Medicare (Part A and Part B). These are health insurance plans offered by private insurance companies that are approved by Medicare. These plans are designed to meet or exceed the coverage provided in Part A and Part B. Medicare Advantage plans vary greatly by geography and carrier.
So why would you want to use a private insurance carrier to administer your Medicare insurance? Simple, most plans provide extra perks as a part of your enrollment. Things like gym memberships, vision, dental, and other services may be covered under a Medicare Advantage plan. These services are not covered under traditional Medicare. Another perk is the addition of a Prescription Drug Plan (Part D). Traditional Medicare does not include prescription drug coverage unless you take out a Medicare Part D plan, which will run you extra. Most Part C plans will include coverage for prescription drugs!
As with any plan, there are pros and cons to everything. Part C plans are typically divided into HMO and PPO networks, meaning that you need to see an in-network provider to take advantage of your plan benefits and avoid higher out of pocket charges. This is why it is important to work with a licensed Medicare insurance agent who can help you navigate the intricacies of the various plans and help make sure you are able to see your preferred doctor(s). For more information on Medicare Advantage Plans, give us a call or schedule an appointment today!

Medicare Supplement Plans

Medicare Supplement Plans in Surprise, AZ

Medicare Supplement plans are really not that complicated. Simply put, they cover the gap between what traditional Medicare covers and what you are responsible for. This is often referred to as the coverage gap. There are 10 plan types available in most states, and each plan is labeled with a different letter that corresponds with a certain level of basic benefits.
For more information on Medicare Supplement plans and choosing the right plan for you, give us a call and schedule a free, no obligation insurance review. During our meeting, we will discuss various benefits and features of traditional Medicare and review what Medicare Supplement carrier is best for you.

Prescription Drug Plans (Part D)

Medicare Part D plans in Surprise, AZ

Many people who are signing up for Medicare don’t realize that prescription drug coverage is not included in Medicare Part A and Medicare Part B. So, unless you sign up for a Medicare Advantage plan that provides prescription drug coverage, you will need a Part D plan. Medicare drug coverage is optional and is offered to everyone with Medicare. If you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union), you’ll likely pay a late enrollment penalty if you join a plan later.
All Part D plans are administered by private insurance companies and have a wide range of coverage options. While Medicare requires all plans to cover certain drugs, you may run into a situation where your prescription may not be covered. Before you select a plan, we highly recommend you give us a call so we can review your individual circumstance and point you in the right direction. Choosing the wrong plan could literally cost you thousands of dollars out of pocket!