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Medicare Simplified
Turning 65 brings a flood of mail, endless commercials, and confusing choices. Our Medicare Advisors are here to clear the clutter. We provide the localized, step-by-step guidance you need to understand your options, avoid costly penalties, and choose a plan with absolute confidence so you can step into retirement with peace of mind.
Scroll down to find some useful information about Medicare, or feel free to contact us to get a quote or ask a question. We are here to help.
Helpful Information
Medicare Coverage
Medicare is a health insurance program for:People age 65 or older,People under age 65 with certain disabilities, andPeople of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).Medicare has:Part A Hospital Insurance: Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.Part B Medical Insurance: Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.Prescription Drug Coverage: Most people will pay a monthly premium for this coverage. On January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. This coverage is to help you lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. If a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.This information comes from www.cms.govBy contacting the phone number on this website, you will be directed to a licensed insurance agent.
Medicare Advantage Plans, sometimes called Medicare Part C, are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through the Medicare Advantage Plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:Medicare Health Maintenance Organization (HMOs)Preferred Provider Organizations (PPO)Private Fee-for-Service PlansMedicare Special Needs PlansWhen you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, there generally are extra benefits and lower co-payments than in the Original Medicare Plan*. Most Medicare Advantage Plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO), and you may have to see doctors that belong to the plan or go to certain hospitals to get services.To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you may have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. In 2026, the standard Part B premium amount is $202.90 (or higher depending on your income). However, some people who get Social Security benefits pay less than this amount. When can I enroll?Keep in mind that Medicare limits when you can join, switch, or drop a Medicare Advantage Plan. You can join a plan when you first become eligible for Medicare. This is anytime beginning three months before the month you turn 65 and ends three months after the month you turned 65. For example, if you turn 65 on May 5, your eligibility period starts on February 1 and ends on August 31.If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after month 25 of your disability.You can switch or drop your Medicare Advantage during an enrollment period between October 15 and December 7 of each year.This information was obtained from www.medicare.gov * Page 2 https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf By contacting the phone number on this website, you will be directed to a licensed agent. Not affiliated with or endorsed by the Government or Federal Medicare Program.
A Medicare Supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like co-payments, coinsurance, and deductibles.If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.What you need to know about Medicare Supplement policiesYou must have Medicare Part A and Part B.If you have a Medicare Advantage Plan, you can switch to a Medicare Supplement insurance policy during certain enrollment periods or if you meet certain criteria (underwriting may apply), but make sure you can leave the Medicare Advantage Plan before your Medicare Supplement insurance policy begins.You pay the private insurance company a monthly premium for your Medicare Supplement insurance policy in addition to the monthly Part B premium that you pay to Medicare.A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.You can buy a Medicare Supplement insurance policy from any insurance company that's licensed in your state to sell one.Any standardized Medicare Supplement insurance policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medicare Supplement insurance policy as long as you pay the premium.Medicare Supplement insurance policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).It's illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you're switching back to Original Medicare.Information obtained from www.medicare.govBy contacting the phone number on this website, you will be directed to a licensed agent.
Medicare Part D helps cover the cost of prescription medications. Whether you are enrolling inMedicare for the first time or reviewing your current coverage, it is important to understand youroptions and enroll on time.When Can You Enroll?Your Initial Enrollment Period generally begins three months before you get Medicare andcontinues for several months afterward. You may also qualify for Medicare before age 65because of certain disabilities or other circumstances.If you don't enroll in Part D when you are first eligible, you may have to pay a permanent late-enrollment penalty unless you have other qualifying prescription drug coverage, such ascoverage through an employer or retiree plan.Part D Plans: Enroll Directly Through MedicarePrescription drug plans (Part D) predominantly no longer work with insurance agents.Because of this, if you need a standalone Part D prescription drug plan, we recommend goingdirectly to Medicare to compare your options and enroll.You can do this in either of two ways:Visit Medicare.gov
orCall 1-800-MEDICARE (1-800-633-4227)
Medicare's Plan Finder allows you to enter your prescription medications and preferredpharmacies, compare available plans and estimated costs, review coverage details, and enrollonline.We Can Help You Through the ProcessEven though you will enroll directly through Medicare, you don't have to figure it out on yourown.We've created a step-by-step written guide and video to help you navigate Medicare.gov andcomplete the Part D enrollment process.Your Step-by-Step Resources📄VIEW THE PART D WRITTEN GUIDEOur written guide walks you through finding Part D plans, entering your medications, selectingpharmacies, comparing costs, reviewing plan details and completing enrollment throughMedicare.gov.📽️ WATCH THE PART D VIDEO TUTORIALThe video provides a visual walkthrough of the Medicare.gov Part D enrollment process. Watchthe Medicare Part D Video TutorialBefore You EnrollHave your prescription information available when you use Medicare's Plan Finder. Enter yourmedications carefully, including the dosage, quantity and frequency, because this informationaffects the plan and cost estimates Medicare.gov provides.Be sure to review:Your preferred pharmaciesMonthly premiumsDeductiblesEstimated annual prescription costsDrug coverage and restrictionsPharmacy network participationStart Your Part D Enrollment1-800-MEDICARE — 1-800-633-4227If you have questions about other Medicare coverage, we're happy to help you understand youroptions.Important: Medicare plans, premiums, formularies, pharmacy networks, benefits, and costs canchange. The information on this page is provided for general educational purposes and is not acomplete description of any Medicare plan.By contacting the phone number on this website, you will be directed to a licensed agent.NOT AFFILIATED WITH OR ENDORSED BY THE GOVERNMENT OR FEDERALMEDICARE PROGRAM.
Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States.If you are not 65, you might also qualify for coverage if you have a disability or end-stage renal disease (permanent kidney failure requiring dialysis or transplant).Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:You already get retirement benefits from Social Security or the Railroad Retirement Board.You are eligible to get Social Security or Railroad retirement benefits but have not yet filed for them.You or your spouse had Medicare-covered government employment.If you are under 65, you can get Part A without having to pay premiums if:You have received Social Security or Railroad Retirement Board disability benefits for 24 months.You are a kidney dialysis or kidney transplant patient.While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.Have questions? Give us a call and let us help you with your Medicare Health insurance needs. By contacting the phone number on this website, you will be directed to a licensed agent.
Medicare Advantage is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.Medicare Advantage Plans include the following:Health Maintenance Organization (HMO) PlanIn most HMO Plans, you can only go to doctors, other health care providers, or hospitals on the plan's list except in an emergency, for out-of-area urgent care, or for temporary out-of-area dialysis. You may also need to get a referral from your primary care doctor to see other doctors or specialists. Find and compare HMO Plans in your area. Preferred Provider Organization (PPO) PlansA Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You pay more if you use doctors, hospitals, and providers outside of the network.Private Fee-for-Service (PFFS) PlansA Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medicare supplement. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.Medicare Special Needs (SNP) PlansMedicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. Find out who can join a Medicare SNP These definitions are directly from www.medicare.govBy contacting the phone number on this website, you will be directed to a licensed insurance agent.
Medicare Supplement policies (also known as Medigap policies) are standardized and must follow federal and state laws designed to protect you. Insurance companies can only sell you a “standardized” policy identified in most states by letters (see the chart below). All policies offer the same basic benefits, but some offer additional benefits, so you can choose which one meets your needs. As you can see in this comparison chart, there are many options from which to choose. As licensed insurance agents, we can help you understand the differences between the plans so that you can decide on the right plan for you. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way. Did you know that each insurance company decides which Medigap policies it wants to sell, and state laws affect which ones they offer? Insurance companies that sell Medigap policies: Don’t have to offer every Medigap plan.Must offer Medigap Plan A if they offer any Medigap policyMust also offer Plan C or Plan F to people who were eligible for Medicare before January 1, 2020, but haven’t yet enrolled.People new to Medicare on or after January 1, 2020 have the right to buy Plan D or G instead of Plan C or F. Keep in mind that Medigap policies may cover Medicare Parts A & B coinsurance after you’ve paid the deductible (unless the Medigap policy also pays the deductible).
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