Learning the Medicare Basics
Medicare is not "One Size Fits All"
You may know that when you turn 65 you qualify for Medicare. Most people become eligible for Medicare when they turn 65 years old.
But did you know that when it comes to Medicare, you have choices?
Do you understand the difference between Medicare plans?
Do you know how to compare plans and choose the right one for you?
Understanding the basics may help you choose wisely. Your choices include:
Original Medicare, which includes hospital stays (Part A) and doctor visits (Part B).
Original Medicare with a stand-alone Prescription Drug Plan (Part D) and/or a Medicare Supplement Insurance Plan.
Medicare Advantage (Part C), which often includes a Prescription Drug Plan plus extra benefits(Part D) in addition to hospital stays (Part A) and doctor visits (Part B).
Important: Most Part C plans include vision, hearing, dental benefits and wellness programs (like gym membership). Medicare Advantage plans (Part C) can also cover more extra benefits than they have in the past, including services like transportation to doctors visits, over-the-counter drugs, adult day-care services, and other health-related services that promote your health and wellness.
Medicare helps million Americans get health benefits. Just as important, it offers you a choice of how you want to receive your benefits.
Hello, I’m Andy Lopez , licensed agent Fernando Lopez (CA License #0659888), and I want to help you save money. With my knowledge and experience, I can help people understand how Medicare insurance works and can recommend the right Medicare Plan for you that fits your needs.
I can help you understand all your Medicare options.
I am here to personally help you find the right plan for you. One-on-one we can look at your needs, explore your choices and decide on a plan with confidence. As your experienced professional in Medicare plans, I’m here when you need me, not just at enrollment, but as a partner through your membership. When you have questions, I’ll get you answers. I would be happy to meet with you one-on-one at your home, in our office or a convenient location of your choosing. Call me today so you can understand the Medicare requirements and have the right coverage available that meets your needs.
We do not offer every plan available in your area.
Any information we provide is limited to those plans we do offer in your area.
Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Medicare Basics
How Does Medicare Work?
Original Medicare is made up of two parts:
Part A provides your hospital insurance
Part B provides medical insurance for things like doctor visits and check-ups
When are you eligible for Original Medicare? (Part A & Part B)
You’re at least 65 years old, or you’re under 65 and qualify on the basis of a disability or other special situation
AND
You’re a U.S. citizen or a legal resident who lived in the U.S. for at least five consecutive years.
When can you Enroll?
Initial Enrollment Period
When you turn 65 or otherwise become eligible for Medicare, you’ll have your Initial Enrollment Period (IEP) Your IEP begins three months before and ends three months after the month of your 65th birthday ( a seven month window). If you have employer or plan-sponsored coverage when you first become eligible, you won’t need to enroll until you retire or otherwise lose the coverage. Prescription drug (Part D) coverage must be creditable or you may be subject to a Late Enrollment Penalty when you enroll in a plan with Part D benefits.
If you’re still working at age 65 and covered by your employer’s health insurance, then in most cases you don’t need to sign up for Part B yet. Once you stop working, you’ll have a special enrollment period of eight months after your employment ends in which to sign up for Part B.
Medicare Basics
October 15th though December 7th
Open Enrollment Period
During Open Enrollment you can add, drop or switch your Medicare plan coverage. The annual open enrollment period for Medicare is October 15th through December 7th. This is the time each year when you can switch from original Medicare to a Medicare Advantage plan; change from your Medicare Advantage plan back to original Medicare; or switch from one Medicare Advantage plan to another.
Special Election Period
Some individuals may also qualify for a SEP depending on certain circumstance.
You may qualify for a Special Election Period if you:
Retire and lose your employer coverage
Move out of the plan’s service area
Receive assistance for the State
Have been diagnosed with certain qualifying disabilities or chronic health conditions
Understanding Your Needs
Question to Consider. Following are a few questions that may help you get closer to understanding your needs.
Are you in good health or do you have chronic conditions?
Which prescription drugs do you take regularly? How much do you spend?
What doctors do you you see regularly and for what kind of care?
How would you feel about seeing a new doctor?
How much do you travel and where?
Are you eligible for any health care coverage besides Medicare? Will you keep that coverage when you retire?
How much did you spend on health care last year? Do you expect similar costs this year?
How does health care fit into your budget? Will you need financial help to pay Medicare premiums?
How you answer the above questions can help determine which type of Medicare plan may be right for you.
Medicare Plan Options
Eligibility Checklist
Enrolled in Original Medicare
And
Live in the plan’s service area
Medicare Advantage
Medicare Advantage plans, typically HMO or PPO products, are insurance plans that combine the benefits of
Part A and B and, in most cases, includes prescription drug coverage and may include extra benefits and services for an additional cost.
What is the advantage of a Medicare Advantage plan?
The payments the company receives from Medicare help with the cost of the plan. Most of the plans have provider networks that provide services at discounted rates. The plan features also give the ability to manage costs and offer the coverage of Medicare A and B at a lower cost than Original Medicare. Some of the extra benefits you could get with a Medicare Advantage plan include:
Prescription drug coverage
Access to wellness programs
Gym membership discounts
Routine hearing, vision and dental coverage and more
Medicare Plan Options
Prescription Drug Coverage
Medicare Part A and Part B do not cover prescription drug
benefits. For prescription drug coverage, you can enroll in
a separate Part D plan. Many Medicare Advantage plans
already offer prescription drug coverage (Part D) as part of their benefits package.
Supplemental Coverage (Medigap Plans)
Some people who are covered by original Medicare purchase a separate Medi-gap plan, also known as Medicare supplemental insurance. These plans help “fill the gap” by partially or fully covering expenses that original Medicare doesn’t provide.
What is the advantage of a Medicare Supplement plan?
A Medicare Supplement or Medi-gap plan offers the beneficiary more flexibility but at a higher premium. The plans range from A to F so you can choose from a range of coverage within this plan. This plan works hand and with Medicare paying the first 80% of all Medicare approved procedures and the supplement paying the other 20%. These’s plans have little to no copayments and no required network of health care facilities, doctors, and other professional. The plan gives you access to any hospital or physician that accepts Medicare in any state. Medicare supplements do not include Part D, that needs to be picked up separately.
Part D refers to the stand alone prescription drug plan. Some plans have deductibles and some don’t. These plans are based on different formularies (list of covered medications) and have different premiums and copayments. Medications are broken up into different tiers or levels including preferred and non-preferred generic and brand drugs. All plans are based on CMS (Medicare) guidelines and have the same initial coverage stage. There is a penalty for not having a credible prescription drug plan during the correct time frame.
Original Medicare and Medicare Advantage Differences?
Original Medicare
Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
If you want drug coverage, you can join a separate Medicare drug plan (Part D).
To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage.
You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
Part A and Part B
You can add: Part D
You can also add: Supplemental coverage
This includes Medicare Supplement Insurance (Medigap). Or, you can use coverage from a former employer or union, or Medicaid.
Medicare Advantage (also known as Part C)
Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.
Plans may have lower out-of- pocket costs than Original Medicare.
In many cases, you’ll need to use doctors who are in the plan’s network.
Most plans offer extra benefits that Original Medicare doesn’t cover— like vision, hearing, dental, and more.
When it comes to Medicare, you have choices
New to Medicare or Age 64 Turning 65?
Medicare is not free. Neither Original Medicare nor a Medicare Advantage plan will pay for everything. The amount you will pay depends on the coverage you choose and the health care services you receive. Medicare and Medicare plans charge premiums. A premium is a fixed amount you pay each month for coverage. You also pay a share of the cost for health care services you receive. The 3 methods of cost sharing are: deductible, copay, and coinsurance. Consider the costs when comparing your Medicare choices, low premium might come with high deductibles, copays or coinsurance rates.
No matter your situation, we can help you get answers to your Medicare questions.
Original Medicare (Part A and B) helps pay for doctor visits and hospital stays, but it does not cover everything and it does not cover prescription drugs.
Medicare Advantage plans (Part C) put a cap on your out-of-pocket costs for Part A and Part B services covered by the plan. It is called Annual Out-of-Pocket Maximum and it provides built-in financial protection. There is no out-of-pocket cap with Original Medicare. Many people choose additional coverage by enrolling in one or more private Medicare or Medicare related plans. We can help you to select a Medicare Advantage plan (Part C) combine Part A, Part B and often prescription drug coverage (Part D) with some plans may offer additional benefits such as: hearing tests, routine vision, dental exams, wellness programs and fitness membership, often with no additional premium. Medicare Advantage plans can also cover more extra benefits than they have in the past, including services like transportation to doctor visits, over-the-counter drugs, adult day-care services, and other health-related services that promote your health and wellness.
Medicare prescription drug plan (Part D) that help pay for medications prescribed by a doctor or other health care professional.
A Medicare supplement insurance plan (Medigap) help pay some of the out-of-pocket costs that come with Original Medicare.
Let us guide you in choosing the right Medicare plan from several private insurance companies.
Find a plan that's right for You, I'm here to help.
Want Additional Resources to help you understand your Medicare options?
Get answers to your hard questions about Medicare.
Go to www.medicare.gov
We do not offer every plan available in your area.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
