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What is Medicare?

Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.

Original Medicare

Original Medicare includes Part A and Part B. You can join a separate Medicare drug plan to get Medicare drug coverage (part D). You can use any doctor or hospital that take Medicare, anywhere in the U.S.

PART A: Hospital

Medicare Part A is hospital insurance and helps cover costs if you are staying in a hospital, skilled nursing facility, or hospital care.

PART B: Medical

Medicare Part B is Medical insurance and helps cover costs of doctor services, outpatient care, durable medical equipment, and many preventive services (like screening, shots or vaccines, and yearly "Wellness" visits.

PART C: Medicare Advantage

Part C, also known as Medicare Advantage, includes Part A, Part B, and sometimes Part D. It is all in one plan. In most cases, you'll need to use a doctor who are in the plans network. Plans may have lower out-of-pocket costs than Original Medicare. These plans may offer some extra benefits that Original Medicare doesn't cover, like Vision, hearing and dental services.



PART D: Prescriptions

Medicare Part D is Prescription Drug coverage and helps cover the cost of many outpatient prescription drugs. If you enroll in a Medicare Advantage Plan this drug coverage is usually included in the plan, otherwise, it is offered through insurance companies as a separate plan.


Medicare Supplemental Insurance (Medigap):

Extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. Policies are standardized, and in most states named by letters, like Plan G or Plan K. The benefits in each lettered plan are the same, no matter which insurance company sells it.



 

MEDICARE

 
When do I sign up for Medicare?
 
  • You can sign up for Medicare three months before turning 65.
  • Some people get Medicare Part A and Part B automatically, and some people have to sign up for it.
    • If you have been on Social Security at least 4 months prior to turning 65, Medicare will enroll you automatically into Medicare parts A and B. You will get your card in the mail about three months prior to turning 65.
    • If you are not receiving Social Security before turning 65, and would like to start Medicare you can sign up by going to your local Social Security office or online at SSA.gov.
  • The initial enrollment period is for 7 months, starting three months before you turn 65 and ending three months after the month you turn 65.
  • If your birthday falls on the 1st of the month, your seven month period starts earlier. It starts four months before you turn 65 and ends two months after the month you turn 65. Generally your Medicare covered starts the first day of the month before you turn 65.

  • If you miss your seven month initial enrollment period, you may have to wait to sign up and pay a monthly late enrollment penalty for as long as you have Part B coverage. The penalty goes up the longer you wait, you may have to pay a penalty if you have to pay a Part A premium, also called "Premium Part A". However, you will not be penalized if you or your spouse is still working and have a creditable health coverage through you (or your spouses) employer.
Do I need Medicare if I am still covered by my or my spouses employer?
  • It depends on how you get your health insurance now and the number of employees that are in the company where you (or your spouse) work.

  • Generally, if you have job-based health insurance through your (or your spouse’s) current job, you don’t have to sign up for Medicare while you (or your spouse) are still working. You can wait to sign up until you (or your spouse) stop working or you lose your health insurance (whichever comes first).

    • If you’re self-employed or have health insurance that’s not available to everyone at the company: Ask your insurance provider if your coverage is employer group health plan coverage (as defined by the IRS.) If it’s not, sign up for Medicare when you turn 65 to avoid a monthly Part B late enrollment penalty.

    • If the employer has less than 20 employees: You might need to sign up for Medicare when you turn 65 so you don’t have gaps in your job-based health insurance. Check with the employer.

    • If you have COBRA coverage: Sign up for Medicare when you turn 65 to avoid gaps in coverage and a monthly Part B late enrollment penalty. If you have COBRA before signing up for Medicare, your COBRA will probably end once you sign up. 

  • We always advise people to meet with us or another trusted Medicare broker to compare the costs between staying on your employer plan vs. going on Medicare. We look at the premiums, deductibles, co-pays, coinsurance and max-out-of-pocket. I would say 60% of the time it makes more sense financially to go onto Medicare rather than stay with your employers plan.

  • After you retire and lose your health insurance through your work, you will have 60 days before your end date and 60 days after to sign up for Medicare and a Medicare plan.

How much does Medicare cost? (2024)

  • Part A premium

    • If you have worked 40 quarters (10 years) in your life, then usually Medicare Part A costs $0. If you have not worked 10 years, Medicare could cost up to $505/month depending on how long you worked in your life. 

  • Part A hospital inpatient deductible and coinsurance You pay:

    • $1,632 deductible for each benefit period

    • Days 1-60: $1,632 coinsurance for each benefit period

    • Days 61-90: $408 coinsurance per day of each benefit period

    • Days 91 and beyond: $816 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

  • Part B premium

  • Part B deductible and coinsurance

    • $240. After your deductible is met, you typically pay 20% of the Medicare-Approved Amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment.

  • Part C premium

    • The Part C monthly premium varies by plan. 

  • Part D premium

    • The Part D monthly premium varies by plan (higher-income consumers may pay more). 

 
When does Medicare coverage start?
  • The date your coverage starts depends on which month you sign up during your Initial Enrollment Period. Coverage always starts on the first of the month.

  • If your birthday falls on the 1st of the month, your seven month period starts earlier. It starts four months before you turn 65 and ends two months after the month you turn 65. Generally your Medicare covered starts the first day of the month before you turn 65.


Why do people sign up for Medicare plans?

With "Original Medicare" there are large deductibles and coinsurance. That is why many people chose to also have a Medicare Plan on top of "Original Medicare". There is no one plan that fits all when it comes to health care so having options to help better fit your needs is what Medicare plans are for.

What types of Medicare plans are their?

There are four main types of Medicare plans: Medicare Advantage plans, Medicare Supplements, Medicare Savings Accounts, and Medicare Cost plans. Some of these plans include Medicare Drug plans and some require you to purchase the Drug plan separately.

Medicare Advantage Plans/Medicare Part C
Medicare Advantage is where Parts A, B, and D come together in one plan. Advantage Plans have lower premiums
  • Premiums varies between company's
  • In network clinic
  • This plan combines Parts A, B, and D
  • Co-pays and Maximum out-of-Pocket
  • Can change plan every year (Oct 15-Dec 7)

Medicare Supplement Plans
  • Premiums varies between company's
  • You can go anywhere that accepts Medicare
  • Must sign up with 6 months of being on Part B
    • Must pass a questionnaires to be able to sign up after the six month of being on Part B.
  • highest amount of coverage
  • keep when moving anywhere
  • Drug plan is separate
  • co-pays, max-out-of-pocket, and deductibles
  • DO NOT need to change each year
  • No bells and whistles (may offer discounts)
Medicare Savings account
Is a gift card reward plan. Depending on plan that is selected, you get a certain dollar amount each year for health related bills. The money rolls over each year. You have to fill out a tax form at the end of the year. You can get tax penalty for using the funds incorrectly. If you were to pass away, you get to keep. The money and your family members can use the funds for their healthcare related needs.
  • Premium $0
  • Deductible (varies between companies)
  • No network
  • Not eligible if you receive VA benefits
  • Separate drug plan
  • Medicare Fee-for-service rates
Medicare Cost Plan
  • Premium Varies
  • can include drug plans or drugs plans can be separate
  • If drug plans are separate you can change your plan every month
  • Some co-pays
  • Maximum out-of-pocket limit
  • May include dental, gym membership, hearing and vision exams
  • Inside a plan can adjust each year

The information on this website is for educational purposes only. While we have taken every precaution to ensure all information is accurate, errors can occur. Life & Health Insurance Advisors, LLC assumes no responsibility for any errors on this page. Sources: Medicare.Gov & SSA.Gov.

Medicare Disclaimer - We do not offer every plan available in your area. Currently we represent 13 organizations which offer about 77 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
 

HOURS & LOCATION
Location

1610 14th Street NW, Suite 205B

Rochester, MN 55901

Email-

Rebecca@LHI-Advisors.com

 

Tel: (507) 259-0037

Hours

Monday - Friday 

8:00 am to 5:00 pm

 

Evenings by Appointment

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