Original Medicare (Medicare Part A & Part B) starts when you turn 65 years old or when you have been permanently disabled for 24 months. Medicare pays doctors and hospitals 80% of the expenses, so you are liable to pay the remaining 20% out of your pocket. Medicare recommends that you get some type of Medicare insurance to cover these 20% of expenses that you have to pay.
Original Medicare comes in two parts. Part A pays for inpatient hospital, skilled nursing facility, hospice and home health care. If you have worked in the USA for 10 years, then you receive Part A benefits on the month that you turn 65.
Part B pays for doctors, clinical lab services, durable medical equipment, preventative services and other medical services. Everyone has to pay a monthly premium to have Part B. For 2022, the Part B premium is $170.10/mo minimum that is deducted monthly from your Social Security check, or billed to you quarterly if you are not drawing Social Security. If you are working and have credible health coverage from your employer, the you can opt-out of Part B until you retire.
Medicare Advantage Plans (Medicare Part C)
A Medicare Advantage with Prescription Drug plan (MAPD) is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A, Part B and prescription drug benefits at little or NO monthly premiums. You pay small co-pay fees when you receive health service with a cap on your maximum out-of-pocket expenses.
They include added benefits such as vision, dental, transportation, gym membership, and more.
There are different types of Medicare Advantage Plans such as an HMO with a network of doctors and hospitals. Also, a PPO that has a network, but is open to all doctors and hospitals who accept Medicare. Out-of-network doctors have higher out-of-pocket fees.
These plans work differently than a Medicare Supplement plan, and are not considered a supplement. Contact us for more information. We can assist you with the whole process from applying for Medicare to getting signed up with a health plan that is right for you.
A Medicare Supplement, or a Medi-Gap plan, is private insurance that covers some of the gaps in original Medicare. Any caregiver that accepts Medicare will take a supplement. because they only need to bill Medicare. Medicare pays their part and sends the remainder of the bill to the supplement which pays their part. You pay a premium each month for your health insurance so that you would have little or no out-of-pocket expenses when you receive health care.
However, Supplements do NOT include coverage for prescription drugs. You need to purchase a stand-alone Prescription Drug Plan (PDP) and pay a monthly premium for your prescription drugs. Also, you will have to pay different levels of co-pay fees for your prescription drugs.
Prescription Drug Plan (Medicare Part D) Only used with Original Medicare or a Medicare Supplement
Prescription Drug Plans are private insurance companies who pay some of the costs for your prescription drugs. You pay your monthly premium for the plan, and pay co-pay fees when you purchase them from your pharmacy. There are five levels of co-pay fees for your drugs based on the retail price of that drug.
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