What Is Medicare?
Medicare came into effect in 1965 under the social security act, with the purpose of providing health insurance to U.S. citizens over the age of 65, regardless of income or medical history.
All U.S. citizens are eligible to receive Original Medicare at the age of 65. Original Medicare consists of Part A (inpatient hospital services) and Part B (outpatient medical services). Prescription drug coverage may be purchased separately under Part D Medicare, and special plans covering Original Medicare, Part D Medicare and more health services, also known as Medicare Part C (Medicare Advantage plans), can be purchased from private insurance companies.
Once you know you qualify for Medicare, you can evaluate your coverage options.
Medicare Eligibility
To be eligible for Medicare, you first have to be a U.S. citizen or legal resident residing in the U.S. for at least 5 years. If you meet that criteria and have worked for at least 10 years, you automatically become enrolled in Medicare Part A at the age of 65, which will cover emergency hospital stays. You also become eligible to enroll in Medicare Part B, covering preventive care and doctor’s visits, for a monthly premium.
Special Circumstances
Certain younger people may qualify for Medicare coverage if they have certain disabilities or life-threatening diseases. If you are under the age of 65, you may qualify for Medicare if you have:
ALS (also known as “Lou Gehrig’s Disease”)
End Stage Renal Disease (ESRD)
Received Social Security Disability Income (SSDI) for 24 months
What’s Not Covered Under Medicare Parts A & BWhile Original Medicare covers some necessary bases, it doesn’t cover all your costs. Services and expenses that are not covered under Original Medicare include:
Most dental care/dentures
Eye exams/prescription glasses
Prescription drugs
Hearing aids
Long-term care
Homeopathic care
Acupuncture
Foot care and orthopedic shoes
Certain routine or physical exams
Deductibles, coinsurance, or copayments for health services
Unexpected medical costs can add up quickly without the right insurance coverage. When Original Medicare (Medicare Parts A and B) doesn’t cut it, explore the option of a Medicare Advantage plan. It offers many of the benefits of a traditional PPO (Preferred Provider Option) or HMO (Health Maintenance Organization) plan and often costs less than Original Medicare.
What is a Medicare Advantage Plan?
Medicare Advantage plans, also called “MA Plans” or “Part C”, are an alternative to Original Medicare and Medicare Part D. MA Plans are offered by private Medicare-approved companies. Besides hospice care, they cover everything Original Medicare (Part A and Part B) covers and more.
Get more coverage under a Medicare Advantage plan. In addition to hospital and medical insurance from Part A and Part B, a MA plan could also cover:
Medicare prescription drug coverage (Part D)
Vision
Dental
Hearing
Wellness programs
Non-Emergency transportation
Emergency care
Non-life-threatening urgent care
These plans have one convenient monthly premium, that’s usually less expensive than Original Medicare. Part C plans also provide a protective annual out-of-pocket cost maximum, which limits how much you pay for medical services each year. Health provider options under Medicare Advantage plans are limited to reliable plan networks.
Medicare Part D
Prescription Drug Plans (PDP)
Once you have enrolled in Medicare Parts A and B, you will also need a Prescription Drug Plans. There are two options for prescription drug coverage that you can benefit from, so let’s take a look at each one.
Medicare Part D isn’t automatically included. Instead, you can get this coverage by enrolling in a stand-alone Medicare Prescription Drug Plan that works alongside your Original Medicare benefits or through enrollment in a Medicare Part C (Advantage) Plan.
If you have Medicare Part C, you can get prescription drug benefits by enrolling in a Medicare Advantage plan that includes this coverage. Also known as Medicare Advantage Prescription Drug plans, these plans give you the option to get your Medicare health and prescription drug benefits covered under a single plan.
Medicare Part D coverage is available through private insurance companies that are contracted by Medicare, so costs and availability may differ between Medicare plans, insurance companies, and location.
What is a Medicare Supplement insurance plan?
Medicare Supplement insurance plans, also called Medigap policies, are used in conjunction with Original Medicare (Part A and Part B) to fill in some coverage gaps, including copayments, coinsurance and deductibles, as well as emergency overseas healthcare. These plans are sold by private companies. Medicare Supplement plans pay for costs you’d normally be responsible for paying under Original Medicare as long as you pay your monthly premium. With a Medicare Supplement plan, you can better predict your expenses and make better use of your hard-earned retirement. The best is that you’re not required to use a network of providers—choose any doctor or specialist that accepts Medicare without a referral, and never worry about losing your preferred physician. Medicare Supplement insurance plans do no not cover long-term care, hearing, vision, dental or prescription drug coverage.
Make Medicare Work is a service of J Johnston Insurance Services, a licensed and certified representative of Medicare Advantage HMO, PPO and PFFS organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal. Enrollment in the plan depends on the plan’s contract renewal with Medicare. Medicare Advantage organizations and/or Medicare Part D plan sponsors comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex.
Out-of-network/non-contacted providers are under no obligation to treat Plan/Part D Sponsor members, except in emergency situations. Please call the Plan’s customer service number or see your Evidence of Coverage for more information, including cost sharing that applies to out-of-network services.
Every year, Medicare evaluates plans based on a 5-Star rating system. You are not required to provide any health related information unless it will be used to determine enrollment eligibility. Licensed sales agents/producers may be compensated based on your enrollment in a health plan.
*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 1800Medicare to get information on all of your options. *While the Center for Medicare and Medicaid Services (CMS) is requiring us to add this disclaimer, please note that we will discuss all plans available in your area, helping you choose the best plan to fit your needs.
