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Eternal Insurance Agency's Medicare Guide

Eternal Insurance Agency is dedicated to providing you with the best service possible. We want to help educate you about Medicare and answer any questions that you might have so that we can make sure your needs are met.

What is Medicare?

The Medicare program is a federally funded healthcare program or a federal health insurance program that helps pay for some of the health care costs or medical expenses for people age 65 and older. All Medicare benefits have to offer are subject to medical necessity. It also covers younger people who are disabled, have kidney disease or ALS (Lou Gehrig's Disease). Medicare official website is https://www.medicare.gov/.

The Medicare federal budget is $722 billion for 2021.

The Centers for Medicare & Medicaid Services (CMS)

CMS manages and cares for people with Medicare and Medicaid.

Medicare Enrollment

Enrollment in Medicare is done through the Social Security Administration, and beneficiaries should call the SSA toll-free phone number, 800.772.1213 to enroll over the telephone or visit a local office for in-person enrollment.

You may enroll in a Medicare plan if you lose group health coverage.

What qualifies me for Medicare?

You are eligible for Medicare coverage if you are at least 65 years old and meet certain requirements. If you have been working long enough, such as 40 quarters of Social Security-covered employment (a quarter is roughly three months) and paid Medicare taxes, or can prove that your work history qualifies under the Railroad Retirement Act (usually 30 years) then you may also qualify.

Do you have to sign up for Medicare at 65?

No, you do not have to sign up for Medicare when you turn 65. You may want to wait until a time in your life that is more convenient if you are still working and covered by group health insurance through work.

What if I am over 65, but work and have employer-based health insurance?

If you are employed or retired from a company that provides private health care coverage for its employees then your employer may opt to provide coverage beyond Medicare eligibility age by continuing such coverage under COBRA. The employee will still be responsible for the full cost of their coverage, but it will be less expensive than purchasing private insurance on the state marketplace.

If you are retired and your former employer does not offer COBRA benefits then in order to continue health care coverage beyond 65-years old, you may want to explore Medigap supplemental policies which provide additional Medicare services that Original Medicare does not cover.

What if I am over 65 but do not qualify for Medicare?

You can still purchase an individual health insurance plan in the state marketplace created by the Affordable Care Act (ACA) which offers many of the same benefits as Medicare.

Is Medicare free?

No, Medicare is not free. You will have to pay a monthly premium and out of pocket costs such as copayments for your doctor visits or other healthcare services.

Parts of Medicare

Original Medicare has two parts Part A and Part B. Private insurance companies run prescription drug coverage, Medicare advantage plan and Medicare supplement plan.

Medicare Part A (Hospital Insurance)

This pays for inpatient hospital stays, skilled nursing care after a short stay in the hospital, and hospice care.

Medicare Part A Benefits and Services Covered

-Inpatient hospital stays: Part A pays for your room, meals and most medical services given to you while in the hospital. You also pay a copayment or coinsurance each time you receive treatment from an acute care doctor on staff at the hospital (except certain preventative treatments like chemotherapy). Hospital inpatient services include, but are not limited to: surgery, chemotherapy, dialysis and certain diagnostic tests.

-Skilled nursing facilities: If you are a Medicare beneficiary and need to go to a skilled nursing facility after being hospitalized for at least three days, Part A will cover up to 100 days of that care.

-Hospice: If you have been diagnosed with an illness in its final stages, hospice can provide palliative relief from pain, discomfort or distressing symptoms caused by the terminal illness.

-Home health services: Medicare will pay for some skilled care and physical therapy if you are homebound or in a rehabilitation facility.

Traditional Medicare has a deductible for Part A and Part B. Part A inpatient hospital deductible for 2021 is $1,484. Part B deductible is $203 for 2021.

Medicare Part B (Outpatient care) This helps pay for doctor's visits, outpatient treatments such as surgery or physical therapy that don't require an overnight stay and other health care providers. You get Part B automatically when you turn 65 (or if you're under 65 and qualify for disability).

Medicare Part B Benefits and Services Covered

-Doctor visits: You can see any physician who is approved by Medicare to receive Part B reimbursements, without limiting yourself to those in your provider network. There is no limit to the number of doctor visits you can have each year.

-Outpatient hospital care: You are eligible for as many days at a Medicare-approved facility as your physician prescribes, often three or four days per week--and sometimes more. There is no limit on the length of time that's covered; coverage ends when treatment has been completed.

-Home health care: You're covered for getting your prescriptions, medical tests and treatments at home. This is ideal if you have a chronic illness or are recovering from an injury, surgery or other trauma that requires long-term treatment in the comfort of your own surroundings--or simply to avoid hospitalization.

-Preventive Services: Preventive Services are covered under Part B. Services include routine physicals, flu shots and cancer screenings.

-Dental Coverage: Basic dental care--such as cleanings, X-rays, fillings or extractions--is not included in Original Medicare but can be purchased separately

Durable Medical Equipment: Durable medical equipment--such as canes, walkers and wheelchairs--is not included in Original Medicare but can be purchased separately.

Medicare Part C

This is a private plan or medical insurance that you can buy from an insurance company also known as Medicare Advantage plan. These plans are health maintenance organizations (HMOs), or preferred provider organizations (PPOs). Medicare Advantage plans cover doctor visits, hospital care, and other medical services just like Part A or B but without the premium costs.

Medicare Part C Benefits and Services Covered:

-Doctor visits

-Hospital care

-Mental health and substance abuse services, including counseling and psychotherapy

-Home health care to help you recover from a chronic illness or injury at home. This includes medical treatments like physical therapy, occupational therapy, speech language pathology treatment, skilled nursing care (also called "nursing-home care"), medical supplies, and other equipment like braces for use at home.

-Hearing services

-Vision services (i.e., exams)

-Medical equipment such as wheelchairs or hearing aids that are medically necessary to treat a chronic illness or injury

-Prescription drugs covered by Medicare Part D that are prescribed for you

-Outpatient rehabilitation, such as physical therapy after a hospital stay or surgery. This includes medical treatments like physical therapy, occupational therapy, speech language pathology treatment; and other equipment like braces for use at home.

Medicare Part D

Part D is your Medicare prescription drug coverage. This helps pay for prescription drugs. Part D coverage is optional but you must have creditable prescription drug coverage when you're eligible for Medicare to avoid paying a lifetime fee called late enrollment penalty. You can have a stand alone prescription drug plan or get prescription drug cover with a Medicare advantage plan.

Medicare beneficiary premiums for stand alone drug plans varies but some Medicare advantage plans premiums are $0 and they include drug coverage.

Medicare supplement insurance

Are plans are designed to cover costs not covered by Medicare, such as copayments and coinsurance.

Income Related Monthly Adjustment Amounts (IRMAA)

If you have a higher income Medicare Part B premium and prescription drug coverage are subjected to an additional premium.

Individuals with the following annual income levels are eligible for Extra Help to pay their Medicare Part B premiums. If you receive Medicaid or SSI, your monthly premium is free and there is no need to do anything more.

Eternal Insurance Agency can help you find a Medicare Advantage plan, a Medicare Supplement plan or a Part D Drug Plan.

If you have any questions regarding benefits covered by the federal government, contact one of our agents at (561) 898-0076 for assistance in finding the best plan for you.

Helpful Links

Federal Government Website

• United States government official site is https://www.usa.gov/
• Centers for Medicare Medicaid Services https://www.cms.gov/
• Health and Human Services (HHS websites) https://www.hhs.gov/

• Health and Human Services administers Medicare under U.S. Centers for Medicare & Medicaid Services. HHS official website is https://www.hhs.gov/. HHS websites will help answer questions about Medicare, such as how to enroll and what it covers.

I hope the helpful links were useful. If you have any questions you may call us at (561) 898-0076, fill out contact form or email us at john@eternalinsuranceagency.com.