Insurance Frequently Asked Questions

Medicare is a federally funded health insurance program, primarily for people 65 and over. Medicare is also available to younger people with certain diseases and disabilities like end-stage renal disease or amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). Depending on the Medicare plan, it can cover expenses related to inpatient care, outpatient care, vision, dental, and prescription drugs.

There are different parts to Medicare, some federally funded and some private.

Medicare Part A covers inpatient care, including hospital visits, nursing home care, home health services, and hospice care.

Medicare Part B covers outpatient care, including medically necessary and preventative care.

Medicare Part C is a health insurance plan that the government requires to cover everything Medicare Parts A and B cover. They’re available through licensed private insurance companies and may include additional benefits such as gym memberships, vision, and dental coverage.

Medigap (Supplemental Medicare) helps pay for some costs not covered by Medicare Parts A and B, such as copayments, coinsurance,  and deductibles.

A Medicare beneficiary is someone who is entitled to Medicare benefits. Medicare is primarily for people 65 and older, but can also be available to younger people with illnesses like ESRD and ALS.

Medicare covers a plethora of healthcare services. From inpatient to outpatient care, Medicare ensures your out-of-pocket costs are minimal. You can have some or a lot of coverage, depending on the Medicare part(s) you have. Each part of Medicare covers a different set of services or health care expenses.

Medicare Part A

Medicare Part A covers a variety of emergency and long-term care services. These services generally include:

• Nursing homes
• Hospital procedures and stays
• Hospice care
• Home health care that occurs after an inpatient stay
• Blood transfusions that you may receive at a hospital (above three pints annually)

Medicare Part B

Medicare Part B covers a broad range of preventative and other medical services. Many preventative services will be 100 percent covered while others may be billed on an 80/20 coinsurance basis. These may include services such as:

• Doctor visits
• Screenings and lab tests
• Counseling, therapy, and mental health
• Shots and immunizations
• Ambulance
• Outpatient care
• Surgeries
• X-rays
• Clinical research studies
• Limited outpatient prescription drugs

Medicare Part C (Medicare Advantage)

Medicare Advantage, also known as “Medicare Part C,” offers all the same benefits as Medicare Parts A and B (“Original” Medicare) above, but many offer additional insurance for services not covered under Original Medicare. Depending on your coverage area, your Advantage plan may include one or more of the following:

• Vision
• Dental
• Hearing aids
• Health and wellness programs
• Gym memberships
• Prescription drug coverage

Medicare Part D

Medicare Part D covers a wide variety of prescription drugs and medications. Each Medicare Part D plan offers a different range of medications (known as a “formulary”) at different rates (known as “tiers”), depending on your coverage area, the cost of medications, and whether the drugs you need are generic or brand name.

Medicare Supplement (Medigap)

Medicare Supplement or “Medigap” helps pay for some health care costs not covered by your Original Medicare or Medicare Advantage plan. These may include expenses such as:

• Deductibles
• Copayments
• Coinsurance
• Care that you receive overseas

Medicare Supplement plans do not cover prescription drugs or medications. Prescription drugs are only covered by Medicare Part D mentioned above and some Medicare Part C plans.

According to the U.S Department of Health and Human Services, “Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources.”

Medicare is a government-run program aimed at aiding individuals who might not be eligible for private health insurance. It provides health insurance benefits to those who are 65 years or older and to those with certain disabilities. These benefits are offered to all eligible applicants, regardless of their income level, and may even provide some coverage at little to no cost.

On the other hand, private health insurance is operated by commercial entities. This means that individuals have more options when it comes to choosing coverage and pricing. However, before you can enroll in a private insurance plan, the insurance company will evaluate your risk based on factors like your medical history and age. Depending on the results of this evaluation, you may be charged a higher premium or even denied coverage.

You are eligible for Medicare when you turn 65. Those younger than 65 with certain disabilities like end-stage renal disease or amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) are also eligible.

There are three primary enrollment periods for Medicare plans: the Initial Enrollment Period, the General Enrollment Period, and the Annual Enrollment Period.

The Initial Enrollment Period (IEP) begins three months before the month you turn 65 and ends three months after the month of your 65th birthday. If you are younger than 65, your Initial Enrollment Period may be triggered by a disability or other conditions.

The General Enrollment Period (GEP) begins every year on January 1 and goes until March 31 and it’s for those who didn’t enroll during their IEP. If you wait until the GEP, you might have to pay some late penalties. Coverage for enrolling during the GEP starts July 1st.

The Annual Enrollment Period (AEP) starts October 15th and ends on December 7th. During this enrollment period, you can switch your Medicare plans, add prescription drug coverage or enroll in a Medicare Supplement (Medigap) plan, or cancel any of your existing plans altogether.

The Special Enrollment Period (SEP) doesn’t have a set start or end date, but can be triggered by qualifying life circumstances including but not limited to moving to a new area, living in a nursing home, or qualifying for both Medicare and Medicaid.

Yes, Medicare premiums are tax deductible as a medical expense as long as you itemize your deductions on your tax return. Only medical expenses that exceed 7.5% of your adjusted gross income (AGI) are deductible, so keep that in mind when doing your taxes.

Depending on your Medicare type, there are a few scenarios in which Medicare may drop you. The most common ones are if:

• You no longer have a qualifying disability
• You fail to pay your plan premiums
• You move outside your plan's coverage area
• Your plan is discontinued

If you're getting Medicare Part A and Medicare Part B, you may automatically enroll if you already get benefits from Social Security (or the Railroad Retirement Board) before you turn 65. If you’re not automatically enrolled, you’ll have to sign up through the Social Security office once you turn 65. If you want to get Medicare Part C, Part D, or Medigap, call us and we can find available Medicare plans in your area.