• The Basics:

  • To make it simple, you will only need to sign up once for Part A and Part B Medicare once you're 65 years old (Original Medicare). This will cover the basics of -hospital (Part A) and Medical care (B)
  • Each year, you can choose how you get your health coverage (and add or switch drug coverage). Open enrollment Oct 15th-Dec. 7th. 
  • Medicare is different from private insurance — Typically, we are used to having either group or couples and even family healthcare coverage. But Medicare does not work that way. Medicare is "individual" healthcare.  it doesn’t offer plans for couples or families. You don’t have to make the same choice as your spouse.    
  • Original Medicare does not cover all the costs for approved healthcare services and supplies. After you meet your deductible (both Part A and B have deductibles you must pay yearly), you pay your share of costs for services and supplies as you get them.(They pay80%, you pay 20%)
  • Services covered by Medicare must be medically necessary. There are some things that Original Medicare will not cover:
    • Contrary to popular belief, Original Medicare does not cover everything. 
    • Some of the items and services Medicare doesn't cover include:
      • Long-Term Care
        (also called
        custodial care
        )
      • Most dental care
      • Eye exams (for prescription glasses)
      • Dentures
      • Cosmetic surgery  
      • Massage therapy
      • Routine physical exams
      • Hearing aids and exams to fit them
      • Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)
      • Covered items or services you get from an opt-out doctor or  provider (except in the case of an emergency or urgent need)
      
      
  •  Medicare also covers many preventive services, like shots and screenings. 
  • You must visit a healthcare provider that accepts 
    Medicare. You pay the full cost if you get a service that Medicare doesn’t cover.
  • There is no limit on what you’ll pay out-of-pocket ( no maximum out-of-pocket) in a year unless you have other coverage (like Medigap, Medicaid, or employee or union coverage.                                                                                           
    

  Choose the way you want your healthcare;

  You can choose either to stay with 

  Original Medicare or choose additional coverage offered by private insurance companies. if you choose Original Medicare, you’ll also decide if you want 

  drug coverage (Part D).

   Don't forget this part. You may be penalized if you don't apply for it unless you already have this coverage in another form, such as veterans benefits. 

   
•  

  Medicare Advantage (Part C)

   Medicare Part C may include Part D and other benefits that Original Medicare does not include.
• Medigap. You may want supplemental coverage, like 

  Medigap or a Medicare Supplement plan to help cover co-pays and co-insurance costs. Medigap insurance does not include Part D. You'll need to add drug coverage (Part D)

  .

How does Medicare Advantage work?

Medicare Advantage bundles your Part A, Part B, and usually Part D coverage into one plan.

•  Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
• You join a plan offered by Medicare-approved private companies that follow rules set by Medicare. 
• Each plan can have different rules for getting services, like needing referrals to see a specialist. Costs for monthly premiums and services you get vary depending on which plan you join.
• Plans must cover all emergency, urgent care, and almost all medically necessary services Original Medicare covers. 
• Some plans tailor their benefit packages to offer additional benefits to treat specific conditions.

With Medicare Advantage, you:

• Need to use doctors in the plan’s network (for non-emergency or non-urgent care).
• May pay a premium for the plan in addition to the monthly Part B premium. Plans may have a $0 premium or may help pay all or part of your Part B premiums.
• Can’t buy or use separate supplemental coverage (like Medigap).
• You must have both parts A and B to join a Medicare Advantage plan.

How does Medicare work with my other insurance?

When you have Medicare and other health insurance (employer coverage*), one will pay first (called a “primary payer”) and the other second (called a “secondary payer”). If you have veterans benefits, in most cases, they will be a "secondary payer." If you have state benefits(Medicaid), they will also be a "secondary payer)

*If you have other insurance, who pays first depends on a number of items, like if you’re still working, the type of insurance you have, and if you have a special situation, like End-Stage Renal Disease (ESRD).

If you have any questions or would like to ask me a question, feel free to call me at 1-855-382-9562

For more information, you can find more details at: https://www.medicare.gov/