Information

During our consult we will:
  • Assess your health care coverage needs

  • Determine general eligibility for health care programs

  • Evaluate and compare health insurance plans and programs

  • Provide enrollment help with Medicare

Look over the following information and gather questions and concerns that you may have.

What Is Medicare?

Medicare is a federal health insurance program run by the Centers for Medicare and Medicaid (CMS).It mainly provides health insurance for people who are at least 65 years old. However, it also covers some younger people with a qualifying disabilities or illnesses.

 

Medicare Eligibility & Requirements – Who Qualifies For Medicare? 

People aged 65 years and older who have been legal residents of the U.S. for at least 5 years, and younger people who are approved for SSDI (Social Security Disability Insurance) Recipients of SSDI are typically eligible to receive their Medicare benefits 2 years after the date they are entitled to the benefits. People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) also qualify for Medicare.

If you have questions about your eligibility, or want someone to walk you through the process, contact us here.

Can You Lose Medicare Benefits?

Usually, the only reason that you would lose your Medicare benefits is that you didn’t pay your premium(s).

Medicare Categories

  1. Part A: Hospital Insurance

  2. Part B: Medical Insurance

  3. Part C: MedAdvantage Plans

  4. Part D: Prescription Drug Plans, Medigap, or Supplement Plans

Medicare Coverage & Benefits Washington State

Medicare coverage is not a one-size-fits-all type of coverage. There are several options, some require that you pay a premium, others are free.

Medicare Parts A & B are considered “Original Medicare.”

The Different Parts Of Medicare

Medicare Part A – An easy way to remember Part A is to think of it as hospital insurance, because Part A covers

  • Inpatient hospital care

  • Skilled nursing facility care

  • Hospice care

  • Home health care

Part A Premium – If you have Medicare Part A, then you usually do not have to pay a premium. If you or your spouse worked over 40 quarters in their lifetime.

Medicare Part B – Health care specific to medical insurance. Part B covers

  • Services from doctors and health care providers

  • Outpatient hospital care

  • Home health care

  • Durable medical equipment

  • Preventive services

Part B Premium – Unlike Part A, Medicare Part B requires a premium. The standard premium changes annually.

Medicare Part C  – MedAdvantage

Medicare Advantage. Combines Part A & Part B and sometimes Part D, and covers

  • All benefits & services covered under Original Medicare Parts A & B

  • Can include Prescription drug coverage (Part D)

  • Run by private insurance companies that are Medicare approved

  • Extra services & benefits for additional cost

Medicare Part D – It’s easier to remember this as prescription drug coverage. Part D details:

  • Prescription drug costs

  • Helps pay for both branded and generic drugs.

  • Run by private insurance companies that are Medicare approved

  • Each plan has its own formularies and contracted pharmacies

Part D Premium – This is offered by insurance companies approved by Medicare, so premiums vary.

Medigap – Also known as Medicare Supplement or Modernized Supplement Insurance. Medigap details:

  • Run by private insurance companies that are required to follow federal and state laws

  • Medigap insurance companies can only offer you a standardized plan

  • Helps fill in the “gaps” or healthcare costs of what original medicare does not cover like deductibles, copays and coinsurance.

 

 FREQUETLY ASKED QUESTIONS

What Is Medicaid?

With Medicare, eligibility is not income based. The major difference between Medicare and Medicaid is financial. Medicaid is the state’s solution to providing health coverage for people with low income.

People who are approved for SSI (Supplemental Security Income) will qualify for Medicaid.

Can You Get Both Medicare & Medicaid?

Medicaid is a joint federal state program that provides health coverage to people with limited incomes. Some people are Dual Eligible and qualify for both Medicare and Medicaid. To see if you can get help to  qualify contact me.

Medicare Important Dates

Turning 65  – When you first become eligible for Medicare at 65, you have a 7 month window to enroll in a Part C and or Part D plan. 3 months before your birthday, your birthday month and 3 months after.

October 15th- December 7th: Medicare Open Enrollment Period (OEP)

This is one time of year you can make changes to your MedAdvantage and or Part D Prescription Drug plans for a January 1st effective date.

January 1st – February 14th: Annual Disenrollment Period (ADP)

During this time you can drop a MedAdvantage to return to Original Medicare. Part D Prescription Drug plans may be purchased if a drug plan was part of the dropped MedAdvantage plan.

Eligible due to disability – When you first become eligible for Medicare due to a disability, you have a 7 month window to enroll in a Part C and or Part D plan. 3 months before your 25th month of disability , your disability month and 3 months after.