Understanding the complexities of Medicare plans requires expertise, especially in the Bay Area where there are a variety of Medicare Advantage plans. Golden Heritage is here to help you navigate through your healthcare options.
What is Medicare?
Medicare is federal health care insurance program for people who are 65 or older, certain people are with disabilities and people with End-Stage Renal Disease (Permanent kidney failure requiring dialysis or a transplant, sometime called ESRD).
To be eligible for Medicare you must be a U.S. citizen or be a permanent resident and have lived in the U.S. for 5 consecutive years.
You are eligible for Medicare if:
- You are 65 years or older; or
- You are younger than 65 years old and
- have a disability and have received collecting Social Security Disability Insurance (SSDI) for at least 24 months; or
- A diagnoses of End Stage Renal Disease (ESRD); or
- A diagnosis of ALS, also known as Lou Gehrig’s disease
There are no income requirements to be eligible for Medicare.
There are four different components of Medicare Coverage:
Part A – Hospital Insurance
- Part A includes coverage for Inpatient Hospital Care, Skilled Nursing Facility, Hospice
Part B – Outpatient Medical Insurance
- Part B includes coverage for medically necessary services and preventative services.
Part C – Medicare Advantage plans
- Part C comes with joining a Medicare Advantage Plan. These plans include Part A & B, plus additional benefits
Part D – Prescription Drug plans
- Part D provides coverage for prescription drug costs. Part D is offered to everyone who qualifies for Medicare but participation is optional.
If you are approaching age 65 and you receive Social Security, you will be automatically enrolled in Medicare Parts A (hospital insurance) and B (medical insurance) when you turn 65. Approximately 3 months prior to your 65th birthday, Medicare will send you an initial enrollment package containing general information about Medicare, a questionnaire, and your red-white-and-blue Medicare card.
If you have both Medicare Parts A & B are eligible for Part C coverage in a Medical Advantage (MA) Plan. All MA plans include hospital (Part A) and medical (Part B) coverage. In addition to Part A & B coverage, MA plans often include Part D, Prescription Drug, coverage, and supplemental benefits, like transportation assistance, dental care, gym membership – and more!
There are four periods to enroll in Medicare:
- Initial Enrollment Period (IEP)
– This is a 7-month period that begins 3 months before the month of your 65th birthday and ends 3 months after the month of your 65th birthday.
- General Enrollment Period (GEP)
– This enrollment period occurs annually from January 1st through the 31st. If you enroll in Medicare during GEP, your coverage is effective the following July 1
- Special Enrollment Period (SEP)
– This is an 8 month Medicare enrollment period that is available to individuals after their current employment or group health plan coverage ends. SEP begins on the 1st day of the 1st month after coverage ends.
- Annual Election Period (AEP)
– AEP occurs annually from October 15 – December 7. This period allows individuals, who have enrolled in Medicare, to make changes to their Part C and Part D coverage. Any changes made during this time will be effective on January 1st of the following calendar year.
If you are eligible for Medicare or have already enrolled in original Medicare, you may be looking into Medicare Advantage plans because they generally offer more benefits than original Medicare.
There are many Medicare Advantage plans in the market and each plan offers different benefits, so you want to find the one that best fits your needs. Medicare Advantage Plan is a trype of Medicare Health Plan Offered by a private company that contracts with Medicare. These plans include Part A, Part B, and usually including Part D prescription drug coverage. Plans may offer some extra benefits that original Medicare does’t cover.
Your decision about how to get Medicare affects how much you pay for coverage, such as monthly premium, deductible, copayments and coinsurance. Often time, you are required to choose an in-network (HMO Health Maintenance Organization) providers, choose a primary care physician (PCP) and get referrals for specialty care (unless it’s urgent or emergency). These plans are typically low or no cost, including Part D benefits and may offer some extra befefits that Original Medicare does’t cover – like certain vision, hearing, and dental service.
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