FAQ

Medicare has four basic parts – Part A, Part B, Part C and Part D. Original Medicare includes Parts A and B, which include hospital and medical coverage respectively. The Medicare Advantage Plan, which is secured through a private insurance company in partnership with the federal government, comprises Part C and helps cover the portions of your care that are not covered under Medicare A and B plans. Part D coverage is the prescription drug plan of Medicare. We recommend speaking with our insurance agent to understand your coverage and benefits.

• You are 65 years of age.
• You are a U.S. citizen or a legal permanent resident who has continuously lived in the United States for at least five years and has been paying Medicare taxes for at least 10 years.
• You have a disability for which you have received benefits continuously for two years.
• You have been diagnosed with End-Stage Renal Disease (permanent kidney failure that requires either dialysis or a kidney transplant).

You may apply for Medicare coverage, Advantage plans and drug plans at the same time that you apply for your retirement benefits. Your Medicare coverage will automatically begin on the first day of the month after you turn 65. If your birthday falls on the first of the month your coverage will automatically begin the first day of the month prior to your birthday.

Regardless of how you choose to apply for Medicare, please take the time to understand your plan options as well as where and how to receive your Medicare benefits, including pharmacies and access to emergency medical services. This will help you avoid penalties and out-of-pocket fees.

If you miss your initial enrollment period, there is a general enrollment session occurring January 1st through March 31st. Please note that enrolling during this period could result in higher premiums.

Low-income residents and households may be eligible for a Social Security Medicare Savings Program. These households also do not need to worry about premiums regarding Medicare Part D plans which include coverage of prescription drugs and medications.

You may be responsible for out-of-pocket costs depending on the plans you choose and the benefits and coverage included in those plans. Medicare Parts A and B fall under the Original Medicare and cover hospital care and medical care respectively. Any care that is not included in these plans, such as dental, vision and hearing care, is considered an out-of-pocket cost. Please make sure you know what is and is not covered in your plan and consider enrolling in a Medicare Advantage Plan or other supplemental insurance as needed. Our insurance agent will be happy to review these plans with you to find the right coverage for your needs.

• Inpatient hospital care as prescribed by a Medicare doctor for both physical and mental illness
• Skilled nursing facility care
• Long-term care hospital services

• Medically necessary services to diagnose and treat qualifying medical conditions
• Preventive care, including flu vaccinations and early screenings for cardiovascular conditions and cancer
• Most outpatient services, such as prescription drugs, ambulance services, etc.

Unlike Part A, most people have to pay premiums for their Part B coverage. These costs can change from year to year depending on your situation.

Medicare Part C is dependent on the insurance companies involved and plan benefits may vary between companies. There may also be additional deductibles or higher copays. Also, where Parts A and B, can be used through public hospitals in the United States, Part C will require you to visit an in-network doctor or hospital. Visiting a doctor or hospital outside this Medicare network may result in a higher fee.

Please speak with our insurance agent to learn more about Medicare Part C coverage so that you can choose the best plans for you and your family.

Medicare Part D covers prescription drugs. You are entitled to this plan when you are covered under Part A or B plans, and this coverage is available to you regardless of your or your family’s income. We recommend that you enroll in Part D coverage, even if you are not currently taking prescription medications, to ensure that you have this coverage if you need it in the future. Medicare premiums for Part D are determined on a case-by-case basis as the amount is based on your prescription cost. Copays can vary from pharmacy to pharmacy based on location, even for the same medications. Ask our insurance experts for help comparing the prices of prescription drugs and prescription drug plans to find the best option for you!