New to Medicare

What Is Medicare?

Medicare is the national health insurance program for people aged 65 and older. 

The Medicare Modernization Act passed in 2003, which expanded coverage to include younger people with disabilities or end-stage renal disease. Today, nearly 60 million Americans receive Medicare benefits.   

The Centers for Medicare and Medicaid Services (CMS) manages the Medicare program. Social Security works in coordination with CMS to facilitate enrollment.

Medicare Is Different Than Medicaid

Medicaid operates as both a federal and state-level program to provide health care coverage to individuals with very little income.  It is possible to qualify for both Medicare and Medicaid at the same time (dual coverage). Those who do will benefit from the two programs working together to lower your health care cost. Find out more about Medicare vs. Medicaid here. 

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Below, we briefly cover the Medicare basics. 


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Medicare Overview

There are four separate parts of Medicare. All of which are voluntary.  

  • Part A is your hospital insurance. It covers all inpatient hospital stays, skilled nursing care, hospice care, and some other home health care. 
  • Part B is your doctors’ insurance. It covers doctor’s services, office visits, medical supplies, and preventive services.
  • Part C is also known as Medicare Advantage. These are private insurance plans that allow you to expand and customize your Medicare benefits.
  • Part D is Prescription Drug coverage. These plans sold by local insurance companies to lower your prescription cost.

Age Is The Only Eligibility Requirement

As stated above, Medicare covers all Americans over age 65. Age is the only Medicare eligibility requirement for US citizens.    

Younger people with disabilities or end-stage renal disease are also eligible. 

Medicare Cost

Part A Premium: Most people don’t pay a premium for Part A. If you’ve worked 40 quarters in which you paid Medicare taxes, then your Part A benefits are free. Individuals who have worked less than 40 quarters will pay a graded amount proportional to how many quarters they have paid Medicare taxes.   

Part A Hospital Inpatient Deductible and Coinsurance. You pay:

  • $1,408 deductible for each benefit period
  • $0 coinsurance for each benefit period Days 1-60
  • $352 coinsurance for days 61-90
  • $704 coinsurance day 91 and beyond 

Part B Premium: The standard Part B premium in 2020 is $144.60.  

Part B Outpatient Deductible and Coinsurance. You pay:

  • $198 yearly deductible
  • After deductible you pay 20% of all outpatient medical care services

Part C Premium: costs vary by plan. 

Part D Premium: costs vary by plan. 

Enrollment Period

The Medicare enrollment period is a seven month period that begins three months before your 65 birthday, includes your birthday month, and continues for the following three months.

If you miss this seven-month window, you will be subject to a 10% financial penalty that may last for as long as you receive benefits.

Fill The Gaps of Medicare With Supplemental Insurance

Although Original Medicare provides excellent benefits, they’re far from comprehensive. Looming within your benefits are copays, coinsurance, and multiple deductibles. These financial gaps can result in high out-of-pocket medical costs.  

Medicare Supplemental Insurance (Medigap) plans fill these financial gaps to reduce or eliminate out-of-pocket medical expenses. The right plan can save you hundreds or even thousands of dollars. 

There are ten different supplement plans. Each plan covers a different set of financial gaps. Our independent agents are here to help you sort through these options and find the best policy that meets your needs and your budget. 

Medicare Advantage – The All In One Health Care Solution

As mentioned above, your original benefits are not fully comprehensive. Not only are there financial gaps, but there are also gaps in covered services. Medicare Advantage plans cover both.

These bundled plans include your original benefits and expand your coverage to include vision, dental, hearing, and prescription drugs. Advantage plans are an all-in-one health care solution. In exchange for a fixed monthly premium, these plans expand your benefits and cover all your out-of-pocket costs. 

Private health insurance companies sell Advantage plans and administer your care through either a Medicare HMO or Medicare PPO network. Currently, over 17 million Americans own a Medicare Advantage Plan. Individuals in poor health benefit most from these policies.  And we strongly suggest you explore what’s available. 

Get Help Customizing Your Benefits

Customizing your benefits is easier than you might think. Our independent insurance agents are here to help you the whole way through.   

Our services are free. And there’s never any obligation when speaking to an agent.  We’ll help you maximize your benefits and reduce your out-of-pocket medical cost.

Thousands of seniors have trusted us to help them protect their health and their finances. See what we can do for you!

Explore your options today. Fill out the form on your screen to get started.

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