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MEDICARE

Congratulations on being on the Medicare journey! No matter where you are in the process, I am here to help and guide you through this major milestone.

WHAT IS MEDICARE?

Medicare is a federal health insurance that is available to individuals over the age of 65. However, you may also be eligible if you have certain disabilities or medical conditions. Key factors to keep in mind when it comes to Medicare:

  1. Generally, you are automatically enrolled for Medicare once you turn 65. If you are 65 or about to be and NOT receiving Social Security benefits, then you will need to sign up.
  2. There are only a few times a year to sign up or change your coverage.
  3. Avoid a penalty by signing up for Medicare Part B when you are first eligible.
  4. You can choose how to get your Medicare coverage.
  5. Financial assistance to cover Medicare costs is available for those who qualify.

YOUR MEDICARE CHOICES

When you are first eligible for Medicare and during certain times of the year, you have a few options when it comes to your Medicare coverage:

  1. Original Medicare, known as Part A and Part B.
  2. Medicare Advantage Plan, known as Part C.
  3. Part D, for prescriptions drugs.
  4. Medicare Supplement Insurance, known as Medigap.

It is important to speak with your doctor or healthcare provider to get a better understanding of why you need certain services or supplies, and ask if Medicare will cover the costs. There might be something you need, that is typically covered, but your provider thinks Medicare will not cover it. If this is your situation, then you may need to read and sign a notice acknowledging that you could possibly be financially responsible for these additional items, services or supplies.

Three factors that determine Medicare coverage:

  1. Laws on the federal and state levels.
  2. Medicare decides on a national level what should be covered.
  3. Claims processing companies determine on a state level what is considered medically necessary and should be covered when a Medicare claim is submitted.

ORIGINAL MEDICARE

This is the standard Medicare offered when you become eligible. This option does include a deductible. Once the deductible is met, Medicare pays its share of the Medicare-approved amounts and you pay your share of coinsurance and deductibles.

  • Includes Part A (Hospital Insurance) and Part B (Medical Insurance).
  • You can choose to add Part D for prescription medicine by joining a Medicare drug plan.
  • You can visit any doctor or hospital in the U.S., where Medicare is accepted.
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