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Medicare Information

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medicap%20(55) Things to Consider Before Enrolling In Any Medigap Options

What is Medicare: 

Medicare is the US Federal Government Health Insurance Program for:

  • People 65 years of age and older.
  • Some people with disabilities under age 65.
  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

*For more information: Medicare & You

Medicare has Four Parts:

Part A (Hospital Insurance)

Most people do not have to pay for Part A.

Helps Pay For:
Care in hospitals as an inpatient, critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities, hospice care, and some home health care.

Most people get Part A automatically when they turn 65. They do not have to pay a monthly payment called a premium for Part A because they or a spouse paid Medicare taxes while they were working.

If you (or your spouse) did not pay Medicare taxes while you worked and you are age 65 or older, you still may be able to buy Part A. If you are part of the 1% required to pay, the 2016 Part A premium is $411.  Medicare Part A deductible is $1,288 which everyone is responsible for. You'll be charged this every time you're admitted to the hospital.  Many people have a Medigap insurance policy or are enrolled in a Medicare Advantage insurance plan that pays this fee.

If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show "Hospital Part A" on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772.

Part B (Medical Insurance)
Most people pay monthly for Part B.

Helps Pay For:
Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Medicare beneficiaries pay a monthly part B premium. The standard Part B premium for 2016 is $104.90. Part B deductible is $147.  Many people have a Medigap insurance policy or are enrolled in a Medicare Advantage insurance plan that pays this fee.

If you have very low income, you may qualify through your state Medicaid program for help paying Part B premiums and the Part A deductible.  There are also a Medicare-managed program known as Extra Help that will help you pay Part D prescription drug expenses.  Weather you qualify for all or part of the assistance depends on your income.
If your 2015 income was above $85,000 a year ($170,000 filing jointly) you'll be charged more for part B.  These premium adjustments range from $42 to 230.80 per month, depending on how much you make.  If your income has changed since you paid your 2015 taxes, you can ask for government to recalculate.

Enrolling in part B is your choice. You can sign up for Part B anytime during a 7 month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-772-1213 to sign up. If you choose to have Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not get any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should get your Medicare premium bill by the 10th of the month. If you do not get your bill by the 10th, call the Social Security Administration at 1-800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772.

Part C (Medicare Advantage Plans)

Medicare Advantage plans are offered by private insurance companies as an alternative to Original Medicare; plans are government subsidized and regulated.

People with Medicare can get their coverage through Original Medicare (the traditional fee-for-service program) or from Medicare private plans (the Medicare Advantage program also known as Medicare Part C). Depending on where you live, you may be able to enroll in a Medicare Advantage Plan offering one or more of the following types of health care: HMO, PPO, PFFS.

 Part D (Prescription Drug Coverage)
Part D Plans are offered by private companies to provide coverage for prescription drug costs; plans are government subsidized and regulated.

Our Medicare Supplement Plans includes:
  • no pre-existing conditions clause
  • free-look thirty (30) day evaluation period
  • state to state policy portability
  • guaranteed renewable coverage

Who is Eligible for Medicare

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are a younger person with a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:

  • You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.

 If you are under 65, you can get Part A without having to pay premiums if:

  • You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
  • You are a kidney dialysis or kidney transplant patient.

While you do not have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. 

If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, call the Social Security Administration. The toll-free telephone number is: 1-800-772-1213. The TTY-TDD number for the hearing and speech impaired is 1-800-325-0778.

You can also get information about buying Part A as well as part B if you do not qualify for premium-free part A.     

For assistance with your Medicare eligibility or would like to speak with one of our Senior Healthcare specialists at LM Financial, please give us a call at (800)748-5538 or click here to contact us.