Learning the Medicare Basics
Find a Medicare Plan that's Right for You
When it comes to Medicare, You have Choices
What is Medicare?
Medicare is a federal health insurance program for people who are age 65 and over, for some younger people receiving Social Security disability benefits and for people of any age with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant). Medicare is administered by the federal government through the Centers for Medicare & Medicaid Services (CMS).
What is Original Medicare?
Original Medicare, also known as traditional Medicare, is a fee-for-service health plan. This means you can choose any doctor or hospital and Medicare will pay its share of the doctor or hospital bill. You pay the rest. Original Medicare pays for many health care services and supplies, but it doesn’t pay all of your health care costs.
You get Part A and Part B of the Original Medicare plan when you’re automatically signed up for Medicare. To get drug coverage under Original Medicare, you must choose and join a Medicare-approved Part D private drug plan.
What is the difference between Medicare and Medicaid?
Medicare is a federal health insurance program for people who are age 65 and over, for some younger people receiving Social Security disability benefits and for people of any age with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant). To learn more about Medicare, visit www.Medicare.gov.
Medicaid, a state- and federal-funded program, provides health coverage for people with lower incomes. The eligibility rules for Medicaid are different for each state. To learn more about your state Medicaid program, visit www.Medicaid.gov. What are the different parts of Medicare?
- Part A (hospital insurance) helps pay for inpatient hospital care, skilled nursing care, hospice care and home health care.
- Part B (medical insurance) helps pay for doctors fees, outpatient hospital visits, some preventive care and durable medical equipment.
- Part C (Medicare Advantage) is an alternative coverage option to Original Medicare that allows you to choose to receive all of your health care services and prescription drug coverage through one plan. Medicare Advantage plans include Part A and Part B covered services, and often includes Part D (prescription drug coverage).
- Part D helps cover the cost of outpatient prescription drugs.
Part A Hospital Insurance What is the premium for Medicare Part A?
Most people don’t pay a premium for Part A because they already paid for it through payroll taxes while working. If you do not have premium-free Part A, you may be able to buy it under certain conditions. The amount of the premium you pay to buy Medicare Part A depends on the number of Social Security credits you have earned.
Part B Medical Insurance
What is the premium for Medicare Part B?
The standard Part B premium is $104.90 in 2015 and $121.80 in 2016
Part B helps pay for doctors' services and outpatient care. It also covers other medical services, such as physical and occupational therapy, and some home health care.
Since 2007, those with a higher-income pay higher Part B premiums. The premium they pay is based on the income they report on their most recent federal tax return. Only single persons with an income greater than $85,000 and married couples with an income greater than $170,000 will pay these higher monthly premiums. However, less than 5 percent of people with Medicare are affected, so most people will not pay higher premiums. Costs are for Original Medicare.
What is Medicare Advantage?
Medicare Part C (also known as Medicare Advantage plans) is an alternative to Original Medicare and is offered by private companies. These plans combine Medicare Part A and Medicare Part B and often include prescription drug coverage (Medicare Part D).
Sometimes, Medicare Advantage plans contain additional benefits that are not included in Original Medicare, such as vision and dental coverage. Medicare Advantage plans must provide you with minimum health benefits set by Medicare.
Also, it is important to note that if you choose a Medicare Advantage plan, you may not purchase a Medicare supplemental insurance plan (Medigap). You may only purchase Medigap with an Original Medicare Part A and Part B plan.
Part D Prescription Drug Coverage
Medicare Part D plans set their own premiums, drug prices and per-prescription costs. These costs will vary from plan to plan. Your Part D costs will depend on the plan that you choose. What you pay for Medicare Part D coverage could be higher based on your income. For example, single persons with an income greater than $85,000 and married couples with an income greater than $170,000 will pay higher monthly premiums. If you have a limited income and resources, you may qualify for Extra Help to pay for some of your Part D costs.
"Andy" Fernando Lopez
California License # 0659888
Licensed Insurance Agent
Licensed Sales Agent
Licensed Sales Representative
Mira Mesa Office Mall
10717 Camino Ruiz, Suite 101, San Diego, CA 92126 Email or call Andy Lopez (858) 549-6758 Specializing in Medicare Plans
Medicare Advantage, Medicare Supplement, Prescription Drug Plan
How Much is the late enrollment penalty for Part A?
If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, your monthly premium may go up 10 percent. You’ll have to pay the higher premium for twice the number of years you could have had Part A, but didn’t sign up.
How Much is the late enrollment penalty for Part B?
Generally, a 10 percent premium penalty will be added to the Part B monthly premium for each 12-month period you could have enrolled but did not. However, if you are covered by an employer or union group health plan through you or your spouse's current active employment, you may qualify for a special enrollment period (special enrollment means you can sign up for Part A and/or Part B anytime you are still covered by the group health plan or during the eight-month period that begins the month after the employment ends or the coverage ends, whichever happens first).
However, creditable coverage does not include continuing coverage under COBRA with a former employer or coverage under a retired spouse’s employer plan. How Much is the late enrollment penalty for Part D? Generally, a penalty of 1 percent per month will be added to the Part D monthly premium for each month you could have enrolled but did not enroll or have coverage at least as good as Medicare’s, also known as “creditable coverage.”
What is Medigap (Medicare Supplemental) insurance?
Medigap is also sometimes referred to as a Medicare supplemental insurance. A Medigap policy, sold by private insurance companies, can help pay some of the health care costs (“gaps”) Original Medicare doesn’t cover, such as Medicare deductibles, coinsurance and some extra benefits such as care when you travel outside the U.S. You have a one-time six-month Medigap open enrollment period that starts the first month you're 65 and enrolled in Part B. This period gives you a guaranteed right to buy any Medigap policy sold in your state regardless of your health status.
If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs first. Then your Medigap policy pays its share of covered benefits. Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as Medicare supplemental insurance. Insurance companies that sell Medigap can only sell you “standardized” Medigap policies, identified in most states by letters.
All Medigap plans offer the same basic benefits but some offer additional benefits. Plans identified by the same letter cover the same benefits regardless of what company sells it.
When do I qualify for Medicare?
Most people 65 or older are eligible for Medicare hospital insurance (Part A) based on their own — or their spouse's — employment. You are eligible at 65 if you:
- Receive Social Security or Railroad Retirement Benefits
- Are not getting Social Security or Railroad Retirement Benefits, but you have worked long enough to be eligible for them
- Would be entitled to Social Security benefits based on your spouse's (or divorced spouse's) work record, and that spouse is at least 62 (your spouse does not have to apply for benefits in order for you to be eligible based on your spouse's work)
- Worked long enough in a federal, state or local government job to be insured for Medicare. I will be turning 65 in a few months. When should I sign up for Medicare?
There is a seven-month period during which you can enroll in Medicare:
- During the three months before your 65th birthday
- During the month of your 65th birthday
- During the three months after your 65th birthday
The best time to sign up for Medicare is three months before your 65th birthday. You should receive a Medicare card about two months before you turn age 65. Your coverage will begin at age 65.
If you are already receiving Social Security benefits when you become eligible for Medicare, Social Security will automatically enroll you in Medicare parts A and B. However, because you must pay a premium for Part B coverage, you can turn it down.
If you’re age 65 or over, still working and covered by a group health plan from your employer, you might not need Medicare Part B right away. Check with your employer and Medicare to find out how Medicare works with other insurance coverage that you may have.
"Andy" Fernando Lopez California License # 0659888 Licensed Insurance Agent
Licensed Sales Agent Licensed Sales Representative
Mira Mesa Office Mall 10717 Camino Ruiz, Suite 101, San Diego, CA 92126 Email or call Andy Lopez (858) 549-6758 Specializing in Medicare Plans Medicare Advantage, Medicare Supplement, Prescription Drug Plan
San Diego County
Licensed Filipino Insurance Agent Mira Mesa, Miramar, Mission Valley, Mission Village, Murrieta, National City, Normal Heights, North Park, Ocean Beach, Oceanside, Filipino Medicare Supplemental Insurance Sales Agent Old Town, Pacific Beach, Paradise Hills, Point Loma, Poway, Ramona, Rancho Bernardo, Rancho Penasquitos, Rancho San Diego, Rancho Santa Fe, Mira Mesa Filipino Licensed Sales Agent, Santa Luz, Solana Beach, Sabre Springs, San Clemente, San Diego, Serra Mesa, San Luis Rey, San Marcos, San Ysidro, Scripps Ranch, Santee, Temecula, Filipino Independent Sales Representative Spring Valley, Torrey Highlands, Tierra Santa, University City, University Heights, Vista, Alpine, Bonita, Filipino Mira Mesa Independent Sales Agent, Carmel Valley, Cardiff By the Sea, City Heights, Clairemont, Carmel Mountain Ranch, College Grove, Coronado, Crown Point, Camp Pendleton, Carlsbad, Del Mar, El Cajon, Filipino Independent Insurance Agent Chula Vista, Escondido, Encinitas, Encanto, East San Diego, Fallbrook, Hillcrest, Imperial Beach, Filipino Independent Mira Mesa Sales Representative, Jamul, Kensington, Kearny Mesa, La Costa, La Jolla, Lakeside, Lemon Grove, Leucadia, Logan Heights, Lake San Marcos, Filipino Licensed Sales Agent La Mesa, Linda Vista, Mission Beach, Mission Hills, Fashion Valley, South Park.