Medicare eligibility generally applies if you or your spouse worked for at least 10 years in Medicare-covered employment, you are 65 years old, and you are a U.S. citizen or permanent resident. However, you might also qualify under certain conditions if you are under 65.

Eligibility Guidelines:

Age 65 or Older

You can receive Medicare Part A without paying premiums if:

• You already receive retirement benefits from Social Security or the Railroad Retirement Board.
• You are eligible for Social Security or Railroad Retirement benefits but haven’t filed for them yet.
• You or your spouse worked in Medicare-covered government employment.

Under Age 65

You may qualify for Part A without premiums if:

• You have received Social Security or Railroad Retirement Board disability benefits for at least 24 months.
• You have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Important Note:

While Part A may be premium-free if you meet the eligibility criteria, Part B requires a monthly premium. This amount is typically deducted from your Social Security, Railroad Retirement, or Civil Service Retirement benefits. If you don’t receive these payments, Medicare will bill you quarterly for your Part B premium.

Have Questions?
Give us a call today, and let us guide you through your Medicare health insurance options.

By contacting the phone number on this website, you will be connected with a licensed insurance agent.

Medicare is a federal health insurance program designed to support:

• People aged 65 or older.
• Individuals under 65 with certain disabilities.
• People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Medicare Coverage Options

Part A: Hospital Insurance

• Most people qualify for Part A without paying a premium, as it’s typically covered through payroll taxes during employment.
• Part A helps cover:
• Inpatient care in hospitals (including critical access hospitals).
• Skilled nursing facility care (not long-term or custodial care).
• Hospice care.
• Some home health care services.
• Eligibility for these benefits is based on specific conditions being met.

Part B: Medical Insurance

• Part B requires a monthly premium.
• It covers:
• Doctor’s services and outpatient care.
• Certain services not included in Part A, such as physical and occupational therapy.
• Some medically necessary home health care services and supplies.

Part D: Prescription Drug Coverage

• Introduced in 2006, this coverage helps reduce prescription drug costs and protects against rising costs in the future.
• Coverage is provided by private insurance companies, with beneficiaries choosing their own drug plan and paying a monthly premium.
• Important: If you delay enrollment in Part D when first eligible, you may face a penalty for late enrollment.

This information is sourced from www.cms.gov.

Have questions? Give us a call! Our licensed agents are ready to guide you through your Medicare options and help you make the best decision for your health needs.

Medicare Part D helps cover prescription drug costs and is available to Medicare beneficiaries. You can sign up for Part D as early as three months before your 65th birthday or if you’re under 65 and eligible for Medicare due to disability.

Why Timely Enrollment Matters

It’s important to enroll in a Part D plan during your initial enrollment period unless you have equivalent drug coverage (such as from a retiree plan). If you delay enrollment without creditable coverage, you may face a permanent premium penalty.

Switching Plans

If you’re already enrolled in a Part D standalone plan or a Medicare Advantage plan with drug coverage, you can switch plans during the Annual Enrollment Period (Oct. 15 - Dec. 7) every year.

Key Updates for 2025

Major changes to Medicare Part D in 2025 include:

1. Out-of-Pocket Cap:
• A new $2,000 annual out-of-pocket maximum for prescription drugs. Once you reach this cap, you will have no additional drug costs for the remainder of the year.
2. Elimination of the Coverage Gap ("Donut Hole"):
• Beneficiaries will no longer face a mid-year cost-sharing phase. Instead, you’ll pay 25% coinsurance throughout the initial phase until you reach the out-of-pocket cap.
3. Adjusted Deductible:
• The annual deductible for many plans will increase slightly to $590, though this may vary by plan.

Phases of Part D in 2025

1. Annual Deductible
   
• You pay 100% of your covered prescription drug costs until the deductible is met.
2. Initial Coverage Phase
   
• After meeting the deductible, you pay 25% coinsurance for covered medications.
3. Catastrophic Phase
   
• Once you reach the $2,000 out-of-pocket cap, you pay $0 for all covered drugs for the rest of the year.

These updates, part of the Inflation Reduction Act, aim to make prescription drug costs more predictable and manageable for Medicare enrollees.

Getting Financial Help

You may qualify for Extra Help if your income and resources fall below certain limits. For 2024:

• Individuals: Annual income less than $22,590; resources up to $17,220.
• Married Couples: Combined income less than $30,660; resources up to $34,360.

Extra Help can significantly reduce your Part D premiums and out-of-pocket drug costs. Learn more about applying for the program on Medicare.gov.

This information is sourced from Medicare.gov.

Have Questions? Call us today to connect with a licensed agent who can guide you through your Part D options and help you save on prescription drug costs.

Medicare Advantage (Part C) is a type of Medicare health plan provided by private companies that contract with Medicare to deliver your Part A and Part B benefits. These plans often include additional benefits and come in several types to fit your unique healthcare needs.

Types of Medicare Advantage Plans

1. Health Maintenance Organization (HMO) Plans

• Key Features:
• Requires you to use doctors, healthcare providers, and hospitals within the plan's network (except in emergencies, urgent care situations, or temporary out-of-area dialysis).
• Referrals from a primary care doctor are typically required to see specialists.
• Best For: Individuals comfortable with limited networks and seeking lower costs.

2. Preferred Provider Organization (PPO) Plans

• Key Features:
• Offers flexibility to see providers both in-network and out-of-network.
• Lower costs when using in-network providers; higher costs for out-of-network care.
• Best For: Those who want more provider options and are willing to pay a bit more for flexibility.

3. Private Fee-for-Service (PFFS) Plans

• Key Features:
• Determines payment amounts for services and how much you pay out-of-pocket.
• No network restrictions; you can see any Medicare-approved provider who agrees to the plan's terms.
• Best For: Individuals who value freedom in choosing their providers without network limitations.

4. Medicare Special Needs Plans (SNPs)

• Key Features:
• Designed for people with specific diseases, conditions, or characteristics (e.g., chronic illness or institutionalized individuals).
• Tailors benefits, provider networks, and drug formularies to meet the unique needs of its members.
• Best For: Those with specific healthcare needs who require tailored coverage.

Which Medicare Advantage Plan is Right for You?

The right plan depends on your healthcare needs, budget, and preferences for provider flexibility. You can compare plan options in your area to find one that works best for you.

This information is sourced from Medicare.gov.

Need Help? Call us today to speak with a licensed agent and explore your Medicare Advantage Plan options.

Medicare Supplement Insurance, also known as Medigap, helps cover some of the costs that Original Medicare doesn’t, like co-payments, coinsurance, and deductibles. These policies are standardized to ensure consistency and are regulated by federal and state laws to protect you as a consumer.

How Medigap Plans Work

• Medigap policies are standardized in most states and identified by letters (e.g., Plan A, B, C, D, F, G, K, L, M, N).
• All plans with the same letter offer the same basic benefits, regardless of the insurance company, but premiums may vary by provider.
• Insurance companies:
• Are not required to offer all Medigap plans.
• Must offer Plan A if they sell any Medigap policies.
• Must offer Plan C or Plan F to those eligible for Medicare before January 1, 2020.
• Must offer Plan D or Plan G to individuals new to Medicare on or after January 1, 2020.

Standardization Exceptions

In some states, Medigap policies are standardized differently:

• Massachusetts
• Minnesota
• Wisconsin

These states have their own unique standardization rules, but the goal remains the same: to provide comprehensive coverage options for Medicare beneficiaries.

Choosing the Right Medigap Plan

When comparing Medigap plans:

1. Understand Your Coverage Needs: All plans cover core benefits, but some include additional benefits like skilled nursing facility coinsurance or foreign travel emergencies.
2. Compare Costs: Premiums vary across insurance companies, even for the same standardized plan.
3. Check Eligibility:
• If you became eligible for Medicare before January 1, 2020, you can still enroll in Plan C or F.
• If you became eligible after January 1, 2020, you can choose Plan D or G instead.

Key Features of Medigap Plans

• Covers coinsurance after you’ve met the deductible (unless the plan also covers the deductible).
• Policies are guaranteed renewable as long as you pay your premiums, even if your health changes.
• Policies only cover one person, so you and your spouse will need separate plans if both require coverage.

Need Help Deciding?

As licensed insurance agents, we can help you compare Medigap plans side by side, explain the differences, and guide you toward the plan that best suits your needs and budget.