Choices with Medicare
Understanding Medicare and Eligibility
Enrolling in Medicare Part A
If you aren’t receiving Social Security or Railroad Retirement Board (RRB) benefits (for instance, because you’re still working), you must sign up for Medicare Part A even if you’re eligible to get it premium-free. You should contact Social Security three months before you turn age 65. If you worked for a railroad, contact the RRB to sign up.
You can sign up for Medicare Part A during the following times:
If you aren’t eligible for premium-free Medicare Part A, you may be able to buy it. However, if you don’t buy Medicare Part A when you’re first eligible, your monthly premium may go up 10%. You’ll have to pay the higher premium for twice the number of years you could have had Medicare Part A, but didn’t join. For example, if you were eligible for Medicare Part A, but didn’t join for two years, you’ll have to pay the higher premium for four years. You don’t have to pay a penalty if you’re eligible for a special enrollment period.
Some People are Automatically Enrolled in Medicare Part A
If you receive benefits from Social Security or the RRB, you automatically get Medicare Part A starting the first day of the month you turn age 65. If you’re under age 65 and disabled, you automatically get Medicare Part A after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months. You’ll get your Medicare card in the mail three months before your 65th birthday or your 25th month of disability.
For more information on Medicare Part A, call Social Security, or visit socialsecurity.gov. If you receive benefits from the RRB, call 1 877 772 5772.
If you have end-stage renal disease (ESRD), different rules apply. Visit your local Social Security office, or call Social Security at 1 800 772 1213 to sign up for Medicare Part A. For more information, visit www.medicare.gov/Publications/Pubs/pdf/10128.pdf to view the booklet, “Medicare Coverage of Kidney Dialysis and Kidney Transplant Services.”
Signing Up for Medicare Part B
If you didn’t sign up for Medicare Part B when you first became eligible, you may be able to sign up during one of these times:
Some People are Automatically Enrolled in Medicare Part B
If you receive benefits from Social Security or the RRB, in most cases, you’ll automatically get Medicare Part B starting the first day of the month you turn age 65. If your birthday is on the first day of the month, your Medicare Part B will start the first day of the prior month. If you’re under age 65 and disabled, you’ll automatically get Medicare Part B after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months. You’ll get your Medicare card in the mail about 3 months before your 65th birthday or your 25th month of disability.
If you don’t want Medicare Part B, follow the instructions that come with the card, and send the card back. If you keep the card, you keep Medicare Part B and will pay Medicare Part B premiums. If you have amyotrophic lateral sclerosis (ALS, also called Lou Gehrig’s disease), you automatically get Medicare Part B the month your disability benefits begin.
If you have Medicare because of end-stage renal disease, you can sign up for Medicare Part B when you sign up for Medicare Part A. If you delay signing up for Medicare Part B, you can get it only during the general enrollment period, and you may have to pay a late enrollment penalty.
If you live in Puerto Rico, and you want Medicare Part B, you’ll need to sign up for it. Contact your local Social Security office for more information.
If you aren’t receiving Social Security or RRB benefits, and you want to get Medicare Part B, you’ll need to sign up for Medicare Part B during your initial enrollment period, which is the seven-month period that begins three months before the month you turn age 65, includes the month you turn age 65, and ends three months after the month you turn age 65.
If you don’t sign up for Medicare Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Medicare Part B may go up 10% for each full 12-month period that you could have had Medicare Part B, but didn’t sign up for it. Usually, you don’t pay a late enrollment penalty if you sign up for Medicare Part B during a special enrollment period.
Medicare Part A Hospital Insurance
Medicare Part A helps cover the following:
You usually don’t pay a monthly premium for Medicare Part A coverage if you or your spouse paid Medicare taxes while working.
Medicare doesn’t cover everything. If you need certain services that Medicare doesn’t cover, you’ll have to pay out-of-pocket unless you have other insurance to cover the costs. Even if Medicare covers a service or item, you generally have to pay deductibles, coinsurance and copayments.
Medicare Part B Medical Insurance
Medicare Part B helps cover medically necessary services like doctors’ services, outpatient care, home health services and other medical services. Medicare Part B also covers some preventive services. You can find out if you have Medicare Part B by looking at your Medicare card.
You pay the Medicare Part B premium each month. Most people will pay the standard premium amount.
There are two kinds of Medicare Part B-covered services:
Medicare doesn’t cover everything. If you need certain services that Medicare doesn’t cover, you must pay for them unless you have other insurance to cover the costs. Even if Medicare covers a service or item, you generally have to pay deductibles, coinsurance and copayments.
Medicare Part C Medical Insurance
A Medicare Advantage Plan (like an HMO or PPO) is another health coverage choice you may have as part of Medicare. It’s important you know what choices are available when selecting your Medicare health benefit options. You can enroll in Original Medicare or select from a variety of Medicare Advantage plans that can include prescription drug coverage and other benefits that may better fit your health care or financial needs.
Medicare Advantage Plans, sometimes called Medicare Part C or MA Plans, are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage. In all plan types, you’re always covered for emergency and urgent care.
Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. Medicare Advantage Plans aren’t considered supplemental coverage.
Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage. In addition to your Medicare Part B premium, you usually pay one monthly premium for the services provided.
Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services, for example, whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan.
Medicare Advantage Plans include the following:
Make sure you understand how a plan works before you join. Not all Medicare Advantage Plans work the same way, so before you join, find out the plan’s rules, what your costs will be, and whether the plan will meet your needs.
More About Medicare Advantage Plans
As with Original Medicare, you have Medicare rights and protections, including the right to appeal.
You can join, switch, or drop a Medicare Advantage Plan at these times:
In most cases, you must stay enrolled for that calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan at other times. Some of these situations include the following:
Call your State Health Insurance Assistance Program (SHIP) for more information.
Medicare Advantage Plans are private health plan options approved by Medicare. Plans are administered by various insurance companies.
Texas Medicare Advantage plans pay instead of Medicare, and you will pay co-pays for medical services.
Medicare Advantage plans are an option for Medicare beneficiaries who have Medicare Parts A & B and live in the plan's service area.
Here are some facts to consider about Medicare Advantage:
Texas Medicare Part D Drug Plans
Medicare offers prescription drug coverage (Medicare Part D) to everyone with Medicare. To get Medicare drug coverage, you must join a Medicare Part D plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and the covered drugs.
There are two ways to get Medicare prescription drug coverage:
Texas Medicare Part D Drug Plans help Medicare recipients control their prescription drug costs. . For 2012, there are approximately 33 Texas Medicare Part D drug plans to choose from.
Medicare Part D covers most types of prescription drugs in the U.S., with just a few exceptions.
For example, the following types of drugs are among those not covered:
However, Part D drug plans work differently than other types of prescription drug insurance.
It's important to understand the Coverage Gap and how it may affect you. To learn how Texas Medicare Part D drug plans work and help understanding Texas Medicare Part D, please contact us.
Texas Medicare Part D drug plans work and help understanding Texas Medicare Part D, please contact us.
Texas Medicare Supplement or Medigap – What is It?
Medicare Supplemental insurance coverage helps pay some of your share of the health care costs not covered by the Medicare Plan; such as deductibles and coinsurance or copayment amounts. Some supplemental health insurance plans also cover certain hospital or medical services not covered by Medicare.
Sometimes called Medigap insurance, Medicare supplements give you freedom to choose your own doctor. Once insured, you can never be dropped due to health reasons.
Medicare Supplemental health insurance coverage is available to you if you are 65 or older and have enrolled in the Medicare Plan, Parts A and B. And in some states, coverage is available if you are under age 65 and are Medicare eligible due to disability or kidney disease.
Medicare Part A and Part B plans do not cover all of your health care costs. If you end up in the hospital or need a doctor’s care, you will end up with out-of-pocket expenses. And with the rising costs of health care, these expenses can end up being very costly.
Texas Medigap insurance policies are designed to fill in the gaps. These plans provide coverage for costs not picked up by Texas Medicare. Your supplemental insurance policy can cover numerous items including: deductibles, co-insurance and co-payments. And when you choose the right plan, your out-of-pocket expenses could cost you absolutely nothing. Contact us today to see how we can eliminate your out-of-pocket expenses.
There are a variety of Medigap plans available to Texans. However, all Texas Insurance companies that sell plans provide at least the same base coverage. That should make it simple to choose a plan that fits your specific needs. Unfortunately, it is still very easy to get confused on coverage and, even worse, to overpay for your coverage.
Currently, there are 10 standardized Medicare Supplement Plans (A, B, C, D, F, G, K, L, M, and N). All companies do not sell all plans. Many people suffer from information overload when it comes to these plans. However, the coverage in a plan F from one company to another will be the same. This helps cut down on the confusion when searching for the right policy.
We help you navigate the maze of choices. It is important to have a Texas Medigap Professional to help you choose correctly.
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