New to Medicare
New to Medicare? Let Us Simplify the Process
Starting Medicare can feel overwhelming, especially with all the parts, plans, and constant mail arriving at your doorstep. At American Senior Savings, we’re here to guide you every step of the way so you can understand your options and make confident decisions about your healthcare.
Key STEPS to Know When Starting Medicare
- Enrolling in Original Medicare (Parts A & B): You’ll sign up for Medicare Part A and Part B through the Social Security office. These are the foundational parts of Medicare.
Medicare Part A
Medicare Part A is part of Original Medicare and is often called “hospital insurance” because it helps cover inpatient care and related services. It’s available for individuals aged 65 and older or younger people with certain disabilities or health conditions.
What Medicare Part A Covers:
- Inpatient Hospital Care
- Covers semi-private rooms, meals, general nursing care, and necessary hospital services like surgery, lab tests, and intensive care.
- Skilled Nursing Facility (SNF) Care
- Covers short-term care, including rehabilitation and therapy, after a hospital stay of at least 3 days.
- Home Health Care
- Provides part-time nursing care, physical therapy, or home health aide services when prescribed by a doctor.
- Hospice Care
- Covers comfort care for individuals with a terminal illness (life expectancy of 6 months or less).
- Includes pain relief, emotional support, and respite care for family caregivers.
Who Is Eligible for Medicare Part A?
- Age 65 or Older: You or your spouse must have worked and paid Medicare taxes for at least 10 years (40 quarters).
- Under 65: You may qualify if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig’s disease).
Summary:
Medicare Part A helps cover hospital stays, skilled nursing care, home health care, and hospice services. It’s a key part of Original Medicare that provides essential coverage for inpatient and end-of-life care. Most people get Part A premium-free if they’ve paid Medicare taxes while working.
Medicare Part B
Medicare Part B is the “medical insurance” part of Original Medicare, which helps cover medically necessary outpatient services and care. It works alongside Medicare Part A to provide comprehensive healthcare coverage for individuals aged 65 and older, as well as certain younger people with disabilities or specific health conditions.
What Medicare Part B Covers
- Doctor Visits & Outpatient Care
- Includes routine and specialist visits, preventive services, and outpatient procedures.
- Preventive Services
- Screenings for cancer (e.g., mammograms, colorectal cancer), diabetes, cardiovascular issues, flu shots, and annual wellness visits. Preventive services are often covered at 100%.
- Durable Medical Equipment (DME)
- Covers equipment like wheelchairs, walkers, oxygen supplies, and other medically necessary items prescribed by a doctor.
- Home Health Services
- Part-time nursing care, physical therapy, occupational therapy, and speech-language services provided in the home.
- Mental Health Services
- Includes outpatient therapy, psychiatric evaluations, and counseling.
- Ambulance Services
- Emergency transportation when medically necessary and other non-emergency ambulance services if pre-approved.
- Certain Prescription Drugs
- Covers medications that are administered in a clinical setting, such as injections, chemotherapy, or immunosuppressive drugs after an organ transplant.
General Costs of Medicare Part B:
- Monthly Premium
- Most people pay a standard monthly premium, which is set by Medicare. Higher-income individuals may pay more based on their income.
- Annual Deductible
- You must pay a yearly deductible before Medicare Part B begins to cover services.
- Coinsurance
- After meeting the deductible, Medicare Part B typically covers 80% of approved costs, and you pay the remaining 20%.
- Late Enrollment Penalty
- If you delay signing up for Part B without other credible coverage, you may have to pay a penalty that is added to your monthly premium.
Eligibility for Medicare Part B
- Age 65 or Older
- You are eligible if you are a U.S. citizen or a legal resident who has lived in the U.S. for at least 5 years.
- Under Age 65
- Eligible if you receive Social Security Disability Insurance (SSDI) for 24 months.
- Individuals with ALS (Lou Gehrig’s disease) or End-Stage Renal Disease (ESRD) qualify without waiting periods.
Enrollment in Medicare Part B
- Initial Enrollment Period (IEP): Starts 3 months before your 65th birthday, includes the month you turn 65, and ends 3 months after.
- General Enrollment Period: January 1st to March 31st each year (coverage begins July 1st).
- Special Enrollment Period (SEP): Available if you have employer coverage and delay Part B without a penalty.
Late Enrollment Penalty: If you don’t enroll in Part B when first eligible and don’t have other credible coverage, you will face a 10% penalty for every 12-month period you delay enrollment.
Summary
Medicare Part B is essential for covering outpatient medical services, preventive care, and durable medical equipment. While there is a premium and coinsurance cost, it ensures beneficiaries have access to medically necessary care and preventive services to maintain their health.
Medicare Part C
Key Points About Part C:
- What It Covers:
- Part C includes everything covered by Medicare Part A (hospital care) and Part B (medical care).
- Most plans also include Part D for prescription drug coverage.
- Some plans offer extra benefits like dental, vision, and hearing.
- Types of Medicare Advantage Plans:
- HMO (Health Maintenance Organization):
- You need to choose a primary care doctor and get referrals to see specialists.
- You must use doctors and hospitals in the plan’s network.
- PPO (Preferred Provider Organization):
- You can see any doctor or specialist, but you’ll pay less if you use the plan’s network providers.
- Referrals are not required to see specialists.
- HMO (Health Maintenance Organization):
- Why People Choose Part C:
- It combines hospital, medical, and often prescription coverage into one plan.
- It may offer additional benefits not covered by Original Medicare.
In Simple Terms:
Medicare Part C (Medicare Advantage) is like a bundle of coverage that includes hospital, doctor, and often drug benefits. You can choose between HMO plans (stay in-network with referrals) or PPO plans (more flexibility to see doctors in and out of network).
Medicare Part D
Key Points About Part D:
Medicare Part D provides prescription drug coverage for people with Medicare. These plans are offered by private insurance companies approved by Medicare and help reduce the cost of prescription medications, both brand-name and generic.
What Part D Covers
Medicare Part D plans cover prescription drugs that you pick up at a pharmacy. Each plan has a formulary, which is a list of drugs the plan covers.
- Types of Drugs Covered:
- Brand-name and generic prescription drugs.
- Medications for chronic conditions (e.g., diabetes, blood pressure).
- Certain vaccines not covered under Part B, like the shingles vaccine.
- Tiers of Coverage:
- Most Part D plans organize drugs into tiers:
- Tier 1: Generic drugs (lowest cost).
- Tier 2: Preferred brand-name drugs.
- Tier 3: Non-preferred brand-name drugs (higher cost).
- Specialty Tier: High-cost medications for rare or complex conditions.
- Most Part D plans organize drugs into tiers:
Who Needs Part D?
- Anyone with Original Medicare (Parts A and B) who wants help paying for prescriptions.
- If you don’t sign up for Part D when you are first eligible and don’t have other creditable drug coverage (like employer coverage), you may face a late enrollment penalty.
Medicare Part D helps pay for the prescription medications you need to stay healthy, so you don’t have to pay the full cost yourself.
Summary
Medicare Part D helps cover the cost of prescription drugs, offering protection against high out-of-pocket medication expenses. Plans vary in cost and the drugs they cover, so it’s important to choose one that meets your needs.
MEDIGAP PLANS AKA MEDICARE SUPPLEMENT PLANS
A Medigap plan, also known as a Medicare Supplement plan, is private health insurance that helps pay for some of the out-of-pocket costs not covered by Original Medicare (Parts A and B). These costs include deductibles, copayments, and coinsurance.
What Medigap Covers
Medigap plans help fill the gaps in Original Medicare, such as:
- Part A Coinsurance & Hospital Costs (after Medicare benefits are used up).
- Part B Coinsurance or Copayments (the 20% you owe for doctor visits and outpatient care).
- Part A Deductible (hospital costs before coverage kicks in).
- Part B Deductible (only in plans bought before 2020).
- Blood (up to the first 3 pints needed during a medical procedure).
- Foreign Travel Emergency Care (some plans cover up to 80% of emergency care costs outside the U.S.).
Important Things to Know About Medigap
- Works With Original Medicare:
- Medigap plans only work with Original Medicare (Parts A and B), not Medicare Advantage (Part C).
- Standardized Plans:
- Medigap plans are standardized by the government and labeled as Plans A, B, C, D, F, G, K, L, M, and N.
- Each plan offers the same basic benefits no matter which insurance company sells it.
- Plan G and Plan N are currently the most popular options for new enrollees.
- No Drug Coverage:
- Medigap does not include prescription drug coverage. You need a separate Part D plan for that.
- Monthly Premium:
- You pay a monthly premium for a Medigap policy in addition to your Part B premium.
- Guaranteed Issue Rights:
- If you enroll in a Medigap plan during your Medigap Open Enrollment Period (6 months after you turn 65 and enroll in Part B), you can’t be denied coverage or charged more due to pre-existing conditions.
Why People Choose Medigap
- Predictable Costs: Helps control out-of-pocket expenses, so you know what to expect.
- Freedom to Choose Providers: You can see any doctor or hospital in the U.S. that accepts Medicare.
- Peace of Mind: Reduces the financial burden of unexpected medical costs.
Summary
A Medigap (Medicare Supplement) plan works with Original Medicare to help pay for costs like deductibles, coinsurance, and copayments. It provides additional coverage to limit your out-of-pocket expenses, offering more financial security and flexibility in your healthcare.
MEDICARE ENROLLMENT PERIODS
Summary of Enrollment Periods
- Initial Enrollment Period (IEP): When you first become eligible at 65.
- General Enrollment Period (GEP): Jan 1 – Mar 31 if you missed IEP.
- Annual Enrollment Period (AEP): Oct 15 – Dec 7 to make changes for the following year.
- Medicare Advantage Open Enrollment Period (MA OEP): Jan 1 – Mar 31 to switch Medicare Advantage plans.
- Special Enrollment Period (SEP): Based on life events.
- Medigap Open Enrollment Period: Best time to buy a Medigap plan without restrictions.
Understanding these periods helps you avoid penalties, maintain continuous coverage, and ensure your healthcare needs are met.
We’re Here to Guide You Through Medicare
Feeling confused about Medicare? You’re not alone! With all the different parts (A, B, C, and D), supplemental options, and piles of mail, it’s easy to feel overwhelmed.
But you don’t have to figure it out on your own.
At American Senior Savings, our friendly and knowledgeable team is here to walk you through the Medicare process step by step. We start by breaking down the basics of Original Medicare so you have a clear understanding of your coverage.
From there, we’ll help you decide which supplemental options best fit your needs, whether you’re transitioning from employer coverage or starting Medicare for the first time.
Once your policy is in place, you’ll have the peace of mind that comes from knowing we’re always just a phone call away to assist with questions or concerns.
Best of all – our service is completely free!
Let us simplify Medicare for you. No cost. No pressure. Just answers you can trust.
Call us today at 888-994-0838 or click here to get started.
What is Medicare Advantage?
A Medicare Advantage (MA) plan is a private health insurance plan approved by Medicare. You may opt to get your Part A, B, and D benefits from a Medicare Advantage plan instead of traditional Medicare. These Medicare private insurance plans usually have an HMO or PPO network of doctors.
What is Part D Drug plans.
Medicare Part D is a federal program that began in 2006. It provides Medicare beneficiaries with access to retail prescription drugs at affordable copays. Prior to 2006, people on Medicare paid mostly out-of-pocket for their medications for over 40 years.
Medicare Part D is coverage for retail prescription drugs that you obtain from a retail pharmacy. This voluntary program allows you to access medications at a more affordable rate. It also provides insurance against catastrophic drug costs.
You do not enroll in Medicare Part D via Social Security. Instead, you will choose a Medicare Part D plan offered by a private insurance company in your state.
What is a Medicare Supplement?
What is a Medicare Supplement? A Medicare Supplement is a type of health insurance sold by private insurers to cover the gaps in Medicare. This is why we refer to the plans as “Medigap Plans.”
Medicare Supplements from private insurance companies have been around as long as Medicare has been. However, congress passed the Omnibus Reconciliation Act of 1980, the first time Medigap plans were federally regulated.
Here’s an easy way to think of a Medicare Supplement. Picture it as a card that sort of bolts onto the back of your Original Medicare. It pays for the costs that Medicare would otherwise pass on to you. Medicare has gaps, like coinsurance, copayments, and deductibles. You must pay for these when accessing medically-approved services.
If you have a Supplement policy, Medicare will first pay its share of your medical expenses. Then, your policy will step in and pay its share. This is usually the remainder of your bill. However, it depends on which policy you choose from the standard offered plans.
How to Apply for Medicare Online
Steps to Apply for Medicare Online
- Visit the Social Security Website
Go to the official Social Security website:- To apply for both Social Security retirement benefits and Medicare, visit:
www.ssa.gov/retire - To apply for Medicare only, visit:
www.ssa.gov/benefits/medicare.
- To apply for both Social Security retirement benefits and Medicare, visit:
- Create or Log Into Your Account
If you don’t already have one, you’ll need to create a “my Social Security” account. Follow the steps to verify your identity and set up your account. - Complete the Online Application
Once you’re logged in, follow the links for Medicare enrollment. The application is simple and can be completed in less than 10 minutes. - Submit and Wait for Confirmation
After submitting your application, you’ll receive a confirmation from Social Security. They may contact you if any additional information is needed.
Need Help While You Wait?
While Social Security processes your Medicare application, our friendly agents at American Senior Savings can help you explore your Medicare Supplement (Medigap) or other coverage options. We’ll guide you through your choices and make sure you’re ready to go when your Medicare starts.
If You Run Into Problems – Call us we can help and walk you through this online enrollment process.
Steps to Apply for Medicare by Phone
- Call Social Security
- Contact the Social Security Administration (SSA) at 1-800-772-1213.
- If you use TTY services, call 1-800-325-0778.
- Request to Apply for Medicare
When connected, let the representative know you would like to apply for Medicare. They will guide you through the process and answer any questions you have. - If You Have Railroad Retirement Benefits
- Contact the U.S. Railroad Retirement Board at 1-877-772-5772 for Medicare enrollment assistance.
- Appointment Scheduling
- If call volumes are high, Social Security may schedule a telephone appointment to complete your Medicare application.
- Forms May Be Sent
- In some cases, the representative will mail you forms to complete. These are typically simple and easy to fill out.
- You will need to complete the forms and return them by mail, which can add some time to the process.
Things to Keep in Mind
- Longer Processing Time: Phone applications can take longer due to mailing delays. If your Medicare effective date is approaching, allow at least 1-2 months of lead time when applying by phone.
- Alternative Options: If time is limited, applying online may be faster and more efficient.
How to Apply for Medicare in Person
If you prefer a face-to-face experience, applying for Medicare in person at a local Social Security office is a great option. This method can also be helpful if you are close to turning 65 and need your application processed quickly.
Steps to Apply for Medicare In Person
- Find Your Local Social Security Office
- Visit the official Social Security website at www.ssa.gov/locator to search for the nearest office in your area.
- Gather Important Documents
- Bring necessary documents like your Social Security number, birth certificate, and proof of citizenship (if applicable).
- Meet with a Social Security Representative
- Inform the representative that you want to apply for Medicare Part A and Part B.
- Ask for a printout or confirmation showing that you have applied. This document provides proof of your enrollment, which can help when applying for:
- Medicare Supplement (Medigap) plans.
- Part D Prescription Drug Plans.
- Ask About Your Medicare Costs
- Discuss important cost-related details, such as:
- Premium-Free Part A: Find out if you qualify for free Part A based on your work history.
- Income-Related Monthly Adjustment Amount (IRMAA): Learn whether your income may impact your Part B or Part D premiums.
- Payment Options:
- If you are not receiving Social Security benefits, you’ll need to pay your Part B premium directly. You can:
- Pay a quarterly bill.
- Set up online monthly payments through your bank or the Medicare website.
- If you are not receiving Social Security benefits, you’ll need to pay your Part B premium directly. You can:
- Discuss important cost-related details, such as:
Why Apply in Person?
- You can get immediate answers to your questions from a knowledgeable representative.
- It’s ideal for those who prefer personal assistance and want to ensure all paperwork is completed accurately.
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