Understanding Medicare

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                                                                        Hoosier Roots with Hoosier Values.

 

Medicare Basics

Medicare is a government run health insurance plan for individuals who are:

  • 65 or older
  • Under 65 who suffer from certain disabilities
  • Individuals of any age with end-stage renal diseases (ESRD), or permanent kidney failure which requires either a kidney transplant or dialysis 
 
 

Different Types of Medicare

Hospital Insurance (Medicare Part A)

  • Helps cover and defray the costs of inpatient care in hospitals
  • Covers stays in skilled nursing facilities, hospice and home health care assistance

Medical Insurance (Medicare Part B)

  • Offers coverage for an array of health care services including hospital outpatient care, durable medical equipment and home health care costs
  • Covers some preventive services that will help you maintain your health and prevent the worsening of current conditions 

Medicare Advantage (Medicare Part C) 

  • Allows individuals to obtain private insurance through Medicare-approved providers.
  • Allows people to obtain the benefits and services covered under Parts A and B, as well as Medicare prescription drug coverage under most plans. Some plans also include additional benefits for extra costs.

Medicare Prescription Drug Coverage (Medicare Part D) 

  • Helps cover the costs of prescription drugs
  • Effectively lowers your prescription drug costs while protecting you from increasing future costs
  • Run by Medicare-approved private insurance providers
 
 

Your Medicare Coverage Paths

There are two primary paths to obtaining Medicare coverage – Original Medicare or a Medicare Advantage Plan.

 
 
 
 

Medicare Enrollment Periods?

Medicare has preset enrollment periods for individuals who are about to, or have recently turned 65. It is important for individuals who require coverage to sign up as soon as they are eligible. This helps ensure you will experience no coverage gaps or premium penalties that could potentially last for as long as you are on Medicare.

 

The Initial Enrollment Period

  • The initial Medicare enrollment period spans 7 months, the three months before you turn 65, the month you turn 65, and the three months following the month you turn 65.

Annual Election Period (AEP)

  • The AEP period generally spans from mid-October to early December, during which you can enroll in or change your Medicare plan. During this period you are also able to enroll or disenroll in Part D if your needs have changed.

Medicare Advantage Disenrollment Period 

  • From January 1st through mid February, you are given an opportunity to disenroll from your Medicare Advantage plan. If you choose to disenroll, you will be enrolled into Original Medicare and will have an option to choose a stand-alone Part D plan.

Special Enrollment Periods (SEP)

  • Special Enrollment Periods are exceptions often offered to individuals covered under an employer’s health plan and who then retire after 65. If this is your situation, you are given the opportunity to enroll without penalties so long as you enroll during the three months prior to your Part B taking effect. Other examples of SEPs include qualifying for Medicare’s Extra Help program for Part D, qualifying for both Medicaid and Medicare, and for individuals who have moved outside of a plan’s service area.
 
 

Medicare Supplement Insurance Plans

Upchurch Insurance Services offers various levels of additional coverage and benefits through Medicare Supplement insurance plans.

Medicare Supplement Plans May Allow You To 

  • Choose your own medical providers so long as they accept Medicare patients
  • Assist with paying for approximately 20% or more of any out-of-pocket costs that are not covered by Medicare Part B
  • Maintain coverage regardless of where you travel throughout the U.S.
  • Guaranteed coverage for life as long as you continue to pay your premiums on time and you answered all qualifying questions honestly and completely

 

 
 

Do You Have Medicare Questions?

State Resources 

You may be eligible for assistance covering the costs of Medicare through your state’s Medical Assistance or Medicaid office. There are certain programs, such as All-Inclusive Care for the Elderly (PACE) and Medicare Savings Programs, which help defray the costs of Medicare for seniors. For more information or to apply for extra help paying for your prescription drugs, go to:http://www.ssa.gov/prescriptionhelp/ or call 1-800-772-1213 for help.

 
 

Other Medicare Resources

Medicare Helpline – 1-800-MEDICARE(633-4227) and 1-877-486-2048 24/7

Medicare’s Website – http://medicare.gov

Administration on Aging – 1-800-677-1116 or go to http://eldercare.gov