Leaving employer coverage to transition to Medicare as your primary insurance can be overwhelming. There is so much information being sent to you in the mail from different companies and their plans. I have helped hundreds of clients sort through their options and decide what is the best plan for them.
Original Medicare is managed by the federal government and provides individuals 65 and older with access to doctors, hospitals, or other health care providers who accepts Medicare. There are four parts A,B,C and D. Each addressing different health care coverages.
The first step is to enroll in Parts A & B at the Social Security office in your county. The other parts and supplemental coverage enrollments can be done through me.
The Four Parts of Medicare
Part A is hospital insurance that assists you with the cost of inpatient care and skilled nursing facility stays. It also helps with things like hospice and home health care. In general, you should think of the inpatient hospital benefit as Medicare coverage for room and board in the hospital.
Part B is your outpatient medical coverage – all of your other coverage outside of your inpatient hospital fees. Without Part B, you would be uninsured for doctor’s visits (including doctors who treat you in the hospital, lab work, preventive services, surgeries, cancer therapy and kidney dialysis. The cost of Part B is set by Social Security and it changes from year to year. Individuals in higher income brackets pay more than those in lower incomes brackets. How much you pay is determined by your adjusted gross income reported to the IRS in recent years.
Part C is voluntary. It is the Medicare Advantage program, or private insurance. The cost of Advantage plans varies by carrier, county of residence, and plan selected. To enroll in a Part C plan, you must first be enrolled in both Parts A and B. You must also live in the plan service area. Once you enroll, your Medicare coverage will from the Advantage plan itself, not from the government.
Part D is insurance for your medication needs. You pay a monthly premium to an insurance carrier and in return, you use the insurance carrier’s network of pharmacies to purchase your prescription medications. Instead of paying full price, you will pay a copay or percentage of the drug’s cost. The insurance company will pay the rest.