Are You Eligible for Medicare?

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States.

If you are not 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:

• You already get retirement benefits from Social Security or the Railroad Retirement Board.
• You are eligible to get Social Security or Railroad benefits but have not yet filed for them.
• You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if:

• You have received Social Security or Railroad Retirement
• Board disability benefit for 24 months. You are a kidney dialysis or kidney transplant patient.

While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.

Have questions? Give us a call and let us help you with your Medicare Health insurance needs.

By contacting the phone number on this website you will be directed to a licensed agent.

Medicare is a health insurance program for:

• people age 65 or older,
• people under age 65 with certain disabilities, and
• people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Part A Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Part B Medical Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. In January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. This coverage is to help you lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

This information comes from www.cms.gov

By contacting the phone number on this website you will be directed to a licensed agent.

• Review any notices from your plan about changes for next year. To learn more about your options download Medicare and You 2023

Compare: In October, use Medicare’s tools to find a plan that meets your needs.

• This is the one time of year when ALL people with Medicare can make changes to their health and prescription drug plans for the next year.

Between: October 15- December 7

• Change from Original Medicare to a Medicare Advantage Plan.
• Change from a Medicare Advantage Plan back to Original Medicare.
• Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
• Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
• Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
• Join a Medicare Prescription Drug Plan.
• Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.
• Drop your Medicare prescription drug coverage completely.

January 1—Coverage Begins

• Your new coverage begins if you switched to a new plan. If you stay with the same plan, any changes to coverage, benefits, or costs for the new year will begin on January 1.

Between January 1–March 31

• If you’re in a Medicare Advantage Plan (like an HMO or PPO), you can make one change to a different plan or switch  back to Original Medicare (and join a stand-alone Medicare Prescription Drug Plan) once during this  time. Any changes you make will be effective the first of the month after the plan gets your request.

• The best time to buy a Medigap policy is during your Medigap Open Enrollment Period, which is the six-month period that begins on the first day of the month in which you turn 65 or older and have enrolled in Part B. (Some states have additional Open Enrollment Periods.) After this enrollment period, you may not be able to buy a Medigap policy. If you are able to buy one, it may cost more.
• If you delay in Part B because you have group health coverage based on your (or your spouse's) current employment, your Medigap Open Enrollment Period won't start until you sign up for Part B.

If you have questions about enrollment please give us a call. We're here to help.

This information comes from www.medicare.gov and Medicare and You.

By contacting the phone number on this website you will be directed to a licensed agent.

   2023 Costs at a Glance

Part A premium

Most people don't pay a monthly premium for Part A (sometimes called "premium-free Part A"). If you buy Part A, you'll pay up to $506 each month in 2023. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $506 in 2023. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $278 in 2023.

Part A hospital and inpatient deductible

 You pay: 

• $1,600 deductible for each benefit period
• Days 1-60: $0 coinsurance for each benefit period
• Days 61-90: $400 coinsurance per day of each benefit period
• Days 91 and beyond: $800 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
• Beyond lifetime reserve days: all costs

Part B premium

Most people pay $164.90 each month (or higher depending on your income). 

Part B deductible and coinsurance

$226. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment.

Part C premium

Part C monthly premium varies by plan

Part D premium

The Part D monthly premium varies by plan (higher-income consumers may pay more)

 This information comes from www.medicare.gov

By contacting the phone number on this website you will be directed to a licensed agent.

To get general or claims specific Medicare information and important telephone numbers. If you need help in a language other than English or Spanish, say “Agent” to talk to a customer service representative.

• 1 800 633 4227
• TTY 1 877 486 2048 www.medicare.gov

State Health Insurance Assistance Program (SHIP)
To get free personalized Medicare counseling on decisions about coverage; help with claims, billing, or appeals; and information on programs for people with limited income and resources.

• Call 1 800 MEDICARE to get the telephone numbers of SHIPs in other states.

Social Security
To get a replacement Medicare card; change your address or name; get information about Part A and/or Part B eligibility, entitlement, and enrollment; apply for Extra Help with Medicare prescription drug costs; ask questions about premiums; and report a death.

• 1 800 772 1213
• TTY 1 800 325 0778
• www.ssa.gov

Coordination of Benefits Contractor
To get information on whether Medicare or your other insurance pays first and to report changes in your insurance information.

• 1 800 999 1118
• TTY 1 800 318 8782

Department of Defense
To get information about TRICARE for Life and the TRICARE Pharmacy Program.

• 1 866 773 0404 (TFL)
• TTY 1 866 773 0405
• 1 877 363 1303 (Pharmacy)
• TTY 1 877 540 6261
• www.tricare.mil/mybenefit

Department of Health and Human Services
Office of Inspector General—If you suspect Medicare fraud.

• 1 800 447 8477
• TTY 1 800 377 4950
• www.stopmedicarefraud.gov

Office for Civil Rights
If you think you were discriminated against or if your health information privacy rights were violated.

• 1 800 368 1019
• TTY 1 800 537 7697
• www.hhs.gov/ocr

Department of Veterans Affairs
If you’re a veteran or have served in the U.S. military.

• 1 800 827 1000
• TTY 1 800 829 4833
• www.va.gov

Office of Personnel Management
To get information about the Federal Employee Health Benefits Program for current and retired Federal employees.

• 1 888 767 6738
• TTY 1 800 878 5707
• www.opm.gov/healthcare-insurance

Railroad Retirement Board (RRB)
If you have benefits from the RRB, call them to change your address or name, check eligibility, enroll in Medicare, replace your Medicare card, and report a death.

• Local RRB office or
• 1 877 772 5772

Quality Improvement Organization (QIO)
To ask questions or report complaints about the quality of care for a Medicare covered service or if you think your service is ending too soon. Call 1 800 MEDICARE to get the telephone number for your QIO.

As you review your Medicare health coverage, here are some things to consider to determine if you have the right coverage or should be looking for a new policy.

Coverage: How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.

Your other coverage: If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your benefits administrator or give us a call before making any changes.

Costs: How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.

Doctor and hospital choice: Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a network? Do you need to get referrals?

Prescription drugs: Do you need to join a Medicare Prescription Drug Plan? Do you already have creditable prescription drug coverage? Will you pay a penalty if you join a drug plan later? What's the plan’s overall star rating? What will your prescription drugs cost under each plan? Are your drugs covered under the plan's formulary? Are there any coverage rules that apply to your prescriptions? Are you eligible for a free Medication Therapy Management (MTM) program?

Quality of care: Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary. How have Medicare and other people with Medicare rated your health and drug plan’s care and services? Get help comparing plans and providers.

Convenience: Where are the doctor's offices? What are their hours? Which pharmacies can you use? Can you get your prescriptions by mail? Do the doctors use electronic health records (EHRs) or E-prescribe? Can you get an electronic copy of your information by email or to store in a personal health record? Which pharmacies can you use? Is the pharmacy you use in the plan’s network? If it’s in the network and your plan offers preferred cost sharing, does your pharmacy offer preferred cost sharing? You may pay less for some drugs at pharmacies that offer preferred cost sharing. Can you get your prescriptions by mail?

Travel: Will the plan cover you if you travel to another state or outside the U.S? Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy supplemental insurance that offers travel coverage.

We know you have questions, please give us a call so that we can help you make the right decision about the policies that best suit your needs.

 Information obtained from www.medicare.gov

By contacting the phone number on this website you will be directed to a licensed agent.

The chart below shows basic information about the different benefits Medigap policies cover.

Crossed Out = the policy doesn't cover that benefit
% = the plan covers that percentage of this benefit
N/A = not applicable

• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
• Part B coinsurance or copayment
• Blood (first 3 pints)
• Part A hospice care coinsurance or copayment
• Skilled nursing facility care coinsurance
• Part A deductible
• Part B deductible
• Part B Excess charge
• Foreign travel exchange (up to plan limits)
• Out-of-pocket limit**: N/A

• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
• Part B coinsurance or copayment
• Blood (first 3 pints)
• Part A hospice care coinsurance or copayment
• Skilled nursing facility care coinsurance
• Part A deductible
• Part B deductible
• Part B Excess charge
• Foreign travel exchange (up to plan limits)
• Out-of-pocket limit**: N/A

• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
• Part B coinsurance or copayment
• Blood (first 3 pints)
• Part A hospice care coinsurance or copayment
• Skilled nursing facility care coinsurance
• Part A deductible
• Part B deductible
• Part B Excess charge
• Foreign travel exchange (up to plan limits): 80%
• Out-of-pocket limit**: N/A

• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
• Part B coinsurance or copayment
• Blood (first 3 pints)
• Part A hospice care coinsurance or copayment
• Skilled nursing facility care coinsurance
• Part A deductible
• Part B deductible
• Part B Excess charge
• Foreign travel exchange (up to plan limits): 80%
• Out-of-pocket limit**: N/A

• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
• Part B coinsurance or copayment
• Blood (first 3 pints)
• Part A hospice care coinsurance or copayment
• Skilled nursing facility care coinsurance
• Part A deductible
• Part B deductible
• Part B Excess charge
• Foreign travel exchange (up to plan limits): 80%
• Out-of-pocket limit**: N/A

• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
• Part B coinsurance or copayment
• Blood (first 3 pints)
• Part A hospice care coinsurance or copayment
• Skilled nursing facility care coinsurance
• Part A deductible
• Part B deductible
• Part B Excess charge
• Foreign travel exchange (up to plan limits): 80%
• Out-of-pocket limit**: N/A

• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
• Part B coinsurance or copayment: 50%
• Blood (first 3 pints): 50%
• Part A hospice care coinsurance or copayment: 50%
• Skilled nursing facility care coinsurance: 50%
• Part A deductible: 50%
• Part B deductible
• Part B Excess charge
• Foreign travel exchange (up to plan limits)
• Out-of-pocket limit**: $6,940 in 2023

• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
• Part B coinsurance or copayment: 75%
• Blood (first 3 pints): 75%
• Part A hospice care coinsurance or copayment: 75%
• Skilled nursing facility care coinsurance: 75%
• Part A deductible: 75%
• Part B deductible
• Part B Excess charge
• Foreign travel exchange (up to plan limits)
• Out-of-pocket limit**: $3,470 in 2023

• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
• Part B coinsurance or copayment
• Blood (first 3 pints)
• Part A hospice care coinsurance or copayment
• Skilled nursing facility care coinsurance
• Part A deductible: 50%
• Part B deductible
• Part B Excess charge
• Foreign travel exchange (up to plan limits): 80%
• Out-of-pocket limit**: N/A

• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
• Part B coinsurance or copayment
• Blood (first 3 pints)
• Part A hospice care coinsurance or copayment ***
• Skilled nursing facility care coinsurance
• Part A deductible
• Part B deductible
• Part B Excess charge
• Foreign travel exchange (up to plan limits): 80%
• Out-of-pocket limit**: N/A

* Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,700 in 2023 before your policy pays anything. (Plans C and F aren't available to people who were newly eligible for Medicare on or after January 1, 2020.)

** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.

*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in inpatient admission.

Source: www.medicare.gov

By contacting the phone number on this website you will be directed to a licensed agent.