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Lenny Rosen, Insurance Agent

LICENSED INDEPENDENT INSURANCE AGENT 

What Is Medicare?

  • Medicare is a federal program that offers health insurance to American citizens and other eligible individuals.
  • The program is often called Original Medicare.  It has two parts - Part A and Part B

Who can get Medicare?

U.S. citizens and legal residents

  • Legal residents must live in the U.S. for at least 5 years in a row, including the 5 years just before applying for Medicare.

You must also meet one of the following requirements:

  • Age 65 or older
  • Younger than 65 with a qualifying disability
  • Any age with a diagnosis of end-stage renal disease or ALS

 

What does Medicare cover?

Original Medicare (Parts A & B) provides many health care benefits

  • Part A covers inpatient hospital and skilled nursing care.
  • Part B covers doctor visits and outpatient care.

You can choose private plans to get more coverage

  • Medicare Advantage plans (Part C) combine Part A and Part B coverage.  They often include drug coverage and other benefits you don't get with Original Medicare.
  • Medicare Prescription drug plans (Part D) help pay for medications.  You can get a standalone Part D plan or get a Medicare Advantage plan that includes drug coverage.
  • Medicare Supplement Insurance (Medigap) helps pay some or all costs not paid by Original Medicare (deductibles, copays and coinsurance).

What are my options?

You can add coverage to Original Medicare or choose a Medicare Advantage plan instead.

  • Original Medicare:  You may add a standalone Part D plan, a Medicare supplement plan or both to Original Medicare (Parts A & B)
  • Medicare Advantage:  You may choose to get your benefits through a Medicare Advantage plan (Part C).  Many plans come with built-in prescription drug coverage.  you can add a standalone Part D plan only with certain Medicare Advantage plan types.

What does Medicare cost?

Medicare and many Medicare plans charge premiums

  • A premium is a fixed amount you pay each month for coverage.

You also pay a share of the cost for health care services you receive.  The three kinds of payments you might have are: Deductible, Copay and Coinsurance

  • Deductible - A set amount you pay out of pocket to covered services each year before Medicare or your plan begins to pay.
  • Copay - A fixed amount you pay at the time you receive a covered service.  For example, you might pay $20 when you visit the doctor or $12 when you fill a prescription.
  • Coinsurance - A percentage of the cost for a covered service that you pay when you receive it.  For example, you might pay 20% and Medicare or your plan would pay 80%.

How do I choose?

Think about your needs so you can see how different coverage options might work for you.  Answer the following questions can help you get started.

Your Health

  • How often do you go to the doctor?
  • What health problems do you have?
  • What medications do you take regularly?

Your Budget

  • What are you able to pay each month in premiums?
  • How comfortable are you covering copays or coinsurance for services?
  • How willing are you to accept the risk of high out-of-pocket costs?

Your Preferences

  • Which doctors, hospitals and pharmacies do you like to go to?
  • How important is it for you to have access to health care while traveling?
  • What other coverage do you have, such as an employer or retiree plan?