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Medicare can be a great and beneficial program for most seniors if it’s set up correctly based on personal needs.
Your local agent can sit down with you and answer any questions you might have.
What is
Medicare
Medicare is the health insurance program for people age 65 and older, and some younger people with disabilities, or anyone with end-stage renal disease (ESRD).
No matter in which Tampa Bay area county you live, you have the understand the Medicare basics, including the parts of Medicare, eligibility, enrollment and more.
What are The Parts Of Medicare?
There are 4 different parts of Medicare that help cover specific services:
- Medicare Part A (Hospital Insurance): Part A generally helps cover many services that you receive in a hospital or long-term care setting.
- Medicare Part B (Medical Insurance): Part B covers certain doctors’ services, outpatient care, medical supplies and preventive services.
- Medicare Part C (Medicare Advantage): Part C, also called Medicare Advantage (MA), are private insurance plans that provide most of Part A and Part B coverage and typically offer extra benefits such as vision, hearing and dental care.
- Medicare Part D (Prescription Drug Coverage): Part D are private insurance plans that help cover the cost of prescription drugs.
What are Medicare Supplement Plans
Medicare Supplement plans, also known as Medigap, are private insurance plans that can help pay healthcare costs that Original Medicare doesn’t pay. Examples include copayments, coinsurance and deductibles.
Medigap plans are not to be confused with Advantage plans (Part C). Advantage plans cover certain areas like Pasco, Pinellas, and Hillsborough but If you have Original Medicare and purchase a Medigap plan, you can go to any doctor or medical facility that accepts Medicare as payment, anywhere in the United States without a referral.
How Does Medicare work
Original Medicare (Part A and Part B) is managed by the federal government. You’ll only need to sign up once, but each year, you can make changes to your health coverage during the Medicare Open Enrollment Period.
Once you become eligible for Medicare, you’ll need to decide how you get your coverage. Generally, there are 2 ways to get Medicare coverage and it’s the same in all Tampa Bay area counties:
- Original Medicare, which includes Parts A Part B only.
- Medicare Advantage, referred to as an “all-in-1” plan, bundles Parts A and B and typically includes prescription drug coverage. Some Advantage plans include extra benefits, like dental, vision and hearing care services.
Keep in mind, if you choose Original Medicare, you’ll also want to consider prescription drug coverage (Medicare Part D) coverage and supplemental coverage (Medicare Supplement plan, also known as “Medigap”) to help manage out-of-pocket Medicare costs.
How To Enroll in Medicare
Whether you’re new to Medicare or want to change your coverage, there are certain times during the year when you can enroll.
Medicare Enrollment Periods
- Initial Enrollment Period (IEP): For many people, IEP begins 3 months before you turn 65 and ends 3 months after. This is your first chance to enroll in Original Medicare.
- Initial Coverage Election Period (ICEP): ICEP begins 3 months before you become eligible for both Part A and Part B. This is when you can enroll in a Medicare Advantage plan with or without prescription drug coverage.
Annual Election Period (AEP): Also known as “Medicare open enrollment” and “annual enrollment period”, AEP is available each year from Oct. 15 – Dec. 7 to any Medicare eligible recipient who wants to enroll or change their coverage.
Special Election Period (SEP): SEPs are opportunities to enroll in or change a Medicare Advantage plan outside of ICEP or AEP. An SEP must be triggered by a qualifying event, like a change in residence or termination of your current plan.
Connect with a Medicare expert In your area
If you live in Pasco, Hernando, Citrus, Pinellas, or Hillsborough County, you can schedule an In-Person appointment right now. Your local agent will come to you just like your plumber or electrician does, you don’t have to leave your house.
Frequently Asked Questions
Medicare is a Federal health insurance program for people 65 years or older, certain people with disabilities, and people with permanent kidney failure treated with dialysis or a transplant. Medicare has two parts – Part A which is hospital insurance, and Part B which is medical insurance.
If you have worked at least 10 years in Medicare covered employment you will qualify for premium free Medicare Part A (Hospital Insurance). To qualify, you must be:
- 65 or older; or
- Disabled and receiving disability benefits from Social Security or the Railroad Retirement Board for 24 months; or
- Have permanent kidney failure treated with dialysis or a transplant
You should contact the Social Security Administration to file an application.
Generally, Original Medicare does not cover prescription drugs. However, Medicare does cover some drugs in certain cases. There are some Medicare Health Plans that cover prescription drugs. You can also check into buying a Part D prescription drug policy for coverage. Medicaid may also help pay for prescription drugs for people who are eligible.
Supplemental insurance policies are sometimes called Medigap plans. Medigap plans are private health insurance policies that cover some of the costs the Original Medicare Plan does not cover.
Medicare Part C, also known as Medicare Advantage, is an option offered by private insurance companies for Medicare beneficiaries.
To enroll in Medicare Part C, you must already be enrolled in parts A and B.
Under a Medicare Advantage plan, you’ll generally be covered for:
- hospital services
- medical services
- prescription drugs
- dental, vision, and hearing services
- additional services, such as fitness memberships
If you have a Medicare Part C plan, it takes the place of original Medicare.
Medicare Part D is an add-on prescription drug coverage for anyone enrolled in original Medicare.
If you are interested in enrolling in Part D coverage, you’ll want to make sure to do so as soon as possible. If you don’t enroll in either Part C, Part D, or equivalent drug coverage within 63 days of your initial enrollment, you’ll face a permanent late enrollment penalty.
If you’ve enrolled in a Part C plan, you won’t need Medicare Part D.
A deductible is the amount you must pay each year before Medicare begins paying its portion of your medical bill. There are deductibles for both the Part A (Hospital Insurance) and Part B (doctor services) portions of Medicare.
Medicare does not cover routine dental care or most dental procedures such as cleanings, fillings, tooth extraction or dentures.
If you are receiving Social Security or Railroad Retirement or disability benefits, you will be automatically enrolled in Medicare Part A and Part B. About 3 months prior to your 65th birthday or 24th month of disability, you will be sent an Initial Enrollment Package that will contain information about Medicare, a questionnaire and your red, white and blue Medicare card.
If your income is limited, your State may help pay your Medicare costs such as your premiums and deductibles. They can help you determine if you are qualified.
You must call the Social Security Administration at 1-800-772-1213 or contact your local Social Security Office to verify your Medicare Part A and Part B coverage. This information can also be found on your red, white, and blue Medicare card.
If you lose your card, you can obtain a replacement card by phone at 1-800-772-1213, or online at the Social Security Administration web site. Make sure you have your Medicare number ready when you call. You should receive your new card in about four weeks.
You can schedule an In-Person appointment right now. Your local agent will come to you just like your plumber or electrician does, you don’t have to leave your house.