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What is Medicare?

  • Medicare is a federal health insurance program for:

    • People who are 65 or older

    • Certain younger people with disabilities (Social Security Disability Income-SSDI)

    • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

  • Original Medicare comes in 2 parts (Parts A & B). The Centers for Medicare and Medicaid Services (CMS) administers Medicare Parts A & B. CMS is an agency within the U.S. Department of Health & Human Services. Part C-Medicare Advantage and Part D-Rx Coverage are also overseen by CMS.

Medicare Part A:

  • Costs nothing for most people if you or your spouse have worked 10 years. You usually qualify for Medicare the 1st day of your 65th birth month. Part A consists of Inpatient Hospital, Skilled Nursing Care, Home Health, and Hospice.

Medicare Part B:

  • Your premium is based on your income. This year’s premium (2021) starts at $148.50 a month. Medicare Part B pertains to doctor’s office visits, day surgery, ambulance, physical therapy, durable medical equipment, tests, procedures, and preventatives. If you are not on Social Security at least 4 months before turning 65, you will need to apply for Medicare Part B. If you are receiving Social Security benefits you will be automatically enrolled in Medicare Parts A & B. You can delay Medicare Part B if you like, but you should understand there is a 10 % yearly penalty associated with not taking Part B if you do not have other coverage that qualifies. We can help you apply for Medicare online or by paper form. Call or email us for more information and or if you need the forms.

Medicare Part C: 

  • Commonly known as “Medicare Advantage” Plans. They are offered by private insurance companies that Medicare oversees. Advantage plans overlay your Original Medicare benefits as an alternative to Medicare. Your Medicare benefits are assigned to the health company of your choosing and they administer your Advantage plan. Advantage plans must have coverage as good/or better than Original Medicare. They may include added benefits not covered by Medicare such as gym memberships, prescription drug coverage, vision, dental, and comprehensive physical exams. Medicare Advantage plans have varied premiums, co-pays, co-insurance, max out of pocket costs, deductibles, and networks. We see people enrolling in Medicare Advantage plans because they resemble the group coverage they had through their employer. Some Medicare Advantage plans include drug coverage, and some do not. If you do not have drug coverage you could accrue a penalty and must pay that penalty for the rest of your life. You can find Medicare Advantage (Part C) plans in your county in the back of the “Medicare and You” book.

Medicare Part D-Rx: 

  • These plans are also sold through private companies that Medicare oversees. They vary in price, have different deductibles, and cover different drugs (formularies) depending on which plan and company you chose. You do not have to take a Part D-Rx plan, but if you don’t take one you will receive a 1% penalty for every month without drug coverage. You will start paying the penalty if you enroll in a drug plan later. If you receive Veterans Benefits this can exclude you from receiving a Part D Drug penalty. Pat Downs Insurance Agency, LLC has many drug plans to choose from and we will do a review of your drugs to ensure the best fitting Part D coverage for you. You can find drug plans in your county by going to the back of the “Medicare and You” book.  

When Will My Medicare Benefits Start? 

  • Your Medicare benefits usually start the 1st of your birth month. The exception is if your birthday is on the 1st of the month, then you will start Medicare the 1st day of the previous month. Medicare Part A and B start after the 24th month for people on Social Security Disability Insurance (SSDI). 

How Do I Enroll in Medicare Part A and B? 

  • If you are receiving Social Security benefits for at least 4 months before turning 65, you will be automatically enrolled in Parts A and B. Your card will be mailed to you approximately 90 days before your birth month. If you are not receiving your Social Security benefits, then you will want to apply for Medicare Part B benefits 90 days before you want benefits to start. Our agency can help direct you, so you do not make a mistake.

What Does Medicare Cover? 

  • Medicare Part A includes coverage for hospital stays, hospital inpatient surgery, medication, nursing care, food, and a semi-private room. If approved by Medicare, it includes up to 100 days of skilled nursing care. This year (2021), the hospital deductible is $1484. It also covers Home Health and Hospice at a $0 co-pay under certain conditions. If you have worked 10 years, you usually will not pay a premium for Part A.  

  • Medicare Part B includes coverage for medically necessary supplies and services, such as outpatient care, day surgery, hospital observation (up to 72 hours), ambulance services, durable medical equipment, labs, tests, procedures, chemotherapy, doctor office visits, and preventatives. There is a monthly premium associated with Part B and without supplemental coverage you may be responsible for 20% of Medicare-approved fees. THIS IS THE PRIMARY REASON PEOPLE SELECT SUPPLEMENTAL COVERAGE. Medicare Part A and B together make up what is known as Original Medicare and there is no drug coverage (except while in inpatient hospital stays). Part B premiums are based on your family’s income and start at $148.50 per month this year in 2021. The Part B yearly deductible is $203 in 2021. 

Can I Delay Medicare Part B Without A Penalty? 

  • Yes, you can delay Medicare Part B and not get a penalty if you or your spouse has:

    • Group health coverage defined by the IRS

    • Creditable drug coverage

    • Your/your spouse is still working

    • Your/your spouse’s employer has more than 20 employees

  • If you elect COBRA or other coverage after age 65 this may cause a gap in health coverage and you may have to pay a lifetime late enrollment penalty for not taking Medicare Part B at the right time. COBRA may not be viewed as creditable coverage under Medicare guidelines. The Medicare Part B penalty is 10% for each year you do not have Part B. If you go on COBRA and are over 65 you usually want to elect Medicare Part B, so you do not get a penalty.

Is There A Special Enrollment Period (SEP) For Leaving Creditable Employer Group Health Coverage After Age 65? 

  • Yes, you will be able to join a Medicare Advantage plan, or Medicare Supplement with a Medicare Part D-Rx plan. Your chance to join lasts for 60 days after the month your coverage ends. If you do not have Medicare Part B at this time you must enroll in Part B. Our agency will help you with all of this. We can even do a cost comparison if this is the right choice or not. Let us compare your employer health plan with Medicare Supplemental plans. 

How Do I Get Supplemental Coverage Once I Am Enrolled in Medicare Parts A and B? 

  • This is where Pat Downs Insurance Agency, LLC shines! We can help you decide because many Medicare beneficiaries are feeling confused about their choices. The mailings you will get from companies are often so overwhelming. Pat Downs Insurance Agency, LLC many of the top companies you see on TV or ads you get in the mail.

How do I choose the plan right for me?

  • Again, there is no one plan that is best for everyone. Everybody is different and there are so many plans out there. This is great because different plans work better for different people but can be overwhelming to make a choice on which one is best for you. 

  • We recommend looking at things like your Budget - are you willing to pay more each month to have more medical bills covered? Are you the type of person that would want the comfort of knowing you have comprehensive coverage if you are admitted into the hospital? Does the thought of medical bills prevent you from going to the doctor? Then maybe we should look at a Medicare Supplement Health plan because you will have little to no bills, but they can cost more. 

  • Or would you rather have a low premium and are willing to pay co-pays almost every time you use medical services? Consider them - a pay-as-you-go plan. Maybe the thought of a high monthly premium is more worrisome than what the bills are if you use medical services? Then maybe we should look at a Medicare Advantage plan.

  • Convenience – Do you want to handle only one card or are you willing to use two or three cards?

  • Networks – Are you okay to make sure you are using in-network providers or do you want to be able to go anywhere Medicare is accepted and have freedom to travel and take the plan with you?

  • When picking a plan – your prescription drugs can be one of the biggest factors. Most drug plans have 5 or 6 tiers and even though the specific drugs you take are a certain tier on one plan, they can be a different tier on another plan. This can cause hundreds and even thousands of dollars in drug costs if you are not looking at this correctly.

Our main goal at Pat Downs Insurance Agency is to help people like you! Nothing gives us more pleasure when we make our clients satisfied and can help educate them and save them money! We would love to sit down with you and find a plan to fit your budget and your lifestyle. Do not hesitate to contact us today! 

Medicare Info
Pat Downs Insurance Agency, LLC: (507) 258-5104

Medicare Call 1-800-MEDICARE (800-633-4227) TTY 1-877-486-2048
Social Security Call 1-800-772-1213 TTY 1-800-325-0778 (M-F 8-5:30)

The information contained on this web page is provided for educational and informational purposes only. While we have taken every precaution to ensure that the content of this page is current and accurate, errors can occur. Pat Downs Insurance Agency LLC assumes no responsibility for any errors or omissions in the content of this page. Sources: Medicare.Gov & SSA.Gov

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