Welcome to the world of Medicare Insurance for your medical needs. Whether you are just turning 65 years old or looking to switch your insurance coverage we are here to help. We strive to help you walk through your options and allow you to choose what will work best for your personal situation.
Below is a summary of the different types of Medicare coverage and how they work. If you have any questions, please give us a call at 425-802-2783, email us at tamarac@heffins.com or schedule a time on our calendar here: SCHEDULE A MEETING
The A – B – C and D’s of Medicare
What is Medicare?
Medicare is a United States federal health insurance program for people 65 or older. In addition, some younger people with disabilities and those with End Stage Renal Disease may also qualify for the program.
Original Medicare
Part A – Hospital Benefits (Premium is $0/month for most people, but can be higher)
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- Inpatient care
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- Skilled Nursing Facility stays
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- Hospice
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- Home Health
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- NOTE: Medicare does not cover long term care
Part B – Medical Benefits (Premium in 2022 is $170.10 for most people, but can be higher)
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- Doctor visits
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- Lab work
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- Preventive services
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- Outpatient surgeries
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- Ambulance
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- Cancer therapy and kidney dialysis
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- Durable medical equipment
Part C – Medicare Advantage program or private insurance (premiums vary by type of plan, county of residence and insurance company)
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- Must be enrolled in Part A and B
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- Is required to provide all the benefits of Original Medicare so that the member is not worse off than they would have been with Original Medicare.
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- Can provide additional benefits not included with Original Medical. Including, dental, vision and hearing benefits.
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- Benefits are designed and claims are by the private insurance company not Medicare
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- Has a network of providers
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- Part C is voluntary, you can choose to enroll therefore you will not enroll in this program with Social Security, but you can work with an independent agent to look at options.
Part D – Prescription drug plans (designed by Medicare, but administered by private health insurance companies
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- Covers prescriptions you pick up at a pharmacy or by mail order.
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- Newest part of Medicare, it started in 2006, prior to Medicare did not offer a benefit for prescription drugs
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- Best to work with an agent to determine which is the best plan for your
When can I enroll in Medicare?
Most people are eligible to enroll in Medicare at age 65, even if you have not retired. You qualify for Medicare at age 65 (or older) if you are a US Citizen or a permanent resident. Other circumstances when you can qualify for Medicare:
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- Individuals who are entitled to Social Security disability for at least 24 months,
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- When you have end-stage renal failure (ESRD), or
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- if you have Amyotrophic Lateral Sclerosis (ALS) also called Lou Gehrig’s disease.
Most people age into Medicare and they have a have a 7-month window to enroll. The name of this enrollment window is your Initial Enrollment Period (IEP). For most people, the IEP begins three months before your birth month, includes your birth month, and the three months after your birth month.
Don’t expect that Medicare will notify you of when it’s time to sign-up either. This can be especially important for those who live out of the country
We usually recommend enrolling as early as possible so that you have your enrollment completed with cards in hand prior to the first day of your birth month.
Apply for Medicare
Applying for Original Medicare (Part A and Part B) is simple.
The Social Security Administration is responsible for determining Medicare eligibility and applications for Parts A (hospital insurance) and B (medical insurance). They offer several easy options so you can choose how to apply for Medicare.
You can apply online, by phone (1-800-772-1213) or in person at the Social Security office. NOTE: if you are already receiving Social Security Income prior to your 65th birthday, then Social Security will automatically enroll you in Medicare Part A and Part B.
If you are not accepting social security income prior to your enrollment window, applying for Medicare can feel intimidating, but your Medicare enrollment will be easier than you might think. Read on for everything you need to know to apply for Medicare.
The Social Security Administration is responsible for determining Medicare eligibility and applications for Parts A (hospital insurance) and B (medical insurance). They offer several easy options so you can choose how to apply for Medicare.
Gary Franke, Tamara Chandler, Brianna Crawford & Melissa Tibbs
Heffernan Insurance Brokers
Individual Health & Medicare Specialists
1100 Bellevue Way NE, Ste 8A-545
Bellevue, WA 98004
425-802-2783 (call or text office line)
tamarac@heffins.com
