MEDICARE
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.
Are you at least 65 years old? Retiring soon? Do you need help saving money on your health insurance?
As your personal Medicare agent, we will work with you to gain a better understanding of your medical and financial situation, guiding you through your options and finding a plan that’s best for you.
What is Medicare?
Medicare is a federal health insurance program that provides benefits to American citizens and others based on age, disability, or a qualifying medical condition.
- Medicare is for you only and doesn’t cover spouses or dependents.
- Medicare includes two parts, A and B.
Who is Eligable?
You must be a U.S. citizen or a legal resident who has lived in the U.S. the 5 previous years before applying for Medicare.
AND you must fall into one of these categories:
- You are age 65 or older
- You are younger than 65 with a qualifying disability
- You are any age with a diagnosis of ALS or end-stage renal disease
When Can I Enroll?
Your initial enrollment period is the month you turn 65 years old, the 3 months prior and the 3 months after
- Are you 65 and still working?
- Did you miss your Initial enrollment window? There are other enrollment windows available. Call us to find out when or visit the medicare website for additional information.
What is Covered by Medicare?
Part A
This is your hospital insurance, which covers things like inpatient hospital care, skilled nursing facility care, home health care and hospice.
- Part A usually doesn’t cover all your hospital bills, and you will pay a deductible before your benefits begin.
- It is premium free if you or your spouse made payroll contributions to Social Security for at least 10 years (40 quarters). If not, you will pay monthly.
Part B
This is your medical insurance for non-hospital related expenses. This includes doctor visits, medically necessary services, and preventative services.
- Part B usually doesn’t cover all your medical costs either, and you will have a deductible before benefits begin.
- You will pay a premium for Part B unless you qualify for financial aid. Visit the Medicare Website to see if you qualify. Click here to visit the Medicare website.
Some Coverages Not Covered by Medicare
- Most care outside the United States
- Long term care
- Custodial care (help with daily living)
- Hospital and psychiatric hospital days beyond set limits
- Hospital expenses such as TV or phone service
- Eye exams, eyeglasses or contacts
- Hearing exams or hearing aids
- Dental exams, cleanings or routine dental care
- Most prescription drugs
- Gym memberships and other wellness benefits
Medicare Might Not Include All the Services You Need
Below are Plans Options We Offer
Medicare Advantage Plans – PART C
Offered by private insurance companies, Medicare Advantage Plans include parts A and B benefits, and include many more coverages often for no additional premium.
Select the expanding sections below for details.
- Prescription Drug (part D) coverage
- Hearing exams or hearing aids
- Dental exams, cleaning, X rays and routine dental care
- Eye exams, eyeglasses or contact lenses
- Gym memberships and other wellness benefits
- Transportation to medical appointments and virtual visits
- Emergency services outside your plan
- HMO- Health maintenance organizations
- PPO- Preferred provider organizations
- POS-Point of service plans
- PFFS- Private fee for service
- SNP- Special needs plans:
- Dual eligible- those with Medicare and Medicaid
- Chronic- for those living with severe and disabling chronic conditions
- Institutional- for those living in contracted skilled nursing facility
- Institutional equivalent- those is assisted living and need extra care
You can enroll during your initial enrollment period and the medicare annual enrollment period. There is an open enrollment and special enrollment period where you can enroll or switch plans if you meet certain criteria.
Call us to find out when it’s time for you or visit the Medicare website for more details.
You must be entitled to part A and Enrolled in Part B to qualify.
- Medicare Advantage plans are often premium free. You will continue to pay your part B premiums, and part A if you have one. Some plans may charge premiums, deductibles, copays or coinsurance. These premiums can vary by year and costs vary based on the covered item or service.
- Where you get your care can affect your costs, many Medicare advantage plans are coordinated care plans and contract with a network of doctors and hospitals.
- Some plans may require you to select a primary care provider from their network.
- You can’t be denied coverage or charged more based on health status.
- Save now, pay for services later.
Prescription Drug Plans – PART D
You can get a Part D plan from private insurance companies in two ways: First, the standalone Part D Plan, OR Medicare Advantage plan that includes part D.
Select the expanding sections below for details.
- Drugs commonly prescribed for by Medicare beneficiaries
- Specific brand name and generic drugs included in the formulary (list of covered drugs)
- Commercially available vaccines not covered under part B
- Drugs not listed on the formulary
- Drugs prescribed for anorexia, weight loss or gain
- Prescriptions for fertility, erectile dysfunction or cosmetic purposes
- Prescription vitamins and minerals, and
- Non-prescription drugs (over the counter)
You must be entitled to part A or enrolled in part B to sign up.
There could be late enrollment penalty if:
- If you didn’t enroll when first eligible for Medicare and didn’t have other creditable drug coverage to qualify for enrollment during a special enrollment period
- You didn’t enroll within 63 days of losing your creditable drug coverage (usually from an employer health plan)
- Costs vary by plan provider, but a stand-alone plan will have a premium. Medicare Advantage plans may not charge extra premium for this coverage.
- Each plan has its own formulary (drug list), may have network pharmacies and you must live in the plan’s service area.
Medicare Supplement Insurance (Medigap)
These plans are offered by private companies but are standardized by the federal government. These plans fill in the gaps and help cover some costs.
Select the expanding sections below for details.
- Part A hospital coinsurance
- Part B coinsurance or copays
- Cost of blood transfusions (first 3 pints)
- Cost for 365 extra hospital days
- Hospice care coinsurance
Some plans may help pay for:
- Part A and Part B deductibles
- Cost of foreign travel emergency care up to plan limits
- Part A skilled nursing facility care coinsurance
- Additional services like vision, dental, hearing or gym memberships.
You can get a Medigap Plan after you are 65 or older and enrolled in parts A and B. You can apply anytime, but the best time to buy this supplemental insurance is during your 6-month Medigap Open Enrollment Period beginning the month you turn 65 and are enrolled in A and B. It usually offers better prices and more choices even if you have health problems. After this enrollment period, your pre-existing health conditions may impact eligibility and costs.
- There are a variety of supplemental plans labeled by different letters. Each plan sets their own premiums, which usually increase with the level of coverage.
- Pay for future services now, not when you use them.
Get Started with Additional Medicare Plans
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