Understanding Your Medicare Benefits
Medicare provides essential health coverage for individuals 65 and older and certain younger individuals with disabilities. Understanding your options helps you make informed decisions about your healthcare coverage.
Why Medicare Planning Matters
Medicare has multiple parts with different coverage options, costs, and enrollment periods. Getting the right coverage for your specific needs can save you thousands in healthcare costs and ensure you have access to the care you need.
*Original Medicare
(Premium free for most)
-Inpatient hospital care
-Skilled nursing facility care
-Behavior & mental health
-Nursing home care
-Hospice care
-Home health services
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(Premium paid to Medicare)
-Primary care/ Specialist
-Medical treatments/ tests
-Laboratory
-Preventative service
-Durable medical equipment
-Outpatient surgery
-Mental health services
-Ambulance services
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A+B+D=C
-May offer benefits like vision, dental, hearing, etc
-Has network restrictions
-Premiums vary by plans and location
-$0 premium options available
-Types include HMO, PPO, SNPs, MSA, PFFS
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-Helps pay for approved prescriptions
-Does not pay 100%, but pays a portion
-Plans have tiers 1-5
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-Extra Insurance you can buy from a private health insurance company to help pay your share of out of pocket cost in Medicare, like copayments, coinsurance, and deductibles.
-There are several plans to choose from-Must have A & B
-Premiums vary by plans, company and location
-Standardized plans labeled A-N
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*Enrollment Periods
7 month period that begins 3 months before your birth month, your birth month and 3 months after your birth month
October 15th-December 7th each year
Join, drop, switch to another MA plan with or without drug coverage
Switch from Original Medicare to MA plan or from MA plan to Original Medicare
Join, drop, switch to another drug plan if on Original Medicare
For more information, please visit ssa.gov and medicare.gov
704-550-4010
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