What is Medicare?

Medicare is a federal program that provides health coverage if you are 65 or older, or under 65 with a disability, no matter your income. It’s divided into several parts that cover different aspects of healthcare.

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The Basics of Medicare

Medicare, a federal health insurance program, provides essential healthcare coverage primarily for individuals over 65, along with younger people who have certain disabilities. It is designed to help with medical costs but may not cover all expenses, such as most long-term care.

What’s Included in Medicare:

Part A
Medicare Part A helps pay for hospital stays and inpatient care
Part B
Medicare Part B helps pay for provider visits and outpatient care

While Medicare Parts A and B provide a crucial safety net, they do not cover all healthcare costs. To address additional expenses, such as prescription drugs, dental, vision, and hearing care, get in contact with a local agent to learn more about your options!

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What Do I Do About Costs Not Covered By Medicare?

After you enroll in Medicare, there are two ways to get additional coverage and the team at River City Senior Benefits can help!

Option 1

Add Additional Coverages

Add Medicare Supplement Insurance (Medigap)

Offered by private companies

Helps pay some or all of the costs not covered by your original Medicare Plan.

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Add A Medicare Part D Plan

Offered by Medicare-approved private companies

A separate Medicare drug plan that helps pay for prescription drugs.

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Option 2

Change to Medicare Advantage

Bundle Plans With Medicare Advantage

Offered by private companies

Part C
Combines Part A (hospital insurance) and Part B (medical insurance) in one plan
Part D
Often include prescription drug coverage
Extra Benefits
Plans may offer some extra benefits that Original Medicare doesn’t cover – such as certain vision, hearing, and dental services.
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Who is Eligible for Medicare?

Legal residents must live in the U.S. for at least 5 years in a row, including the 5 years just before applying for Medicare.

To be eligible for Medicare, you must be a U.S. citizen or legal resident AND you must meet one of these requirements:

Age 65 or older
Younger than 65 with a qualifying disability
Any age with a diagnosis of end-stage renal disease or ALS

When Can You Enroll for Medicare?

You can enroll in Medicare during the Initial Enrollment Period (IEP), which begins three months before you turn 65 and ends three months after the month you turn 65.

If you do not enroll in medicare when you are eligible (unless you have creditable coverage in place, such as a employer based group plan {Cobra is not creditable coverage}) you will be penalized both on part B and part D when you do enroll. Ask us for details. You can enroll in Part B in January, February, or March if you declined to take it when previously eligible. It would then start the 1st of the following month.

There are also Special Enrollment Periods (SEPs) for those who qualify under certain circumstances. Whether due to changes in employment status, relocation, or other qualifying events, SEPs ensure that individuals can enroll in Medicare outside the typical enrollment windows.

If you have additional question about when you are eligible to enroll in Medicare, give us call and we’ll help you navigate your medical coverage options.

When Does Coverage Begin?

Medicare coverage typically becomes active on the first day of the month after enrollment, depending on when the individual signs up. For example, if someone enrolls during their Initial Enrollment Period (IEP), coverage will usually begin on the first day of the month they turn 65. However, if enrollment happens during the General Enrollment Period (GEP), coverage may start on the first day of the month after enrollment.

It’s essential to enroll during the appropriate enrollment period to avoid delays in coverage. Additionally, specific circumstances, such as enrollment due to disability or special enrollment periods, may have different effective dates for coverage. Give us a call for more information tailored to your individual situation.

Questions and Answers About Medicare

How do I apply for Medicare?

If you are receiving Social Security benefits already, you will be automatically enrolled in Medicare Parts A and B. To apply for Medicare, you can do so through the Social Security Administration (SSA). For expert assistance, please give our exceptional team at River City Senior Benefits a call.

What is the difference between Medicare Part A and Part B?

Medicare Part A, also known as Hospital Insurance, covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services. Medicare Part B, known as Medical Insurance, covers medically necessary services such as doctor’s visits, outpatient care, preventive services, and durable medical equipment.

How does Medicare Part D work?

Medicare Part D is prescription drug coverage provided by private insurance companies approved by Medicare. These plans help cover the costs of prescription drugs, and you can enroll in a Part D plan alongside Original Medicare or a Medicare Advantage plan that includes Part D coverage.

Can I switch from Original Medicare to a Medicare Advantage Plan?

Yes, you can switch from Original Medicare (Part A and Part B) to a Medicare Advantage Plan (Part C) during certain enrollment periods. These include the Annual Enrollment Period (AEP) from October 15 to December 7 each year and other special enrollment periods for specific qualifying circumstances. Learn more about Medicare Advantage Plans here.

What are the penalties for late enrollment in Medicare?

Late enrollment in Medicare can result in penalties, particularly for Medicare Part B and Part D. The Part B late enrollment penalty increases your Part B premium by 10% for each full 12-month period you could have had Part B but didn’t sign up. The Part D late enrollment penalty is calculated similarly based on the number of months without creditable prescription drug coverage.

How do Medicare Advantage Plans differ from Original Medicare?

Medicare Advantage Plans, or Part C plans, are offered by private insurance companies approved by Medicare. They provide all benefits covered by Original Medicare (Part A and Part B), often with additional benefits such as prescription drug coverage (Part D), vision, dental, and hearing benefits. These plans typically have network restrictions but may offer cost-saving advantages. To learn more, visit our Medicare Advantage page or give us a call today!

What should I consider when choosing between Medicare Supplement Plans?

When selecting a Medicare Supplement Plan, also known as Medigap, consider factors such as coverage benefits, monthly premiums, out-of-pocket costs, provider networks, and additional perks like coverage for foreign travel emergencies. Evaluate your healthcare needs and budget to choose a plan that best meets your requirements.

How can I find out if my current healthcare providers accept Medicare?

You can directly inquire with your healthcare providers or their billing offices about accepting Medicare. Alternatively, you can use the Medicare.gov website or call Medicare’s toll-free number to search for providers in your area who accept Medicare.