Medicare Options Explained

What is Medicare?

Medicare is a medical insurance program for people aged 65 and older. Started in 1965 to help older adults pay for health care. Medicare is a federally run program and can be used as your sole coverage for health insurance or or as a companion coverage with other policies you may purchase.

Medicare is designed primarily for people over age 65, but over the years it has been expanded to cover some younger people with disabilities. Most likely, Medicare will not cover all of your health care expenses. There may be premiums, deductibles and co-pays and some services may not be covered.

How do I know what I need?

Understanding the Medicare maze can be frustrating and feel overwhelming, but let’s simplify your choices.

• Will you go with Original Medicare Part A & B with a Medicare Supplement (Medigap) and Part D prescription drugs? or
• Will you go with a Medicare Advantage plan (Part C)?

Part A and B (Original Medicare)

Part A and B are sometimes called traditional or original Medicare. Part A helps pay for hospital bills, and most of the time you have already paid for your Part A premiums through payroll taxes while you were working. Part B helps pay for visits to the doctor and other health care services, including screenings for some types of cancer, diabetes and heart disease.

Think of Part A as your hospital insurance plan. It covers stays in the hospital, nursing care and some home health services or skilled nursing care after a hospital stay and hospice care. This part of your coverage pays about 80% of your Medicare-approved hospital costs for the first 60 days you are in a hospital. If you need to stay longer, you will be responsible for part of the costs.

Part B pays for part of your doctor visits, some medical equipment, home health care, outpatient procedures, rehab, X-rays, tests, ambulance services, mental health care, and blood services. Part B is optional and requires a premium and a small deductible.

To learn more about Original Medicare Part A and B, click Here.

Medigap (Medicare Supplements)

Medigap is sometimes called Medicare Supplements.  It is a health insurance policy that is sold by private insurance companies to fill the “gaps” in Original Medicare Part A & B coverage.  It helps to pay for the healthcare costs that Part A & B do not cover.

Part C (Medicare Advantage)

Part C plans are also called Medicare Advantage plans. These are plans that are approved by Medicare and offered by private insurance companies. They are an alternative to Part A and B plans, or original Medicare as described above. Sometimes they cover prescription drugs. To learn more about Medicare Advantage Part C plans, click Here.

Part D (Prescription Drug Plan)

Part D plans are also private plans, approved by Medicare that help people with Part A and B pay for prescription drugs. Part D is optional and offered by private insurance companies. Each plan varies in premiums, deductibles and co-pays. You must be enrolled in Part A or B to enroll in the Optional Part D plan. To learn more about Medicare Part D plans, click Here.

How do I know if I am eligible for Medicare?

Most of the time, to qualify for the full benefits of Medicare, you must be 65 and have earned the coverage. This means that you or your spouse (or possibly your former spouse) worked and paid Medicare and Social Security taxes for at least ten years.

But, you may also qualify if you are disabled or meet other requirements. You must be a U.S. citizen or permanent resident. For complete information about your eligibility requirements for Medicare, please contact your local Social Security office or go to Medicare.gov.” and then link Medicare.gov to their website.

What about my family?

Medicare is not family coverage. If you qualify for Medicare, you are insured as an individual. You cannot add your children or younger spouse to your plan. Your spouse must qualify individually.  As you may know, young adults can now stay insured under a parent’s employer plan or a private insurance plan up to age 26.

Understanding Medicare does not have to be overwhelming.  We specialize in Medicare coverage and are here to help you find the best plan to meet your individual needs.  Please contact us today with any questions or to schedule your appointment. Please contact California Coastal Insurance today to schedule your FREE Medicare insurance review.