What is Medicare?

The Nation’s largest health insurance program, Medicare provides high-quality health care to:

• People age 65 and older
  
• People under age 65 with certain disabilities
  
• All people with end-stage renal disease
  

Administered by Centers for Medicare and Medicaid Service (CMS) and has 4 Parts:

• A & B – managed by the federal government and referred to as Original Medicare
  
• C & D – offered by private insurance companies with an approved Medicare contract
  

What does Original Medicare Cover? (Parts A & B)
Part A - There is no premium for Part A, you contributed to Medicare by paying taxes while you worked. However, there are deductibles and co-pays you will be responsible for paying.  (Many people purchase a Medicare Supplement to pay those costs.)

• Hospital – In-Patient
  
• Skilled Nursing Facility Care
  
• Hospice Care
  
• Some home healthcare
  

Part B – There is a premium for Part B. There are also deductible and copay responsibilities.  (Many people choose to purchase a Medicare Supplement or “Gap” plan to pay these costs.

• For Most individuals the monthly premium is $104.90. Some people pay more based on their income.

What is not covered by Original Medicare?

• Deductible for Part A
  
• Hospital copay – days 61-90
  
• Skilled Nursing Facility copays Days 21-100
  
• Annual Hearing Exams
  
• Dental Services
  
• Prescription Drugs
  

Medigap – Medicare Supplement Plans:

• Health insurance policies that are sold by private insurance companies
  
• Supplements cover medical benefit “gaps” such as Part A & Part B deductible and coinsurance.
• There are 11 standardized plans (A, B, C, D, F and High Deductibles F, G, K, L, M, N)
  
• Does not include Part D prescription drugs 
  

Part D – Medicare Prescription Drug Coverage is offered by private health insurance companies with an approved Medicare contract and helps to cover prescription drug costs with Stand-alone plans and Medicare Advantage Plans.  Extra help is available for beneficiaries with limited income and resources.

Part C – Medicare Advantage Plans are offered by private health insurance companies with an approved Medicare Contract and one must have Part A & Part B to enroll and must continue to pay Part B premiums. Part C may require using specific network providers.  Advantage Plans combine Part A (hospital) and Part B (Medical) plus add on benefits and features not covered by Part A and Part B.

What costs are paid by beneficiaries?

• Part B Premium + Part C premium (if applicable)
  
• Medical Coverage: Co-pays until maximum out-of-pocket is met (varies by plan)
  
• Prescription Coverage: May not be included in all plans; Copays and Coinsurance – vary by plan
  
• Medicare Advantage Plans may cost less than traditional Medicare + Medicare Supplement + Prescription drug plan, but there are out of pocket expenses in the Advantage Plans. An awareness of this is important in order to evaluate potential costs.
  

When can I enroll in Medicare?

• Initial Enrollment Period: 7 months surrounding 65th birthday
  
• Annual Enrollment Period: October 15 – December 7 for a January 1 effective date
  
• Special Enrollment Period: Specific events such as termination of employer coverage, moving to a different service area, or other specific events.
  

Medicare Supplements are available for enrollment all year-round. Medical underwriting may apply.

To learn more about Medicare Programs, visit www.medicare.gov or contact Jenmar Insurance Services for a complimentary consultation.