Medicare FAQ's (with GMB variable fields)

Choosing the right Medicare plan for you can be intimidating, especially for those new to Medicare. There are many options, including Original Medicare Part A and Part B, Medicare Advantage, Part-D, and Medicare Supplemental plans (Medigap). On top of that, deciding which insurance carrier to choose, understanding all the rules and enrollment periods so you don't incur a penalty can be overwhelming. Each person's situation is unique and different; what might be right for one spouse may not be for the other; the products available in your county may be different than the county next door. That's why it is so essential to work with an experienced independent Medicare agent from %location_address_locality%. At %location_locationName%, we have the Medicare expertise needed to help you understand the options and identify the right plan for you. Call us at %location_primaryPhone% to set up a time to conduct a Medicare review if you are already enrolled in Medicare or to review your options if you are about to turn 65.

If you are under 65 and disabled, there are some special rules about when you become eligible for Medicare. Again, every person's situation is unique. There may be additional rules or benefits that apply to your specific situation, which is why it is crucial to work with an experienced independent Medicare agent familiar with the rules around eligibility for Medicare when disabled like we at %location_locationName% are.

You automatically get Part A and Part B after you have been receiving:

• Disability benefits from Social Security for 24 months
• Certain disability benefits from the RRB for 24 months

If you have Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig's disease, you will automatically get Part A and Part B the month your disability benefits begin.

For more information on Medicare and the options available to you, visit our website at %location_websiteUrl% or to set up a time to discuss your options, call us at %location_primaryPhone%.

Several types of Medicare Advantage plans are available, and a Health Maintenance Organization (HMO) is one of them. If you join an HMO Plan, you will need to go to your Primary Care Physician (PCP) within the HMO’s network of doctors to get most of the routine care you will need. If you do need to see a specialist, you will need to get a referral from your PCP before you see them; otherwise, those services may not be covered. This process is much easier than it used to be, and most referrals are done electronically, so you don't have to pick up a paper referral from your PCP's office. There are some cases when you can receive services from doctors outside the HMO network, including the following:

• Emergency care
• Out-of-area urgent care
• Out-of-area dialysis

There is also a variation of HMO plans called HMO-POS (the POS stands for Point-Of-Service). These plans allow you to go out-of-network for certain services. But, it usually costs more if you go to one of those out-of-network doctors. We at %location_locationName% can help you determine if a Medicare Advantage HMO is the right plan for you. Give us a call at %location_primaryPhone% to discuss the options available to you.

Medicare Advantage Private Fee For Service (PFFS) plans are a type of Medicare Advantage Plan that is generally only available in rural areas where there are not many plan options available. PFFS plans do not require you to choose a primary care physician (PCP) or need a referral to see a specialist like HMO plans do. Not all PFFS plans have a physician and hospital network; you must receive care within. Some PFFS plans allow you to go to any Medicare doctor, healthcare provider, or hospital, as long as they accept the plan’s payment terms and agrees to treat you. One additional unique aspect of PFFS plans is that doctors can accept a PFFS plan's payment terms for one treatment and not another. It is very important if you are enrolled in a PFFS plan to ask if your doctor or other health care provider will accept your PFFS plans payment terms for every treatment you receive. For more information on PFFS plans and availability in your area contact %location_locationName% at %location_primaryPhone%.

 The four main parts of Medicare are:

· Original Medicare Part A – Medicare Part A (hospital insurance) covers Medicare inpatient care that is care received while in a hospital, skilled nursing facility, and, in certain circumstances, at-home treatment.

· Original Medicare Part B – Medicare Part B (medical insurance) covers medical services provided by doctors, nurses, and other health care professionals. Part B coverage includes outpatient care, ambulance services, preventive services, and durable medical equipment. It also covers part-time home care and rehabilitative services, including physical therapy.

· Part-D (Prescription Drugs) – Medicare Part-D covers prescription drugs and is a Medicare plan offered by private insurance companies that provides drug coverage to those enrolled in Original Medicare, Original Medicare with a Medicare Supplement, and Medicare Advantage (MAPD) plans that include drug coverage. 

· Part C (Medicare Advantage) – Medicare Advantage is a bundled Medicare plan offered by private insurance companies that completely replaces your Original Medicare Part A and Part B benefits and often included Part-D drug benefits.

There is one additional product also included in the Medicare family of options; they are called Medicare Supplements (Medigap). Medicare Supplement policies are offered by private insurance companies that help fill "gaps" in Original Medicare. 

We at %location_locationName% can help you understand the many parts of Medicare and determine what the right fit is for you. Give us a call at %location_primaryPhone% to discuss the options available to you.

At a high-level, Medicare Part A (Hospital Insurance) covers the following:

· Hospital care of inpatient

· Conditioned home health services

· Nursing facility care provided that custodial care isn’t the only care required

· Hospice care

Medicare Part A covers hospital expenses that are critical for your inpatient care, including semi-private room, nursing services, meals, medications included in your inpatient treatment, and other related services and supplies from the hospital. 

Part A also has critical inpatient care provided through:

· Critical access hospitals

· Acute care hospitals

· Long-term care hospitals

· Mental health care

· Inpatient rehabilitation facilities

· Participation in a clinical research study

In most cases, you won't have to pay a monthly premium for Medicare Part A Hospital Insurance if you and your spouse paid Medicare taxes for at least 40 quarters (equal to about ten years of working). If you do not meet the qualifications for a premium-free Part A, you can buy it. If you paid Medicare taxes for less than 30 quarters, the premium is $458 in 2020. If you paid Medicare taxes for 30-39 quarters, the cost is $252 in 2020. For more information on Medicare Part A, visit us at %location_websiteUrl%.

Medicare Part B (medical insurance) covers medical services provided by doctors, nurses, and other health care professionals. Part B coverage includes outpatient care, ambulance services, preventive services, and durable medical equipment. It also covers part-time home care and rehabilitative services, including physical therapy.

Medicare Part B covers:

• Medically necessary services: Services provided by doctors, nurses, and other health care professionals or supplies needed to diagnose or treat your medical condition and meet accepted standards of medical practice.
• Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best. You pay nothing for most preventive services if you get the services from a health care provider who accepts Medicare assignment.

Most people will pay the standard Part B premium of $144.60 in 2020 but based on your income; you could pay more due to the Income Related Monthly Adjustment Amount (IRMAA).

It is important to understand what Original Medicare Part A and Part B do not cover. Some of the items and services Medicare doesn't cover include:

· Long-term care (also called custodial care )

· Most dental care

· Eye exams related to prescribing glasses

· Dentures

· Cosmetic surgery 

· Acupuncture 

· Hearing aids and exams for fitting them

· Routine foot care

· Part A and B copayments, coinsurance, deductibles

· Prescription Drugs

To determine if Medicare covers a specific test, item, or service, you can visit www.medicare.gov/coverage.

Medicare Supplement plans can help pay some of the health care costs Medicare does not, including:

· Copayments

· Coinsurance

· Deductibles

Medicare Advantage plans must, at a minimum, offer the same benefits as Original Medicare Part A and Part B but, in most cases, offer significantly more benefits. These additional benefits are sometimes called supplemental benefits and include things such as lower cost-sharing, dental, vision, hearing, meal plans, fitness memberships, transportation, and much more. Most Medicare Advantage plans also include Medicare prescription drug coverage and is commonly known as MAPD plans.

To ensure that you understand what is covered, what is not, and the options available to fill in those gaps or enhance your coverage, contact %location_locationName% at %location_primaryPhone% or visit our website at %location_websiteUrl%.