Medicare Insurance Plans & Benefits

Healthcare is important at every life stage. In retirement, you have fewer resources to pay for it. The federal government established Medicare for seniors and others to have affordable access to health insurance. But which plan(s) should you choose? To get the right coverage at the right price, choose wisely. These resources can help you make choices that are best for you.

Medicare Eligibility Requirements: Are you eligible?

• Seniors aged 65 and older
• People affected by end-stage renal disease
• Younger people with eligible disabilities and receiving social security

Medicare Enrollment Process Basics: How Do You Sign Up or Register?

If you have been receiving social security benefits, you will be automatically enrolled in Medicare at age 65. You should receive enrollment cards and information in the mail about 3 months before your 65th birthday.

If you have not been receiving social security benefits and are not automatically enrolled, it will be your responsibility to sign up. This can be done online or at your local social security office.

There are certain times of the year when you can sign up for Medicare. Most people sign up for Medicare parts A and B (Original Medicare) during the Initial Medicare Enrollment Period. This period begins 3 months before your 65th birthday and ends 3 months after your birthday. Signing up during this period can help avoid delayed benefits and any late enrollment periods. It can also help you to avoid any financial penalties associated with late enrollment.

What does Medicare Cover?

In general, each part of Medicare covers specific services and aspects of healthcare. Most people choose to receive Original Medicare benefits, parts A and B, the fee-for-service program offered by the government. This means Medicare will cover a portion of an approved, but limited amount of healthcare costs and the individual receiving the benefits then becomes responsible for the rest.

There are up to 4 parts (A, B, C, and D) of the Medicare plan:

1. Part A covers inpatient and hospital costs.
2. Part B provides outpatient coverage.
3. Part C is a “bundled”, all-in-one type of coverage designed to decrease out-of-pocket costs associated with Medicare.
4. Part D provides prescription drug coverage.

What services are not covered by Traditional Medicare?

Original Medicare does not cover:

• Dental
• Vision
• Prescription
• Overseas emergencies

What are the costs associated with Medicare?

There are deductibles, premiums, coinsurances, and copayments associated with all parts of Medicare. Out-of-pocket expenses can be a burden to seniors functioning on a fixed income. Fortunately, there are Medicare Savings Programs (MSP) available to help cover some of these costs.

Part A costs: “Premium-Free Part A”

Most will not have to pay out of pocket for Medicare Part A, as long as you or your spouse have paid Medicare taxes for a certain amount of time while working. You can qualify for “Premium-Free Part A” if:

• You or your spouse had Medicare-covered government employment.
• You are eligible for social security benefits.
• You already get retirement benefits from Social Security.

If you do not meet the requirements for premium-free part A, you will have the option to purchase it. In 2021, the premium of Medicare Part A cost either $259 or $471 depending on how long you or your spouse has worked and paid into the Medicare taxes.

Part B costs

You will pay a monthly premium for Medicare Part B. Most people will pay the standard premium amount. In the year 2021, the standard Part B premium cost is $148.50 each month.

If your modified adjusted gross income from the past 2 years reports an income above a certain amount, you may have to pay an additional amount called an Income Related Monthly Adjustment Amount. This cost is in addition to your monthly premium.

Part C costs

There are a variety of costs associated with this type of plan, meaning the out-of-pocket expenses will vary between individuals and plans chosen. Some of these plans will require premiums, deductibles, and copayments. On the bright side, assistance is available to low-income individuals to help with these costs, and reduce the burden on seniors with fixed incomes.

Part D costs

The costs of your drug coverage through Medicare can vary greatly. These costs will depend on a multitude of things such as:

• The pharmacy you use.
• Your personal prescriptions and whether they are covered under your plan.
• If you have met your deductible or received emergency coverage.
• The level of the prescription drug.
• If you are getting extra help paying for coverage costs.

The costs associated with Medicare drug coverage include premiums, copayments, deductibles, and coverage costs.

Medicare Part A - Original Medicare Covering Hospital Care

Medicare Part A includes coverage for hospital stays, care received in a skilled nursing facility, hospice care, and some home health care facilities. It is important to note that this part of Medicare acts as basic coverage for room and board while in the hospital. It does not cover any scans, tests, or surgeries that may occur while staying in the hospital.

In most cases, you will not have a monthly premium for Medicare Part A. As long as you or your spouse paid Medicare taxes for a certain amount of time, your premium will be completely covered.

Medicare Part B - Original Medicare Covering Standard Doctors Visits

Simply put, Medicare Part B is your outpatient coverage. This includes most doctor visits, surgeries, lab work, diagnostic testing, and preventive services. It also includes coverage for some clinical research, ambulance services, and mental health services. Without Medicare Part B, you would not have any coverage for doctor visits, including those that occur during inpatient hospital stays. Furthermore, Medicare Part B provides coverage for cancer treatments and renal disease procedures like kidney dialysis. These services would also carry potentially crippling expenses without the coverage offered through Medicare.

Medicare Part C - Medicare Advantage

Medicare Part C, also known as a Medicare Advantage Plan, is an optional, bundled, “all-in-one” type of coverage. The coverage received will be similar to the benefits received in Part A and Part B. In addition, the plans usually include drug coverage as well. Some of these plans may also provide coverage for dental, vision, and hearing benefits.

Medicare Advantage Plans are offered by private, Medicare-approved insurance companies. They are typically PPO or HMO and allow for care only within their own network of providers.

Part D - Enhanced Prescription Drug Coverage

Medicare Part D is your prescription drug coverage and is sometimes referred to as a “pharmacy card”. This service will allow you to purchase your prescription drugs at a much lower, affordable price than they regularly retail for. This insurance provides coverage for current and future prescription needs. With prescriptions often retailing for hundreds of dollars, Medicare Part D is an important benefit to have.

Each Part D plan is different. They can vary in specific drugs covered and in cost, but all plans offer a standard level of coverage set by Medicare. These plans will also have different monthly premiums. The amount you will be required to pay depends on the plan and level of coverage you select.

Long-Term Care

Long-term care often has a focus on basic tasks in everyday life, also known as activities of daily living. This means that most are not medical care. Because most are not directly related to medical care, Medicare does not provide coverage for long-term care and you will be responsible for 100% of related costs.

Assisted Living

Medicare does not offer coverage for assisted living expenses. Medicare may cover some short-term stays within a skilled nursing facility or rehabilitation center while you recover from illness or injury.

Home Health

Several conditions will need to be met for Original Medicare to cover home health-care-related costs. These conditions include:

• You must be certified as homebound by a doctor.
• You must be under the care of a doctor, and this doctor must regularly review the services provided under your plan of care.
• It must be certified by your doctor that you have a need for intermittent skilled nursing care, physical therapy, speech pathology, or continued occupational therapy.
• Your treatment must be safe and effective
• The time period of services, frequency, and amount of treatment needs to be of a reasonable amount

Dental Coverage

Original Medicare, unfortunately, provides no coverage for dental care. This includes all dental procedures including cleanings, fillings, dental plates, tooth extractions, and even dentures. Medicare Part A can pay for inpatient hospital care in an emergency situation, or have the need for a complicated dental procedure, even though it doesn’t actually provide dental coverage.

If you have Original Medicare and decide that you also want dental coverage, you have the options of buying a separate dental plan or enrolling in a Medicare Advantage Plan (Medicare Part C) that includes dental benefits.

Vision Coverage

Original Medicare does not provide coverage for routine eye care including eye exams for contacts and eyeglasses.

Hearing Aid Coverage

Medicare does not cover the costs associated with hearing aids, exams, or fittings. This means that you will be responsible for 100% of related costs.

Hospital Stays

Medicare Part A covers inpatient hospital care as long as the hospital that you are at accepts Medicare and as long as you are admitted with a doctor's order stating that you need inpatient hospital care to treat your illness or injury.

Ambulance

Medicare Part B covers ambulance transportation to a hospital or skilled nursing facility as long as it’s for medically necessary care. Medicare may also cover costs associated with emergency transportation in an airplane or helicopter if you need immediate care that ground transportation can’t provide.

Hospice

Hospice is a type of program that focuses on the care of a terminally ill patient. This includes all aspects of their care including alleviating pain and symptoms and attending to their emotional and spiritual needs by prioritizing comfort and support during their end-of-life care.

In order to qualify for hospice care, there are some requirements you will need to meet. First, your doctor must certify that you are terminally ill, meaning your life expectancy is 6 months or less. Also, when you agree to hospice care, you are agreeing not to receive any life-sustaining measures. This means that the care you are agreeing to is palliative care and comfort measures only. This care will not cure your illness.

Once this is established, you will have to sign a statement that chooses hospice for all future care. Your Medicare Hospice coverage includes:

• Medicare, nursing, and social services
• All services and equipment needed for symptom management
• Drugs and services needed for pain relief
• Aide and homemakers services
• Spiritual and grief counseling for you and your family, or other services needed to provide you with pain and symptom relief

With the cost of healthcare continuing to rise, the out-of-pocket costs associated with Original Medicare also continue to increase. Medicare Supplement or Medicare Advantage plans can be used to cover some of the unpredictable healthcare needs and rising costs. If you don't have a trusted adviser as a guide, you may end up paying more for an insurance plan that doesn't fit your needs.

After taking into consideration the pricing, websites, discounts, and customer service of the current plans available, we were able to compile a list of the best supplement plans available now. The best Medicare Supplement plans in 2021 include Mutual of Omaha, Humana, AARP, Aetna, and Cigna.

Researching a plan for you is the most important part of getting the best coverage option for you. Each plan can offer a plethora of different benefits, and the cost can vary greatly.

When choosing a supplemental insurance company, remember that user experience goes hand-in-hand with coverage. If you can’t find information quickly or understand it clearly, you will be unable to advocate for your own medical coverage. We recommend checking out more than one option, and while doing so - bear in mind the following features:

• Price transparency
• Usability of the website
• Ease in comparing plans
• Availability of educational content on the health insurance website
• Availability of local agents to ask in-person questions

We know that understanding Medicare is easier said than done. SAO is committed to helping Medicare-eligible seniors connect with providers near them to give them peace of mind that they are aware of the best choices. While online information from reputable sources like medicare.gov are great resources, it is always important to involve a professional as well. There is no need to navigate this process alone. This simple online form will notify one of our highly trained SAO staff to reach out and assist you in answering some of your tough Medicare questions.