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Understanding The Basics of Medicare

Medicare is a health insurance program for:

  • people age 65 or older
  • people under age 65 with certain disabilities
  • people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)

 

Medicare has:

Part A Hospital Insurance

Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

 

Part B Medical Insurance

Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Prescription Drug Coverage

Most people will pay a monthly premium for this coverage. On January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. This coverage is to help you lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. If a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

The above information comes from www.cms.gov

 

 

Are You Eligible for Medicare?

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States.

 

If you are not 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines.

 

You can get Part A at age 65 without having to pay premiums if:

  • You already get retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to get Social Security or Railroad benefits but have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if:

  • You have received Social Security or Railroad Retirement
  • Board disability benefit for 24 months. You are a kidney dialysis or kidney transplant patient.

While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.

Have questions? Give us a call and let us help you with your Medicare Health insurance needs.

 

By contacting the phone number on this website you will be directed to a licensed agent.

Medicare Learning Center
  • Understanding The Basics of Medicare
  • Medicare Advantage Plans
  • What is Medicare Supplement (Medigap) Insurance?
  • Part D Prescription Drug Plans
  • Medicare 2025 Costs at a Glance
  • Coordinated Medicare/Medicaid Benefits

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With a dedication to client-centric service and extensive industry expertise, Medicare Optimized empowers individuals across the Pacific Northwest and beyond to navigate their Medicare options with confidence and ease. While we primarily serve the Puget Sound community, we are licensed in several states throughout the country. No matter where you're located our mission is to ensure that you receive tailored guidance and support in selecting the most suitable Medicare plan to meet your unique healthcare needs and budgetary considerations. Whether it's deciphering plan benefits, exploring supplemental coverage options, or optimizing prescription drug coverage, our team of experienced professionals is dedicated to delivering unparalleled assistance and peace of mind to every Medicare beneficiary we serve. At Medicare Optimized, we believe in fostering long-term relationships built on trust, transparency, and a commitment to enhancing the healthcare journey for all.

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We do not offer every plan available in your area. Currently we represent 16 organizations which offer 206 products. Any information provided is limited to those plans that we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.

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