Understanding Medicare: A Comprehensive Guide

Petravage Insurance Co. is here to assist you in making informed decisions regarding your Medicare coverage. With our help, you can ensure that you receive the best healthcare benefits available to you.

What is Medicare?

Medicare is a government program in the United States that provides health insurance coverage for individuals aged 65 and older, as well as certain younger individuals with disabilities.

How does it work?

Medicare has four parts:

• Part A (Hospital Insurance) – Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.

• Part B (Medical Insurance) – Covers doctor visits, outpatient care, preventive services, and medical supplies.

• Part C (Medicare Advantage Plans) – Private insurance plans that include Part A and Part B coverage, often with additional benefits.

• Part D (Prescription Drug Coverage) – Helps cover the cost of medications.

Most people qualify for premium-free Part A if they or their spouse paid Medicare taxes for at least 10 years. Otherwise, you may need to pay a premium for coverage.

When am I eligible?

To be eligible for Medicare, individuals must be citizens or permanent residents of the United States who have paid into the Social Security system for at least 10 years. Additionally, individuals under the age of 65 may qualify for Medicare if they have certain disabilities or conditions, such as end-stage renal disease.

• Initial Enrollment Period (IEP) – This is a 7-month window that starts 3 months before you turn 65, includes your birth month, and extends 3 months after.

• General Enrollment Period (GEP) – If you missed your IEP, you can enroll between January 1 and March 31 each year, but you may face late penalties.

• Special Enrollment Period (SEP) – If you have qualifying circumstances (like employer coverage ending), you can enroll outside the standard periods.

• Medicare Advantage & Part D Open Enrollment – Runs from October 15 to December 7 each year, allowing individuals to switch or enroll in new plans.

You can find more details on Medicare.gov or SSA.gov.

How do Medicare supplements work?

Medicare supplement plans, also known as Medigap, are insurance policies designed to help cover some of the costs that original Medicare does not pay, such as copayments, coinsurance, and deductibles. These plans are sold by private insurance companies and can help ease the financial burden of healthcare expenses for seniors.

Each Medigap plan offers a different set of benefits, and standardization means that plans with the same letter offer the same coverage, regardless of the insurer. Beneficiaries can enroll in a Medigap plan during their Medicare open enrollment period, which begins when they turn 65 and are enrolled in Medicare Part B. .

It’s important to note that Medigap plans do not cover prescription drugs; for that, beneficiaries will need to enroll in a separate Medicare Part D plan. Overall, these plans provide valuable financial protection and peace of mind for those navigating healthcare in their later years