Medicare (Post-65)

What it is and How to Fill the Gaps

What is Medicare?

Medicare is a federal health insurance program in the United States that primarily covers individuals aged 65 and older, as well as certain younger people with disabilities. It is funded through payroll taxes, premiums paid by beneficiaries, and general revenue.

There are four parts to Medicare:

  1. Part A: Hospital Insurance, which helps cover inpatient care in hospitals, skilled nursing facilities, hospice care, and some home health care.

  2. Part B: Medical Insurance, which helps cover outpatient care, preventive services, medical supplies, and doctors' services.

  3. Part C: Medicare Advantage Plans, which are offered by private companies approved by Medicare to provide Part A and Part B benefits. They often include prescription drug coverage as well.

  4. Part D: Prescription Drug Coverage, which is insurance that helps cover the cost of prescription drugs. This coverage can be added to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.

Overall, Medicare plays a crucial role in providing healthcare coverage for millions of Americans, ensuring access to essential medical services and medications.

In Summary:

Original Medicare, Parts A and B, pays for many of your health-care services and supplies, but it does not pay for everything. That’s why you may want to consider getting a Medicare Supplement insurance policy, also called a Medigap policy. A Medigap policy is sold by private insurance companies. These plans help pay some of the hospital and medical costs that Original Medicare does not cover, such as copayments, coinsurance, and yearly deductibles. Basically, a Medigap policy fills the “gaps” in Original Medicare coverage.

Example of How Medigap Policies Work with Medicare:

A Medigap policy supplements your Original Medicare benefits, which is why these policies are also called Medicare Supplement plans. If you have Original Medicare and a Medigap policy, Medicare will pay first, as your primary insurance, and your Medigap policy will fill in the cost gaps. For example, suppose you have a $5,000 ambulance bill and have not yet met the yearly Medicare Part B deductible. Medicare Part B will pay 80% of your ambulance bill, minus the deductible amount. The Medigap policy would then pay your remaining 20% coinsurance of your $5,000 ambulance bill. Some Medigap policies also pay the remainder of the Medicare Part B deductible you still owe

Insurance Plans that are not Medigap:

  • Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)

  • Medicare Prescription Drug Plans (Part D)

  • Medicaid

  • Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)

  • TRICARE

  • Veterans' benefits

  • Long-term care insurance policies

  • Indian Health Service, Tribal, and Urban Indian Health plans

Medicare Educational Videos

These videos are for educational purposes. We represent many of the top carriers available and will review your unique situation to be able to offer you a variety of carrier products and plans to choose from.

Signing up for Medicare

Medicare & You: Traveling Abroad

Medicare For Under 65 Beneficiaries

Medicare FAQs:

  • Assuming you have met the work-related eligibility requirements, you may begin enrollment into Medicare 90 days in advance of the month you turn 65.

  • Medicare does not have spousal or dependent coverage. Medicare is individual. If your spouse has reached age eligibility (65), then they can enroll in Medicare of their own accord 90 days in advance of the month they turn 65.

  • Maybe. If the employer group has 20 eligible employees or more, and you’re going to continue to work, then yes it’s an option. But there are many things to consider.

  • Part “A” is typically in place, and a paid-up benefit when you turn 65. Part “B” is not, unless you have enrolled in Social Security prior to age 65. If you have not filed to receive Social Security benefits, then you need to proactively enroll in Part “B” benefits and begin paying for them.

  • Yes. However, you will not have prescription coverage, and you will face unlimited exposure to those costs due to the gaps in Original Medicare.

  • You usually can. It’s important to be sure your doctor accepts Medicare. Some don’t.

  • Yes, for up to 100 days, after a required three-day hospital stay.

  • No. But some Advantage plans offer limited dental coverage.

  • No, a retiree plan will typically wrap around Medicare primary benefits.

  • Part “D” is the Prescription Drug plan Medicare introduced in 2006.

  • In addition to having a huge gap in coverage, you will likely face a penalties from Medicare. A Part “B” penalty can be 10% of your Part “B” premium for each 12-month period outside of Medicare, and up to 1% of the national average of a Part “D” plan for each month absent Part “D”.

  • Part “C” is another name for Medicare Advantage. Also named MA, MSA, or MA-PD (when prescriptions are included).

  • Online at SSA.gov or in person at a local Social Security office.

  • This is a Medicare term that establishes previous coverage being at least as good as Medicare’s. Typically is in play for Part “D” to avoid penalty.

  • No.