Medicare
Understanding Medicare
Discover how Medicare works and understand all your options with Lourie Life & Health.
The information below is designed to help make learning about your health care options as easy as possible when you are ready for Medicare. We are here to help you every step of the way - from understanding the Medicare basics to exploring your options and choosing the right plan for you.
Let us help you find the right coverage.
We are committed to helping our clients understand their Medicare coverage options using our expertise and experience. We are not here to sell you something, we are here to be your advocate.
Lourie Life & Health is here to simplify Medicare.
We enjoy helping people make important decisions regarding their Medicare coverage. This can be very confusing, and we like to simplify this process so that our clients can feel comfortable and confident with the choices they make.
Please scroll through the different sections below or you can check out our YouTube Educational Videos Here
What is Medicare?
Medicare is a federal program to help people age 65 and over (or under 65 for those who qualify) cover health care costs. It currently consists of four different coverage parts labeled with letters: A, B, C, and D.
The parts of Medicare coverage
You can also learn more by watching this brief video below
ORIGINAL MEDICARE
Hospital Insurance
Medical Insurance
COVERAGE OPTION 1
(also called Medigap plans)
Prescription Drug Coverage
COVERAGE OPTION 2
Medicare Advantage
Your Coverage Options
Why you need additional coverage
You are still responsible for deductibles and co-insurance with traditional Medicare (Part A and B only). The co-insurance you are responsible for is 20% of the bill, and there is no out-of-pocket maximum for this co-insurance. That means there is no limit to the amount of co-insurance you could be required to pay and why you need to consider additional coverage.
Most prescription drugs are not covered under Medicare Parts A and B. You may want to purchase drug coverage through a separate Prescription Drug plan (Part D) or through a Medicare Advantage plan (Part C).
This example is for illustration purposes only. No coverage or payment is meant to be implied.
Enrollment
Let us prepare you for the Medicare enrollment process.
How To Enroll
When eligible for Medicare, you need to determine the next steps. Each individual situation may be different and it's important to know what to do.
| If You.... | ...Then You |
|---|---|
| Plan to retire at age 65 or are not working, and do not already receive Social Security benefits | Need to sign up for Medicare Part A and/or Part B.
Contact the Social Security Office 3 months before
your 65th birthday
|
| Already receive Social Security retirement, disability, or Railroad Retirement Board benefits | Automatically get Medicare Parts A & B and should receive your Medicare card in the mail 3 months before your 65th birthday |
| Have Medicare prior to 65, due to disability or end stage renal disease | Can stay on or change your existing Medicare Advantage Plan or consider a Medicare Supplement Plan with a Part D plan |
| Are under 65 but just became eligible for Medicare | Should contact Lourie Life & Health for all of your options |
Turning 65
If you are not automatically enrolled in Medicare, then you will need to sign up. This enrollment period is time-sensitive. You have an initial enrollment period to sign up for Part A and/or Part B. You may have to pay a late enrollment penalty if you do not sign up when you first become eligible.
Initial Enrollment Period
The Initial Enrollment Period is the seven month period that begins three months before you turn 65, includes the month of your 65th birthday, and ends with the three months after you turn 65. Even though you have several months, the best time to enroll is during the first three months of your eligiblity to make sure you get coverage as soon as you are 65.
Working Past 65
If you and/or your spouse are 65 or older, currently covered by an employer-provided group health plan, and plan to continue working, you may have options. Contact your employer or union benefits administrator to find out how your coverage works with Medicare.
Can I stay on my current employer coverage?
- If the company has more than 20 employees, you can stay on your current coverage. However, we recommend you review your options to understand if adding Medicare may be beneficial to you.
- You may also want to contact your employer or union benefits administrator to find out how your coverage works with Medicare. It may be to your advantage to enroll in Part A and to delay enrolling in Part B.
- If the company has less than 20 employees, Original Medicare will be primary and you will need to apply 3 months before your 65th birthday.
- You may also want to contact your employer or union benefits administrator to find out how your coverage works with Medicare.
When you stop working
You may qualify for a Special Enrollment Period if you or your spouse worked past the age of 65 and were covered by group insurance when you initially became eligible. You can sign up for Medicare while you are still covered by your group plan or during the eight months after your employment ends.
Enrollment Periods
An opportunity to enroll after the initial enrollment period may exist if you have a change in circumstances. You may not have to pay a late enrollment penalty if you enroll during this time period.
Annual Enrollment Period: Oct. 15 - Dec. 7
- You can change from a Medicare Supplement Plan to a Medicare Advantage Plan (Part C)
- You can change from current Medicare Advantage Plan to a different Medicare Advantage Plan
- You can change Prescription Drug Plans (Part D)
- You can drop a Medicare Advantage Plan or a Part D Plan
Medicare Advantage Open Enrollment Period: Jan. 1 - Mar. 31
- You can change from a Medicare Advantage Plan to a different Medicare Advantage Plan
- You can change from Medicare Advantage Plan to Original Medicare and a Medicare Supplement and Prescription Drug Plan (you may have to go through underwriting to qualify for the Medicare Supplement)
Special Enrollment Periods include, but are not limited to:
- Loss of group (employer) coverage
- Move (changing homes, moving to a skilled nursing facility or rehab institution)
- Change in eligibility for Medicaid or Low-Income subsidy (Extra Help)
- Have a qualifying chronic condition (for example: diabetes or heart disease)
Anytime
You can change Medicare Supplement Plans (you may have to go through underwriting to qualify)
Education
Let us teach you the complexities of your coverage options.
Original Medicare - Part A & B
Enrolling in Original Medicare when you become eligible is the first step in your Medicare choices.
Part A - Hospital Insurance
Part A includes coverage for inpatient hospital care, hospice care, and inpatient care in a skilled nursing facility (rehab). This typically has a $0 premium (if you qualify) and deductibles and copays may apply.
Part B - Medical Insurance
Part B covers medical care and services provided by doctors/other medical professionals, durable medical equipment, and outpatient visits. This typically includes a monthly premium, an annual deductible and 20% co-insurance with no out-of-pocket maximum.
Medicare Supplement
If you choose Original Medicare, one coverage option to help cover out-of-pocket costs (like co-insurance and deductibles) for Medicare-covered services is a Medicare Supplement Plan.
You can also learn more by watching this brief
How Medicare Supplement Works
When you have a Medicare Supplement Insurance policy (also known as Medigap), it helps fill the gaps that Original Medicare does not. There are a variety of plans offered, and each one has a different level of coverage. You will want to consider adding a separate standalone Prescription Drug Plan (Part D). You do not need and cannot use a Medicare Supplement policy if you choose a Medicare Advantage Plan.
Benefits of Medicare Supplements
Medicare Advantage - Part C
Medicare Advantage Plans include services covered by Part A, Part B, and usually Part D. They are offered by Medicare-approved private companies that must follow rules set by Medicare.
You can also learn more by watching this brief
How Medicare Advantage Works
With a Medicare Advantage Plan, you will receive all Original Medicare (Parts A & B) covered services. Most Medicare Advantage plans include Part D drug coverage.
Benefits of Medicare Advantage
Prescription Drug Plans
Prescription Drug Plans (Part D) provide coverage to help reduce your costs for medications through the mail or from a retail pharmacy. These plans are offered by select private companies and there are two ways they can be purchased:
How Prescription Drug Plans Work
Prescription drug plans cover a variety of brand-name and generic prescription drugs. These plans have different premiums, deductibles, and copayments that you pay in addition to your Original Medicare premium and any other premiums depending on the plan that you may choose. Every plan also has its own list of covered prescription drugs called a formulary, which lists those drugs that are covered as well as its own network of participating pharmacies.
Appointment Checklist
It is important to make sure you bring the correct information to your appointment so one of our licensed agents at Lourie Life & Health can help you determine the right option based on your needs and budget. Please bring the following information and documents to your appointment:
Checklist
We offer in-person and over-the-phone services for your Medicare questions.