Medicare

So, You Received Your Medicare Card, Now What?
Has Medicare Confusion Set In With All The Mailers?
Do You Wish You Had Someone To Cut Through The Clutter?

If you are having these questions, you are not alone. For over 20 years, Al Crouse and Associates has assisted individual Medicare beneficiaries from all across North Carolina in selecting a Medicare health plan that best suits their needs. We offer Medicare Supplements and Medicare Advantages from multiple companies that we represent. We have been recognized by multiple insurance carriers for outstanding sales and service achievements. If you would like to be contacted by us, please complete the Request For More Information, and one of our licensed health agents will contact you. We pride ourselves in not engaging in high pressure sales tactics, and truly working with you in selecting a Medicare health plan that suits your needs.

In the meantime, please see the Medicare information below that may be helpful to answer some of your questions.

The A, B, C and D’s of Medicare

What is Medicare?

  • Medicare is a federal insurance program established in 1965
  • Administered by CMS (Centers For Medicare/Medicaid Services)
  • Eligible at age 65 and under age 65 for beneficiaries with certain disabilities and ESRD
  • Do not have to be receiving Social Security Retirement Income to be eligible if over age 65
  • If under 65 and qualify for Social Security Disability Income, eligible after 29 months (Elimination Period of 5 months, 24 months of receiving Social Security Disability Income)
  • Exception if ESRD (End Stage Renal Failure)

What Are The 4 Parts Of Medicare?

  • Medicare Part A Hospital
  • Medicare Part B Medical
  • Medicare Part C Medicare Advantage
  • Medicare Part D Prescriptions

Medicare Part A

  • Generally Premium Free-No Cost
  • Covers Hospitalization
  • 2022 Part A Deductible $ 1556 – 60 Days
  • Days 61-90 $ 389 Per Day
  • Days 91+ $ 778 Per Day (60 Lifetime Reserve)
  • Covers Skilled Nursing
  • 1-20 Days 100%
  • 21-100 Days All But $ 194.50 Per Day
  • Covers Hospice Care

Medicare Part B

  • 2022 Standard Premium $ 170.10
  • Covers Office Visits, Outpatient Surgeries and Procedures, Diagnostic
  • Tests, Durable Medical Equipment, Chemotherapy Infusions
  • 2022 Part B Deductible $ 233
  • Pays 80% After Deductible-No Cap On Out-of-Pocket Expense

Medicare Part C

  • Established in 1997
  • Commonly Referred As Medicare Advantage Plans
  • Sold By Private Insurance Companies Contracted By Medicare
  • Combine Medicare Part A, Medicare Part B, and Typically Medicare Part D
  • Can Offer Additional Benefits-Dental, Vision, Hearing, OTC Items
  • HMO and PPO Product Offerings-Network Based
  • Co-Pays For Utilized Services Similar to Employer Group Insurance
  • Contain Out-of-Pocket Maximums

Medicare Part D

  • Implemented in 2006
  • Medicare Part D Plans Are Offered By Private Insurance Companies
  • Contracted By Medicare
  • Can Be Offered As a Standalone Plan or in a Medicare Advantage Plan
  • Part D Plans May Contain A Deductible
  • 2022 Coverage Gap (Donut hole) Limit $4430-Then Pay 25%

Medicare Pathways

Option 1 Medicare Supplements

  • Original Medicare Part A and Part B As Primary Insurance-Paired With A Medicare Supplement- And A Standalone Part D Plan
  • Medicare Supplement Also Referred as Medi-Gap Coverage-Covers
  • Deductibles and 20% Co-Insurance
  • Typically Has A Higher Monthly Premium But Lower Out-of-Pocket
  • Costs For Utilized Services
  • No Network Restriction

Option 2 Medicare Advantage

  • Combines Medicare A, B, and Typically D Benefits In An All-In-One Plan
  • Purchased From Private Insurance Company
  • Over 26 Million Beneficiaries Enrolled Nationwide
  • Beneficiaries Do Not Present Original Medicare Card For Services-Only The Carrier ID
  • Pay Co-Pays and Coinsurance Until Out-of-Pocket is Met
  • Network Based Plans Similar To Employer Group Health Plans
  • Offer Additional Benefits Not Offered By Medicare-Dental Vision Hearing etc

Medicare Enrollment Timelines

Medicare Part A and Medicare Part B

  • Initial Enrollment Period- 7 Month Window With Age 65 Centered- 3 Months Before, Month Turn Age 65, And 3 Months After
  • If Receiving Social Security Retirement Income-Enrolled Automatically-Usually Receive Medicare Card 90 Days Before Turn Age 65
  • If Not Receiving Social Security Retirement Income-Enroll Online At www.ssa.gov – Do Not Have To Enroll In Social Security Income To Receive Medicare

Delayed Medicare Part B Enrollment

  • Can Waiver Medicare Part B If You or Spouse Are Actively Working And Enrolled On Group Insurance
  • Can Elect Medicare Part B At A Later Date Without Penalties If Above Criteria Is Met
  • Enroll In Delayed Medicare Part B By Having An Employment Verification Form Completed By Employer And Submit To Local Social Security Office Along With A Form 40B
  • Recommend Starting Delayed Medicare Part B Enrollment Process 45 Days Ahead And Having Medicare Health Plan Coincide With Medicare Part B Start Date

Medicare Part C and Medicare Part D

  • Initial Election Period- Same as Medicare Part B centered around Age 65
  • Under Age 65- Enrollment thru the 28th month of receiving SSDI
  • Yearly Election- Annual Enrollment Period Oct 15th to Dec 7th
  • Special Enrollment- Loss of Employer Group Health Plan, Move, etc.

Resource Documents To Assist You

  • Medicare and You This is the official U.S. government Medicare handbook.
  • Choosing a Medigap Policy A Guide to Health Insurance for People with Medicare. Published by the Centers for Medicaid and Medicare services and the National Association of Insurance Commissioners.
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