What Is Medicare?
Medicare is a government run health insurance program for seniors age 65 and older, those under 65 with certain disabilities, and those with end-stage renal disease.
What Is the Difference Between Medicare and Medicaid?
- This is a federal insurance program for individuals older than 65 — or younger than 65 if you have a disability
- Participants may pay small monthly premiums for non-hospital coverage
- Fairly standard across the United States
- This is an assistance program for low-income individuals of all ages
- There is usually no cost for covered medical expenses — though a small copayment is sometimes required
- Program varies from state to state
What You Need to Know About Medicare in Denver, Colorado
Participation in this health care plan for seniors is essentially mandatory if you want to have health insurance. While you can, and probably should, have additional private insurance, you must enroll in Medicare in order for supplemental insurance to take effect.
When you turn 65, Medicare becomes the primary insurance/payer. Under Original Medicare, any private insurance you may have is secondary and will not pay until Medicare has paid its share. The only insurance that remains primary to Medicare is employer group coverage that covers 20 or more employees.
What Does Medicare Cover?
There are several parts to Medicare. Whether you are in Denver, Colorado or Dallas Texas, it is important to understand what is covered so you can make the most informed decisions as you approach this stage of your life.
- Part A covers part of the cost of hospitalizations.
- Part B covers part of the cost of doctor visits and other health care services.
- Part C are Medicare Advantage plans sold by private insurance companies and take the place of Original Medicare (Parts A & B).
- Part D covers part of the cost of prescription drugs and is offered through private insurers.
What is NOT Covered by Medicare?
- Long-term care
- Cosmetic Surgery
- Eye examinations related to prescription glasses
- Hearing aids and exams for fitment
- Routine foot care
- Most dental care
Who Is Eligible for Medicare?
Medicare is available for people aged 65 or older, and younger people with disabilities. It also comes in two parts: A is hospital insurance and B is medicare insurance
Eligibility for premium-free Medicare Part A
- 65 or older
- Receiving retirement benefits from Social Security
- Eligible for Social Security but haven’t filed yet
You can buy Part A coverage if you don’t qualify for it.
Eligibility for Medicare Part B
- 65 years or older
A U.S. citizen or permanent resident lawfully living within the country for at least five continuous years
How Much Does Medicare Cost?
Some people think Medicare is free health insurance for seniors. This is not true. Our Medicare planning team in Denver, Colorado can help you understand all you need to know regarding the costs of the program.
You may not have to pay premiums for Part A, but that’s because you or your spouse already paid into the system through Medicare taxes for at least 10 years. When people think “free” they are referring to the monthly premiums. If you are hospitalized, you will still pay a deductible before Medicare pays its share. If your hospitalization lasts for more than 60 days, you will be responsible for paying part of the daily rate.
Part B is not free, except for those who qualify for low-income special assistance. If you are receiving Social Security benefits, Medicare will deduct your monthly premium from your check. If you haven’t started receiving Social Security yet, you will get a bill from Medicare for the premiums. High-income individuals pay an extra amount on top of the base premium. In addition to the monthly premium, there is an annual deductible that you or your supplemental insurance must pay before Medicare pays its share. Medicare pays only part of the bill, you or your other insurance pays the remaining amount.There is also no limit to the out-of-pocket expenses you could pay under Original Medicare. According to the Employee Benefit Research Institute, Original Medicare (Part A & B) only covers about 62% of the cost of healthcare services. This is why having supplemental insurance is critical. We have experienced professionals in this field in Denver, CO to help guide you through the process. Medicare planning services can save you stress and money.
How to Enroll in Medicare
Some individuals think enrollment in Medicare is automatic. This is only true if you are receiving Social Security when you turn 65 (applying only to Part A and Part B.) If you are not receiving Social Security, you will need to proactively sign up for Medicare three months before your 65th birthday. You can enroll through the Social Security Administration by calling or going online to www.medicare.gov
If you don’t enroll in Medicare during the appropriate enrollment periods, you may have to pay a late enrollment penalty when you finally do enroll. This late enrollment penalty increases your monthly Part B premium for life.
Choosing the Right Medicare Plan for You
You have several options, depending on where you live. You can:
- Elect Original Medicare.
- Elect Original Medicare and add drug coverage with a Medicare Part D prescription drug plan.
- Substitute a private Medicare Advantage plan for Original Medicare.
- Substitute a private Medicare Advantage plan that also includes Medicare Part D prescription drug coverage in place of Original Medicare.
- Elect Original Medicare, add a Medicare Supplement insurance plan to pay for any gaps in coverage and add coverage with a Medicare Part D prescription drug plan.
How We Can Help
Our team can provide professional Medicare Planning Services in Denver, Colorado to help you meet your health care needs. Our Medicare experts shop the marketplace to find the best plan for your needs, at the lowest possible cost. Determining which Medicare plan is right for you can be difficult but with the help of our Medicare consultancy services, finding the right senior health care plan is made easy. Discover the Dechtman difference by talking with an advisor today.