Learn About Medicare

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Medicare Part A:

1. Hospital Insurance: Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
2. Inpatient Hospital Care: Includes semi-private rooms, meals, general nursing, and other hospital services and supplies.
3. Skilled Nursing Facility Care: Covers care in a skilled nursing facility that's certified by Medicare.
4. Hospice Care: Provides for services like doctor services, nursing care, medical equipment, and hospice aide and respite care for terminal illness.

Medicare Part B:

1. Medical Insurance: Covers outpatient care, doctor visits, preventive services, and medical supplies.
2. Doctor Visits: Includes visits to doctors and other health care providers.
3. Outpatient Care: Covers services like lab tests, X-rays, outpatient surgeries, and durable medical equipment (DME).
4. Preventive Services: Includes services like flu shots, screenings (e.g., for cancer, diabetes, and cardiovascular disease), and annual wellness visits.
5. Some Home Health Care: Covers certain medically necessary services like part-time skilled nursing care, physical therapy, and speech-language pathology services.

It's important to note that Medicare Part A is generally premium-free for most people who have worked and paid Medicare taxes for a sufficient duration. Medicare Part B requires a monthly premium, which is income-based.

 Medicare Part A (Hospital Insurance):

• Premium: For most people, Part A is premium-free if you or your spouse paid Medicare taxes while working.
• Deductibles: The inpatient hospital deductible in 2024 is $1632 per benefit period.

Medicare Part B (Medical Insurance):

• Premium: The standard premium amount is $174.70 per month in 2024, but this can vary depending on your income.
• Deductible: You must pay an annual deductible of $240 before Medicare starts to pay its share.
• Co-insurance/Co-payment: Generally, you pay 20% of the Medicare-approved amount for most doctor services, outpatient hospital services, and durable medical equipment.

 If you have Part A and Part B, you can join a Medicare Advantage Plan, sometimes called “Part C”. This type of Medicare health plan is offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). 

Insurance companies can decide if a plan will be available to everyone with Medicare in a state, or only in certain counties. Insurance companies may also offer more than one plan in an area, with different benefits and costs. Each year, insurance companies can decide to join or leave Medicare. 

Each year, plans set the amounts they charge for premiums, deductibles, and services. The plan (rather than Medicare) decides how much you pay for the covered services you get. What you pay the plan can only change once a year, on January 1. 

There’s no yearly limit on what you pay out of pocket under original Medicare. Medicare Advantage Plans have a yearly limit on what you pay out of pocket. Once you reach your plan's limit, you'll pay nothing for covered services for the rest of the year.

Plans must cover all medically necessary services that Original Medicare covers. Plans may also offer some extra benefits that Original Medicare doesn’t cover— like certain vision, hearing, and dental services. 

In many cases, you can only use doctors and other providers who are in the plan’s network and service area (for non-emergency care).

Call 702-660-0056 to discuss Medicare Advantage Plan options in your area.

Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare.  

All Medigap policies are standardized. This means, policies with the same letter offer the same basic benefits no matter where you live or which insurance company you buy the policy from. There are 10 different types of Medigap plans offered in most states, which are named by letters: A-D, F, G, and K-N. Price is the only difference between plans with the same letter that are sold by different insurance companies. 

Medigap doesn’t cover everything. Medigap plans generally don’t cover:

• Vision or dental care
• Hearing aids
• Eyeglasses

Call 702-660-0056 to discuss Medicare Supplement options in your area.

 All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes. A plan’s list of covered drugs is called a “formulary,” and each plan has its own formulary. Medicare drug coverage typically places drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier. 

Under Original Medicare and Medigap policies, Prescription Drug Plans must be purchased separately. Most Medicare Advantage Plans include drug coverage.

There is a late enrollment penalty that can be added to your Medicare drug coverage (Part D) premium. You may have to pay a late enrollment penalty if at any time after your Initial Enrollment Period is over, there's a period of 63 or more days in a row when you don't have Medicare drug coverage or other creditable prescription drug coverage. You’ll generally have to pay the penalty for as long as you have Medicare drug coverage. 

Don't wait and risk any penalties. Call 702-660-0056 to speak to an agent about Prescription Drug Plans in your area.

Original Medicare doesn’t cover some benefits like eye exams, most dental care, and routine exams. Stand alone dental, hearing, or vision plans can be purchased separately. 

Medicare advantage plans may offer some extra benefits that Original Medicare doesn't cover - like certain vision, hearing, and dental services.