Proud to Offer Medicare Plans & Guidance Upstate NY & the Greater Capital Region
Medicare is a federal government health insurance program for those 65 and older, with disabilities, or people who require dialysis or a kidney transplant due to permanent kidney failure. Just like Social Security, Medicare is a tax entitlement program you contribute a small sum of money to for a minimum amount of time.
There are four components or “parts” to Medicare. Our qualified staff will work with you to explore all that Medicare has to offer.
Part A of Medicare covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Most people are eligible for Medicare when they turn 65. You can qualify for Part A before 65 years of age if you have a disability, End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). In order to receive all of the benefits, you must have been born in the United States or at least a citizen for five consecutive years. Part A is free to those who have paid into Medicare taxes for 40 full quarters.
Part B covers medical services and supplies. This includes doctor’s visits, outpatient care, preventative care, and more. In order to receive Part B benefits, you will need to sign up during your Initial Enrollment Period or (IEP). The premium is typically deducted from your Social Security check. If you aren’t collecting Social security yet you will have to pay your premium directly. Medicaid, and other government assistance programs may cover your Part B premium if you have a lower income.
Part C (Medicare Advantage) is administered by private health insurance companies and includes all benefits of Parts A and B, as well as some additional benefits original Medicare doesn’t offer. You must have Parts A and B in order to join a Medicare Advantage Plan. By having a Medicare Advantage Plan your claims and Medicare coverage is through the plan instead of original Medicare. You may pay a monthly premium to the health insurance company for a Part C plan and must continue to pay your part b premium. Many Part C plans include Part D coverage. Medicare Advantage comes in the form of HMO, PPO, PFFS, SNP. And MSA.
Part D is the prescription drug benefit of Medicare. It is offered by private companies and is often included in a part c plan or can be obtained with a stand-alone part d plan. Each part d plan varies in cost and specific drugs covered. You must have Parts A and/or B to join a Part D plan.
Medicare Supplement (Medigap)
Medicare Supplements are offered by private companies at an additional premium to help fill the deductibles and coinsurance with Original Medicare. Supplements act as a secondary payor to your original Medicare benefits and cannot be paired with a Part c plan. Many people join a stand-alone Part D plan for prescription drug coverage. You must have both Parts A and B of Medicare to join a Medicare supplement.