Health Wealth Protect LLC

Medicare is a federal health insurance program for people 65+ and certain individuals under 65 with qualifying conditions. While most people know the basics, the different parts of Medicare can quickly become overwhelming.

Here’s a simple breakdown:

Original Medicare (Parts A & B)

• Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing care, hospice, and some home health services.
• Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical equipment. Typically pays about 80% of approved costs.

Medicare Advantage (Part C)

• Offered by private insurance companies approved by Medicare
• Combines Part A and Part B
• Often includes extra benefits like prescription drug coverage, dental, or vision

Prescription Drug Coverage (Part D)

• Helps cover the cost of medications
• Offered through private insurance companies
• Can be added to Original Medicare or included in some Advantage plans

Medicare coverage includes premiums, deductibles, and out-of-pocket costs. Understanding these early helps you avoid surprises.

Part A Costs

• Usually no monthly premium if you’ve paid Medicare taxes
• Includes deductibles and coinsurance
• Covers hospital-related care, but not personal items or long-term custodial care

Part B Costs

• Standard monthly premium (varies based on income)
• Covers outpatient services, doctor visits, and preventive care
• Typically requires you to pay about 20% of approved services

Out-of-Pocket Expenses

• Deductibles, copays, and coinsurance apply
• Many people choose additional coverage (like supplements or Advantage plans) to reduce these costs

Enrollment Timing Matters

• Your Initial Enrollment Period lasts 7 months around your 65th birthday
• Delaying enrollment without qualifying coverage may result in lifelong penalties

Medicare does not automatically include prescription drug coverage, so you’ll need to choose how to get it.

Your Options

• Enroll in a standalone Part D plan
• Choose a Medicare Advantage plan that includes drug coverage

Costs to Know

• Monthly premiums vary by plan
• Plans may include deductibles and copays
• Costs depend on your medications and pharmacy network

Important Considerations

• Each plan has its own list of covered drugs (formulary)
• Some medications may require approval or step therapy
• Make sure your prescriptions and pharmacy are covered

Avoiding Penalties

• Enroll when first eligible, even if you don’t currently take medications
• If you delay without creditable coverage, penalties may apply long-term

Who Qualifies?

• Age 65 or older with a work history (or spouse’s) paying Medicare taxes
• Under 65 with certain disabilities or conditions like ESRD

Automatic Enrollment

• If you’re already receiving Social Security benefits, you’ll typically be enrolled automatically in Parts A and B

When to Enroll

• Initial Enrollment Period: 3 months before, the month of, and 3 months after your 65th birthday
• Special Enrollment Periods may apply if you have employer coverage or other qualifying situations

Why Timing Is Important

• Missing enrollment windows can lead to penalties and delayed coverage
• Planning ahead ensures your coverage starts when you need it

Choosing the right Medicare coverage depends on your doctors, prescriptions, and personal priorities. A one-size-fits-all approach doesn’t work.

Health Wealth Protect LLC provides clear, personalized guidance to help you make the right decision with confidence.

Call (505) 417-6565 to schedule your free consultation.