MEDICARE ADVANTAGE PLAN

How Medicare Works.

WE'RE HERE TO HELP

Choosing the right Medicare plan can be stressful. We are here to offer the best solutions for you. The medicare maze is confusing especially with all the items you receive in the mail, phone calls, and the advertisements you see on television. Let us help you navigate through the in's and out's of Medicare.

Most people become eligible for Medicare when turning 65. If you are already taking Social Security benefits when you turn 65, then you automatically get Part A and Part B starting the first day of the month you turn 65 (if your birthday is on the first day of the month, Part A and B will start the first day of the prior month). You'll get your Medicare card in the mail 3 months before your 65th birthday.  If you are not receiving retirement benefits from Social Security or the RRB, you must enroll to get Medicare.  Some people who are under 65 become eligible for Medicare on the basis of disability.  If you are under 65 and disabled, you will automatically get Part A and B after receiving disability benefits from Social Security or certain disability benefits from the RRB for 24 months.  You'll get your Medicare card in the mail 3 months before your 25th month of disability benefits.  If you have ALS (Lou Gehrig's disease), you'll get Part A and B automatically the month your Social Security disability benefits begin.  If you have End-Stage Renal Disease (ESRD) and you want Medicare, you'll need to sign up.

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PART A - HOSPITAL INSURANCE

Part A covers hospitalization (after a deductible), some inpatient care in skilled nursing facilities, hospice, and other inpatient needs. Some home health care is also covered by Part A.

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PART B - MEDICAL INSURANCE

Some of the benefits of Part B are medically necessary doctor services, outpatient surgery, physical therapy, home health care, medical equipment, and other medically necessary benefits.

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PART C - MEDICARE ADVANTAGE PLAN

These plans are provided through private insurance companies approved by Medicare. These plans may provide additional benefits than found in Original Medicare with low premiums and co-pays. For example, additional benefits may include coverage for a comprehensive routine annual physical exams, dental, vision, routine foot care, and gym memberships. Plans include an out-of-pocket annual maximum to protect a person from catastrophic illness. Medicare Advantage plans are available with and without prescription drug coverage, Part D.

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PART D - PRESCRIPTION COVERAGE

Part D of Medicare provides outpatient prescription drug coverage. It can be purchased as a standalone program with a separate premium or can be included in a Medicare Advantage plan. Plans are offered by private insurance companies and vary in price and benefit design. The drugs included on their approved drug list called formularies are subject to minimum federal requirements. You can choose from many options to find the drug plan that is best suited to your needs.

WE'RE HERE TO HELP

Choosing the right Medicare plan can be stressful. We are here to offer the best solutions for you. The medicare maze is confusing especially with all the items you receive in the mail, phone calls, and the advertisements you see on television. Let us help you navigate through the in's and out's of Medicare.

Most people become eligible for Medicare when turning 65. If you are already taking Social Security benefits when you turn 65, then you automatically get Part A and Part B starting the first day of the month you turn 65 (if your birthday is on the first day of the month, Part A and B will start the first day of the prior month). You'll get your Medicare card in the mail 3 months before your 65th birthday.  If you are not receiving retirement benefits from Social Security or the RRB, you must enroll to get Medicare.  Some people who are under 65 become eligible for Medicare on the basis of disability.  If you are under 65 and disabled, you will automatically get Part A and B after receiving disability benefits from Social Security or certain disability benefits from the RRB for 24 months.  You'll get your Medicare card in the mail 3 months before your 25th month of disability benefits.  If you have ALS (Lou Gehrig's disease), you'll get Part A and B automatically the month your Social Security disability benefits begin.  If you have End-Stage Renal Disease (ESRD) and you want Medicare, you'll need to sign up.

MOUNTAIN MEDICARE OFFERS INDIVIDUALIZED SOLUTIONS, EDUCATION, AND PRODUCTS FOR MEDICARE BENEFICIARIES. QUALITY COVERAGE, PERSONALIZED SERVICE, AND HIGHLY TRAINED STAFF.

ORIGINAL MEDICARE CONSISTS OF PART A (HOSPITAL COVERAGE) AND PART B (PHYSICIAN COVERAGE).

Part A:  Most people get premium-free Part A. If you buy Part A, you’ll pay a monthly premium. You pay a $1,556 inpatient hospital deductible for each benefit period. A benefit period begins the day you’re admitted and ends when you haven’t received any inpatient hospital care for 60 days in a row. If you go into a hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.

Part B:  Each year the Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023, a decrease of $5.20 from $170.10 in 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from the annual deductible of $233. Once the deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services.There’s no limit for what you pay out-of-pocket.

Part D:  Medicare Prescription Drug Plans (PDPs) add drug coverage to Original Medicare. To get Medicare prescription drug coverage, you must join a plan offered by a Medicare-approved private insurance company. If you don’t join a Medicare Prescription Plan when you are first eligible, you may have to pay a late enrollment penalty. Each plan can vary in cost and specific drugs covered, but the deductible cannot exceed $505 for 2023 from $480. Some plans may not have a deductible.

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“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”