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Medicare Planning, Life Insurance Planning and Senior Health Specialists

Understanding Your Medicare Options

Your Medicare Costs

The standard Part B premium amount in 2023 is $164.90. Most people will pay the standard Part B premium amount.

If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you'll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.

Welcome Medicare & You

Your Medicare Costs. The standard Part B premium amount in 2023 is $164.90. Most people will pay the standard Part B premium amount.

What are the Parts of Medicare?

Your Medicare Costs

The standard Part B premium amount in 2023 is $164.90. Most people will pay the standard Part B premium amount.

Part A - How Does it Work?

Medicare Part B deductible & coinsurance In 2023, you pay $164.90 for your Part B deductible. After you meet your deductible for the year, you typically pay 20% of the Medicare-approved amount for these: Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.

Part B How Does it Work?

What's not covered by Part A & Part B?

Medicare doesn't cover everything. Some of the items and services Medicare doesn't cover include:
Long-Term Care (also called custodial care) See What is Long Term Care Long Term Care on this website?

What is Not Covered

Medicare Annual Enrollment Period

You must have Medicare before you can enroll in a Medicare Advantage Plan or Drug plan (Part D). Outside Open Enrollment (October 15 - December 7) you can enroll only during specific times, like your Initial Enrollment Period or a Special Enrollment Period.

Annual Enrollment Period

What is Medicare Advantage? Medicare Advantage plans are sometimes called Medicare Part C plans. These are private insurance plans offered by major insurance companies. The Medicare system pays these private insurance companies to offer these plans. The companies, in turn, provide you with benefits. What does a Medicare Advantage Plan cover?

What is Medicare Part C?

What is Medicare Advantage? Medicare Advantage plans are sometimes called Medicare Part C plans. These are private insurance plans offered by major insurance companies. The Medicare system pays these private insurance companies to offer these plans. The companies, in turn, provide you with benefits.

Medicare Advantage Explained

Health Maintenance Organization (HMO)
In HMO Plans, you generally must get your care and services from providers in the plan's network, except:
Emergency care
Out-of-area urgent care
Out-of-area dialysis
In some plans, you may be able to go out-of-network for certain services. But, it usually costs less if you get your care from a network provider. This is called an HMO with a point-of-service (POS) option. Find and compare HMO Plans in your area.

What is a Medicare HMO?

Private Fee-for-Service (PFFS) Plans

A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medi-gap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

Private Fee for Services Option

Special Needs Program

Eligibility- You can join a Medicare SNP if you meet these requirements:

You have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) .

Special Needs & Medicare

What is Medicare Part D & Penalty?

Medicare drug coverage (Part D)

How does Medicare drug coverage work? Medicare drug coverage helps pay for prescription drugs you need. Even if you don’t take prescription drugs now, you should consider getting Medicare drug coverage.

Medicare Part D (Rx)

Sus costos de Medicare El monto estándar de la prima de la Parte B en 2022 es de $ 170.10. La mayoría de las personas pagarán el monto de la prima estándar de la Parte B. Si su ingreso bruto ajustado modificado según lo informado en su declaración de impuestos del IRS de hace 2 años está por encima de una cierta cantidad, pagará el monto de la prima estándar y un Monto de ajuste mensual relacionado con los ingresos (IRMAA). IRMAA es un cargo adicional agregado a su prima.

Spanish - Part A

Medicare Part B Deducible y coseguro de la Parte B
En 2022, paga $ 233 por su deducible de la Parte B. Después de alcanzar su deducible para el año, generalmente paga el 20% del monto aprobado por Medicare por estos:
Servicios médicamente necesarios: servicios o suministros necesarios para diagnosticar o tratar su afección médica y que cumplen con los estándares aceptados de la práctica médica.
Servicios preventivos: atención médica para prevenir enfermedades (como la gripe) o detectarlas en una etapa temprana, cuando es más probable que el tratamiento funcione mejor.

La Parte B cubre cosas como:
Investigación clínica
Servicios de ambulancia
Equipo médico duradero (DME)
Salud mental
Paciente interno
Paciente externo
Hospitalización parcial
Obtener una segunda opinión antes de la cirugía
Medicamentos recetados para pacientes ambulatorios limitados

Spanish - Part B

Lo que no está cubierto por la Parte A o la Parte B de Medicare

What's Not Covered

Medicare no cubre todo. Si necesita ciertos servicios que Medicare no cubre, deberá pagarlos usted mismo a menos que:

Tienes otro seguro que los cubre
Tiene un plan de salud de Medicare que los cubre
Incluso si Medicare cubre un servicio o artículo, generalmente debe pagar su deducible, coseguro y copago.
Algunos de los artículos y servicios que Medicare no cubre incluyen:
Cuidado a largo plazo (también llamado cuidado de custodia)
La mayoría de los cuidados dentales
Exámenes de la vista relacionados con la prescripción de anteojos
Dentadura postiza
Cirugía cosmética
Acupuntura
Audífonos y exámenes para adaptarlos.
Cuidado de rutina de los pies

Spanish - What's Not Covered?

Hay 2 formas principales de obtener su cobertura de Medicare.

Medicare Original & Medicare Advantage.

Medicare Original incluye seguro hospitalario (Parte A) y médico (Parte B). Si desea cobertura de medicamentos, puede agregar un plan de medicamentos por separado (Parte D).

Spanish - Original/Advantage.

Medicare Part D Prescriptions Drugs

Part D

La cobertura de medicamentos recetados de Medicare es un beneficio opcional. Medicare ofrece cobertura de medicamentos recetados a todas las personas que tienen Medicare. Si decide no obtener la cobertura de medicamentos de Medicare cuando es elegible por primera vez, es probable que pague una multa por inscripción tardía si se inscribe más tarde, a menos que se aplique una de las siguientes:

Spanish - Part D

Medicare Advantage Parte C

Medicare Advantage es una alternativa “todo en uno” a Original Medicare. Estos planes "combinados" incluyen la Parte A, la Parte B y, por lo general, la Parte D.

Descripción - Medicare Advantage

Spanish - Medicare Advantage

Período de inscripción anual de Medicare

Debe tener Medicare antes de poder inscribirse en un plan Medicare Advantage o un plan de medicamentos (Parte D). Fuera de la Inscripción abierta (del 15 de octubre al 7 de diciembre), puede inscribirse solo durante momentos específicos, como su Período de inscripción inicial o un Período de inscripción especial.

Spanish - Annual Enrollment

Medigap policies are standardized

Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as "Medicare Supplement Insurance." Insurance companies can sell you only a "standardized" policy identified in most states by letters.

All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs.

Supplement Insurance Plans

Medicare is a U.S. government-sponsored health insurance program primarily designed to provide medical coverage for individuals aged 65 and older, as well as certain younger individuals with disabilities. Medicare coverage is generally limited to medical services received within the United States and its territories. Therefore, the standard Medicare plans (Part A and Part B) do not typically provide coverage for medical services obtained outside the United States.

Traveling Abroad

Medicare primarily covers medically necessary services that are considered skilled care and are provided by trained medical professionals. This includes services such as hospital care, doctor visits, skilled nursing care, home health care, and some hospice care.

Medicare Part A might cover a limited stay in a skilled nursing facility (SNF) under specific conditions, but only for a short period of time and under strict eligibility criteria.

Long Term Care Benefits

Medicare does provide coverage for certain types of in-home care, but the coverage is limited and comes with specific eligibility criteria. Here's what you need to know: Home Health Care Services: Medicare Part A and Part B may cover home health care services if the following conditions are met: A doctor certifies that you're homebound, meaning it's difficult for you to leave your home without assistance due to a medical condition.

Home Care Benefits

Crystal Clear Insurance

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