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Introduction to Medicare

Our mission at Copeland Insurance Group for our beneficiary’s health insurance customers is simple: “To help Medicare and Medicaid Beneficiaries get the most from their healthcare”.

Helping people in the community is exactly what we do. Since 1962 we have helped thousands of people just like you not only make sense of the confusing subject of “Medicare" and "insurance”, but figure out ways to save money in the process. We have offices across the USA with representatives in almost every state to help you and your family.

Please take the opportunity to get to know us. Let our years of experience help you today. Let our experience work for you.

Medicare 101

As a federal health insurance program, Medicare stands out among the examples of successful social programs if for no other reason than the fact that it has survived for the past five decades with few significant modifications. To understand how Medicare affects your life as an American citizen, you need to appreciate that the program was an unprecedented measure in its day. Today, it continues to fulfill a vital need for senior citizens and those with certain disabilities or illnesses.

Original Medicare is coverage managed by the federal government. Generally, there's a cost for each service. Here are the general rules for how it works:

Factors that affect Original Medicare out-of-pocket costs

  • Whether you have Part A and/or Part B. Most people have both.
  • Whether your doctor, other healthcare provider, or supplier accepts assignment.
  • The type of healthcare you need and how often you need it.
  • Whether you choose to get services or supplies Medicare doesn't cover. If you do, you pay all the costs unless you have other insurance that covers it.
  • Whether you have other health insurance that works with Medicare.
  • Whether you have Medicaid or get state help paying your Medicare costs.
  • Whether you have a Medicare Supplement Insurance (Medigap) policy.
  • Whether you and your doctor or other healthcare provider sign a private contract.

The different parts of Medicare help cover specific services:


Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home healthcare.


Medicare Part B (Medical Insurance)

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.


Medicare Part C (Medicare Advantage Plans)

A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.


Medicare Part D (Prescription Drug Coverage)

Part D adds prescription drug coverage to Original Medicare.


NAVIGATING MEDICARE OPTIONS
START HERE

STEP 1: Decide how you want to get your coverage.

Original Medicare

Part A (Hospital Insurance)

AND
/OR

Part B (Medical Insurance)

STEP 2: Decide if you need to add drug coverage.

Part D
(Medicare Prescription Drug Coverage)

You can have Part A and/or Part B to get this coverage.

STEP 3: Decide if you need to add supplemental coverage.

Medicare Supplement Insurance (Medigap) Policy
You must have Part A and Part B to buy a Medigap policy.

Medicare Advantage (Part C)

Part A (Hospital Insurance)

AND

Part B (Medical Insurance)

STEP 2: Decide if you need to add drug coverage.

Part D
(Most Medicare Advantage Plans cover prescription drugs. You may be able to add drug coverage in some plan types if not already included.)

If you join a Medicare Advantage Plan, you can't use a can't be sold a Medigap policy.

Remember, Medicare plans can change each year.

Important Medicare Dates:

September & October – Review & Compare

  • Review: Your plan may change. Review any notices from your plan about changes for next year.
  • Compare: Starting in October, use Medicare’s Plan Finder to find a plan that meets your needs.

October 15 – Open Enrollment Begins

This is the one time of year when ALL people with Medicare can make changes to their health and prescription drug plans for the next year.

  • Decide: October 15 is the first day you can change your Medicare coverage for next year.

December 7 – Open Enrollment Ends

In most cases, December 7 is the last day you can change your Medicare coverage for next year. The plan must get your enrollment request (application) by December 7.

January 1 – Coverage Begins

Your new coverage begins January 1 if you switched to a new plan. If you stay with the same plan, any changes to coverage, benefits, or costs for the new year will begin on January 1.

What should I consider when choosing or changing my coverage?

Convenience

Where are the doctors' offices? What are their hours? Do the doctors use electronic health records or prescribe electronically? Which pharmacies can you use? Is the pharmacy you use in the plan's network?

Cost

How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you pay out-of-pocket? Your costs may vary and may be different if you don't follow the coverage rules.

Coverage

How well does the plan cover the services you need?

Doctor and Hospital Choice

Do your doctors and other healthcare providers accept the type of coverage you have? Are the doctors you want to see accepting new patients? Do you need to get referrals? Do you have to choose your hospital and healthcare providers from a network? If so, is your doctor in the network? Can you go outside of the network?

Prescription Drugs

Do you need to join a Medicare drug plan? Are your drugs covered under the plan's formulary? Are there any coverage rules that apply to your prescriptions (like prior authorization, step therapy, quantity limits, etc.)? Do you already have creditable prescription drug coverage (for example, through a current or former employer or union)?

Quality of Care

Are you satisfied with your medical card? The quality of care and services offered by plans and other healthcare providers can vary. Medicare has information to help you compare how well plans and providers work to give you the best care possible.

Travel

Will you have coverage in another state or outside the U.S.

Your Other Coverage

Do you have, or are you eligible for, other types of health or prescription drug coverage (like through a former or current employer or union)? If so, read the materials from your insurer or plan, or call them to find out how the coverage works with, or is affected by, Medicare. If you have coverage through a former or current employer or union or another source, talk to your benefits administrator, insurer, or plan before making changes to your coverage. If you drop your coverage, you may not be able to get it back.

Making Changes to your Coverage after January 1

Between January 1–February 14, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare, you’ll have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form. In certain cases, you may be able to make other changes if you qualify for a Special Enrollment Period.

How does my other insurance work with Medicare?

When you have other insurance and Medicare, there are rules for whether Medicare or your other insurance pays first.

If you have retiree insurance (insurance from your or your spouse's former employment)...

Medicare pays first.

If you're 65 or older, have group health plan coverage based on your or your spouse's current employment, and the employer has 20 or more employees...

Your group health plan pays first.

If you're 65 or older, have group health plan coverage based on your or your spouse's current employment, and the employer has fewer than 20 employees...

Medicare pays first.

If you're under 65 and disabled, have group health plan coverage based on your, a spouse's, or a family member's current employment, and the employer has 100 or more employees...

Your group health plan pays first.

If you're under 65 and disabled, have group health plan coverage based on your or a family member's current employment, and the employer has fewer than 100 employees...

Medicare pays first.

If you have Medicare because of End-Stage Renal Disease (ESRD)...

Your group health plan pays first for the first 30 months after you become eligible to enroll in Medicare. Medicare will pay first after this 30-month period.

All your Medicare Insurance Needs can be taken care of with one call

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