Medicare

What is Medicare? Who qualifies?
Medicare is the government financed health insurance program for seniors and others receiving Social Security benefits. All persons aged 65 and over are eligible for Social Security benefits, and disabled persons who have received Social Security for 24 months are eligible for Medicare. Individuals who have Lou Gehrig’s disease can receive Medicare immediately upon approval of Social Security Disability Insurance (SSDI).

How does Medicare work?
Medicare has four parts that cover different health care aspects.
Part A pays for hospital stays and other related services like home care, and is free to individuals entitled to Social Security (individuals with less than 30 quarters of Social Security coverage can purchase Part A coverage for $407 per month in 2015 or $224 if the individual has between 30-39 quarters). The deductible for 2015 is $1,260 per 60-day benefit period.
Part B pays for doctor’s visits and related costs, and premiums are means-tested, so can range from $104.90 to $335.70 per month in 2015. The deductible is $147 in 2015.
Part C is Medicare Advantage, a program where individuals can opt to receive the same benefits as Part A and B and possibly additional benefits through private companies. These can be various types of insurance, including HMOs, PPOs, SNPs, PFFS or PACE. Subscribers must continue to pay the Part B premium, and possibly an extra premium for Advantage plans.
Part D is Medicare’s prescription drug coverage, which can be offered through a Medicare Advantage plan or through a stand-alone plan. Premiums are variable, though assistance is available with premiums and deductibles for low-income persons. Individuals who do not enroll in a Part D plan when eligible will be subject to the Late Enrollment Penalty on premiums should they later sign up for Part D coverage.

Additional coverage is available in the form of Medicare Supplemental Insurance (also known as Medigap policies). These are plans offered by private companies to provide additional benefits including original Medicare deductible and coinsurance coverage, and other benefits. These plans are standardized into Plans A, B, C, D, F, G, K, L, M and N. The factors in choosing supplemental insurance may then largely rely on cost and reputation of the company.

For more in depth information on Medicare topics, please select from the list below. Counselors are available at 303-333-3482 to help with education, enrollment, problems and appeals.You may also find helpful information at Medicare’s official site, at the Centers for Medicare and Medicaid Services (CMS), or from Colorado’s Senior Health Insurance assistance Program (SHIP).

Original Medicare (Parts A and B)

What do we mean by ‘Original’ Medicare? Medicare Parts A and B, together often colloquially known as Original Medicare or Straight Medicare, are the direct government insurance most people think of when they think of Medicare. Together they provide hospitalization and medical services coverage, including doctor’s visits, screenings, emergency room care, surgery, medical supplies and equipment, home care, skilled nursing ...

Medicare Advantage (Part C)

What are Medicare Advantage Plans? Though it is a different ‘part’ of Medicare, Part C or Medicare Advantage is a method for beneficiaries to receive their standard Medicare benefits (Parts A and B) through a private carrier, possibly with additional benefits and/or costs. The federal government pays each Advantage plan a monthly amount to provide the same care as Original ...

Medicare Prescription Drug Coverage (Part D)

What is Part D? Part D is how Medicare provides prescription drug coverage to Medicare beneficiaries. Coverage is provided solely through private insurance carriers, and is available as a stand-alone prescription drug plan (PDP) or as part of a Medicare Advantage Plan. Coverage is available for generic and name-brand drugs under a formulary. Plans are not allowed to discontinue coverage ...

Medicare Supplements (Medigap)

Medicare Supplemental Insurance policies (also known as Medigap policies) are sold by private insurance carriers in order to complement Original Medicare or Medicare Advantage and offer coverage for other treatments and services not approved by Medicare. These policies are regulated by federal and state governments, and must be offered in standardized form. Eleven plans can be offered, but all carriers ...

Medicare Extra Help for Low Income Persons

For individuals who receive Part D prescription drug coverage and are low-income, there is assistance available for the costs of deductibles and co-pays. This Extra Help is also known as the Low Income Subsidy (or LIS). Who is eligible? To receive Extra Help, persons must be eligible for Medicare Part D and have income less than 100% of the Federal ...