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 who are eligible for Social Security Retirement Insurance (having earned at least 40 quarters of Social Security coverage), and disabled persons who have received Social Security Disability Insurance (SSDI) for 24 months are eligible for Medicare. Individuals who have Lou Gehrig’s disease can receive Medicare immediately upon approval of SSDI. Individuals who have been diagnosed with End Stage Renal Disease can be receive Medicare without a determination of disability.

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, and those with 40 quarters of coverage (in 2017 individuals can purchase Part A coverage for $413 per month (with less than 30 quarters) or $227 (between 30-39 quarters). The deductible for 2017 is $1,316 per 60-day benefit period.

Learn more about Original Medicare (Parts A & B)
Part B pays for doctor’s visits and related costs, and premiums are means-tested, so can range from $104.90 to $428.60 per month in 2017. The premium will vary depending on whether the individual is receiving Social Security benefits (and benefits from a “hold harmless” protection from high medical inflation) and whether the individual and/or their spouse is a high earner (subject to an Income Related Monthly Adjustment Amount). The Medicare Part B deductible is $183 in 2017.

Learn more about Original Medicare (Parts A & B)
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 the Advantage plan.

Learn more about Medicare Advantage (Part C)
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. Part D plans are potentially subject to Income Related Monthly Adjustment Amounts over and above the plan premium, paid directly to Medicare or deducted from a Social Security benefit.

Learn more about Medicare Prescription Drug Plans (Part D) Learn more about Extra Help With Prescription Drug Costs (Low Income Subsidy)
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.

Learn more about Medicare Supplements (MediGap)

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).