Understanding Medicare and finding the best option for you
Contact us today to discuss your specific question about Medicare and how we can help you utilize the best option for you.
What is Medicare, and when am I eligible?
Medicare is a health insurance program for individuals aged 65 and older, as well as for younger individuals with certain qualifying medical conditions or disabilities under government regulations.
If you don’t have a qualifying condition, you become eligible to apply for Medicare starting three months before your 65th birthday and up to three months after. If you have health insurance through an employer, you may choose to keep your existing coverage instead of enrolling in Medicare.
Understanding Medicare Advantage
Medicare Part A
Medicare Part A (Hospital Insurance) covers inpatient hospital care and some skilled nursing facility care.
Medicare Part B
Medicare Part B (Doctor and Outpatient Insurance) covers doctor visits, specialists, outpatient care, durable medical equipment, and preventive services like screenings, shots, vaccines, and annual wellness visits.
Medicare Part C
Medicare Part C (Medicare Advantage) plans are offered by private companies and bundle Parts A, B, and usually D. They may also include extra benefits like vision, hearing, and dental, which aren’t covered by Original Medicare.
Medicare Part D
Medicare Part D (Prescription Drug Coverage) is available to everyone with Medicare. To get this coverage, you must join a Medicare plan that offers it. While optional, enrollment by a certain deadline is required to avoid penalties added to your Original Medicare premium.
Three main Medicare options:
Original Medicare
Original Medicare is a federal health insurance program for people 65 or older, and some younger individuals with qualifying medical conditions or disabilities. It includes Part A (hospital insurance) and Part B (medical insurance). You can add a separate Part D plan for prescription drug coverage. Original Medicare typically covers 80% of approved healthcare costs, with you paying the remaining 20%. It generally doesn’t cover prescription drugs, vision, dental, hearing, or long-term care.
Medicare Supplement
Medicare Supplement insurance (Medigap) is extra coverage you can buy from a private company to help pay your share of Original Medicare costs. These plans have a monthly premium. Medigap plans help cover copayments, coinsurance, and deductibles. While some plans may offer limited dental, vision, and hearing benefits, they do not include prescription drug coverage (Part D). You’ll need a separate Part D plan for drug coverage.
Medicare Advantage
Medicare Advantage plans (Part C) are offered by private companies as an alternative to Original Medicare. These Medicare-approved plans bundle Part A, Part B, and Part D coverage. They aim to limit your out-of-pocket costs and often include extra health and wellness benefits. You must be enrolled in Original Medicare before joining a Medicare Advantage plan.
What is the right plan for me?
Your Medicare choice impacts your coverage, prescription drug costs, and other key health and wellness benefits. We’ve partnered with Medicare Champions to help you understand your options. They can:
- Ensure you don’t miss your Individual Enrollment Period and know your exact deadlines.
- Explain the different parts of Medicare and available plan options.
- Help you enroll in a plan that meets your needs.
Before deciding on a plan
Before choosing a Medicare plan, make sure to:
- Check if the plan covers your area.
- Confirm your doctors are in-network (see a list of plans NEXS Medical accepts).
- Verify your prescriptions are covered.
- Review plan costs (copays, coinsurance, deductibles) to ensure it fits your budget.
If you choose Original Medicare, enroll in Parts A and B as soon as you’re eligible and talk to a licensed health insurance expert about your plan options.
Medicare Advantage
Medicare Advantage plans (Part C) are offered by private companies as an alternative to Original Medicare. These Medicare-approved plans bundle Part A, Part B, and Part D coverage. They aim to limit your out-of-pocket costs and often include extra health and wellness benefits. You must be enrolled in Original Medicare before joining a Medicare Advantage plan.
For more information
Need help with Medicare? We offer complimentary support through our partnership with Medicare Champions. Call 877-910-5451 (TTY: 711) to connect with a licensed insurance agent Monday-Friday, 9 am to 8 pm EST.
While Medicare Champions (by Unified Growth Partners Corporation) can help you explore some options (currently 67 plans from 5 organizations), it’s important to see all available plans. For a complete picture, visit Medicare.gov, call 1-800-MEDICARE, or contact your local SHIP.
You can find more information about Medicare at Medicare.gov or by calling 1-800-MEDICARE. We are not affiliated with or endorsed by the government or Federal Medicare program.
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