Medicare Knowledge Educational Workshop​: Helping Seniors Navigate Their Medicare Coverage Journey

​Original Medicare

• Part A: Hospital Insurance – covers inpatient hospital stays, skilled nursing facility care, hospice care and some home health care.
• Part B: Medical Insurance – covers certain doctors' services, outpatient care, medical supplies, and preventive services.

• Part C: Medicare Advantage – an alternative to Original Medicare (Parts A and B) offered by private insurance companies that includes additional benefits.
• ​Part D: Prescription Drug Coverage – helps cover the cost of prescription drugs.

Medicare Eligibility

Eligibility for Medicare is primarily based on age and work history. Individuals aged 65 or older who have worked and paid Medicare taxes for at least 10 years are eligible for premium-free Part A. Those under 65 may qualify if they have certain disabilities or end-stage renal disease. Enrollment periods are crucial, with the Initial Enrollment Period starting three months before the month you turn 65 and lasting seven months.

Medicare Coverage

​Medicare coverage is extensive but varies by part:

• Part A covers hospital-related expenses, such as semi-private rooms, meals, and general nursing.
• Part B covers outpatient care, preventive services, and some home health care, but requires a monthly premium.
• Part C (Medicare Advantage) combines Parts A and B and often includes additional benefits like vision, dental, and hearing, offered by private insurers.
• Part D helps cover the cost of prescription drugs and is also offered through private insurers.
• Medicare Supplement – Covers costs associated with Medicare Part A deductible and copays except for the part B deductible, depending on what plan you choose.
• Ancillary Plans – such as dental, hearing, vision, and hospital indemnity that can greatly help cover out of pocket costs.

Choosing between Original Medicare, Medicare Advantage, or a Medicare Supplement depends on individual health needs, preferences and budget.

Costs Associated with Medicare

​While Medicare provides substantial coverage, it is not free. Beneficiaries are responsible for premiums, deductibles, and copayments. For example, Part A is typically premium-free if you've paid Medicare taxes, but it has a deductible. Part B has a monthly premium and an annual deductible. Medicare Advantage, Medicare Supplements and Part D plans have their own costs, which can vary.
​
To manage costs, individuals can look into programs like Medicaid, Medicare Savings Programs, Medigap policies, and ancillary plans that help cover out-of-pocket expenses.

​How to Enroll and Common Pitfalls

​Enrolling in Medicare is a critical step. It can be done online, by phone, or in person at a Social Security office. It's essential to enroll during the Initial Enrollment Period to avoid late enrollment penalties. Common mistakes include not understanding the difference between Original Medicare, Medicare Supplements, and Medicare Advantage, missing enrollment deadlines, and not considering additional coverage for prescription drugs. Missing these enrollment deadlines can result in lifelong penalties.

​Conclusion

​In summary, understanding Medicare is vital for making informed healthcare decisions. By knowing what Medicare covers, who is eligible, the associated costs, and how to enroll, you can ensure you or your loved ones receive the healthcare they need. Stay informed, ask questions, and take advantage of resources available to you. Thank you for your time, and I encourage you to continue learning about Medicare to make the best choices for your health and well-being. If you would like a deeper more informative look at your Medicare options, I invite you to attend one of our free Medicare Education Workshops, (all locations are on the Events page on this website), either in person or on demand on our website at www.tsgotinsurance.com. If you need help getting your coverage started, I invite you to call me at 972-814-8990. There is no obligation, and we never charge for helping you. Thank you for attending today.