Need Medicare coverage? This group explains the basics of plans offered

Medicare open enrollment starts Oct. 15

Do you have questions about what's covered in Medicare?

It’s that time of year: Just 11 more days until the annual enrollment period begins for Medicare.

With Medicare enrollment right around the corner, it’s important to be prepared during this next phase of life and to help guide your loved ones during the process.

Brooklynn Chandler Willy, president and CEO of Texas Financial Advisory, explained the basics of Medicare and the “ins and outs” of enrollment and Advantage Plan selection.


What do baby boomers need to know about Medicare?

  • Open enrollment begins Oct. 15 and ends on Dec. 7.
  • For those who do not enroll in Medicare on time, you will pay a monthly penalty.
  • You may pay too much in premiums or out-of-pocket costs if you do not get the right private insurance to go with Medicare.
  • If you do not plan for higher health care costs in retirement, you could run out of money or not be able to get the care you need.

What is Medicare?

Medicare is the National health insurance program for people 65 and older. Enrollment is through the Social Security Administration (SSA), and it’s administered by the Centers for Medicare and Medicaid Services (CMS).


Who is eligible for Medicare?

  • Everyone over 65 for all U.S. citizens.
  • Legal residents who have lived in the U.S. continuously for at least five years.
  • Some people under 65 who are eligible for Social Security under disability benefits

What does Medicare cover?

1) Part A covers part of the costs of hospitalizations.

2) Part B covers part of the costs of medical services, such as doctor visits, procedures, and diagnostic tests.

Takeaway: The bills for Parts A and B are paid by Medicare.

3) Part C is an alternative way to get Medicare.

You can sign up for a Medicare Advantage plan offered by a private insurer and get all of your services under Parts A and B, and usually prescription drug coverage, as well, through the plan.

Instead of Medicare paying for your hospital and doctor bills, it pays the insurance company offering the Medicare Advantage plan a flat payment for each enrollee. Then the plan is responsible for managing and coordinating your care.

4) Part D is prescription drug coverage.

It is offered by private insurers who contract with Medicare. Each prescription drug plan is slightly different, which is why you’ll want to shop carefully for your drug plan.

Takeaway: Parts C and D are where private insurance comes in for Medicare.

Even if you don’t take any prescription drugs when you first go onto Medicare, Texas Advisory Financial advises to sign up for a Part D drug plan. If you go without drug coverage for very long you’ll face a penalty when you finally do enroll.


What does Medicare not cover?

  • Long-term care
  • Dental care
  • Vision care
  • Hearing aids
  • Acupuncture and other alternative care
  • Amounts not covered by deductibles and coinsurance (20%)

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