Medicare is a federal government program that provides health insurance coverage for Americans who are:
- 65 years of age and older.
- Under 65 and are receiving Social Security Disability Insurance (SSDI) for a certain amount of time.
- Under 65 and with End-Stage Renal Disease (ESRD).
Medicare benefits are divided into two parts:
Part A primarily covers inpatient hospital, skilled nursing facility care and home health care. Once enrolled in Medicare, you will receive these benefits automatically and do not pay premiums for them (you’ve already paid for them through your taxes).
Part B is your health insurance coverage that covers two types of services, including medically necessary services to treat illnesses or conditions, such as doctor’s office visits, lab work, x-rays and outpatient surgeries and preventive services to keep you healthy, like cancer screenings and flu shots.
Licensed agents at Barajas Insurance Group can answer your questions about Medicare and help you review the differences between a Medicare Advantage Plan and a Medicare Supplement insurance plan. Your individual health, budget, preferences and other circumstances will help guide you into the plan that best fits your needs.
Medicare Advantage Plans
Private insurance companies that are regulated by the government offer Medicare Advantage plans. These private companies are required to offer the same protections as Original Medicare with an out of pocket maximum and most Medicare Advantage plans include prescription drug coverage. Hearing and vision benefits are other common, though not mandatory benefits that some plans offer as well.
It is important to review the details of each Medicare Advantage Plan as they all vary in benefits and network providers which is why Barajas Insurance agents are here to help.
If you decide to sign up for a Medicare Advantage plan, you may enroll between October 15th to December 7th – the period known as Annual Enrollment Period – in order for your coverage to start the first of the following year.
Medicare Advantage Plan Details
- You must be enrolled in Medicare Part A and Part B before enrolling in a Medicare Advantage plan through a private insurance company, you must live in the plan service area and you cannot have end-stage renal disease (ESRD) although some exceptions may apply. Medicare Advantage plans may be a low or no monthly premium in addition to the monthly Part B premium that you pay to Medicare.
- There are other election periods that you may qualify for instead of enrolling during the Annual Enrollment Period, some of these Special Election Periods include:
- Turning 65, aging into Medicare known as Initial Enrollment Period
- Retirement (losing your employer coverage)
- Moving out of the plan’s service area
- Receive assistance from Social Security (Extra Help)
- Receive assistance from the State (Medicaid)
- Have been diagnosed with a certain qualifying disability or chronic health condition
There are more special elections. For clarification or to see if you qualify, please call Barajas Insurance Group, LLC toll free at (888) 347-2278.
Medicare Supplement Insurance Plans
Private insurance companies sell Medicare Supplement Insurance Plans (sometimes called MediGap) that are designed to fill the “gaps”in Original Medicare.
Medicare Supplement Insurance Plans help pay some of the health care costs that Original Medicare doesn’t cover, like:
- Some Medicare Supplement Insurance plans also cover services that Original Medicare doesn’t cover, such as medical care when you travel outside the U.S.
- If you have Original Medicare and you buy a Medicare Supplement policy, the two work in tandem when you have a medical claim.
- Medicare will pay its share of the Medicare-approved amount for covered health care costs and then your Medicare Supplement Insurance Plan pays its share.
Medicare Supplement Plan Details
- You must be enrolled in Medicare Part A and Part B before buying a Medicare Supplement policy and you pay the private insurance company a monthly premium for your Medicare Supplement policy in addition to the monthly Part B premium that you pay to Medicare.
- Medicare Supplement policies only cover one person. If you and your spouse both want Medicare Supplement coverage, you will each need to buy separate policies.
Medicare Supplement Insurance Plan/Medigap Policies Don’t Cover Everything
Items not covered by Medicare Supplement Insurance Plans include:
- Prescription drugs (If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D)
- Long-term care
- Vision exams, eyeglasses, contacts
- Hearing aids
- Private-duty nursing
Medicare Prescription Drug Plans (Part D)
Medicare Prescription Drug plans (Part D) are optional stand-alone plans that provide creditable prescription drug coverage (Part D) for beneficiaries who keep the Original Medicare plan as opposed to going with a Medicare Advantage Plan, the majority of which include prescription drug coverage. Even though Medicare Prescription Drug plans are optional, you may be subject to a late enrollment Part D penalty by Medicare. Contact Barajas Insurance Group if you have questions regarding this late enrollment Part D penalty.
Barajas Insurance Group, LLC agents can help you choose an alternative to in Original Medicare coverage such as Medicare Advantage Plans, Medicare Prescription Drug Plans and Medicare Supplement Plans. Our licensed agents can also help provide quotes for individual healthcare coverage or for businesses of every size that need affordable healthcare coverage options to offer employees.
Life insurance decision making can be a tough and stressful endeavor, but to help with the process, it begins with consulting a licensed agent who can explain the many product offerings on the market, the pro and cons of each type of life insurance and determine which type best fits your current life circumstances such as age, marital status, health and tolerance for financial risk.
Individual Health Insurance / Affordable Care Act
If your employer does not provide health insurance for you and your family, the Barajas Insurance Group, LLC can assist you in obtaining a policy with coverage you need.
Our independent agents have access to insurance options that are either on the Affordable Care Act marketplace or off the marketplace. Since March of 2010, when the Affordable Care Act was signed into law, you have access to insurance options that will not financially penalize you or deny you due to having pre-existing conditions. At Barajas Insurance Group, LLC our independent agents will help you see if a government subsidy is a fit or not. By utilizing our access to national and regional insurance carriers it allows us to find the best coverage options for each individual and family.
Call our office toll free at (888) 347-2278 to arrange an appointment to discuss your needs with a licensed insurance agent who can answer your questions and provide quotes for you to consider.
Business Health Insurance
Licensed agents at the Barajas Insurance Group, LLC help businesses of every size, small (2-50 employees), medium (51-150 employees) and large (150+ employees) find health insurance with the best rates and coverage to offer employees.
Contact us today to find out how we can help you find the right insurance policy options for your company to offer your employees to provide for their healthcare. Call (888) 347-2278 to schedule an appointment with a licensed independent agent.
To arrange a private complimentary consultation, call the Barajas Insurance Group, LLC toll free at (888) 347-2278. We will be happy to meet you in our office, your home or another convenient location to discuss your healthcare insurance options.
By providing your information above, you are granting permission for a licensed sales agent to contact you by phone or email to answer your questions or provide additional information about Medicare Advantage Plans, Medicare Prescription Drug Plans and Medicare Supplement Insurance Plans.