Medicare 101

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Medicare 101

Who is eligible for Medicare? Medicare is a federal program that offers health insurance to American citizens and other eligible individuals who are U.S. citizens and legal residents. Legal residents must live in the U.S. for at least 5 years in a row, including the 5 years just before applying for Medicare. You must also meet one of the following requirements: • Age 65 or older • Younger than 65 with a qualifying disability and have received Social Security Disability benefits for 24 consecutive months• Any age with a diagnosis of end-stage renal disease or ALS.


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Part A Medicare covers Inpatient Hospital Hospitalization and Inpatient Skilled Nursing. You Have Deductibles and Coinsurance Medicare does not pick up 100% of the costs.

Part B Medicare is Medical Coverage for physician services, outpatient tests and procedures, medical supplies and labs. After you pay your Part B Deductible, Medicare will pay 80% of medicare approved charges.

Medicare Part C is also referred to as Medicare Advantage Plans which are most commonly Medicare HMOs and PPOs. These are plans offered through private insurance companies and approved by Medicare.

Medicare Part D is prescription drug coverage. You can get Part D either through a stand-alone part d prescription drug plan or through a Medicare Advantage plan that includes Prescription coverage

How Medicare Works

Health coverage managed by the federal government is called “original medicare.” Typically, there is a cost for every service. In the majority of cases, you are able to go to any doctor, other health care provider, hospital, or another facility as long as it is enrolled in Medicare and is accepting new Medicare patients. Original Medicare does not cover most prescriptions, with a few exceptions. However, drug coverage can be added by joining a Medicare Prescription Drug Plan (Part D). You do not have to select a primary care doctor with Original Medicare; in most cases, you don’t need a referral to see a specialist, as long as the specialist is already enrolled in Medicare.

You may already have employer or union coverage that may pay costs that Original Medicare does not. If not, then you may want to purchase a Medicare Supplement Insurance (Medigap) policy. If you are receiving Social Security benefits before turning 65, then you should be able to automatically receive notification of your enrollment in Medicare shortly before your 65th birthday or your 25th month of disability. Other individuals need to apply by calling or visiting their Social Security office in order to receive Medicare. You can learn more about Medicare options for enrollment from the government website or by talking to one of our agents.

Can I Afford Medicare?

How Medicare pays is that you usually pay a set amount for your health care (deductible) before Medicare pays its share. Medicare then pays its share, and you pay your share (coinsurance/copayment) for covered services and supplies. There isn’t a yearly limit for what you pay out-of-pocket, and you usually pay a monthly premium for Part B. You typically don’t have to file Medicare claims, as the law stipulates that providers and suppliers must file your claims for the covered services and supplies you receive.

Contact Us Today

You can learn more about Medicare options from our dedicated agents. If you are looking for a “Medicare insurance agent near me” in Palm Beach County, call Absolute Best Insurance today!

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