Medicare

Medicare

Most Americans over 65 years old or under 65 years of age with a permanent disability for over 2 years would qualify for Medicare, a Federal program. Medicare itself is divided into (4) different parts: A, B, C, & D.

- Part A: Covers 80% of hospital services, and individuals qualify for this program after contributing for a minimum of (10) years in Medicare taxes.


- Part B: Covers 80% of medical services (PCP & Specialist). Beneficiaries will receive this coverage because approximately $165 (sometimes more) is deducted from their Social Security benefit check.


- Part D: This is administered privately and covers prescription drug benefits. This benefit usually has a monthly premium, a deductible, and co-payments for medication. Additionally, if an individual decides to opt out of this program, they will typically get penalized by Social Security.


- Part C: Also known as the Medicare Advantage plan, it complements the other 20% not covered under Medicare Parts A & B. It also provides additional benefits such as:


  - Dental, Vision & Hearing
  - Over-The-Counter benefits
  - Financial assistance for groceries, utility bills, and gas
  - Gym membership
  - Part B Giveback (Certain insurance companies would pay up to $102 out of the $165 a beneficiary pays for Part B). This could put an additional $102 in your pocket.
 - Dual Benefits (Beneficiaries with Medicare & Medicaid) pay $0 copayments for providers, medications, and hospital services (D-SNP).
  - Assisted Living Benefits for Non-Medicaid beneficiaries (I-SNP)
 - Most Medicare Advantage plans have $0 or low monthly premiums, deductibles, or copayments for medical services.


As a State Licensed insurance brokers, we are certified to offer these benefits through multiple Medicare Advantage insurance carriers, such as:


- Amerigroup
- Horizon/BCBS & Braven Health
- United Healthcare/AARP
- Wellcare
- Clover
- Humana
- Aetna
- And others

In addition, we would also assist you with the following State & Federal Extra Help programs:

- Medicaid and MLTSS: To qualify for Home Health Services and Adult Medical Daycare, a beneficiary must first qualify for Medicaid or MLTSS based on low income or dire health condition.

- SLMB: This State program aids in paying for a beneficiary’s Part B responsibility (about $165 per month). In most instances, the state would reimburse a client for (5) months of their Part B premium (about $825) and would add $165 to their Social Security monthly benefit check moving forward.


- Low Income Subsidies, PAAD & Senior Gold: These pharmaceutical assistance programs provide aid to an applicant with copayments for medications, cover up to $36 of their monthly premium, and could cover their prescription-related deductible.