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Medicare is a Federal Health Insurance Program. To be eligible for Medicare you must be a US Citizen or Legal Resident and one of the following.
- Age 65
- Been disabled for 24 months or more
- Have End Stage Renal Disease or ALS
There are Four Parts to Medicare:
Part A, Part B, Part C and Part D
Part A & Part B are known as Original Medicare. This means Medicare is the primary provider for your health insurance payments. Part C (Medicare Advantage), Part D, and Medicare Supplements are insurance plans offered by independent insurance companies. These plans cover some of the costs associated with original Medicare.
Part A covers Hospitalization. This includes inpatient hospitalizations, skilled nursing, home health care and hospice care. If you, or your spouse, have worked 40 quarters in your lifetime, Part A is no cost to you. If you do not meet these requirements, you may purchase Part A. For 2017 the deducible for Part A is $1,316 per 60 day benefit period.
Part B covers Medical. This includes doctor visits, screenings, lab work, x-rays, outpatient services, etc. Unlike Part A, Part B has a monthly premium. The standard premium in 2017 for most Americans is $134/month and is taken directly out of your Social Security check. If your income is greater than $85,000 as an individual or $170,000 as a couple your premium could be more than the standard rate. The annual deductible for Part B is $183 for 2017. After the deductible has been met, Medicare will pay 80% of your Part B charges and you will be responsible for the remaining 20%. If you do not enroll into Part B when you are first eligible, you may be assessed a Late Enrollment Penalty.
Part C or Medicare Advantage plans are offered through independent insurance companies that contract with Medicare which becomes the primary provider for your health insurance payments. These plans combine Part A & Part B coverage, as well as offering additional benefits such as; hearing, vision, dental & fitness memberships, and may also include coverage for Part D Prescription Drugs. These plans have low premiums and deductibles along with Co-Pays and Co-Insurance. To be enrolled into a Medicare Advantage Plan you must: be enrolled in Original Medicare Part A & B, reside in the plan's service area (Networks), and cannot be diagnosed with End Stage Renal Disease. Enrollments Periods
Part D is Prescription Drug Coverage offered through independent insurance companies. Part D Prescription Drug plans differ between insurance companies and are required to be the same or better than Medicare Guidelines.
For 2017, the Part D Prescription Drug Guidelines are:
- Deductible is $400.
- Initial Coverage Stage: You pay copays until your total drug cost reaches $3,700.
- Coverage Gap: You pay a coinsurance (51% of Generics and 40% of Brands) of the prescription until your TROOP reaches $4,950.
- Catastrophic Coverage: Generics are $3.30, Brands are $8.25, or 5% whichever is greater.
If not enrolled into a Part D Prescription Drug Plan or have other creditable drug coverage when first eligible, you may have a Late Enrollment Penalty. Forms of other creditable drug coverage include: Wisconsin Senior Care, Employer or Union plan, Low Income Subsidy, or VA.
Medicare Supplements aka "MediGap" plans are offered by independent insurance companies and help cover some of the costs that Original Medicare does not.
- Medicare is the primary provider with a Medicare Supplement being secondary. You may purchase a Medicare Supplement to cover Medicare deductibles and coinsurance amounts.
- Medicare Supplements do not cover Part D Prescription Drugs, so a Part D Prescription Drug Plan may be necessary.
- When first eligible for Medicare Part B, you can purchase a Medicare Supplement without any Medical Questions asked. This is called Open Enrollment. If you lose other coverage, you may be able to enroll into a Medicare Supplement through Guarantee Issue.
- If you are outside the Open Enrollment/Guarantee Issue Period, the insurance company will require medical questions to be completed. Click here to review the Wisconsin Mandated Benefits. offered on all Medicare Supplements.
Navigating Medicare can be confusing and tiresome. Let 5 Star Insurance Group make things clear with a free informational seminar on Medicare. We host meetings at multiple locations around Northeast and Central Wisconsin. Click on the Events tab at the top of our homepage to attend a Medicare 101 seminar near you or contact us at (920) 831-3210 to schedule a one-on-one appointment with our Licensed and Certified Health Insurance Consultants today.