Medicare

Medicare is a federally funded health insurance program that provides health care coverage for people aged 65 or older. If you are under the age of 65, you may qualify for Medicare coverage if you are afflicted with certain disabilities. 

If you are likely to be eligible for Medicare coverage soon, you should learn more about the options you have for Medicare coverage. 

Original Medicare

The standard form of Medicare coverage, Original Medicare, has two main components: Medicare Part A and Medicare Part B. 

Medicare Part A provides benefits that cover hospital care services, including:

  • Inpatient care delivered in a hospital
  • Care in a skilled nursing facility
  • Inpatient nursing home care 
  • Home health care services
  • Hospice care

Medicare Part A also covers a lifetime limit of up to 190 days of inpatient mental health care in a psychiatric hospital for each beneficiary. 

Medicare Part B Provides benefits that cover medical services, including:

  • Medically necessary services
  • Preventive services
  • Clinical research participation
  • Ambulance transportation
  • Durable medical equipment purchases
  • Mental health care services delivered in inpatient, outpatient, and partial hospitalization settings 

Once you sign up for Original Medicare, you will have access to all of these benefits, but ensure that you check with your health care provider before receiving services to confirm that your care will be covered under Medicare. 

Medicare Part D (Prescription Drug Coverage)

Original Medicare does not provide comprehensive prescription drug coverage. If you need prescription drug benefits, Medicare Part D can provide you with affordable access to prescription medications that are prescribed to you by your health care providers.

If you choose to enroll in this optional benefit, Medicare will cover some of the costs for medications listed in their formulary. The formulary is a list of prescription drugs that are covered under the policy. Medicare Part D plans can choose which drugs they cover and place them into different tiers that determine their cost to the consumer.

Medicare Supplement Insurance

Medicare Supplement Insurance (Medigap) policies are designed to help Original Medicare beneficiaries cut down out-of-pocket costs. There are currently 10 available plans, each offering different benefits. If you are interested in purchasing a Medigap policy, Proinsurance Hawaii can point you in the direction of the best plan for your unique situation.

We Are Here To Help

Medicare Advantage

Medicare Advantage Plans are Medicare plans offered through private companies that have contracted with Medicare to deliver Part A and Part B benefits directly to consumers. Therefore, if you choose to enroll in a Medicare Advantage plan, you are guaranteed to at least have coverage matching the benefits of an Original Medicare Plan.

Medicare Advantage Plans also frequently include Prescription Drug coverage and may include additional benefits, such as dental, hearing, or vision benefits. As these plans are purchased through private insurance providers, they have more flexibility in the benefits that they can provide. However, this often means Medicare Advantage Plans may come at a higher cost.

Enrollment

If you are eligible for Medicare benefits, you can enroll in your preferred plan during the following standard periods:

  • Initial Medicare Enrollment Period: This period begins three months before you turn 65 and ends three months after you turn 65. The Initial Enrollment Period also includes your birth month, adding up to a total of 7 months where you are eligible for enrollment
  • General Medicare Enrollment Period: The General Medicare Enrollment period is for people who do not enroll during their Initial Enrollment Period. It spans January 1 to March 31. People who enroll during this period will receive coverage on July 1. 
  • Special Enrollment Period: Under certain conditions, you may be eligible for a Special Enrollment Period that falls outside of the standard periods listed above. Consult with an expert to learn if your situation qualifies you for a Special Enrollment Period.
Are You Planning To Enroll In Medicare?

Having help with the Medicare enrollment process can ensure that you select coverage that effectively covers your long-term healthcare needs. Allow Proinsurance Hawaii to support you.

Contact us now to schedule a meeting. We will help you find the coverage you need to secure a long, healthy, and happy life.