Understanding Medicare

Shawn Plummer, CRPC

Chartered Retirement Planning Counselor

What is Medicare?

Medicare is a federal health insurance program designed for individuals aged 65 and older and certain younger individuals with disabilities or specific medical conditions. This program ensures you access essential healthcare services, providing peace of mind as you age. Medicare is divided into different parts, each covering specific aspects of healthcare:

Costs and Enrollment

  • Premiums: Beneficiaries pay monthly premiums for Part B and Part D. Costs can vary based on income.
  • Taxes: Medicare is funded through payroll taxes.
  • Enrollment: Initial enrollment starts three months before turning 65 and lasts until three months after the 65th birthday. Delayed enrollment may result in higher premiums.
Medicare

Medicare vs. Medicaid

  • Eligibility: Medicare is primarily for those aged 65 and older or with specific disabilities, while Medicaid serves low-income individuals and families.
  • Funding: Medicare is federally funded, whereas Medicaid is jointly funded by state and federal governments.
  • Coverage: Medicare covers hospital and medical services, while Medicaid includes long-term care and may offer additional dental and vision care services.
Best Medicare Plan

How We Can Help

At The Annuity Expert, we understand that navigating Medicare can be overwhelming. Our mission is to help you find the best solutions at the lowest costs, tailored to your unique needs. With 15 years of experience as an insurance agency, annuity broker, and retirement planner, we have the expertise to guide you through every step of the process.

Understanding Your Concerns

  • Confusion and Complexity: Medicare can be confusing with its various parts and coverage options. You may feel overwhelmed trying to understand what each part covers and what you need.
  • Costs and Affordability: You might worry about the cost of premiums and out-of-pocket expenses. Ensuring that you have adequate coverage without breaking the bank is crucial.
  • Enrollment Deadlines: Missing enrollment deadlines can lead to higher premiums and gaps in coverage, adding to your stress and financial burden.

Our Commitment to You

We believe in finding the best solutions for our clients, ensuring that you receive the coverage you need at a price you can afford. Our team is dedicated to helping you navigate the complexities of Medicare with confidence and ease.

Medicare Provides

What We Recommend

To achieve the best results, follow these high-level steps:

  • Contact Us for a Free Consultation:
    • What Happens: We discuss your specific needs and circumstances.
    • Main Benefit: Personalized advice and a clear understanding of your options.
  • Receive a Tailored Medicare Plan:
    • What Happens: We design a Medicare plan tailored to your needs.
    • Main Benefit: Comprehensive coverage that fits your lifestyle and budget.
  • Ongoing Support and Adjustments:
    • What Happens: We provide continuous support and make adjustments as your needs change.
    • Main Benefit: Peace of mind knowing your healthcare needs are always covered.

Features We Provide

  • Expert Advice: Comprehensive understanding of Medicare to guide you.
    • Benefit: Confidence in making informed decisions.
  • Customized Plans: Tailored Medicare plans to meet individual needs.
    • Benefit: Optimal coverage and cost savings.
  • Ongoing Support: Continuous assistance and plan adjustments.
    • Benefit: Long-term satisfaction and security.

Addressing Common Objections

  • “It’s too complicated.”
    • Response: We simplify the process, providing clear, easy-to-understand guidance.
  • “I can’t afford the premiums.”
    • Response: We find the most cost-effective plans tailored to your financial situation.

Not working with us could result in higher costs, missed deadlines, and inadequate coverage. Partnering with The Annuity Expert ensures that you receive expert advice, optimal plans, and continuous support, leading to financial security and peace of mind.

Experience the confidence and relief of having a trusted partner by your side. Contact us today for free advice or a free quote.

Need Help Getting Medicare?

Medicare Inquiry
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Frequently Asked Questions

Is anyone eligible for Medicare?

Most individuals aged 65 or older, and some younger individuals with specific disabilities or medical conditions, are eligible for Medicare in the United States.

Do I automatically get Medicare when I turn 65?

If you already receive Social Security benefits, you will typically be enrolled in Medicare automatically when you turn 65. Otherwise, you must sign up for Medicare during your Initial Enrollment Period.

What are the 4 types of Medicare?

The four types of Medicare are: 1) Part A (Hospital Insurance), 2) Part B (Medical Insurance), 3) Part C (Medicare Advantage), and 4) Part D (Prescription Drug Coverage).

How do I get a Medicare card?

To get a Medicare card, you need to be eligible for Medicare. If you’re automatically enrolled, the card will be mailed to you three months before your 65th birthday or after your 25th month of disability benefits. Otherwise, you can apply online or visit your local Social Security office.

What is a Medicare savings account?

A Medicare Savings Account (MSA) is a Medicare Advantage Plan that combines a high-deductible health plan with a medical savings account. Simply put, it is an account you can use to pay for your healthcare services before your insurance starts covering them.

What disabilities qualify you for early Medicare?

After 24 months of receiving Social Security Disability Insurance (SSDI) benefits, you’ll automatically qualify.

Does Medicare cover funeral expenses?

While Medicare does not cover funeral expenses, there are several ways that people on Medicare can get help with paying for their funeral. One option is to purchase a life insurance policy that will pay out upon the policyholder’s death. This type of life insurance policy is called final expense or burial insurance. Another option is to set up a funeral trust, an account used to pay for funeral expenses.

How long will Medicare pay for nursing home stays?

Medicare Part A will cover skilled nursing care under specific conditions for a limited time. Here’s a breakdown:
Days 1-20: Medicare will pay the total cost for each benefit period.
Days 21-100: For each benefit period, you pay a daily co-payment (which can vary from year to year), and Medicare covers the rest.
Days 101 and beyond: Medicare will not pay; you are responsible for all costs.

Does Medicare cover palliative care?

Medicare Part A and Part B do provide coverage for palliative care. This includes doctor and nurse visits, physical or occupational therapies, and some prescription medications to ease symptoms.

Does Medicare pay for assisted living?

No, Medicare does not pay for assisted living or other long-term care facilities. Long-term care insurance is a good alternative.

What’s the average cost of supplemental insurance for Medicare?

The average cost of supplemental insurance for Medicare, often called Medigap, varies widely based on the plan type, region, and insurance company. Premiums typically range from $50 to $300 per month. However, checking current rates and comparing providers for accurate figures is essential.

Does Medicare cover long-term care?

Medicare provides limited coverage for long-term care. It primarily covers short-term skilled nursing or rehabilitation services following a hospital stay. Medicare does not pay for extended custodial care, such as assistance with daily living activities. Individuals often rely on Medicaid, private insurance, or personal savings for prolonged long-term care.

Does Medicare Part B pay for assisted living?

No, Medicare Part B doesn’t cover assisted living.

Does Medicare Part B pay for nursing homes?

No, Part B doesn’t cover long-term nursing home care.

Does Medicare pay for cremation?

No, Medicare doesn’t cover funeral or cremation costs.

Does Medicare pay for a home assistant?

No, but it may cover home health services.

Does Medicare pay for home health aides?

Yes, if medically necessary and under specific conditions.

Does Medicare pay for senior daycare?

No, it doesn’t cover adult daycare.

Does Medicare pay for skilled nursing?

Yes, for a limited time after a qualifying hospital stay.

How do I get Medicare to pay for an ambulance?

If medically necessary, Medicare Part B may cover it.

How do I get Medicare to pay for a caregiver?

Medicare doesn’t typically cover caregiver services.

How do I get Medicare to pay for home care?

Must be homebound and require skilled services.

How do I get Medicare to pay for incontinence supplies?

Generally, Medicare doesn’t cover incontinence supplies.

How do I pay for Medicare without social security?

You can pay directly, through bank drafts, or Medicare Easy Pay.

How do I pay social security and Medicare taxes for self-employed?

Through the Self-Employment Tax using Schedule SE with your tax return.

How do you pay for Medicare?

Through Social Security deductions or direct payments.

How do you pay for Medicare Part B without collecting social security?

Direct billing, bank draft, or Medicare Easy Pay.

How does Medicare pay as a secondary payer?

After the primary insurance is paid, Medicare pays its share of the remaining costs.

How long does Medicare pay for a nursing home?

Up to 100 days after a 3-day qualifying hospital stay.

How long does Medicare pay for dialysis?

It covers dialysis indefinitely, but terms can vary.

How long does Medicare pay for hospice?

As long as the patient meets the hospice criteria.

How long does Medicare pay for inpatient psychiatric care?

Up to 190 days in a lifetime.

How long does Medicare pay for rehab?

After a qualifying hospital stay, up to 100 days in a skilled nursing facility.

How long does Medicare pay for rehab after hip replacement?

Up to 100 days if criteria are met.

How long will Medicare pay for CPAP supplies?

Indefinitely, but supplies are replaced at specific intervals.

How long will Medicare pay for home health care?

As long as you’re eligible and the services are medically necessary.

How long will Medicare pay for immunotherapy?

As long as it’s deemed medically necessary.

How many days does Medicare pay for a skilled nursing facility?

Up to 100 days after a 3-day qualifying hospital stay.

How many therapy sessions does Medicare pay for?

As many as deemed medically necessary, but there may be limits.

How many times will Medicare pay for rehab?

There is no set limit, but each time must meet the criteria.

How much does Medicare Part B pay for physician fees?

Typically 80% after the deductible is met.

How much do you pay for Medicare?

Varies by income and specific medicare plan; Part B premium was $148.50/month in 2021.

How much does Medicare pay?

Varies by service; often 80% for Part B services after deductible.

How much does Medicare pay for a chiropractic adjustment?

Covers manual manipulation of the spine if medically necessary.

How much does Medicare pay for air ambulance?

If medically necessary, Part B may cover it; the patient pays 20%.

How much does Medicare pay for Alzheimer’s care?

It doesn’t cover long-term care but may cover some services and treatments.

How much does Medicare pay for cataract surgery?

Part B covers surgery and intraocular lens; the patient pays 20%.

How much does Medicare pay for family caregivers?

Doesn’t pay family caregivers but may cover home health services.

How much does Medicare pay for freestyle libre?

Part B may cover it if the criteria are met; the patient pays 20%.

How much does Medicare pay for glasses after cataract surgery?

Provides an allowance towards standard frames/lenses.

How much does Medicare pay for hearing aids?

Doesn’t cover hearing aids.

How much does Medicare pay for home health care per hour?

Doesn’t pay per hour; covers services if criteria are met.

How much does Medicare pay for hospice per day?

Covers hospice care; the exact amount can vary.

How much does Medicare pay for hospital stays?

Part A covers inpatient stays; the patient pays the deductible.

How much does Medicare pay for hospital stays per day?

Depends on the length of stay; deductible for the first 60 days in 2021.

How much does Medicare pay for laser cataract surgery?

Covers basic surgery costs; patients may pay extra for laser.

How much does Medicare pay for long-term nursing home care?

Doesn’t cover long-term care; it covers limited skilled nursing care.

How much does Medicare pay for memory care facilities?

Doesn’t cover memory care facilities.

How much does Medicare pay for nursing homes?

Covers up to 100 days after a qualifying hospital stay.

How much does Medicare pay for outpatient surgery?

Part B covers it; the patient typically pays 20% after the deductible.

How much does Medicare pay for physical therapy?

Part B covers it; the patient pays 20% after the deductible.

How much did Medicare pay for physical therapy in 2022?

Part B covers it; exact amounts can vary yearly.

How much does Medicare pay for physical therapy per visit?

Part B covers it; the patient pays 20% after the deductible.

How much does Medicare pay for portable oxygen concentrators?

Part B covers it if medically necessary; the patient pays 20%.

How much does Medicare pay for Remicade infusions?

Part B may cover it; the patient pays 20% after the deductible.

How much does Medicare pay for urgent care visits?

Part B covers it; the patient typically pays 20% after the deductible.

How much does the government pay Medicare Advantage plans?

Varies: the government pays a set amount to plans for each enrollee.

How much will I pay for Medicare?

Depends on income and a specific plan.

How much will Medicare pay for total knee replacement?

Parts A & B cover it; the patient is responsible for deductibles and coinsurance.

How often does Medicare pay for a new glucose meter?

Every 5 years if medically necessary.

How often does Medicare pay for a colonoscopy?

Once every 10 years for routine screening; more often if high risk.

How often does Medicare pay for eye exams?

Every 12 months for diabetes; doesn’t cover routine exams.

How often does Medicare pay for gynecological exams?

Pelvic exams every 24 months; annually if at risk.

How often does Medicare pay for mammograms?

Screening mammograms every 12 months.

How often does Medicare pay for mammograms after age 70?

Every 12 months.

How often does Medicare pay for podiatry?

If medically necessary due to diabetes or other conditions.

How often does Medicare pay for respite care?

As part of the hospice benefit, limits apply.

How often will Medicare pay for a walker?

When medically necessary, typically every 5 years.

How often will Medicare pay for a wheelchair?

When medically necessary, typically every 5 years.

How often will Medicare pay for an MRI?

When medically necessary, there is no set limit.

How often will Medicare pay for blood tests?

When medically necessary, some screenings are annual.

How often will Medicare pay for prolia injections?

Every 6 months if criteria are met.

How to get Medicare to pay for dental implants?

Medicare doesn’t typically cover dental implants.

How to get Medicare to pay for eyelid surgery?

Only if it’s medically necessary, not for cosmetic reasons.

How to pay for Medicare Part B?

Social Security deductions, direct billing, or bank drafts.

How do I pay Medicare online?

Through Medicare Easy Pay or your bank’s online service.

How do you pay Medicare premiums?

Social Security deductions, direct billing, bank drafts, or Medicare Easy Pay.

What does Medicare Part A pay for?

Inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.

What does Medicare Part B pay for?

Outpatient care, doctor’s services, preventive services, and some home health care.

What does Medicare pay?

Varies by service; often 80% for Part B services after deductible.

What does Medicare pay for?

Hospital care, doctor visits, preventive services, and more, depending on the part.

What equipment does Medicare pay for?

Durable medical equipment like wheelchairs, walkers, and oxygen if medically necessary.

What kind of bed will Medicare pay for?

Hospital beds if medically necessary.

Why do I have to pay Medicare tax?

To fund the Medicare program for current and future beneficiaries. It is also a federal requirement.

Why do I pay for Medicare?

To cover your share of the program’s costs.

Why do I pay Medicare tax if I don’t have insurance?

Medicare tax funds the program for current beneficiaries; you’ll benefit when eligible.

Shawn Plummer, CRPC

Chartered Retirement Planning Counselor

Shawn Plummer is a Chartered Retirement Planning Counselor, insurance agent, and annuity broker with over 14 years of first-hand experience with annuities and insurance. Since beginning his journey in 2009, he has been pivotal in selling and educating about annuities and insurance products. Still, he has also played an instrumental role in training financial advisors for a prestigious Fortune Global 500 insurance company, Allianz. His insights and expertise have made him a sought-after voice in the industry, leading to features in renowned publications such as Time Magazine, Bloomberg, Entrepreneur, Yahoo! Finance, MSN, SmartAsset, The Simple Dollar, U.S. News and World Report, Women’s Health Magazine, and many more. Shawn’s driving ambition? To simplify retirement planning, he ensures his clients understand their choices and secure the best insurance coverage at unbeatable rates.

The Annuity Expert is an independent online insurance agency servicing consumers across the United States. The goal is to help you take the guesswork out of retirement planning and find the best insurance coverage at the cheapest rates

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