Medicare Plans
Ulness Health offers 1-on-1 meetings and educational seminars for understanding your Medicare options.
Serving Appleton, Neenah, Menasha and the Fox Cities. Let’s find the best plan for you.
We offer Medicare Advantage, Medicare Supplement and prescription drug plans from more than 20 companies!
WHAT IS MEDICARE?
What is Medicare? – Medicare is a federal health insurance program in the United States that provides coverage for people who are 65 or older, as well as for some younger people with disabilities or certain medical conditions. It is administered by the Centers for Medicare & Medicaid Services (CMS) and is funded by taxes, premiums, and government funding.
Who is eligible for Medicare? – Eligibility depends on several factors, including age, disability status, and certain medical conditions. To be eligible, you must meet one of the following criteria:
- You are 65 years of age or older
- You have been receiving Social Security disability benefits for at least 24 months
- You have been diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease)
If you are 65 or older, you are eligible for Medicare regardless of your income or medical history. If you are under 65, you may be eligible for Medicare if you have a qualifying disability or medical condition.
What are the parts of Medicare? – Medicare is divided into four parts: Part A, Part B, Part C, and Part D. Part A covers hospital stays, skilled nursing facility care, hospice care, and home health care. Part B covers doctor’s visits, outpatient services, preventive services, and medical equipment. Part C, also known as Medicare Advantage, is an alternative to traditional Medicare and is provided by private insurance companies. Part D covers prescription drug costs.
How do I sign up for Medicare? – To sign up for Medicare, you need to be eligible for the program. Generally, you are eligible if you are 65 or older, or if you have a qualifying disability or medical condition.
If you are already receiving Social Security benefits, you will be automatically enrolled in Medicare Part A and Part B when you turn 65. You should receive your Medicare card in the mail about three months before your 65th birthday. If you don’t want Part B, you must let Social Security know by following the instructions that come with your card.
If you are not receiving Social Security benefits, you will need to enroll in Medicare yourself. You can do this by visiting the Social Security website or by calling their toll-free number: 1-800-772-1213. You can also visit your local Social Security office in person.
It’s important to enroll in Medicare during your initial enrollment period, which starts three months before the month you turn 65 and ends three months after the month you turn 65. If you miss this enrollment period, you may have to pay a penalty for late enrollment.
MEDICARE PLAN COVERAGE OPTIONS
In addition to traditional Medicare, there are three other types of Medicare coverage options available: Medicare Advantage, Medicare Supplements (Medigap), and Prescription Drug Plans.
Medicare Advantage, also known as Medicare Part C, is provided by private insurance companies and offers an alternative to traditional Medicare. Medicare Advantage plans must cover at least the same services as Parts A and B, and may also include additional benefits like prescription drug coverage, vision, and dental. Some plans also offer benefits like gym memberships or dental/vision services. Medicare Advantage plans typically have lower out-of-pocket costs than traditional Medicare, but you may be limited to a network of providers.
Medicare Supplement Insurance (Medigap) plans are designed to help cover costs not covered by traditional Medicare, such as copayments and deductibles. Medigap plans are offered by private insurance companies and can help fill in the gaps in traditional Medicare coverage. It’s important to note that you cannot have a Medigap plan and a Medicare Advantage plan at the same time.
Medicare Part D is the prescription drug coverage option available to Medicare beneficiaries. This coverage is offered by private insurance companies and helps pay for the cost of prescription medications. Part D coverage is optional, but if you don’t enroll in a Part D plan when you’re first eligible, you may have to pay a penalty if you decide to enroll later.
If you have traditional Medicare and want prescription drug coverage, you can enroll in a standalone Part D plan. However, if you have a Medicare Advantage plan, your prescription drug coverage may be included in your plan. Be sure to review your plan’s drug formulary to make sure your medications are covered.
If you have a Medigap plan, you will need to enroll in a standalone Part D plan for prescription drug coverage. Medigap plans do not include prescription drug coverage.
Choosing the right Medicare coverage option for your needs can be overwhelming. It’s important to review your health care needs and budget carefully, and to compare the costs and benefits of each option before making a decision.
Medicare is complicated! Let our team of local insurance experts help find the best plan for you.
MEDICARE PLAN COSTS AND FEES
Medicare costs and fees can vary depending on the type of coverage you choose and your individual circumstances. Here are some of the costs you may encounter:
- Medicare Part A: Most people do not pay a premium for Part A, as long as they have worked and paid Medicare taxes for at least 10 years. However, there may be coinsurance and deductibles for hospital stays and other services.
- Medicare Part B: The standard premium for Part B is $164.90 per month in 2023, but it may be higher if your income exceeds certain thresholds. There is also a deductible, and you’ll typically pay 20% of the Medicare-approved amount for most services.
- Medicare Advantage: Costs for Medicare Advantage plans can vary widely, but most plans have a monthly premium in addition to your Part B premium. You may also have copays or coinsurance for services, and some plans have deductibles.
- Medicare Supplement: Medigap plans have a monthly premium in addition to your Part B premium. The cost of the premium will depend on the plan you choose, and some plans may have deductibles or copayments.
- Prescription drug coverage (Part D): The cost of Part D coverage will depend on the plan you choose, but you may have a monthly premium, deductible, copays, and coinsurance.
It’s important to review your costs and fees each year during Medicare’s Open Enrollment Period to ensure you’re still getting the coverage you need at a price you can afford. Additionally, if you have limited income and resources, you may be eligible for assistance with Medicare costs through programs like Extra Help or Medicaid.
FREQUENTLY ASKED QUESTIONS ABOUT MEDICARE PLANS
- When can I enroll in Medicare? You can enroll in Medicare during your Initial Enrollment Period, which is the seven-month period that begins three months before your 65th birthday month and ends three months after your 65th birthday month. If you miss your Initial Enrollment Period, you can enroll during the General Enrollment Period, which runs from January 1 to March 31 each year.
- Do I need Medicare if I have employer-sponsored health insurance? If you’re still working and have employer-sponsored health insurance, you may not need to enroll in Medicare right away. However, you should check with your employer to see if they require you to enroll in Medicare. If you’re not sure whether to enroll, it’s a good idea to meet with a Medicare expert.
- Can I change my Medicare coverage after I enroll? Yes, you can change your Medicare coverage during Medicare’s Open Enrollment Period, which runs from October 15 to December 7 each year. You can switch from traditional Medicare to a Medicare Advantage plan, switch from one Medicare Advantage plan to another, or switch from one Part D plan to another.
Still have more questions?
FREE WORKSHOPS
If you are looking to learn more about Medicare health plans, Ulness Health Insurance Agents offers free educational seminars. Click the green button below to view the full list of seminars.
SCHEDULE A 1-ON-1 MEETING
Ulness Health Insurance Agents are your local Medicare experts serving Appleton, Neenah, Menasha, and the rest of the Fox Cities. Our team provides free, personalized consultations year-round to help you understand and choose the right plan for your needs and budget. Contact us today to schedule your one-on-one meeting and get started on the path to affordable, comprehensive coverage.
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