Beauty OF ARIZONA, NEVADA & TEXAS

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Medicare is is a national health insurance program established and administered by the federal government.  It operates under the same rules and regulations no matter where you live in the US.  You generally become eligible for Medicare when you turn 65.  Some people may qualify earlier if they receive Social Security Benefits or have been diagnosed with ALS (Lou Gehrig's Disease) or end-stage renal disease.

Medicare consists of 4 Parts.  Part A, Part B, Part C and Part D, you can find more detailed information on the Compare Plans Page.

Original Medicare consists of Medicare Part A and Medicare Part B. Original Medicare is an 80/20 Healthcare plan.  This means taht Medicare will pay for 80% of all Medicare Covered Expenses and all medically necessary procedures.  Then, after Medicare pays, you are responsible for the remaining 20%.

Medicare is not free there are monthly premiums and cost sharing for things such as deductibles and coinsurance. Today there are over 57 million people on Medicare, there are over 900,000 doctors and hospitals who accept Medicare in the United States.  Your Initial Enrollment Period (IEP) for Medicare is 7 months long beginning 3 months before your "Birth Month" and continues until 3 months after you turn 65.   Some conditions may qualify some people for Medicare benefits before they reach 65.  

During your IEP you are GUARANTEED issue into Medicare and any Medicare Supplement Plan or Medicare Advantage Plan you choose. During this special period, there are no Medical questions to answer and nothing about your past or present health status needs to be disclosed! 

After your IEP, anyone on Medicare is welcome to apply for any Medicare Supplement plan they choose, but; everyone will be subject to Medical Underwriting approval in order to join.  If you care in good overall health, are not dependent on Insulin, have not had Cancer for at least 5 years and have no Cardiac issues (Pacemakers, Stents, Defibrillators) and you do not have ALS or End Stage Renal Disease you should qualify.

There are late penalties if you miss your IEP and do not have any other credible health coverage (such as employer coverage).  You can apply for Medicare from the Social Security Administration in person, online or by telephone.

Your first major decision once you become eligible and you decide to enroll in Medicare and speificallyin Medicare Part B is your right to enroll in a Medicare Supplement plan with guaranteed issue rights. This means that you are guaranteed to be accepted into any Medicare Supplement plan of your choosing, regardless of your past health challenges or health history.  You will have no medical questions to answer either, This is a critical decision as after you have enrolled in Medicare Part B for 6 months and have chosen not to enroll in a Medicare Supplement, you will never again have the opportunity for Guaranteed Acceptance.  After six months, you will have to answer all Medical Questions and you will be subjecting to Medical Underwriting.

Medicare was created by the United States Congress in 1965.  Congress broke Medicare into two main parts that still exist today.  Part A covers hospital benefits and Part B covers outpatient benefits.

MEDICARE PART A pays for hospital stays, skilled nursing care , blood and hospice. About 99% of people enrolled in Medicare Part A never will have to pay a premium for their Part A coverage because of teh Medicare Taxes they paid through payroll deductions throughout their working careers.

MEDICARE PART B pays for outpatient services such as preventative care, doctor visits, lab work, diagnostic imaging, outpatient surgery, durable medical equipment, chemotherapy, radiation treatments and more.

EVERYONE who enrolls in Medicare Part B must pay their monthly Medicare Part B Premium and their Annual Part B Deductible, regardles of whether they participate in Original Medicare, a Medicare Advantage Plan or if tehy choose Original Medicare with a Medicare Supplement policy. Part B can be Paid by Credit Card, DIrect Bill, EFT Transfers or can be paid from your monthly Social Security Benefits.

For 2022 the monthly Medicare Part B premium is $270.10 and the Annual Part B Deductible will be $233.

Both Medicare part A and Medicare Part B are 80% paid for by the government and 20% is the responsibility of the beneficiary or the patient. With Original Medicare you are free to choose and Doctor or Hospital that accepts Medicare Terms for payment. (Approximately 94% of all Doctors accept Medicare.

MEDICARE PART C is also known as Medicare Advantage.  These plans are still 80/20 plans where the private insurance company pays for 80% of covered services and you are responsible for the other 20% And, you must pay your 20% share whenever you receive medical services. You are also responsible to pay for any/all co-pays and deductibles. Since most M/A plans are either HMO (Health Maintenance Organization) or a PPO network (Preferred Provider Organization). With these plans you must use the Doctors and Hospitals listed in their network in order to receive full coverage for any procedure.  

MEDICARE PART D covers Prescription Drugs. Because there is no prescription drug coverage with Original Medicare (except for those drugs and medications that are provided during ahospital stay).  

On October 8, 2003 President George W. Bush signed Medicare Prescription Drug coverage into law.

 Medicare Part D covers retail prescription drugs for Medicare beneficiaries through unique, stand-alone drug insurance plans. . 

 You pay a monthly premium to join any Medicare Part D Prescription Drug plan available in your area that fits your needs the best choose in addition to the discounted price for your prescription medications.   T

hese plans vary from $7.50 - $139 per month. We strongly believe that it is best to work with an experienced Medicare Broker like us to find the best plan at the lowest cost for your own individual needs.

All Medicare Supplement (Also referred to as Medigap) plans are identified by a letter and each plan has the exact same coverage coast to coast.  The only difference is the price the insurance companies charge in each state.  

Medicare Supplement Plans became available in 1990 and these plans are all standardized and must follow the guidelines set by Medicare itself.  Medigap Plans are lettered and although the coverage is the same from each Insurance Company their prices will vary.  These are Plans A, B, C, D, F, G, K, L, M and N. The most common plans sold are Plans F, G and N.

Depending on which Medicare Supplement Plan you choose, Medicare pays their 80% share and they then bill your Medicare Supplement Insurance company for the remaining 20% share.

Plan G is the best and the most comprehensive Medicare Supplement available to new Medicare Beneficiaries as of 1/1/2020.  Plan F stopped being available for new Medicare Beneficiaries on that date but is still available for those enrolled in Medicare prior to 1/1/20. in 99.9% of cases, you will never have a bill from Medicare.  

With A Plan G Medicare SUpplement plan, Medicare pays their 80% share for any/all Medicare approved and Medically necessary procedures and your Plan G pays the remaining 20%.  You pay nothing! 

Medicare will pay their share and your Medicare Plan G Supplement will pay the rest.  Honestly, this is the best deal in Healthcare in the US. The best way to look at this is your Maximum Out-Of-Pocket Expense is your monthly premium.   The majority of Plan G beneficiaries pay well under $2,000 a year in premiums and when you realize that the lowest MOOP (Maximum Out-Of-Pocket Expense)  you can find with a limited no-cost Medicare Advantage plan is between $3,000 - $4,000 there absolutely  is no comparison. 

THe biggest benefit with a MedicareSupplement or Medigap plan is you can choose ANY Doctor, go to ANY Hospital ANYWHERE in the United States and you are covered!  WHy would anyone choose a limited Medicare Advantage plan with local networks and limited choices for Physician's and Healthcare Facilities when you have less exposure and better coverage with a Medicare Supplement Plan G? And, not just that but once you are approved and enroll in a Medicare Supplement, your plan  can never cancel your policy, as long as your premiums are paid. That is true peace of mind for you and your family.

 You must continue to pay your Medicare Part B premium even if you are enrolled in a Medigap Plan.  

 Items not covered by Medicare Supplement Plans are:  

• Routine dental, vision and hearing exams
• Hearing Aids
• Eyeglasses or contacts
• Long Term Care or Custodial Care
• Retail Prescription Drugs

Medicare does cover Cataract Surgery, Maccular Degeneration, and a limited amount of CHiropractic and Accupunture therapies.

A Medicare Advantage Plan is a private health insurance plan approved by Medicare.  You have the option to receive your Part A, Part B and Part D benefits from a Medicare Advantage Plan instead of Original Medicare.  Originally these private insurance company offerings were referred to simply as Medicare Part C.  Medicare Advantage plans usually have and HMO or PPO network of physicians and hospitals. All Medicare Advantage Plan's are 80/20 Plans where the insurance company pays 80% of the covered charges and you are responsible for paying your 20% share as you go. Each year you in the fall Annual Enrollment Period you will need to choose a new plan for the coming year 

MA and MA/PD (Medicare Advantage Plans) were created as an alternative to Original Medicare and Medicare Supplemental/Medigap insurance.  By joining one of these plans, you direct Medicare to pay the Advantage Plan a set monthly amount for your care.  In return, the plan will deliver all of your Part A & Part B benefits and services.  Essentially your care and services are managed by a private insurance company instead of the government.  The Insurance carrier takes on all of the risk. And, unfortunately, each Insurance Company makes it own rules and they have final say on what procedures are covered and which ones are not.

You must continue to pay your Medicare Part B premium each month, you must be enrolled in Medicare Plan A and Plan B and you must live in the Medicare Advantage Plan' service area.

Medicare Advantage plans are NOT Medigap plans.  They work completely differently because your insurance company pays all of your bills instead of Medicare.

Medicare Advantage Plans may offer built in supplemental benefits to their beneficiaries such as limited Dental, Vision and Hearing benefits, but not every Medicare Advantage plan has each of these benefits, so comparing MA plans and MA/PD plans is a lot of work each year.

Medicare Part D is a Voluntary Prescription Drug Plan that was introduced in 2006 to help Seniors on Medicare with a way to help them cut down on the costs associated with Prescription Drugs. 

Any beneficiary who is enrolled in Medicare Part A or Medicare Part B is eligible to enroll in a Part D Plan.

Medicare Part D is simply insurance for your medications.  You pay a monthly premium to an insurance company for your Part D Plan. In return, you use the insurance carriers network of pharmacies to purchase your prescription medications.  Instead of paying full price, you will pay a copay or a percentage of the drugs cost and the insurance company pays the rest.

Plans vary by state but most start around $25-$35 per month.

Two things we always recommend to our clients are:

 #1 You should never overpay for a Part D Medicare Preescription Drug Plan that covers more than you need because you are always able to change or switch your Part D plan each year during the Fall Medicare Annual Enrollment Period taht rund from October 15th through December 7th.  Then, if you decide to change plans becasue either the costs went up or your prescription medications changed, your new plan will begin on January 1st for the upcoming year. 

#2 Everyone should download a copy of the Good RX app onto their Phone, Tablet or PC. Then, whenever a medication is prescribed check the price on Good RX and compare that with what your new medication would cost with your Part D Drug plan.  In many cases, it is less expensive to use a free Good RX coupon than using your plan.  That is why we  compare every medication our clients have to ensure they are in the best plan, to save them the most money and we gladly review their plans each fall to ensure they are always  in the right Part D plan that saves them the most money on their prescription medications every year.

Medicaid is a program to provide health care services to low-income individuals, primarily children, older adults, persons with disabilities, pregnant women and caretakers of children.

Medicaid is administered at the state level, although it is jointly funded by the state and federal tax dollars.  Each state sets its own income and eligibility requirements.

Although Medicaid covers some of the same services that Medicare typically covers, such as hospital care and doctor visits, it also offers benefits that Medicare doesn't, such as Long Term Care, Vision and Dental Care.

IT is possible to qualify for both Medicare and Medicaid and this is know as being "dual eligible".  This can be particularly helpful if an individual needs help with Long Term Care and a few other items that are not covered by Medicare.