WHAT IS MEDICARE?
Medicare is our country’s health insurance program for people age 65 or older. If you are not 65 or older, you may also qualify if you have permanent kidney failure or receive Disability benefits. Medicare consists of four parts. Part A (Hospital Insurance), Part B (Medical Insurance) Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).
Beneficiaries don’t pay a monthly Medicare Part A premium if they or their spouse paid Medicare taxes while working for a certain amount of time. The standard Part B premium for 2025 is $185 monthly for single individuals who have a modified adjusted gross income of less than $106,000. If you decline to enroll in Part B when first eligible and do not have creditable coverage, you’ll pay a lifetime penalty when you sign up later.
Contact The Holden Agency for a complete explanation of Medicare and your options at (888) 722-1582.
Medicare Part A
Medicare Part A Covers:
- Inpatient Hospital Care
- Skilled Nursing Facility Care (SNF)
- Behavioral & Mental Health
- Hospice Care
- Home Health Services
- Nursing Home Care
Medicare Part A Does Not Cover:
- Dental
- Vision
- Hearing
Medicare Part B
Medicare Part B Covers:
- Ambulance services
- Clinical research
- Durable medical equipment (DME)
- Limited outpatient prescription drugs
- Mental health & substance use disorders
- Oxygen equipment & accessories
Medicare Part B Does Not Cover:
- Dental
- Vision
- Hearing
Medicare Part D
Medicare Part D Covers:
The cost of prescription drugs. To get Medicare drug coverage, you must join a Medicare-approved plan through a Private Insurance Company that offers drug coverage.
Two options to receive Medicare Part D coverage are:
- A separate Medicare Drug Plan
- A (Part C) Medicare Advantage Plan that combines Parts A, B, & D
Medicare Part C – Medicare Advantage
Medicare Part C Plans (also known as Medicare Advantage Plans) are offered by private insurance companies. Medicare Advantage Plans combine Medicare Part A, Medicare Part B into one plan and some also include Medicare Part D (prescription drug coverage). Medicare Advantage Plans can offer additional benefits that Original Medicare (Parts A&B) do not cover.
In addition to everything covered in Parts A & B, a Medicare Part C (Medicare Advantage Plan) can also cover:
- Dental
- Vision
- Hearing
- Gym Memberships
- Transportation
- And More…
Medicare Supplement – Medigap
Medicare Supplement Insurance (also known as Medigap) is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare.
They can help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles that Original Medicare Parts A&B do not cover.
You get a 6 month “Medigap Open Enrollment” period, which starts the first month you have Medicare Part B and you’re 65 or older. During this time, you can enroll in any Medigap policy and the insurance company can’t deny you coverage due to pre-existing health problems. After this period, you will be subject to medical underwriting if you try to join. You may not be able to buy a Medigap policy, or it may cost more.
Medicare & Tricare
Tricare for Life is a health care program for active-duty service members, military retirees, and their families who are eligible for Medicare Part A and Part B . Most people with TRICARE who are entitled to Part A must also have Part B to keep their TRICARE drug benefits. For beneficiaries who delay their Part B, whenever the sponsor’s active duty status ends, you must have Medicare Part B to remain TRICARE-eligible.
If you have TRICARE and join a separate Medicare drug plan, your Medicare drug plan pays first, and TRICARE pays second.
If you join a Medicare Advantage Plan with drug coverage, your Medicare Advantage Plan and TRICARE may coordinate benefits if your Medicare Advantage Plan network pharmacy is also a TRICARE network pharmacy. Otherwise, you can file your own claim to get paid back for your out-of-pocket costs.
If you join a Medicare Supplement, Tricare for Life will become the payor of last resort.