Medicare ABC: Get Medicare Insurance Agents

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FAQs

Medicare ABC has the goal to make your experience with Medicare a pleasant one without the confusion of health insurance and Medicare. As a leader in the Health Insurance Marketplace, our goal is to help you achieve optimal health and financial wellness, starting with offering you a health insurance plan that meets your needs at a reasonable cost.
It doesn’t stop here, After enrollment, we help people make the most out of their plan to guide you through your healthcare journey from verifying benefits, explaining claims, finding doctors/specialists, and in addition to this, we can help to set up appointments.
We’re here to make sure that your experience with enrolling on a Medicare Plan is as smooth as it can be

In order to receive the 148.50 dollars from social security that you’re being deducted, when completing your health insurance enrollment, we can help you apply to different programs such as SLMB known also as Specified Low-Income Medicare Beneficiary, LIS (Low Income Subsidy), or Medicaid which help with the part b premium. However, we may only apply you for these programs if you qualify in terms of monthly income.

  • If you have worked 10 years or completed 40 quarters and reported taxes, you may obtain part a premium free but will have to pay 148.50 for part b. 
  • If you have worked 30 – 39 quarters, you may acquire a part a for 279 plus the 148.50 monthly. 
  • If you have worked less than 30 quarters, then you will have to pay 471 plus 148.50

If you have low income or resources, and you qualify for Medicare,  you may apply for the following programs which help pay for Medicare:

  • SLMB: Specified Low Income Medicare Beneficiary: Helps Pay for $148.50 Part B Premium.
  • SPAP: State Pharmaceutical Assistance Programs: Helps Pay for Prescriptions $5.00 for Generic and $7.00 for the brand name.

LIS: Low-Income Subsidy: Helps pay for prescriptions making Generic $3.70 and  $9.20 brand name.

Medicare is a federal program for people ages 65 and older,  people who are disabled,  people who have kidney failure, or Lou Gehrig’s disease. Medicaid is for families or individuals who have low income or resources. However, if you are a senior who has a low income you may apply for Medicaid.

In order to have more benefits in addition to Medicare, you may enroll in a Medicare Advantage which is a combination of part a, part b, part c, and d. With a medicare advantage plan, you may have dental and vision benefits among additional benefits depending on the insurance plan that you choose.

Here in Medicare ABC, apart from asking questions about your doctors and prescriptions, in order to give you the most appropriate Medicare Advantage plan, Supplemental Plan, or Prescription Drug Plan, our agents can help pre-qualify you for any state or federal programs that help pay for Medicare. In addition to this we will help you enroll you in the most appropriate plan you qualify and help you apply for any additional programs that help pay for Medicare costs.

 If the appointment is by phone, in person, or home appointment you need the following documents:

  • Social Security Card 
  • Medicare Card with Part A and B 
  • Drivers License or ID

The advantage of having a Medicare Advantage plan is that Original Medicare covers only 80% of your medical costs. The other 20% has to be covered by you. However, if you enroll in a Medicare Advantage plan, it helps cover the 20% that Original Medicare does not cover.

You may enroll in a medicare advantage plan during the following Inscription Periods:

    • Initial Enrollment Period (IEP): This is when you first enroll in Medicare you may enroll in a Medicare Advantage plan.
    • Medicare Advantage Open Enrollment Period (MAOEP): Runs from January 1st-March 31st. During this time you may change to another Medicare Advantage plan once.
  • Special Election Period (SEP): If you qualify for LIS you may be able to enroll in a Medicare Advantage plan. If you qualify for Medicaid, you may enroll in a Dual Special Need Plan which comes with additional benefits. 
  • Annual Enrollment Period (AEP): during this time, you may change your health insurance plan. This program runs from October 15th to December 7th 

In order to get a plan with us, you may  do any of the following options:

  • Call any of our Medicare Advisor’s agents
  • Visit any of your 10 Locations where an agent could help you to the local office closest to you. 
  • If you have a smartphone we can also enroll you using our Medicare Advisors enrollment system

If any of these options do not seem to work for you, no need to panic. In addition to these options, we have agents that can visit your house in order to complete your enrollment process at no cost to you.

When it comes to Medicare Advantage plans, you may only have one active plan. You are not allowed to have more than one medicare advantage plan.

Depending on the enrollment period you may be able to replace your plan, here are the following options that allow you to replace:

  • Medicare Advantage Open Enrollment Period: This allows you to change to another Medicare Advantage Plan once from January 1st to March 31st.
  • Annual Enrollment Period: This allows you to change your medicare advantage plan from October 15th to December 7th. 

Special Election Period: If you qualify for Medicaid or LIS you may be able to change your plan to Dual Special Need Plan or another Medicare Advantage plan.

What Is Medicare Part A?

Medicare Part A is hospital insurance. Part A covers inpatient hospital care, limited time in a skilled nursing care facility, limited home health care services, and hospice care.

Medicare Part A typically doesn’t cover the full amount of your hospital bill, so you will probably be responsible for a share in the cost. You will also have to pay a deductible before Medicare benefits begin. Medicare will then pay 100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility. After that, you pay a flat amount up to the maximum number of covered days. Your Medicare Part A benefits cover some of the costs for a total of 90 days in a hospital and 100 days in a skilled nursing facility. Medicare also covers up to 60 “lifetime reserve days.” These are days you stay in a hospital longer than 90 days in a row. You get a lifetime total of 60 reserve days.

Medicare Part A typically doesn’t cover the full amount of your hospital bill, so you will probably be responsible for a share in the cost. You will also have to pay a deductible before Medicare benefits begin. Medicare will then pay 100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility. After that, you pay a flat amount up to the maximum number of covered days. Your Medicare Part A benefits cover some of the costs for a total of 90 days in a hospital and 100 days in a skilled nursing facility. Medicare also covers up to 60 “lifetime reserve days.” These are days you stay in a hospital longer than 90 days in a row. You get a lifetime total of 60 reserve days.

Medicare Part B

Medicare Part B is medical insurance. Part B benefits cover certain non-hospital medical expenses like doctors’ office visits, blood tests, X-rays, diabetic screenings and supplies, and outpatient hospital care.

You pay a monthly premium for this part of Original Medicare. The fee can be higher for people with high incomes. A different government program, Medicaid, can help cover Medicare Part B premiums for low-income beneficiaries.

Medicare Part B beneficiaries are usually responsible for a portion of their health care costs. You’ll have to pay a small deductible each year before your Medicare Part B benefits kick in, and then you’ll generally pay 20% of the bill when you go to a participating Medicare doctor. Medicare pays the full cost of many lab tests and services requested by your doctor.

Medicare Part C

Medicare Part C, or Medicare Advantage, insurance often includes every type of Medicare coverage in one health plan. It’s offered by private insurance companies contracted through CMS to provide a Medicare benefits package as an alternative to Original Medicare. Medicare Advantage is optional, but to obtain this private insurance, you must also have Original Medicare, Part A and Part B. You also continue to pay your Part B premium if you have a Medicare Advantage plan. Browse Medicare Advantage plans

While Medicare Advantage plans are required to provide all Medicare Part A and Medicare Part B benefits (except hospice care), plans can also include different additional benefits, which vary among the individual private health insurers. Many Medicare Advantage plans include prescription drug coverage. Some plans might have a lower deductible, while also allowing you to pay a smaller share of the remaining costs. Medicare Advantage plans may even cover certain health care services that Original Medicare, Part A and Part B, does not cover, like eye exams, hearing aids, dental care, or health care received while traveling outside the United States.

Medicare Part D

Medicare Part D is optional prescription drug coverage. Medicare Part D is available as a stand-alone plan through private insurance companies, and the monthly fee varies among insurers. You will share in the costs of your prescription drugs according to the specific plan in which you’re enrolled. Those costs can include a deductible, a flat copayment amount, or a percentage of the full drug cost (called “coinsurance”).

Browse Medicare Part D plans If you want prescription drug coverage, you can get it through a Medicare Advantage plan if there’s one in your area that offers this coverage. You can use the simple form on this page and enter your zip code to view a list of Medicare Advantage plans in your area. If you have limited income and cannot afford your medications even though you receive Medicare Part D benefits, you may qualify for the Extra Help program, which offers financial assistance for your monthly premium, deductible, copayment, or coinsurance.

¿Qué es la Parte A de Medicare?

La Parte A de Medicare es un seguro hospitalario. La Parte A cubre la atención hospitalaria para pacientes hospitalizados, el tiempo limitado en un centro de atención de enfermería especializada, los servicios limitados de atención médica domiciliaria y los cuidados paliativos. Por lo general, la Parte A de Medicare no cubre el monto total de la factura del hospital, por lo que probablemente será responsable de una parte del costo. También deberá pagar un deducible antes de que comiencen los beneficios de Medicare. Luego, Medicare pagará el 100% de sus costos por hasta 60 días en un hospital o hasta 20 días en un centro de enfermería especializada. Después de eso, paga una cantidad fija hasta el número máximo de días cubiertos. Sus beneficios de la Parte A de Medicare cubren algunos de los costos por un total de 90 días en un hospital y 100 días en un centro de enfermería especializada. Medicare también cubre hasta 60 "días de reserva de por vida". Estos son los días que permanece en el hospital más de 90 días seguidos. Obtienes un total de por vida de 60 días de reserva. Por lo general, la Parte A de Medicare no cubre el monto total de la factura del hospital, por lo que probablemente será responsable de una parte del costo. También deberá pagar un deducible antes de que comiencen los beneficios de Medicare. Luego, Medicare pagará el 100% de sus costos por hasta 60 días en un hospital o hasta 20 días en un centro de enfermería especializada. Después de eso, paga una cantidad fija hasta el número máximo de días cubiertos. Sus beneficios de la Parte A de Medicare cubren algunos de los costos por un total de 90 días en un hospital y 100 días en un centro de enfermería especializada. Medicare también cubre hasta 60 "días de reserva de por vida". Estos son los días que permanece en el hospital más de 90 días seguidos. Obtienes un total de por vida de 60 días de reserva.

Parte B de Medicare

La Parte B de Medicare es un seguro médico. Los beneficios de la Parte B cubren ciertos gastos médicos no hospitalarios como visitas al consultorio del médico, análisis de sangre, radiografías, exámenes y suministros para diabéticos y atención hospitalaria para pacientes ambulatorios. Usted paga una prima mensual por esta parte de Medicare Original. La tarifa puede ser más alta para las personas con ingresos altos. Un programa gubernamental diferente, Medicaid, puede ayudar a cubrir las primas de la Parte B de Medicare para beneficiarios de bajos ingresos. Los beneficiarios de la Parte B de Medicare generalmente son responsables de una parte de sus costos de atención médica. Tendrá que pagar un pequeño deducible cada año antes de que comiencen sus beneficios de la Parte B de Medicare, y luego, por lo general, pagará el 20% de la factura cuando vaya a un médico participante de Medicare. Medicare paga el costo total de muchas pruebas de laboratorio y servicios solicitados por su médico.

Parte C de Medicare

El seguro de la Parte C de Medicare, o Medicare Advantage, a menudo incluye todos los tipos de cobertura de Medicare en un plan de salud. Lo ofrecen compañías de seguros privadas contratadas a través de CMS para proporcionar un paquete de beneficios de Medicare como alternativa al Medicare Original. Medicare Advantage es opcional, pero para obtener este seguro privado, también debe tener Medicare Original, Parte A y Parte B. También seguirá pagando la prima de la Parte B si tiene un plan Medicare Advantage. Explore los planes Medicare Advantage Si bien los planes Medicare Advantage deben proporcionar todos los beneficios de la Parte A y la Parte B de Medicare (excepto los cuidados paliativos), los planes también pueden incluir diferentes beneficios adicionales, que varían entre las aseguradoras de salud privadas individuales. Muchos planes Medicare Advantage incluyen cobertura de medicamentos recetados. Algunos planes pueden tener un deducible más bajo, al mismo tiempo que le permiten pagar una parte menor de los costos restantes. Los planes Medicare Advantage pueden incluso cubrir ciertos servicios de atención médica que Medicare Original, Parte A y Parte B, no cubre, como exámenes de la vista, audífonos, atención dental o atención médica recibida mientras viaja fuera de los Estados Unidos.

Medicare Parte D

La Parte D de Medicare es una cobertura de medicamentos recetados opcional. La Parte D de Medicare está disponible como un plan independiente a través de compañías de seguros privadas y la tarifa mensual varía entre las aseguradoras. Compartirá los costos de sus medicamentos recetados según el plan específico en el que esté inscrito. Esos costos pueden incluir un deducible, un monto de copago fijo o un porcentaje del costo total del medicamento (llamado “coseguro”). Explore los planes de la Parte D de Medicare Si desea cobertura de medicamentos recetados, puede obtenerla a través de un plan Medicare Advantage si hay uno en su área que ofrezca esta cobertura. Puede usar el formulario simple en esta página e ingresar su código postal para ver una lista de planes Medicare Advantage en su área. Si tiene ingresos limitados y no puede pagar sus medicamentos a pesar de que recibe los beneficios de la Parte D de Medicare, puede calificar para el programa de Ayuda adicional, que ofrece asistencia financiera para su prima mensual, deducible, copago o coseguro.