Guide to Medicare in the United States

  • What is Medicare?
  • How to apply for Medicare?
  • What is the Original Medicare cover?
  • What is the difference between Medicare and other insurance?
  • What is Part D?
  • What is the Supplement Plan?
  • What is the Advantage Plan(Part C)?

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Medicare is the nation’s medical health insurance program for eligible people 65 years of age or younger. Certain people under the age of 65 are also eligible for Medicare, including people with disabilities, permanent kidney failure, and amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Generally, you can qualify if you meet the following requirements.

First, you are 65 years of age or older; second, you are a U.S. citizen or a green card holder who has lived in the U.S. for more than five years; and third, you have been filing tax returns legally for 10 years or have earned 40 work quarters (only $1,410 of income is required to earn one quarter point this year, with a maximum of four quarter points per year. Therefore, in 2020, you only need to earn $5,640 per year to earn four quarter points. If you do not have a job, you can rely on your spouse to meet the 40-point requirement. However, you must also be 65 years old and have legal status to qualify.

What parts are included in MEDICARE? What coverage is covered?

Medicare (also known as the “Red and Blue Card”) consists of 2 parts.

1. Medicare Part A (Part A)

2. Medicare Part B (Part B)

People with Medicare have a blue card and a red card, commonly known as the “red and blue card”.

Medicare Part A and Medicare Part B are called traditional plans.

1. Medicare Part A :

Reimburses a portion of the cost of hospitalization, such as inpatient care, skilled nursing and hospice services, and home health care services. There is no premium for “Part A”, but there is a $1,408 deductible for each year of hospitalization. There is no charge for the first 60 days of hospitalization, but there is an out-of-pocket expense of $352 per day for stays longer than 60 days and $704 per day for stays longer than 90 days.

2. Medicare Part B :

Reimbursement for necessary medical services such as office visits, specialists, preventive services, emergency services, etc. Part B pays a monthly premium of at least $144.60 (this is the 2020 rate and is subject to change each year), the amount of which depends on taxable income. In addition to the premium, there is an annual deductible of $198. Partial reimbursement of medical services means that 80% of the cost is reimbursed and the remaining 20% is paid by you, there is no upper limit, this may constitute a problem for some people, the specific plan will be mentioned later in the article.

The benefits of the Medicare Card are :

No network restrictions, nationwide coverage, can be used in any hospital or clinic that accepts Medicare Cards throughout the United States.
No prior authorization required
No referrals are required to see specialists.

With a medicare card, what else do you need?

Medicare Card traditional plans do not include prescription drug coverage. In 2003, Congress passed a new law that added a plan specifically to reimburse prescription drugs called Part D. The lowest price this year 2020 is only $7.20 (SilverScript Smart Rx plan). Average $13- $20 per month. Prices have dropped an average of 34% in the last three years. If you need to take special medications, you will pay a higher premium. “Medicare Part D” has one more point: delaying applications for the plan results in a lifetime late application penalty!

Do I need a supplemental plan?

Traditional plans (Medicare Parts A and B) reimburse you for 80% of your expenses and Part D reimburses you for prescription drugs. This leaves an uncapped 20% uncovered portion that can be a concern for your quality retirement. But don’t worry, you can buy a supplemental plan! Supplemental Plan G (Medigap Plan G) will reimburse the remaining 20% of your Part A deductible, including travel abroad for medical emergencies (80%). The supplemental plan is approximately $150-$180 per month. It is the same as the Red and Blue Card: no network restrictions, coverage throughout the U.S., no prior authorization required, no referrals needed for specialty visits.
One key point: the government requires that as long as you apply for a Supplemental Plan within 6 months of the Red and Blue Card’s effective date, the insurance company must offer you the lowest price and cannot deny you coverage. If this period is exceeded, the insurance company will investigate your health status and has the right to increase or even deny your coverage based on your health status. So, make sure you pay attention to the application deadline for the Supplemental Plan and try not to miss it!

What is the total cost now?

Part A – $0

Part B – $170.10 / per month

Part D – $15 / per month

Supplement Plan G(Medigap Plan G) – $180 / per month

Average cost: $170.10 + $15 + $180 = $365.10 / per month. If you are financially able, it is recommended that you purchase both the Supplemental Plan and the Part D Plan, so that you can pay approximately $339.60 per month to cover almost all of your medical expenses for the entire year. If you are not financially able to afford it and find the monthly premium too expensive, you can consider the “Part C” plan, also known as the “Advantage Plan”.

Part C, (aka Advantage Plan)

Part C, the discount plan, is offered by a licensed private health insurance company and covers all the medical services that are covered under Part A and Part B, so it can be used in place of the Red and Blue cards. Unlike Supplemental Plans, many Part C plans do not require premium payment. Unfortunately, however, the network coverage is small and you will have to pay a registration fee for each doctor’s visit. Discount plans even include services not covered by traditional plans, such as dental, vision and hearing aids, as well as other benefits and services, gym memberships, transportation, and over-the-counter drug programs. In addition to network restrictions, Part C requires a portion of the medical costs to be shared.
Customers who choose a Part C discount plan have the option to add, change, cancel or switch their existing plan between October 15 and December 7 of each year. For example, if you switch from a traditional plan to a Part C discount plan, switch from a Part C to a traditional plan, convert from one Part C plan to another Part C plan, move from a Part D prescription drug plan to another Part D plan, or if you are eligible for the first time and did not purchase one, you can apply during this period and the changes made will be effective January 1 of next year, 2021. If you miss this period, you will need to wait until this time next year to make another change or application.

Choose any one you like

To recap, there are different plan options for seniors insurance. If you choose only the traditional plan with 80% reimbursement plus a Part D prescription drug plan, you will pay an average monthly premium of $159.00. If you want to add a supplemental plan to cover the remaining 20%, your monthly premium will increase by approximately $180; an average of $339.00 per month. If you want the lowest price for your coverage, you can choose a Part C discount plan with no monthly fee, but this plan has network limitations and requires pre-approval status. Whatever you decide, you can contact us. We can work out a plan that suits your individual situation.

The following is an example of a Advantage Plan: