Navigating Medicare

Your Comprehensive Guide to Healthcare in Retirement

For millions of Americans turning 65 or living with certain disabilities, Medicare becomes the cornerstone of their healthcare coverage. However, with its various “Parts” and numerous supplemental options like Medicare Advantage and Medigap, understanding Medicare can feel like navigating a maze. At Bob Greenberg – CLTC Insurance Services, we specialize in demystifying Medicare, providing clear, personalized guidance to help you choose the plans that best suit your health needs, budget, and lifestyle. Our goal is to empower you to make informed decisions, ensuring you receive the comprehensive healthcare coverage you deserve without unnecessary confusion or financial strain.

Let’s break down the essential components of Medicare:

Original Medicare (Parts A & B): The Foundation

• Medicare Part A (Hospital Insurance): This part primarily covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most people don’t pay a monthly premium for Part A if they or their spouse paid Medicare taxes through employment for a specified period (typically 10 years or 40 quarters). Part A helps with the costs associated with facility-based care after you meet a deductible.
• Medicare Part B (Medical Insurance): Part B covers doctor’s services, outpatient care, medical supplies, and preventive services. Unlike Part A, most people pay a monthly premium for Part B, which can be deducted from Social Security benefits. After you meet an annual deductible, Medicare typically pays 80% of the Medicare-approved amount for services, leaving you responsible for the remaining 20% (coinsurance), with no annual limit on out-of-pocket costs.

While Original Medicare (Parts A and B) provides foundational coverage, it’s important to understand its limitations. It doesn’t cover prescription drugs, routine vision, dental, or hearing care, and it has deductibles and coinsurance that can accumulate, potentially leading to significant out-of-pocket expenses. This is where other Medicare options come into play.

Medicare Part D (Prescription Drug Coverage): Essential for Many

Prescription drug costs can be a major concern for seniors. Medicare Part D plans are standalone plans offered by private insurance companies approved by Medicare. These plans help cover the cost of prescription drugs. Each Part D plan has its own list of covered drugs (formulary), tiered pricing, deductibles, copayments (co-pay), and coinsurance, which can vary significantly. Choosing the right Part D plan involves carefully reviewing your current medications and understanding the plan’s structure to minimize your out-of-pocket drug costs. We can help you compare plans and identify the one that best covers your specific prescriptions.