Medicare Made Easy

A simple guide to understanding Medicare and your available options.

What is Medicare?

Medicare is a federal health insurance program for people…

Ages 65 and older

Under age 65 with certain disabilities

Any age with end-stage renal disease or kidney failure

Original Medicare Parts A & B provide a menu of benefits, but it’s not a complete package and although deductibles, coinsurance and copays are competitive, there are no limits to the amount of money you can spend out of pocket, which could leave you responsible for paying thousands in out of pocket costs.

However, these gaps in coverage can be supplemented by employer coverage, Medicare Advantage (Part C), or a Medicare Supplement (Medigap) with a Medicare Prescription Drug plan (Part D).

The Big Question?

You may be wondering “Do I need to enroll in Medicare?” and for most people turning 65, the answer is yes.

However, it still depends on your exact situation. Before we proceed with simplifying your understanding of Medicare, it’s important that we determine when you need to take action.

Click the button to be redirected to Medicare’s eligibility tool, where you can answer a few short questions and estimate your deadline to enroll into Medicare without any future re-occurring penalties.

Once completed, write your results down – specifically your Initial Enrollment Period deadlines – and return to this page to complete your introduction into Medicare.

Medicare Part A

Helps cover costs associated with inpatient hospitalization, skilled nursing, hospice and blood services.

There is no yearly limit on annual out of pocket costs.

For most people, Part A premiums start at $0/mo

Inpatient Hospitalization

You Pay

Part A Inpatient Deductible

Days 1 - 60

$1,600

Daily Inpatient Copay

Days 61 - 90

$400

Daily Inpatient Copay

Days 91 - 150

$800

Daily Inpatient Coinsurance

Days 151+

100%

Skilled Nursing, Hospice & Blood

You Pay

Skilled Nursing Confinement

Days 1 - 20

Daily Skilled Nursing Copay

Days 21 - 100

$200

Skilled Nursing Coinsurance

Days 101+

100%

Hospice Care

Certified Terminal

Respite Care

Blood

Pints 1 - 3

100%

Pints 3+

Medicare Part B

Helps cover costs associated with physician services, outpatient care, blood, tests and supplies.

Part B also has no yearly limit on annual out of pocket costs.

For most people, Part B premiums start at $164.90/mo

Physician, Outpatient Care & Labs

You Pay

Part B Deductible

Annual (2022)

$226

Medical Expenses

Coinsurance

20%

Outpatient Hospital Services

Minimum Coinsurance

20%

Additional Hospital Costs

100%

Excess Doctor Charges

Max 15% of Approved Amount

100%

Medical Expenses

Coinsurance

Home Healthcare & Blood

You Pay

Home Healthcare

Costs For Care

Durable Medical Equipment

20%

Blood

Pints 1 - 3

100%

Pints 3+

20%

Covering the Gaps of Original Medicare

Aside from certain group health plans, there are 2 main ways to cover the gaps with Original Medicare. Both options have their advantages, depending on what you personally find valuable. Luckily, they are easy to understand, so relax and take a deep breath, this is much easier than you think.

Medicare Supplement

Also known as Medigap

Medicare Advantage

Also known as Part C

Important questions to consider...

Medicare Supplement

Medicare Advantage

Do I have freedom to choose my providers/hospitals?

Yes

No

Do I need referrals to see a specialist?

No

In some cases

Can my plan benefits change?

No

Yes

Is coverage guaranteed renewable if premiums are paid?

Yes

No

Does it include prescription drug coverage (Part D)?

Purchase Seperately

Usually, Yes

Now hang on, let's not get ahead of ourselves...

Medigap plans generally charge more in monthly premiums than the alternative, Medicare Advantage.

It’s important to shop both options carefully and make sure you stay with a price that you can comfortably afford.

Additionally, Medicare Supplement and Medicare Advantage plans vary by insurance company. Premiums, deductibles and out of pocket costs can vary by plan, and in some cases you may need to purchase prescription drug coverage separately as noted above.

It’s important to understand the differences between your options, and any future restrictions you may face. If you make the wrong decision now and want to change in the future, you may be subject to health underwriting, meaning not everyone will be accepted.

It’s important to make the right decision today to help avoid these risks in the future.

Part D

Prescription Drug Coverage

Medicare drug coverage helps pay for out of pocket prescription drugs costs. Even if you don’t take prescription drugs now, you should consider getting a stand alone Part D plan or a Medicare Advantage plan that includes it.

If you decide not to get Part D when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, you’ll likely pay an ongoing late enrollment penalty when you finally join a plan.

Generally, you’ll pay this penalty for as long as you have Medicare drug coverage.

Avoid late enrollment penalties

If you do not enroll into Original Medicare when you are first eligible, you may face re-occurring penalties, which in some cases must be paid for as long as you live.

Part A Penalty

10% penalty based on your Part A premium. You will have to pay the penalty for twice the number of years you weren’t signed up.

Doesn’t apply to premium-free Part A

Part B Penalty

10% penalty for each 12 month period that you weren’t signed up, multiplied by your Part B premium.

Penalty is paid monthly for life.

Part D Penalty

1% penalty multiplied by the “national base premium”, times the number of months you didn’t have Part D or creditable coverage.

Penalty is paid monthly for life.

My employer has more than 20 employees, do I need Medicare?

Answer: If you have a group health plan and your employer has more than 20 employees, you still need to enroll in Part A, but you can wait to enroll into Parts B & D until you stop working or lose health insurance, whichever comes first.

You will only have a certain amount of time to enroll to avoid late enrollment penalties.

My employer has less than 20 employees, do I need Medicare?

Answer: If you have a group health plan and your employer has less than 20 employees, your employer coverage might not cover costs for services if you haven’t signed up for Parts A, B & D.

You may also face re-occurring late enrollment penalties, which in some cases may be lifetime.

Assistance you can count on

Shield Me Insurance provides no-cost full service assistance to help you with your enrollment into Original Medicare Parts A & B and/or Social Security, as well as a free, easy to understand comparison of your options to help cover any remaining out of pocket costs not covered by Original Medicare.

For our clients who are sick of the constant calls about Medicare, we even provide no-cost concierge service to register you to the federal do-not-call list, helping you eliminate unwanted tele-marketed sales calls.

You have needs. We have experience. Let’s find a solution together.

RSVP A CONSULTATION (321) 205-3149

Request a quote

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CMS Required Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.