Medicare

Medicare offers numerous plan options, which can be confusing when you're trying to select the one that best fits your needs. Making an uninformed decision about your plan may result in inadequate coverage for your specific healthcare requirements.

We provide the convenience of scheduling a meeting in your own home at a time that suits you, and we encourage the presence of family members or friends. Our aim is to ensure you choose the right plan that covers all the Medicare benefits you're eligible for.

The federal government provides Original Medicare for individuals aged 65 and older or those under 65 with specific disabilities. Original Medicare comprises two parts, Part A and Part B. It covers hospital services and outpatient care but does not include vision and dental care, acupuncture, most prescription drugs, long-term care like nursing homes, and services or supplies that aren't deemed medically necessary.

Part A - Hospital Care

It includes coverage for hospital expenses and the majority of services you receive while hospitalized as an inpatient. While some individuals are automatically enrolled in Part A, others will need to go through a sign-up process.

Who qualifies for Medicare Part A?

Medicare Part A is generally available to the following individuals:

Individuals Aged 65 and Older: Most U.S. citizens and legal residents become eligible for Medicare Part A at the age of 65.
People with Certain Disabilities: Those under 65 with specific disabilities, such as amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD), may also qualify for Medicare Part A.
Individuals with ESRD: Individuals with End-Stage Renal Disease (ESRD) who require dialysis or a kidney transplant can be eligible for Medicare Part A.

What services are not covered under Medicare Part A?

Services not covered under Medicare Part A include long-term care, most prescription medications, dental care, vision care, hearing aids, cosmetic surgery, acupuncture, routine foot care, custodial care, and more.

How much does Medicare Part A cost?

Most beneficiaries qualify for premium-free Part A if they or their spouse have paid Medicare taxes for at least 10 years. If you're not eligible for premium-free Medicare Part A, you may have the option to purchase it. If you've paid Medicare taxes for 30-39 quarters, the monthly premium is $285. If you've paid less than 30 quarters, the monthly premium is $518.

Is there a late enrollment penalty for premium Part A?

Medicare Part A typically doesn't have a late enrollment penalty for most people. If you or your spouse paid Medicare taxes while working, you're generally eligible for premium-free Part A at age 65. If you're eligible and don't enroll during your Initial Enrollment Period (which begins three months before your 65th birthday and ends three months after), you can enroll during a Special Enrollment Period without a penalty.

However, if you're not eligible for premium-free Part A and you don't enroll during your Initial Enrollment Period or a Special Enrollment Period, you may be subject to a late enrollment penalty when you eventually enroll. This penalty can increase your monthly Part A premium.

Does Medicare provide dental and vision coverage?

Original Medicare (comprising Part A and Part B) generally does not provide comprehensive coverage for dental and vision care. Here's what you need to know:

Dental Coverage: Original Medicare does not cover routine dental care, such as dental check-ups, cleanings, fillings, extractions, dentures, or most other dental procedures. There are very limited circumstances, such as dental services required as part of a covered inpatient hospital stay, where Medicare may cover some dental care.

Vision Coverage: Similarly, Original Medicare typically does not cover routine vision care. This includes eye exams for eyeglasses or contact lenses and the cost of glasses or contact lenses. Medicare Part B might cover certain vision-related services when they are considered medically necessary, such as cataract surgery or treatment for certain eye diseases.

Part B - Medical Care

Medicare Part B covers specific healthcare expenses that are not included in Part A, including doctor visits, outpatient hospital care, physical and speech therapy, laboratory tests, blood transfusions, medical equipment and supplies, and ambulance services. It's important to note that Original Medicare typically covers around 80% of the costs for services under Part B, leaving you responsible for the remaining 20%.

What type of services are not covered under Part B?

Services not covered under Part B include routine dental care, routine vision care, hearing aids, cosmetic surgery, acupuncture, routine foot care, long-term care, most outpatient prescription drugs, and transportation to medical appointments, among others.

How much does Part B cost?

The cost of Medicare Part B can vary based on your income. The standard monthly premium for Medicare Part B enrollees will be $185 for 2025, an increase of $10.30 from $174.70 in 2024. However, if your income is above a certain threshold, you may pay a higher income-related monthly adjustment amount (IRMAA) in addition to the standard premium.

The IRMAA is assessed based on your modified adjusted gross income (MAGI) from two years ago. The higher your income, the higher the IRMAA you'll pay.

Is there a late enrollment penalty for premium Part B?

Yes, there can be a late enrollment penalty for Medicare Part B if you don't sign up for it when you're first eligible and you don't have other creditable health coverage, such as through an employer. The penalty is applied to your Part B premium, and it increases the longer you delay enrollment.

The late enrollment penalty is assessed as an additional percentage of the standard Part B premium for every 12-month period you were eligible for Part B but didn't enroll. The penalty remains in effect for as long as you have Part B. You may need to pay this penalty if you enroll in Part B after your Initial Enrollment Period ends.

To avoid the late enrollment penalty, it's crucial to enroll in Medicare Part B during your Initial Enrollment Period, which typically begins three months before your 65th birthday, includes your birth month, and extends for three months afterward. If you're eligible for Medicare due to a disability, you'll have an Initial Enrollment Period based on your disability onset date. If you miss this initial window, you can sign up during the General Enrollment Period, but you might face a penalty.