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Are You Approaching 65?

Important information you need to know before enrolling in Original Medicare.
If you are approaching age 65, you probably have questions about Original Medicare. Let us help.

Who’s Eligible?

Most people age 65 and older who are citizens or permanent residents of the U.S. are eligible for Medicare Part A (hospital insurance) without paying a monthly plan premium. You’re eligible for free Medicare Part A if you are 65 and:

You receive or will be eligible for Social Security benefits.
Or you receive or will be eligible for railroad retirement benefits.
Or you or your spouse (living, deceased, or divorced) had employment where Medicare taxes were paid for 40 or more quarters.
If you do not fit into any of these groups, you can still get Medicare Part A by paying a monthly plan premium if you are a U.S. citizen or have been lawfully admitted to the U.S. and lived here for at least five years.

You are eligible for Medicare Part B (medical insurance) if you are eligible for Part A. Part B is optional and you will need to pay a premium based on your income.

Part A – Hospital Insurance

Benefits generally include:

Medically-necessary inpatient care in hospitals
Inpatient care in skilled nursing facilities
Hospice care
Home health care
Part B – Medical Insurance

Benefits generally include:

Outpatient care
Physician’s services
Physical and occupational therapist services
Additional home health care services
Some preventive services
Medicare (Part A and Part B) does not cover everything. Aside from required deductibles, coinsurance and copayments, some of the items and services that aren’t covered include: most prescription drugs, custodial care (help with bathing, dressing, etc.) in a nursing home, long-term care in a nursing home, dental care and dentures (with only a few exceptions), first three pints of blood, eye refractions, hearing tests for hearing aid fitting, routine or yearly physical exams (except the one-time physical exam within the first six months you have Part B), some screening tests, some vaccination shots, some diabetic supplies, care while traveling abroad, and more.

Original Medicare covers you anywhere in the U.S., even if you’re away from home for several months at a time. If you want to travel outside the country, however, be aware that Original Medicare coverage applies only within the U.S. and its territories, such as Puerto Rico and the U.S. Virgin Islands. With only a few exceptions, Original Medicare will not cover you outside the U.S.

If you’re going to travel outside of the U.S. and want coverage in case of an emergency, consider a Medicare Supplement plan that specifically covers this need or a Medicare Advantage plan.

Important Note: If you are employed and plan to continue working after you turn 65, talk to your company’s benefits administrator to review your current insurance coverage before you purchase insurance to supplement or replace your Original Medicare plan. You may already have the benefits you need through your group insurance.

Medicare Advantage Plans

(also known as Part C)
Hospital and Medical combined
Replaces Original Medicare Parts A and B, combining them into one plan.
Offers the same coverage as Original Medicare, plus may offer extra benefits such as prescription drug coverage.
Available through private insurers.
Premiums vary by plan.
Must have Medicare Parts A and B to enroll.
Must be a Florida resident.
Claims are submitted by your physician or hospital directly to your Medicare Advantage plan. You will receive EOB’s from your Medicare Advantage plan.
Plan types include:

HMO (Health Maintenance Organization): Requires you to use only network providers, except in emergencies.
PPO (Preferred Provider Organization): Allows you to visit in- or out-of-network providers; However, your out-of-pocket costs will most likely be lower if you use in-network providers.

Sometimes referred to as “Medigap” plans

Adds benefits that pay for many health care costs that Original Medicare requires you to pay (e.g. coinsurance, copayments, and deductibles).
Optional coverage available through a private insurer.
Premiums vary by plan.
Must have Medicare Parts A and B.
Must be a Florida resident.
Claims are submitted by your physician or hospital directly to Medicare, and then automatically crossed over to your Medicare Supplement plan. You will receive Medicare Summary Notices from Medicare and from your Medicare Supplement plan.