North San Diego County Medicare Specialists

Medicare Insurance

Medicare Supplement Insurance also is known as “Medigap” fills in gaps Original Medicare and is offered by private companies.

Traditional Medicare plans pay for much, but not for all, and do not pay the costs for covered healthcare services and supplies. A Medicare Supplement Insurance (Medigap) policy/plan can help pay some remaining part of the healthcare costs, including:
  • Copayments
  • Coinsurance
  • Deductibles
Medicare Supplement Insurance consists of two parts. Medicare Part A – hospital insurance and Medicare Part B – medical insurance. Medicare Part A covers Medicare inpatient care that is care received while in a hospital, nursing facility, and, in particular, circumstances, at-home treatment. Most people became automatically eligible for Medicare Part A when they reach the age of 65. It is possible when they are already getting retirement benefits from social security or the railroad retirement board. A person also qualifies for Medicare Part A before 65 if he/she is a disabled person, last-stage at renal disease, or amyotrophic lateral sclerosis. To be eligible for Medicare Part A, you must be either a United States citizen or a legal permanent resident of the USA at least five straight years.

Medicare Part A covers:

  • Hospital care of inpatient
  • Conditioned home health services
  • Nursing facility care provided that custodial care isn’t the only care required
  • Hospice care
Medicare Part A beneficiaries receive full coverage for hospital expenses that are critical for your inpatient care, including semi-private room, nursing services, meals, medications included in your inpatient treatment, and other related services and supplies from the hospital. Part A also has critical inpatient care provided through:
  • Critical access hospitals
  • Acute care hospitals
  • Long-term care hospitals
  • Mental health care
  • Inpatient rehabilitation facilities
  • Participation in a clinical research study
Medicare Part A insurance does not cover the costs of a private room, your private-duty nursing, your care items expenses as shampoo, telephone, and television. It also does not cover the cost of blood. You do not pay for blood if the hospital gets it from a blood bank without any charges. But if the hospital purchase blood for you, you have to pay for the first three units that you will receive each.

Medicare Part A Costs

In Medicare Part A, you don’t pay a monthly premium for Hospital Insurance coverage if you and your spouse paid Medicare taxes while working.  You will get a premium-free Part A at the age of 65 if:
  • You are receiving retirement benefits from social security
  • You are receiving services from the railroad retirement board.
  • You or your partner/spouse had government employment covering Medicare.
If you’re under 65, you can also get premium-free Medicare Part A:
  • You are a disabled person and got social security or railroad retirement board
  • You have last stage Renal Disease
If you are not qualified for a premium-free Part A plan, you can buy it.
  • The approximate cost is $458 each month.
If you paid Medicare taxes for less than 30 quarters, the approximate premium is $458. If you pay Medicare taxes for 30-39 quarters, the approximate cost is $252. Part A hospital inpatient cost and co-insurance include $1,408 deductible for each benefit period. Co-insurance includes:
  • Days 1-60: $0 for each benefit period
  • Days 61-90: $352 per day of each benefit period
  • Days 91 and beyond: $704 per each “lifetime reserve day” after day 90 for each benefit period

Medicare Part A Enrollment

You will automatically get enrolled in Part A Medicare insurance if you turned 65 and receiving social security retirement benefits or railroad retirement board benefits. You will start receiving Medicare Part A benefits from the first day of the month you turned 65. If your birthday is on the first day of the month, your services will begin the month before you turn 65. The high time to get a Medicare plan is during your 6-month Medigap open enrollment period. You will get better prices and more policies.

Medicare Part A Eligibility

You are eligible for a Medicare supplement insurance Part A if:
  • You are age 65 or older and a U.S. citizen.
  • You are a legal resident of at least five years.
  • You are getting retirement benefits.
  • You are disabled and getting disability benefits.
  • You have the last-stage renal disease (ESRD).
  • You have amyotrophic lateral sclerosis.

Medicare Part A Premiums

Most Medicare part beneficiaries do not pay a premium if they worked at least ten years and paid Medicare taxes at that time. People who aren’t able to get premium-free Medicare Part A can also get themselves enroll in Part A and pay a premium. Four ways to pay your Premium:
  • Pay online via Medicare account.
You can pay by your credit card, and debit card into your Medicare account online
  • Pay directly from your Bank saving Account
You can also directly pay your premium from your savings account
  • Medicare Easy Pay
The third and free service that automatically deducts your premium payments from your savings or checking account each month is Medicare’s easy pay app on the 20th of the month.
  • Mail check to Medicare