Medicare Education

Stay in the Know

Providing education and consulting services on hospital insurance and health care services planning to seniors is what we do best. Our team in Central Texas focuses on assisting our clients plan and maximize their Medicare benefits. This includes addressing Medicare medical and hospital insurance, prescription drugs coverage and Medicare Advantage.

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Medicare Basics

What is Medicare?

Medicare is the federal health insurance program for people 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD).

When and how do I sign up for Medicare?

If you're already getting Social Security benefits, you'll be automatically enrolled into Medicare and will receive your Medicare card three months before your 65th birthday (or 25th month of disability).

Elderly Couple Contract

What is Medicare Advantage?

Medicare Advantage, also known as Medicare Part C, is a private health insurance plan approved by Medicare that will help you bridge the gap when traditional Medicare alone doesn’t cover all costs. It was created because many seniors could only afford the original Medicare plan, and not the Medigap for additional coverage. In these cases, seniors ran the risk of facing high costs and even medical bankruptcy. Medicare Advantage is an alternative to Medigap. It includes Part A and Part B, and sometimes the Part D drug plan. With Medicare Advantage you could pay a lower price than Medigap, while still receiving out-of-pocket medical spending caps.

Signing a Contract

Is the Medicare Advantage plan right for you?

The first thing you should do with health care services planning is to decide what you need now and might need in the future. Then have a look at the benefits the different plans offer. Remember, Medicare usually doesn’t cover everything, so it’s a good idea to find a plan to fill in the gaps. American Senior Benefits of Texas is here to help guide you through the world of Medicare and alternative plans, so you get the best coverage for your needs at the price you can afford.

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What are Medicare Supplements?

Understanding your Medicare benefits can ensure you’re prepared for any out of pocket costs for healthcare treatments. As your partner in senior healthcare education, we’re happy to answer your questions and offer affordable healthcare service options that meet your needs. Medicare Parts A, B, C, and D, offer distinctive benefits based on your income and the level of service you’ve arranged for.

 

The ABC's of Medicare

Understanding your Medicare benefits can ensure you’re prepared for any out of pocket costs for healthcare treatments. As your partner in senior healthcare education, we’re happy to answer your questions and offer affordable healthcare service options that meet your needs. Medicare Parts A, B, C, and D, offer distinctive benefits based on your income and the level of service you’ve arranged for.

Part A covers:

Inpatient care in a hospital

Skilled nursing facility care


Inpatient care in a skilled nursing facility


(not custodial or long-term care)

Hospice care

Home health care


Most Medicare recipients get Part A premium-free since it is earned by working and paying Social Security taxes.

How does the Medicare Advantage plan work?

By joining one of these plans, you direct Medicare to pay the Advantage plan a set monthly amount for your care. In return, the plan will deliver all of your Part A & Part B services. They take on all of your medical risk. You must continue to pay your Medicare Part B premium while enrolled in an Advantage plan, be enrolled in both Medicare Parts A and B, and live in the plan’s service area. Medicare Advantage policies aren’t Medigap plans. They work differently because they pay instead of Medicare, not after Medicare. Sign up during the enrollment periods. You’ll only need to answer one question.

What coverage can you expect to receive?

With traditional Medicare you have to pay deductibles, for example, a 20% co-insurance on Part B. You can go to any doctor or hospital that participates in Medicare, which most do. Like other private health insurance plans, Medical Advantage usually has an HMO or PPO network of doctors to choose from, and usually they are local. With Medical Advantage, you pay co-payments on healthcare services. Each plan is different in regards to cost sharing. Some may charge you more for a visit to a specialist than a primary care doctor. Some charge a daily rate for hospital visits and others a flat rate for your entire stay. It’s also worth noting that Medicare Advantage plans are subject to change on an annual basis.

Part B covers:

Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.

Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.


Part B also covers things like:


Clinical research


Ambulance services


Durable medical equipment (DME)


Mental health


Limited outpatient prescription drugs


Most Medicare recipients pay a monthly premium for Part B. In 2020, the premium for most people is $144.60. Some high-income individuals pay more than the standard premium. Your Medicare Part B premium also can be higher if you do not enroll when you are first eligible, also known as your initial enrollment period.

Part C covers:

Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. Your Medicare services aren’t paid for by Original Medicare. Below are the most common types of Medicare Advantage Plans.


Health Maintenance Organization (HMO) Plans


Preferred Provider Organization (PPO) Plans


Private Fee-for-Service (PFFS) Plans


Special Needs Plans (SNPs)


You must have Part A and Part B to enroll in Part C. Monthly premiums vary depending on your state, private insurer, and whether you select a health maintenance organization or a preferred provider organization.

Part D covers:

Part D involves Medicare prescription drug coverage which helps cover the cost of prescription drugs. Many people pay a premium for Part D. However, people with low income and resources may qualify for extra help from Social Security to pay the premium and deductible. To see if you qualify for extra help visit