Bringing the pieces together

It is important to look at your health care coverage every year to make sure it meets your needs. We can help you find the right plan for medicare in Rochester NY.

What is Medicare?

Medicare is a Federal program that offers health insurance to American citizens and other individuals that are eligible.

You must meet one of the following requirements:

* Be 65 or older

* Have a diagnosis of End-Stage Renal Disease (ESRD), any age

* Have a qualifying disability, under the age of 65. You must be on disability for 24 consecutive months.

How to enroll in Original Medicare:

You should be automatically enrolled if you are receiving Social Security or benefits from Railroad Retirement Board when you become eligible. You will receive your Medicare card in the mail.

You will need to enroll in Medicare if you are not receiving Social Security benefits when you become eligible for Medicare. You are able to enroll by calling Social Security or visiting the Social Security office.

Medicare Insurance Rochester NY

(terms to know)

* Original Medicare:

Part A: Hospital Services

Part B: Medical Services

* Medicare Advantage Plans

(Part C) offered by private health insurance companies with an approved Medicare contract.

* Medicare Prescription Drug Plans

(Part D) Purchased in addition to Parts A and/or B benefits (unless it is included with your Part C Medicare Advantage plan).

* Medicare Supplement Insurance Plans

(Medigap Plans) Offered by private insurance companies. Supplements Part A and B benefit and do not include Part D prescription drug coverage.

Rochester Medicare

Original Medicare Part A:

What is covered?

In general, Part A covers:

Hospital care
Skilled nursing facility care
Nursing home care (as long as custodial care isn't the only care you need)
Hospice
Home health services

Original Medicare Part B:

What is covered?

Part B covers two types of services:

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 assignments. Part B covers things like:

Clinical research
Ambulance services
Durable medical equipment (DME)
Mental health
Inpatient
Outpatient
Partial hospitalization
Limited outpatient prescription drugs

What Original Medicare A & B Does Not Cover:

Medicare doesn't cover everything. If you need certain services Medicare doesn't cover, you'll have to pay for them yourself unless you have other insurance or you're in a Medicare health plan that covers them. Even if Medicare covers a service or item, you generally have to pay your deductible, coinsurance, and copayments. Some of the items and services that Medicare doesn't cover include:

Long-term care (also called custodial care)
Most dental care
Eye examinations related to prescribing glasses
Dentures
Cosmetic surgery
Acupuncture
Hearing aids and exams for fitting them
Routine foot care

Many of these options may not be covered with Original Medicare, but could be covered under Medicare Advantage Plans or Medicare Supplement Plans.

Medicare Advantage Plans Rochester NY

bringing better coverage (Part C)

Most Medicare Advantage Plans offer coverage for things Original Medicare doesn’t cover, such as some vision, hearing, dental, and fitness programs (like gym memberships or discounts). Plans can also choose to cover even more benefits. For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness.

Perfect medicare plans do exist. For easy enrollment and best Rochester medicare advantage plans, schedule your consultation today.

Medicare Supplement Plans Rochester NY

Medicare Supplement plans are also called Medigap. They are designed to work with Original Medicare Parts A and B. They help pay for some health care costs not covered by Original Medicare, such as deductibles and coinsurance. You must have Medicare Parts A and B to qualify for a Medicare Supplement plan. These plans are offered by private insurance companies in your state. People with Original Medicare and a Medicare supplement can choose from any of the stand-alone Part D prescription plans to pay for their drugs.

Medicare Part D - Prescription Drugs

All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes,” like drugs to treat cancer or HIV/AIDS. A plan’s list of covered drugs is called a “formulary,” and each plan has its own formulary. Many plans place drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier.

Resources

New York State EPIC Program Seniors

The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program for seniors administered by the Department of Health. It assists income-eligible seniors aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs. Seniors can apply for EPIC at any time of the year and must be enrolled or eligible to be enrolled in a Medicare Part D drug plan to receive EPIC benefits and maintain coverage.

EPIC provides secondary coverage for Medicare Part D and EPIC-covered drugs purchased after any Medicare Part D deductible is met. EPIC also covers approved Part D excluded drugs once a member is enrolled in Part D.

EPIC has two income-based plans. The Fee Plan is for members with income up to $20,000 if single or $26,000 if married. The Deductible Plan is for members with incomes ranging from $20,001 to $75,000 if single or $26,001 to $100,000 if married.

LIS (Low Income Subsidy)/Extra Help

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $5,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 states or the District of Columbia.

Medicaid (NYS)

Medicaid is a program for residents in New York State who can't afford to pay for medical care. Medicaid pays for a number of services, but some may not be covered because of age, financial circumstances, family situation, transfer of resource requirements, or living arrangements. These services may be provided using your Medicaid card or through your managed care plan if you are enrolled in one.

Medicare Savings Program (MSP)

The Medicare Savings Program (MSP) is a Medicaid-administered program that can assist people with limited income in paying for their Medicare premiums. Depending on your income, the MSP may also pay for other cost-sharing expenses. When you enroll in an MSP, you will automatically receive Extra Help, the federal program that helps pay most of your Medicare prescription drug (Part D) plan costs. Many Medicare beneficiaries who may not qualify for Medicaid because of excess resources may qualify for an MSP.

Looking for coverage? Get in touch for the best solutions for medicare in Rochester NY.

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