Medicare Solutions

Why work with Simpler Horizons?

We know that you’re getting besieged with mail from the insurance carriers and it may be overwhelming. We like making it simple! We work with most Medicare insurance companies and can be your advocate in dealing with them. We will fill out all the paperwork and eliminate the associated stress while making sure you avoid any late enrollment penalties. Finally, we won’t just help you enroll and disappear, we communicate with you all year long so that you’re made aware of enrollment periods, plan updates, and prescription drug changes. Best of all, we never charge for our services!

What is Medicare?

Medicare is a federal health insurance plan that came into effect in 1965 with the purpose of providing health insurance to U.S. citizens over the age of 65, regardless of income or medical history. Original Medicare consists of Part A (inpatient hospital services) and Part B (outpatient medical services). Prescription drug coverage may be purchased separately under Part D Medicare, and special plans covering Original Medicare, Part D Medicare and more health services, also known as Medicare Part C (Medicare Advantage plans), can be purchased from private insurance companies.

Am I Eligible?

To be eligible for Medicare, you first have to be a U.S. citizen or legal resident residing in the U.S. for at least 5 years. If you meet that criteria and have worked for at least 10 years, you automatically become enrolled in Medicare Part A at the age of 65, which will cover emergency hospital stays. You also become eligible to enroll in Medicare Part B, covering preventive care and doctor’s visits, for a monthly premium.

Certain younger people may qualify for Medicare coverage if they have certain disabilities or life-threatening diseases. If you are under the age of 65, you may qualify for Medicare if you have:

  • ALS (also known as “Lou Gehrig’s Disease”)
  • End Stage Renal Disease (ESRD)
  • Received Social Security Disability Income (SSDI) for 24 months.

The Basic Benefits

Medicare Part A

For most people, it has no premium. After meeting a deductible, Part A covers inpatient care in a hospital and skilled nursing facility (not custodial or long-term care), hospice care, and home health care (not all). There are co-pays associated with stays longer than 60 days as well as no out-of-pocket limit.

Medicare Part B

There is usually a premium for Part B that can increase based on income. It helps cover medically necessary doctor’s visits, outpatient care, medical equipment, mental health, and other medical services. Part B also covers many preventive services. Once you pay your yearly deductible, Medicare generally pays 80% of medical services. You are generally responsible for 20% coinsurance with no out-of-pocket limit.

Medicare Part D

Part D is a prescription drug coverage policy. It covers both generic and name-brand drugs. There are a variety of plans available offering various costs and coverage. Part D coverage is optional and is offered to everyone with Medicare. If you decide not to get it when you’re first eligible, and you don’t have other creditable coverage, you’ll likely pay a late enrollment penalty if you join a plan later.

Filling the Medicare Gaps

Medicare Supplement

All Medicare Supplement Insurance Plans are sold by private companies and offer a variety of plan choices to fit your needs and budget. They fill in the gaps of Medicare with various healthcare benefits at variable prices. Keep in mind that a Medicare supplement plan does not provide Part D prescription drug coverage. So, you will need an additional plan for Part D.

Medicare Advantage (Part C)

Medicare Advantage is quickly becoming popular because of the extra benefits that are offered such as extra days in the hospital, cheap out-of-pocket costs for doctor visits and low (to no) premiums. Not only do Medicare Advantage Plans offer the medical coverage you need, but most include Part D drug coverage. In most cases, you will have a limited network service area, which means you will need to visit providers who are in the same network. The most effective way to choose the right plan is to talk to an agent who can help you compare the cost and coverage.

Guiding You

Book a Virtual Appointment While we love meeting face-to-face, we understand the need for social distancing at this time; therefore, we are happy to provide full support over the phone or online. Book a personal appointment with one of our advisors today!