Medicare Solutions
Medicare Part A
Medicare Part A is Hospital Insurance that helps you cover inpatient care for hospital visits, skilled nursing facility care, hopsice care, and home health care.
Medicare Part B
Medicare Part B is Medical Insurance that helps you cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment such as wheelchairs, walkers, hospital beds, etc., and other preventive services such as screenings, shots, vaccines, and yearly wellness visits.
Medicare Part C
Medicare Part C is a Medicare Advantage Plan offered by private companies that combines Medicare Part A and Medicare Part B into one managed care plan that often includes Part D prescription drug benefits. Medicare Part C plans may offer additional benefits not provided by Original Medicare.
Medicare Part D
Medicare Part D helps cover the cost of prescription drugs including many recommended shots or vaccines. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules outlined by Medicare.
Medicare Supplement Plans
Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like: Copayments, Coinsurance, and Deductibles.
Some Supplement policies also cover services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here's what happens:
Medicare will pay its share of the Medicare-Approved Amount for covered health care costs.
Then, your Medigap policy pays its share.
*It's illegal to have a Medicare Supplement policy if you have a Medicare Advantage Plan. Its either one or the other.
Maximize Your Medicare Plan Benefits
Call to request your no-obligation Medicare Benefits review today, at no cost to you!
Benefits Unique to Some Plans
✓ Meals
✓ Over the Counter Products
✓ Transportation
✓ Expanded At-Home Telehealth
Additional Benefits
✓ Cash Back Benefit, up to $148.50 added back to your Social Security check every month.
Call now to see if you qualify.
Sam Toprani | Pinnacle Medicare Solutions®
We can help you find the Medicare insurance that's right for you.
If you are asking the following Questions, you've come to the right place!
What is Medicare?
Why and when you need medicare?
Turning 65?
Retiring and leaving an employer group health plan?
What happens if you don’t have it?
There are penalties for not having both Part B and Part C!
Medicare has two Coverage Options
Option 1:
Original Medicare + Prescription Drugs Plan (Part D) + Supplemental Plan
Includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
• A Medicare Drug Plan (Part D) is required, otherwise there could be a penalty.
• A Medicare Supplement Plan can be purchased for a monthly premium to help pay either some or most of your Medicare out-of-pocket cost in original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage plans.
• You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
OR
Option 2:
Medicare Advantage
Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.
• Plans may have lower out-of-pocket costs than original Medicare, but not always.
• In many cases, you’ll need to use doctors who are in the plan’s network.
• Most plans offer extra benefits that original Medicare doesn’t cover such as vision, hearing, dental, and more.
Medicare + Supplement Plans
vs.
Medicare Advantage Plans
Medicare Supplement Plans
Doctors & Hospitals
You Can Select your doctors and hospitals as long as they accept medicare Patients.
Specialist Referrals
You Can see a specialist without a referral.
Networks
No network restrictions. Coverage goes with you across the United States.
Enrollment
You can apply to buy a Medicare Supplement Plan any time after you turn 65 and join Medicare Part B. Services are monthly, so you can make changes during the year.
Costs
You pay a monthly plan premium in addition to your Part B premium. When you use services, your out-of-pocket cost are limited.
Prescription Drug Coverage
Prescription drug coverage is not included. You will need to purchase a Medicare Part D Plan.
Medicare Advantage Plans
Doctors & Hospitals
You will normally be req uired to use doctors & hospitals in the plan network.
Specialist Referrals
You may need referrals and may be required to use a network specialist.
Networks
You may have network restrictions. Emergency care is covered for travel within the United States & sometimes abroad.
Enrollment
Generally, there are specific periods during the year when you can enroll or switch to another Medicare Advantage Plan unless you qualify for a special election period.
Costs
Generally, you pay a low or $0 monthly plan premium in addition to your Part B premium. When you use services, you pay co-pays, co-insurance, and deductibles.
Prescription Drug Coverage
Prescription drug coverage is included in many plans.
State Assistance
Medicare Savings Program
Medicare Savings Programs (MSPs) are Medicaid-administered programs for people on Medicare who have limited income and resources. These programs help those who are qualified to afford Medicare. There are four different Medicare Savings Programs, each with different income and resource eligibility limits.
-Qualified Medicare Beneficiary
-Specified Low-Income Medicare Beneficiary
-Qualifying Individual
-Qualified Working and Disabled Individual
Call today to see if you qualify for a Medicare Savings Program.
For Connecticut, the Medicare Saving Program only have QMB, SLMB, and ALMB Levels
Connecticut’s MSP program offers much more generous limits than most other states and automatically includes the extra help / Low-Income Subsidy (LIS) for those approved at any of the 3 levels of the MSP.
State Prescription Drugs Assistance with Low Income Subsidy (LIS)
All three Medicare Savings Program levels also automatically enroll you into the Low-Income Subsidy (LIS), also called “Extra Help”. The LIS pays the full cost of a Medicare Part D (prescription coverage) benchmark plans, or a portion of non-benchmark plans, yearly deductibles, and co-insurance, or co-pays. This coverage remains the same even if you reach the coverage gap. The LIS also allows you to change your Medicare Part D or Medicare Advantage plans outside of the open enrollment period.
Dual Advantage Plans
A Dual Special Needs Plan is a special kind of Medicare Advantage coordinated-care plan. It is an all-in-one plan that combines your Medicare Part A and Part B benefits, your Medicare Part D prescription drug coverage, your Medicaid benefits and additional health benefits such as vision, dental or fitness. Call today to see if you are eligible.
MEDICARE
People over 65
People with Disabilities
People with end-stage renal disease
Hospital Services (Part A),
medicak car (Part B),
prescription drugs (Part D)
Low monthly premiums
Deductiables for hospitalization
Potential out-of-pocket costs
October 15th – December 7th
Or three months
following 65th birthday
MEDICAID
Low-income individuals
and families
Hospital services, physician
services, laboratory and x-ray,
home health services
No cost
(potential copayment)
Available at any time
Medicare vs. Medicaid
Many people confuse Medicare and Medicaid. Medicare and Medicaid are two separate, government-run programs.
- Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income.
*There are certain qualification limitations. - Medicaid is a federal program administered by the states that provide health coverage if you have a low income. Medicaid has several levels for different age groups.
- If you are eligible for both Medicare and Medicaid, you can have both. They will work together to provide you with health coverage and lower your costs.
Also know that while Medicare and Medicaid are both health insurance programs administered by the government, there are differences in covered services and cost-sharing. Call today to learn more about your options and to see if you are dual-eligible.
Other Programs & Assistance
Medicaid for Low Income Individuals and Families
Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
Some states have expanded their Medicaid programs to cover all people below certain income levels.
Even if you don’t qualify for Medicaid based on income, you should apply. You may qualify for your state’s program, especially if you have children, are pregnant, or have a disability. You can apply for Medicaid any time of year. Get in touch today to review options open to you!
Tri-Care and VA Benefits for Government Employees and Veterans
This is a health care plan for active-duty service members, military retirees, government employees & retirees, and their families. Most people with TRICARE entitled to Part A must have Part B to keep TRICARE drug benefits. If you have TRICARE, you don’t need to join a Medicare drug plan. However, if you do, your Medicare drug plan pays first, and TRICARE pays second.
If you join a Medicare Advantage Plan with drug coverage, your Medicare
Advantage Plan and TRICARE may coordinate their benefits if your Medicare Advantage Plan network pharmacy is also a TRICARE network pharmacy. Call today for a review of your plan!