Football Meets Medicare Season

What happens every Fall? Cooler weather, turning leaves, football, and Medicare Open Enrollment. Guess which topic this column is going to cover today?

Football.  Just kidding – we are going to talk about the ABCs of Medicare and Open Enrollment.  

What Is Medicare?

Medicare is a federal program designed to provide a basic level of healthcare for people aged 65 and older. It is available to:

• U.S. citizens
• Lawful U.S. residents who have lived in the country for at least 5 years

The Four Parts of Medicare: A, B, C, and D

Part A: Hospital Coverage

• Covers inpatient hospital stays and other institution-provided inpatient care.

Part B: Doctor Coverage

• Covers physicians’ services, durable medical equipment, outpatient therapy, diagnostic x-rays, and laboratory tests.
• Requires a monthly premium.

Parts A & B: Original Medicare

• Automatically enrolled if you start receiving Social Security at age 65.
• If you don’t want Part B, you must opt out.
  If you delay Social Security, you must manually apply for Medicare when you turn 65.

The Four Parts of Medicare: A, B, C, and D

Part A: Hospital Coverage

• Covers inpatient hospital stays and other institution-provided inpatient care.

Part B: Doctor Coverage

• Covers physicians’ services, durable medical equipment, outpatient therapy, diagnostic x-rays, and laboratory tests.
• Requires a monthly premium.

Parts A & B: Original Medicare

• Automatically enrolled if you start receiving Social Security at age 65.
• If you don’t want Part B, you must opt out.
• If you delay Social Security, you must manually apply for Medicare when you turn 65.

Medigap Plans: Filling the Coverage Gaps

Even with Original Medicare, not all medical costs are covered. That’s where Medigap (Supplemental Insurance) comes in.

• Helps pay for expenses not covered by Parts A & B.
• Benefits are standardized by Medicare into plans C, D, E, F, G, H, I, J, M, and N.
• Accepted by nearly all providers.

The Rise of Medicare Advantage and Part D

Part D: Prescription Drug Coverage

• Must be purchased separately through a private insurance company.

Part C: Medicare Advantage Plans

Introduced in 2003, these private plans replace Original Medicare. They often include additional benefits such as:

• Dental care
• Eye care
• Prescription drug coverage (sometimes combined with Part D)

Types of Advantage Plans include:

• HMO
• HMO point of service
• PPO
• Private fee-for-service
  Special needs plans
• Medical savings account plans

Key considerations:

• Most require in-network providers.
• Out-of-network care usually costs more.

Medicare Open Enrollment: What You Can Change

Open Enrollment allows you to:

• Switch from Original Medicare to an Advantage Plan
• Switch from an Advantage Plan back to Original Medicare (note: Medigap requires medical qualification if added later)
• Join, switch, or drop Part D

Medicare Advantage Plan Switch Window

From January 1 to March 31, you can change from one Advantage Plan to another.

Simplifying Medicare Choices

This is only a broad overview. Medicare law has many details, and it can be confusing. Working with a Medicare consultant can help you choose the plan that best fits your needs.

Final Word: Don’t Miss Out

Most importantly, don’t let this federal health insurance benefit pass you by. As former Cowboys Coach Mike McCarthy said:

“Carpe Omnia!” — Seize Everything.

Protect Your Medicare Benefits

At Hammerle Morris Law Firm, we understand that Medicare choices can be overwhelming. The right decisions help protect your health, finances, and peace of mind.

Whether you’re preparing for open enrollment, exploring Advantage Plans, or reviewing supplemental coverage, our team can guide you through the process. Schedule a consultation today to ensure your Medicare decisions work in your best interest.

Virginia Hammerle is an accredited estate planner and represents clients in estate planning, probate, guardianship, and contested litigation. She may be reached at legaltalktexas@hammerle.com. This blog contains general information only and does not constitute legal advice.