{"id":13088,"date":"2025-04-06T06:00:50","date_gmt":"2025-04-06T11:00:50","guid":{"rendered":"https:\/\/legaltalktexas.hammerle.com\/?p=13088"},"modified":"2025-06-18T11:56:22","modified_gmt":"2025-06-18T16:56:22","slug":"medicare-explained","status":"publish","type":"post","link":"https:\/\/hammerle.com\/legaltalk\/legal-talk\/medicare-explained\/","title":{"rendered":"Medicare Explained for the Approaching 65 and Older Crowd"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">My goal today: give an overview of Medicare for the 65+ crowd in 550 words or less.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Ready?<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">What is Medicare?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Medicare is a federal entitlement program. The government guarantees that eligible individuals will <\/span><a href=\"https:\/\/hammerle.com\/legaltalk\/estate-planning\/new-rule-could-make-it-easier-to-get-medicare-payment\/\"><span style=\"font-weight: 400;\">receive benefits<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There are several triggers for eligibility, but this column will focus on only age eligibility. Under that criterion, you must be 65 years old, have worked at least 40 quarters of covered employment, and be either a US citizen or a holder of a green card for at least five years.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">The Four Parts and Two Choices of Medicare<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">There are four parts to <\/span><a href=\"https:\/\/hammerle.com\/legaltalk\/estate-planning\/turning-65-my-medicare-journal\/\"><span style=\"font-weight: 400;\">Medicare<\/span><\/a><span style=\"font-weight: 400;\">: A, B, C, and D.\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Parts A and B are considered original Medicare.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Part C is the Medicare Advantage Program.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Part D is drug coverage.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">When you first sign up for Medicare, you have two choices:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The first choice is to sign up for Original Medicare, which is Parts A and B, join a separate Medicare drug plan known as Part D, and then purchase a Medicare supplemental policy that pays for additional coverage and helps with out-of-pocket costs.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The second choice is to sign up with a private company for Part C, which is Medicare Advantage.\u00a0\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Now for the explanations.\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Part A primarily provides for hospital and very limited nursing home benefits.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Part B provides coverage for physicians, tests, shots or vaccines, medical equipment, outpatient care, and home health care.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Part C is Medicare Advantage.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Part D is coverage for drugs.<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">Original Medicare vs. Medicare Advantage<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Let\u2019s compare and contrast your choice between Original Medicare and Medicare Advantage.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Original Medicare<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Under original Medicare, you can use any doctor or hospital that takes Medicare anywhere in the U.S. In most cases, you do not need a referral to see a specialist. Under Medicare Advantage, you can only use doctors and other providers who are in the plan\u2019s network and service area for non-emergency care, and you may need a referral to see a specialist.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Under Original Medicare, for Part B-covered services you pay a monthly premium. You also pay a coinsurance of 20% of the Medicare-approved amount after you meet your deductible. If you purchase a supplemental policy, then it will help pay the coinsurance amount.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Medicare Advantage<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Under Medicare Advantage, you pay the Part B monthly premium, but you also may have to pay the plan\u2019s premium. Out-of-pocket costs vary, but you are not allowed to purchase supplemental insurance to cover them.\u00a0 You will have a yearly limit for what you pay for covered Part A and Part B services, but there will be different limits for in-network and out-of-network services.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Differences in Coverage<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">There are also differences in coverage. Original Medicare covers most medically necessary services without prior authorization. Medicare Advantage must also cover all medically necessary services, but the plan can use its criteria to determine medical necessity. You usually need to get prior authorization.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Most Medicare Advantage plans include Part D coverage and forbid you from joining a separate Medicare Drug Plan. For Part D coverage in Original Medicare, you will need to purchase a separate Medicare Drug Plan of your choice. Starting in 2025, the <\/span><a href=\"https:\/\/www.cms.gov\/inflation-reduction-act-and-medicare\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Inflation Reduction Act<\/span><\/a><span style=\"font-weight: 400;\"> caps out-of-pocket prescription drug costs for Medicare Part D beneficiaries at $2,000 annually.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Start Planning for Medicare With Hammerle Morris<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">You need to pay attention when you reach 65. Timing is critical for benefits and to avoid a penalty for not signing up when you are first eligible.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">My professional preference, shared by most attorneys who practice in this area, is Original Medicare with Part D and supplemental insurance, but I recommend <\/span><a href=\"https:\/\/hammerle.com\/lewisville-attorney\/#form\"><span style=\"font-weight: 400;\">hiring<\/span><\/a><span style=\"font-weight: 400;\"> a Medicare broker who can shop coverage and explain your options to you.<\/span><\/p>\n<p><i><span style=\"font-weight: 400;\">Virginia Hammerle is an accredited estate planner and represents clients in estate planning, probate, guardianship, and contested litigation. She may be reached at <\/span><\/i><a href=\"mailto:legaltalktexas@hammerle.com\"><i><span style=\"font-weight: 400;\">legaltalktexas@hammerle.com<\/span><\/i><\/a><i><span style=\"font-weight: 400;\">. This blog contains general information only and does not constitute legal advice.<\/span><\/i><\/p>\n","protected":false},"excerpt":{"rendered":"<p>My goal today: give an overview of Medicare for the 65+ crowd in 550 words or less. Ready? What is Medicare? Medicare is a federal entitlement program. The government guarantees that eligible individuals will receive benefits. There are several triggers for eligibility, but this column will focus on only age eligibility. Under that criterion, you [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":13089,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"categories":[21],"tags":[],"class_list":{"0":"post-13088","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-legal-talk"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Medicare Explained | Hammerle Morris Law Firm<\/title>\n<meta name=\"description\" content=\"Approaching 65? 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