Your Local Medicare Specialists

Medicare is the federal health insurance program for people who are 65 and older, as well as some people under 65 with certain disabilities or conditions. You're eligible if you're 65 or older and a U.S. citizen or permanent resident who has lived in the U.S. for at least 5 years. You may also be eligible if you're under 65 with certain disabilities, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's disease).

Your Initial Enrollment Period begins 3 months before your 65th birthday month and ends 3 months after your birthday month (7 months total). If you miss this window, you may have to pay late enrollment penalties and wait until the General Enrollment Period (January 1 - March 31) to sign up. If you're still working and have employer coverage, you may qualify for a Special Enrollment Period.

Part A (Hospital Insurance): Covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.

Part B (Medical Insurance): Covers doctors' services, outpatient care, medical supplies, and preventive services.

Part C (Medicare Advantage): Private plans that combine Parts A and B, often including Part D.

Part D (Prescription Drug Coverage): Covers prescription medications through private plans.

Original Medicare (Parts A & B): Run by the federal government, allows you to see any doctor or hospital that accepts Medicare nationwide, requires separate Part D plan for prescription coverage.

Medicare Advantage (Part C): Offered by private companies, typically includes prescription drug coverage and extra benefits like dental and vision, but limits you to provider networks and specific geographic areas. Plans often have $0 premiums but may have different copays and deductibles than Original Medicare.

Medigap insurance is sold by private companies to help pay for costs that Original Medicare doesn't cover, such as copayments, coinsurance, and deductibles. These standardized policies (named by letters like Plan G or Plan N) work alongside Original Medicare. You generally need both Part A and Part B to buy a Medigap policy, and the best time to buy is during your 6-month open enrollment period when you first get Part B.

Medicare generally does not cover long-term custodial care, which helps with daily activities like bathing, dressing, and eating. However, Medicare Part A does cover skilled nursing facility care for up to 100 days per benefit period if you meet specific conditions: you must have a qualifying 3-day hospital stay and need daily skilled care from medical professionals. After 20 days, you pay coinsurance of $209.50 per day for days 21-100 in 2025.

Medicare covers part-time skilled home health services when you're homebound and under a doctor's care plan. This includes skilled nursing care, physical therapy, occupational therapy, and speech therapy. However, Medicare does not cover 24-hour care, personal care assistance (like bathing and dressing), meal preparation, or housekeeping when that's the only care you need. These services are considered custodial care, not skilled medical care.

Skilled Care: Medical care that requires licensed professionals, such as nurses or therapists. Examples include IV therapy, wound care, physical therapy, and medication management. Medicare covers skilled care when medically necessary.

Custodial Care: Non-medical assistance with daily living activities like bathing, dressing, eating, and mobility. This type of care can be provided by family members or non-medical caregivers. Medicare generally does not cover custodial care.

Yes, Medicare Part A covers skilled nursing facility care if you meet these requirements: (1) You had a qualifying 3-day inpatient hospital stay, (2) You enter the skilled nursing facility within 30 days of leaving the hospital, (3) You need daily skilled care for the same condition treated in the hospital. Medicare covers 100% for days 1-20, you pay $209.50/day for days 21-100, and you pay all costs after 100 days per benefit period.

Medicare covers outpatient rehabilitation services when medically necessary and prescribed by a doctor. This includes physical therapy, occupational therapy, and speech-language pathology services. These services can be provided in various settings including outpatient facilities, skilled nursing facilities, and your home (if you qualify for home health care). Medicare Part B typically covers 80% of the approved amount after you meet your annual deductible.

Since Medicare has limited long-term care coverage, consider these options: (1) Long-term care insurance to help pay for custodial care, (2) Health Savings Accounts if you're still working, (3) Personal savings and investments, (4) Medicaid planning for those with limited income and assets, (5) Veterans benefits if you're a qualifying veteran. We can help you understand your options and connect you with specialists for comprehensive long-term care planning.