Medicare Federal Health Insurance

1. Target Audience
   Citizens or green card holders who have held their status for over five years, individuals aged 65 or older, those under 65 with a disability for more than 24 months, or individuals with End-Stage Renal Disease (ESRD).

2. Types of Insurance
   Original Medicare (Part A, Part B) + Part D (Prescription Drug Plan) + Medigap Supplemental Insurance.
   Medicare Advantage (Part C).

3. Overview of Original Medicare Part A and Part B
   (1) Part A (Hospital Insurance): If you or your spouse have legally reported taxes in the U.S. for 10 years (40 work quarters), this part is free. Medicare covers 80% of medical costs, and the individual pays a 20% copay.
   (2) Part B (Outpatient Insurance): Covers doctor visits and non-physician medical services, with a premium of $148.50/month or more. If not purchased by age 65, a permanent penalty may apply. Medicare pays 80% of medical costs, and the individual pays a 20% copay.

4. Overview of Part C / Medicare Advantage Plans
   Provided by private insurance companies and classified as commercial insurance, with varying premiums, many of which are free. There are network restrictions for the doctors and medical institutions you can visit, categorized as HMO, HMO-POS, PPO, etc., with different costs for in-network and out-of-network services. Most plans have an annual maximum out-of-pocket limit, which ranged from $3,300 to $7,550 in 2022. In addition to Part A and Part B benefits, these plans often include Part D prescription drug coverage and many additional benefits such as dental, vision, hearing, non-prescription drugs, transportation to medical appointments, and fitness memberships.

5. Part D (Prescription Drug Plan)
   Offered by private insurance companies and classified as commercial insurance. If not purchased by age 65, a permanent penalty may apply.
   (1) Premiums vary by company, typically ranging from $15 to $35.
   (2) Prescription drugs are generally categorized into five tiers (Tier 1, Tier 2, Tier 3, Tier 4, Tier 5), with varying out-of-pocket costs.

6. Medicare Supplemental or Medigap Plans
   Provided by private insurance companies, these plans work alongside Original Medicare as secondary insurance to cover the 20% copay for Parts A and B. Some plans also help cover out-of-pocket costs, Part B premiums, blood transfusions, and emergency services abroad. Plans are categorized as A/B/C/D/F/G/K/L/M/N. Plans C and F are currently not accepting new applicants. The same plan may have different premiums among different companies, typically ranging from $100 to $300.

If you have any questions, please feel free to contact us.