Many people have questions about Medicare, their coverage and when they should enroll. This page provides answers for some common questions. We welcome you to contact SBI Benefits today for more information about Medicare in Las Vegas and Sparks, Nevada, and to make an appointment with our insurance agent.

What Are the Four Parts of Medicare? +

Medicare has four basic parts – Part A, Part B, Part C and Part D. Original Medicare includes Parts A and B, which include hospital and medical coverage respectively. The Medicare Advantage Plan, which is secured through a private insurance company in partnership with the federal government, comprises Part C and helps cover the portions of your care that are not covered under Medicare A and B plans. Part D coverage is the prescription drug plan of Medicare. We recommend speaking with our insurance agent to understand your coverage and benefits.

Qualifying for Medicare in Las Vegas, NV +

You may qualify for Medicare or Medicare Advantage Plans if you meet the following requirements:

  • You are 65 years of age.
  • You are a U.S. citizen or a legal permanent resident who has continuously lived in the United States for at least five years and has been paying Medicare taxes for at least 10 years.
  • You have a disability for which you have received benefits continuously for two years.
  • You have been diagnosed with End-Stage Renal Disease (permanent kidney failure that requires either dialysis or a kidney transplant).

You may apply for Medicare coverage, Advantage plans and drug plans at the same time that you apply for your retirement benefits. Your Medicare coverage will automatically begin on the first day of the month after you turn 65. If your birthday falls on the first of the month your coverage will automatically begin the first day of the month prior to your birthday.

Applying for Medicare in Las Vegas, NV +

You may apply for Medicare through your local Society Security office, or you may register online or over the phone. For additional peace of mind, consider registering for Medicare through one of SBI Benefits’s authorized, professional insurance agents.

Regardless of how you choose to apply for Medicare, please take the time to understand your plan options as well as where and how to receive your Medicare benefits, including pharmacies and access to emergency medical services. This will help you avoid penalties and out-of-pocket fees.

How To Enroll in Medicare Services +

In most cases your enrollment period for Medicare services begins just before or after your 65th birthday so that you can begin maximizing your benefits within three-months of turning 65. For example, if your 65th birthday is on April 16th, your window of enrollment will begin January 16th and remain open until July 16th. Failure to enroll during this period may incur penalties.

If you miss your initial enrollment period, there is a general enrollment session occurring January 1st through March 31st. Please note that enrolling during this period could result in higher premiums.

Exceptions to Premiums +

You can avoid penalties and higher premiums if you are over the age of 65, still working and covered by private insurance for your employer. This will prevent you from being penalized for your plans with Part B premiums. If you are over age 65 and still working you may also apply for Part A as a backup, with no extra cost.

Low-income residents and households may be eligible for a Social Security Medicare Savings Program. These households also do not need to worry about premiums regarding Medicare Part D plans which include coverage of prescription drugs and medications.

Out-of-Pocket Costs +

You may be responsible for out-of-pocket costs depending on the plans you choose and the benefits and coverage included in those plans. Medicare Parts A and B fall under the Original Medicare and cover hospital care and medical care respectively. Any care that is not included in these plans, such as dental, vision and hearing care, is considered an out-of-pocket cost. Please make sure you know what is and is not covered in your plan and consider enrolling in a Medicare Advantage Plan or other supplemental insurance as needed. Our insurance agent will be happy to review these plans with you to find the right coverage for your needs.

What Does Medicare Part A Cover? +

Medicare Part A covers hospital care. This includes:

  • Inpatient hospital care as prescribed by a Medicare doctor for both physical and mental illness
  • Skilled nursing facility care
  • Long-term care hospital services

What Does Medicare Part B Cover? +

Medicare Part B covers medical care. This includes:

  • Medically necessary services to diagnose and treat qualifying medical conditions
  • Preventive care, including flu vaccinations and early screenings for cardiovascular conditions and cancer
  • Most outpatient services, such as prescription drugs, ambulance services, etc.

Unlike Part A, most people have to pay premiums for their Part B coverage. These costs can change from year to year depending on your situation.

What Does Medicare Part C Cover? +

Medicare Part C is an advantage plan that you may receive through a private insurance company. These plans are legally required to offer the same benefits as Part A and Part B, but also include additional Medicare benefits such as dental, vision and hearing care.

Medicare Part C is dependent on the insurance companies involved and plan benefits may vary between companies. There may also be additional deductibles or higher copays. Also, where Parts A and B, can be used through public hospitals in the United States, Part C will require you to visit an in-network doctor or hospital. Visiting a doctor or hospital outside this Medicare network may result in a higher fee.

Please speak with our insurance agent to learn more about Medicare Part C coverage so that you can choose the best plans for you and your family.

What Does Medicare Part D Cover? +

Medicare Part D covers prescription drugs. You are entitled to this plan when you are covered under Part A or B plans, and this coverage is available to you regardless of your or your family’s income. We recommend that you enroll in Part D coverage, even if you are not currently taking prescription medications, to ensure that you have this coverage if you need it in the future. Medicare premiums for Part D are determined on a case-by-case basis as the amount is based on your prescription cost. Copays can vary from pharmacy to pharmacy based on location, even for the same medications. Ask our insurance experts for help comparing the prices of prescription drugs and prescription drug plans to find the best option for you!