Dear 65: What is Medicare?
As I get closer to you, I have many concerns and one significant one is MEDICARE! Questions like What, Why, How, Who and When constantly occupy my thoughts. What exactly is Medicare? Why should I consider enrolling in Medicare? How can I enroll in Medicare? Who can I rely on for guidance with Medicare? Why do I feel so baffled?
Due to these concerns, there is a significant need for Medicare education among Americans.
My name is Myriam Leiva, a licensed insurance agent whose main focus is Medicare. I have been in the financial industry for 15 years and 7 out of those 15 I’ve been specializing in Medicare. In 2017 my father-in-law was diagnosed with a massive tumor and advanced stomach cancer. We took him to our local hospital and saw a surgeon who advised him to have this monstrous tumor removed immediately, which we all agreed was the right thing to do. This surgeon only demanded a referral from a primary care physician (PCP) whom my father-in-law had never met before. His PCP was called immediately to get the referral needed for surgery. After contacting the PCP, they reassured us by saying, “Not a problem, we will arrange a referral; we just need the patient to visit the office.” Following the PCP visit, he provided a referral to his personal oncologist but declined to refer us to the surgeon we preferred and who had previously treated him at the hospital. He explained that the surgeon we wanted to see was not in his group of doctors. Later on, I discovered that the problem did not lie with the Primary Care Physician, the plan carrier, or the plan itself that my father-in-law was enrolled in. The main concern was our lack of knowledge about his Medicare plan. Since that moment, I made the choice to delve deeper into Medicare and its various options, ultimately obtaining my license. I have a strong desire to enlighten other Medicare beneficiaries about their choices and help them navigate the complexities of Medicare.
Medicare is a complex topic, so in this post, I will delve into the question: What is Medicare?
Medicare is a federal program that offers health insurance to American citizens and other eligible individuals based on age, disability or a qualifying medical condition. Medicare is individual insurance and doesn’t cover spouses or dependents. Established in 1965, Medicare initially consisted of Parts A and B, known as Original Medicare. With evolving needs, Medicare Advantage plans (Part C) and Part D prescription drug coverage were subsequently introduced. Unlike Original Medicare, Medicare Advantage and Part D plans are private health insurance policies offered by private insurance companies.
Medicare typically covers services (such as lab tests, surgeries, and doctor visits) and items (like wheelchairs and walkers) deemed “medically necessary” for treating illnesses or conditions. With a focus on providing health and financial stability to millions of older individuals and those with disabilities, Medicare includes essential health services like hospital care, physician visits, and prescription medications. If you are turning 65, enrolling in Medicare is not mandatory, but delaying enrollment could result in late penalties.
If you or a loved one are nearing your 65th birthday, or have been on Medicare for a while but still have unanswered questions swirling in your mind, it’s essential to get familiarized with Medicare and all of its parts.
ABOUT MYRIAM LEIVA:
Myriam Leiva, a native Floridian, is a fluent Spanish speaker with over 15 years of experience in the financial services sector. She hosts a show on Legends Radio in her hometown of Palm Beach County, FL, aiming to offer education, clarity, guidance, and resources to her audience. As an experienced Medicare Advisor, Myriam provides valuable insight and assistance on Medicare Supplements, Medicare Advantage Plans, and prescription drug plans. She also aids in Part A&B filing with Social Security, representing some of the nation’s most reputable carriers. Myriam takes pleasure in connecting with her clients and fostering strong relationships with them.