Demystifying healthcare so you can focus on your actual health.
For those not on Medicare
Not old enough for Medicare and don't receive health insurance through an employer? You need individual coverage. Here's what you need to know:
I utilize Health Sherpa — a platform directly integrated with the Healthcare Marketplace. This allows us to quickly find the best plans and apply any income-based tax credits you qualify for to lower your monthly premium. We can filter plans specifically by your preferred doctors, specialists, and necessary medications.
Turning 65? Or qualifying through disability (like ESRD)? The transition to Medicare doesn't have to be overwhelming. Let's break down the alphabet soup.
Hospital Insurance. Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. For most people who have worked at least 10 years in the US, Part A is premium-free ($0/month).
Medical Insurance. Covers certain doctors' services, outpatient care, medical supplies, and preventive services. Everyone pays a monthly premium for Part B (the amount is based on your income level).
Medicare Advantage. Private health plans that bundle Part A and Part B together. They often include Part D (drugs) and add extra benefits Original Medicare doesn't cover, such as vision, dental, and hearing.
Prescription Drug Coverage. Standalone plans added to Original Medicare (A & B). Each plan has its own formulary — so it's critical we check your specific medications against the plan to ensure they are covered affordably.
Your Initial Enrollment Period begins 3 months before the month you turn 65, includes your birthday month, and extends 3 months after. It's crucial to sign up during this 7-month window to avoid permanent late enrollment penalties.
Original Medicare (A & B) lets you see almost any doctor in the country, but has no out-of-pocket maximum and no drug coverage. Medicare Advantage (Part C) has a network (HMO or PPO), bundles in drug coverage, adds extras like dental/vision, and provides a safety-net out-of-pocket maximum for the year.
Yes. If you have limited income and resources, you might qualify for "Extra Help" (also known as the Low-Income Subsidy) from Medicare to pay Part D premiums, deductibles, and co-insurance. I can help you determine if you qualify and walk you through the application.
I'll break it down for you in plain English. No jargon, no pressure.
Talk to Jimmy About Medicare