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Medicare Coverage

Medicare and Medicaid Coverage for Seniors in St. Charles, Missouri

When you turn 65, you have the opportunity to start receiving medical care via Medicare. This is a wonderful tool that helps seniors receive the care they need to live a full life. But it can also be complicated to understand all the options and nuances of Medicare.

Martin Estepp is here to help you ever step of the way.

Medicare is a federally-administered health insurance program known as Original Medicare. There are two main parts of Original Medicare – Part A and Part B, with each covering certain healthcare costs.

Medicare Part A

Hospital Insurance

Covers hospital stays and inpatient care, including but not limited to:

  • Semi-Private Room
  • Hospital Meals
  • Nursing Services
  • Intensive Care
  • Critical Care
  • Drugs
  • Medical Supplies
  • Lab Tests
  • X-Rays
  • Operating Room Costs
  • Recovery Room Costs
  • Rehab Services
  • Part-Time Home Care
  • Hospice for the Terminally Ill

Medicare Part B

Medical Insurance

Covers doctor visits and outpatient care, including but not limited to:

  • Doctor Visits
  • Annual Wellness Visit
  • Preventive Services
  • Flu Shots & Vaccines
  • Mammograms
  • Lab Services
  • X-Rays & Tests
  • Physical Therapy
  • Occupational Therapy
  • Speech-Language Pathology
  • Mental Health Care
  • Medical Equipment
  • Ambulance & ER Services
  • Nursing Care

Get preventive services

Medicare covers many preventive services at no cost to you. Ask your doctor or other health care provider which preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits) you need.

Martin Estepp

A "Senior Helping Seniors"

  • I am a licensed Medicare Advisor who represents Sunshine Senior Services.
  • I am a senior who has been in the insurance profession for over 40 years. I am well-qualified and well-informed concerning Medicare and Medicaid programs.
  • I have been a guest speaker at Lindenwood University.
  • I provide education programs for SSM at different venues.
  • I am a caregiver for my wife.

Medicare Advantage Plans

You can get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan (like an HMO or PPO). If you have Original Medicare, the government pays for Medicare benefits when you get them. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits. If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage. These coverages are subject to co-pays and coinsurance.

Sometimes people ask, what do Medicare Advantage Plans cover? Medicare Advantage Plans must cover all of the services that Original Medicare covers, except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.).

Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or hearing programs. Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D).

Talking to an independent Medicare benefits consultant like Martin is important to ensure you’re finding the coverage that best suits your needs.

MeDICARE SUPPLEMENT PLANS (Medigap)

Medicare supplement plans (also called MediGap) are private health insurance specifically designed to supplement and work only with Original Medicare. Private insurance companies sell Medicare supplement plans. Medicare supplement plans help pay some of the coinsurance, copayments, and deductibles in Original Medicare.

They may also cover certain medical services Medicare doesn’t cover. People who are enrolled in Original Medicare and buy a Medicare supplement plan will generally have a certain amount of their Medicare-approved health care costs covered (depending on the plan they choose).

Health insurance companies offer a variety of MediGap plans, so talking to someone who is knowledgeable about the all options available in your area is key. Martin is here to help answer your questions and guide you toward the right coverage. What is the right coverage? The plan that meets your needs.

MEdicare pRescription Drugs (part D)

Plans are administered by various insurance companies. They all offer benefits, which meet minimum federal standards. Some plans have additional benefits beyond federal requirements. Plans can be reviewed and changed each year. Formularies, deductibles and an individual’s medication need can and do change.

A formulary is a list of drugs (both generic and brand name) that are selected by your health plan as the drugs they prefer to treat certain health conditions.

Covered prescription drugs are assigned to 1 of 5 different levels with corresponding copayment or coinsurance amounts.

MEDICARE & MEDICAID:

Medicare is a federal program.

Medicaid is a federal program administered by the states. The program is funded jointly by the states and the federal government.

Medicare Saving Programs (QMB) for individuals with limited income and resources.

Special Needs Plans are also known as Dual Plans.

ADDITIONAL COVERAGES OFFERED

Often seniors experience costs outside of the reach of various Medicare plans. That’s why Martin has sought out additional insurance types to account for the various expenses a senior may incur during their golden years.

Hospital Indemnity

Hospital Confinement Indemnity Insurance is designed to help fill some of the co-payments, deductibles and out-of-pocket expenses of your health insurance plan. Cash benefits are paid directly to you to help cover the costs associated with hospital confinement, ambulance trips, critical accidents, skilled nursing stays and more.

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You’ll be surprised to learn the benefits available to you. All you have to do is share your story with me. I love to listen. I’m available to meet in person, by phone or virtually. Let’s talk!

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Estepp Insurance: Medicare Benefits Consultant is not connected with or endorsed by the United States government or the federal Medicare program.

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