Medicare Coverage San Antonio

Cuellar & Associates guides you through the process of getting adequate coverage as you approach the age of 65.

What does caring for your health mean at this age?

What kind of coverage is essential and what is not necessary in your medicare coverage plan? 

As with all of our products and services, to get the most accurate information for your situation, please reach out to our Medicare health insurance professionals today.

Get Your Custom Medicare Quote Today

Our Medicare experts will put together a personalized quote just for you.

Or give us a call at 210-558-0811 for a consultation.

The Main Components of a Medicare Insurance Plan

Medicare is broken down into four parts, all of them are vital to what should be covered as you approach open enrollment.

San Antonio families are important to us, especially the health and medicare coverage of our Seniors.  These are the four parts of medicare insurance coverage to pay attention to while you are researching medicare insurance and coverage plans.

Part A: Medicare Coverage for Hospital Stays

When you apply for Medicare insurance coverage, you will automatically be enrolled in Part A. It is the most important part of your medicare coverage.

Part A of Medicare insurance coverage involves hospital stays, including nursing care that you might come across in the event of an accident or other incapacitation.  In most cases, regardless of where your coverage is coming from, Part A of Medicare insurance coverage is included.  Your premium does not pay into Part A Medicare.

Medicare coverage under Part A Medicare is part of a “pay-into” system that is taken in the form of an automatic withdrawal from paychecks before reaching the age of 65.

Here is the catch: although coverage under this part of Medicare is included, it charges a significant deductible each time you are admitted to a hospital. Health insurance plans under this section of Medicare vary year to year (The average deductible for 2021 is $1,484) but in the event of hospitalization, a Medicare insurance plan will cover most of the costs of your first 60 days in the hospital (with exceptions, depending on your health insurance).

If you are a United States citizen who may have not worked long enough in the U.S. to qualify for Medicare, there are other options to secure health insurance plans.

Cuellar & Associates is here to understand your situation and help you through enrollment, choosing your Medicare coverage, and utilizing your new health insurance as cost efficiently as possible. 

Medicare nurse
Two people in Medicare consultation

Part B: Medicare in Regards to Doctor and Outpatient Services

There are several components in regards to Part B Medicare, so understanding what Medicare plans offer is crucial to getting the right coverage for you. 

Part B Medicare involves outpatient services including diagnostic screenings, medical equipment used, lab tests, and ambulance services. It is a broad category of Medicare insurance, one in which Cuellar & Associates wants to make sure you have sufficient coverage. It involves additional costs so many people often defer signing up for Part B Medicare if they are working and have insurance through their job (another option is if you are already covered under your spouse’s insurance plan). 

However, if you do not have health insurance coverage, nor have signed up for Medicare insurance coverage in the past, signing up for health insurance with Part B Medicare coverage will save you a higher premium down the line.

We understand that the scope of Medicare insurance coverage is vast, Cuellar & Associates is committed to making sure San Antonio families know about all of their options when choosing a health plan.

Part C: Medicare Advantage: Difference in Coverage and Health Insurance

Medicare Advantage is the private health insurance alternative to the federally run original Medicare. Think of Advantage as a kind of one-stop shopping choice that combines various parts of Medicare into one plan.

If you decide on a Medicare plan, you’ll still need to enroll in parts A and B and pay the Part B premium.  In addition, you will need to choose a Medicare Advantage plan and sign up with a private insurer.

The federal government requires these plans cover everything that original Medicare insurance covers.  Some plans pay for services that original Medicare does not, including dental and vision care. In addition, in recent years the Centers for Medicare and Medicaid Services, which sets the rules for Medicare, has allowed Medicare Advantage plans to cover such extras as wheelchair ramps and shower grips for your home, meal delivery and transportation to and from doctors’ offices.

Most Medicare Advantage plans also fold in prescription drug coverage. Not all of these plans cover the same extra benefits, so make sure to read the plan descriptions carefully.

Medicare Advantage plans generally are either health maintenance organizations (HMO) or preferred provider organizations (PPO).

Mother and daughter thinking about medicare
Pharmacist for Medicare coverage

Part D: How Medicare Works With Prescription Drugs

Coverage for prescription drugs in San Antonio is almost as vital as Part B Medicare (doctor’s visits and diagnostic tests).  Getting coverage under this aspect of a Medicare insurance plan can be the most important. 

Each insurance plan has premiums and other out-of-pocket costs that group together under part D. These come in the form of co-pays for medication or a percentage of the prescription costs. This aspect of Medicare coverage is highly dependent on one’s health, and coverage under this section of medicare depends on your personal health.

For example:

If your total drug costs — the amount you and your Part D insurance plan have paid — reaches $4,130, you will be responsible for 25 percent of the price of the rest of the prescription drugs you buy during the year. 

If, however, your drug costs continue to mount, you may reach the point of qualifying for catastrophic insurance coverage. In these cases the cost of what’s covered usually comes out to around 5%. That means that you are responsible for 5% of the cost of your prescription drugs. In this aspect of Part D Medicare, you want to make sure your Medicare insurance coverage is sufficient. 

HMO vs. PPO: The Basics of Where You Can Get Medicare Treatment in San Antonio TX

HMO: Health Maintenance Organization

PPO: Preferred Provider Organization

If you’re planning for Medicare insurance coverage, you might have a similar choice if you decide to get coverage through Medicare Advantage.

Let’s take a closer look at HMO vs. PPO Medicare Advantage coverage plans to fully understand the differences.

What you may want to consider when choosing between an HMO and PPO Medicare coverage is whether or not you prefer to visit a specific doctor. Health insurance is one thing, but feeling comfortable with a health physician is its own decision. If you choose to stay with your doctor that is outside of a Medicare coverage group, then a PPO might be for you.

Regardless of the type of health plans, PPO Medicare health insurance coverage allows one to see a specialist without a referral. For many people qualifying for Medicare, this is very important. Under an HMO Medicare plan, you are required to get your physician’s approval before you visit a specialist. PPO Medicare Advantage plans offer flexibility in who you choose to see, but will typically have higher premiums. With HMO Medicare plans, since you generally agree to see a physician in the designated group, your premiums may be lower.

You might need to take a more active role in care coordination in a PPO health insurance plan.  For example, if you visit providers outside the Medicare Advantage PPO plan’s network, you may have to give information about the medical care you have received and your prescription drugs to doctors who treat you.


We Are Ready To Assist You

We are experienced at helping our clients get the right Medicare insurance coverage plans.  Contact Cuellar & Associates today to get the most accurate information for your situation.

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