What is Medicare?
Medicare is a federal health insurance plan. Generally, when a U.S. citizen turns 65 or is on disability for 24 months, they are eligible to join.
Original Medicare consists of Part A (inpatient hospital services) and Part B (outpatient medical services). In addition to Medicare, one can sign up for a prescription drug plan, called Part D, and a Medicare Supplement, or a Medicare Advantage plan, called Part C. These additional plans are covered through private insurance companies.
Part A
Part A covers inpatient hospital services. Typically, there is no monthly premium. After meeting a deductible, Part A will cover inpatient care in a hospital, skilled nursing facility, hospice care, and some home health care. Patients will be charged a copay for each additional day beyond the first 60 days in the hospital, with no out-of-pocket limit.
Part B
Part B covers outpatient medical services. This includes doctor visits, labs, diagnostic tests and procedures, medical equipment, mental health services, and a variety of preventative services. There is a deductible that generally increases from year to year. Once the deductible is met, Medicare will typically cover 80% of the medical services. By and large, you are responsible for 20% coinsurance with no limit to your out-of-pocket expense.
Part D
Part D is a policy that covers prescription drugs. There is a wide variety of plans that cover an array of brand and generic medications. Plans vary in regard to premiums, which medications are covered, and out-of-pocket expenses. Part D plans are optional and available to all Medicare members. Should you decide to refrain from purchasing a Part D plan when you are first eligible, and you don't have other creditable coverage, you will likely incur a late enrollment penalty if you eventually opt to sign up for a plan.
The Basics
Medicare Supplement
Medicare Supplements, also known as MediGap plans, are sold by private insurance companies. There are several plan types and they vary by cost and coverage. A Medicare Supplement is intended to augment that which the original Medicare does not cover. This plan enables you to see doctors and go to hospitals throughout the United States with little to no out of pocket cost. Please note that Medicare Supplements do not include Part D (prescription drug) coverage.
Medicare Advantage
Medicare Advantage Plans, also called Part C, refer to plans that help cover some of the cost that Medicare does not pay for. These plans are offered by private insurance companies and more often than not, will include drug coverage. The monthly premium for Medicare Advantage plans start at low to no cost a month. The plan covers a host of medical benefits and services for which you will be charged a copay (starting at low to no cost). This plan also includes a variety of non-medical benefits such as vision, hearing, acupuncture, and transportation. Typically the network of providers for these benefits is limited.
The optimal path to choosing a plan is to consult a qualified agent. A knowledgeable agent will assess your unique needs, help you review plans, navigate the Medicare system, and ensure you receive what you need from the Healthcare system.
How to fill Medicare gaps
Guiding You
It would be my pleasure to provide you with full support in navigating the Medicare system as well as finding the right plan based on your needs. Whether you feel most comfortable meeting in person, over the phone, or online, I would be delighted to assist you in this journey. Book a personal appointment with me today!
