" class="object-cover object-center"> WHAT IS MEDICARE INSURANCE?
Medicare is a federal health insurance program designed for individuals who are 65 years old and older, as well as some younger individuals with specific medical conditions or disabilities. This program is divided into several parts, and it's essential to understand how these parts work together.
MEDICARE PART A
PART A is hospital insurance that helps cover the costs of inpatient care and stays in skilled nursing facilities. It also assists hospice and home health care. In general, you can think of the inpatient hospital benefit as Medicare coverage for room and board in a hospital.
Part A covers the costs of a semi-private room; however, it's important to note that it does NOT cover all treatments that may occur in a hospital or clinical setting, such as outpatient surgeries. Those treatments typically fall under Part B.
For most people, the cost of Part A at age 65 is $0. This is because you have paid taxes during your working years to pre-fund the premiums for your hospital benefits. You can also qualify for Part A at no cost through a spouse or ex-spouse’s work history. Even if you do not automatically qualify for premium-free coverage, most people aged 65 can still obtain it—but they would need to pay a significant premium.
MEDICARE PART B
Part B provides your outpatient medical coverage. It essentially covers most medical services that occur outside of inpatient hospital care. Without Part B, you would not have insurance coverage for doctor visits, including consultations with physicians while you are hospitalized. Additionally, you would lack Medicare coverage for lab work, preventive services, ambulance services, and outpatient surgeries.
Most importantly, Part B covers critical treatments such as cancer therapy and kidney dialysis. These services can be extremely costly without Part B and supplemental coverage.
The cost of Part B is determined by Social Security and is subject to change each year. Individuals with higher incomes typically pay more for Part B than those with lower incomes. Your modified adjusted gross income, as reported to the IRS, will determine your Part B premium.
MEDICARE PART C
PART C refers to the Medicare Advantage Program, which is a type of private insurance. The costs of Advantage plans can vary depending on the insurance carrier, your county of residence, and the specific plan you choose.
To enroll in a Medicare Advantage plan, you must first be enrolled in both Part A and Part B of Medicare. Even if you find a Part C plan with a very low premium, you will still need to pay for Part B. Additionally, you must reside within the plan's service area and apply during an authorized election period.
Once you enroll, your Medicare coverage will be provided through the Advantage plan itself, rather than directly from the government.
It's important to note that enrolling in Part C does not occur at the Social Security office because it is a voluntary program. Many individuals prefer to obtain their Medicare coverage through Original Medicare and traditional Medigap plans. Consequently, those who do not wish to enroll in an Advantage plan simply choose not to do so.
MEDICARE PART D
PART D is the newest component of our national health insurance program for individuals aged 65 and older. For many years, Medicare did not provide coverage for prescription medications. However, in 2006, the federal government introduced Part D, and millions of Medicare beneficiaries enrolled to receive coverage for their outpatient prescription drugs.
Part D covers retail prescription medications that you can either pick up at the pharmacy or order through mail order. To enroll in a Part D drug plan, you need to choose a carrier and sign up for their specific plan. Most states offer around 30 different drug plans to choose from. To find the plan that best meets your needs, it's advisable to have an agent conduct a Part D analysis using Medicare’s prescription drug finder tool.
Before selecting a plan, it's important to understand the differences between your options, specifically Medicare Supplements and Medicare Advantage Plans. Many individuals enroll in Advantage Plans believing they are the same as Supplements, but that is not the case.
MEDICARE ADVANTAGE PLAN
A Medicare Advantage Plan is a type of Medicare health plan provided by a private company that has a contract with Medicare to deliver all your Part A and Part B benefits.
Medicare Advantage Plans include several types of plans: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans, Special Needs Plans (SNPs), and Medicare Medical Savings Account Plans.
If you are enrolled in a Medicare Advantage Plan, your Medicare services are covered through that plan instead of Original Medicare. Most Medicare Advantage Plans also include coverage for prescription drugs.
**What do Medicare Advantage Plans cover?**
Medicare Advantage Plans must cover all the services that Original Medicare covers, except for hospice care. It’s important to note that Original Medicare still covers hospice care even if you are enrolled in a Medicare Advantage Plan. All types of Medicare Advantage Plans provide emergency coverage and urgently needed care.
Additionally, Medicare Advantage Plans may offer extra benefits, such as vision, hearing, dental care, and health and wellness programs. Most plans include Medicare prescription drug coverage (Part D). Along with your Part B premium, you typically pay a monthly premium for the Medicare Advantage Plan.
You can request a written advance coverage decision from the plan to confirm whether a specific service is medically necessary and will be covered. If the plan denies coverage for a service you believe you need, you will be responsible for all related costs if you did not ask for an advance coverage decision.
MEDICARE SUPPLEMENT PLAN
Medicare supplement insurance, commonly known as Medigap, helps cover some of the healthcare costs that Original Medicare does not, such as copayments, coinsurance, and deductibles.
Additionally, some Medigap policies offer coverage for services that Original Medicare doesn't include, like medical care during travel outside of the U.S. If you have Original Medicare and purchase a Medigap policy, Medicare will first pay its share of the Medicare-approved amount for covered healthcare costs. Then, your Medigap policy will cover its portion.
It is important to note that a Medigap policy is different from a Medicare Advantage Plan. While Medicare Advantage Plans are alternative ways to receive Medicare benefits, a Medigap policy simply supplements your Original Medicare benefits. Here are some key points to know about Medicare Supplement insurance:
- If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but ensure that you can leave the Medicare Advantage Plan before your Medigap policy takes effect.
- You will pay a monthly premium to a private insurance company for your Medigap policy, in addition to the monthly Part B premium you pay to Medicare.
- A Medigap policy covers only one person. If both you and your spouse want Medigap coverage, you will need to set up two separate policies.
- Any standardized Medigap policy is guaranteed renewable, even if you have health issues. This means that the insurance company cannot cancel your Medigap policy as long as you continue to pay the premium.
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This is a solicitation of insurance. Agent is a licensed and certified representative of multiple Medicare Advantage and Prescription Drug plans each with a Medicare contract. Enrollment depends on contract renewal. Contact may be made by an insurance agent or insurance company. Not affiliated with or endorsed by any government entity or agency. "We do not offer every plan available in your area. Currently we represent several organizations which offer many products in your area. Please contact Medicare.gov, 1-800-MEDICARE MEDICARE (TTY: 1-877-486-2048), 24 hours a day, 7 days a week, or your local State Health Insurance Program (SHIP) to get information on all your options." This is a proprietary website and is not associated, endorsed or authorized by the Social Security Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services. This site contains decision-support content and information about Medicare, services related to Medicare and services for people with Medicare. If you would like to find more information about the Medicare program please visit the Official U.S. Government Site for People with Medicare located at http://www.medicare.gov