Medicare Parts
Medicare comprises four parts: Part A, Part B, Part C, and Part D. Part A covers hospital stays, skilled nursing care, and hospice care. Part B covers doctor visits, preventive care, and medical equipment. Part C, also referred to as Medicare Advantage, integrates Parts A and B and typically offers supplementary benefits such as vision and dental. Part D covers prescription drugs. It is crucial to have a thorough understanding of the distinct parts of Medicare to arrive at informed decisions regarding your healthcare coverage.
Hospital Insurance
Medicare Part A covers your hospital expenses. This includes hospital stays, skilled nursing care, hospice, and home health-care services. You may have to pay various deductibles, coinsurance, and copayments. You earn Part A by paying taxes toward Medicare while working for 10 years (or 40 quarters). If you did not earn Part A, you will pay a premium
Medicare Options
Before selecting your plan, we want to make certain you understand your plan options; if you struggle to understand the difference between Medicare Supplement and Medicare Advantage plans, we are happy to provide a complimentary review.
Medicare Supplement Plans (Medigap)
Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private insurance company to help pay your share of costs in Original Medicare.
You may only have a Medicare Supplment, or MediGap Plan, if you have Original Medicare Parts A and B. All Medicare Supplement, or Medigap policies are standardized. This means, they offer the same basic benefits no matter where you live or which insurance company you buy the policy from.
There are 10 different types of Medigap plans offered in most states, which are named by letters: A-D, F, G, and K-N. Price is the only difference between plans with the same letter that are sold by different insurance companies. What else should I know about these lettered plans?
Every Medigap policy must follow federal and state laws designed to protect you.
Source: medicare.gov
Medicare Advantage Plans
Medicare Advantage Plans provide all of your Part A and Part B benefits, including new benefits that come from laws or Medicare policy decisions. Plans must cover all emergency and urgent care (both physical and mental), and almost all medically necessary services Original Medicare covers. Medicare Advantage Plan benefits exclude clinical trials and hospice services. But if you’re in a Medicare Advantage Plan, Original Medicare will still help cover your costs for hospice care, and some costs for clinical research studies.
The plan can choose not to cover the costs of services that aren't medically necessary. If you are not sure whether a service is covered, check with your provider before you receive the service.
With a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn't cover, like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (like routine check ups or cleanings). Plans can also cover even more benefits. For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs that Part D doesn’t cover, and services that promote your health and wellness. Check with the plan before you enroll to see what benefits it offers, if you might qualify, and if there are any limitations.
Source: medicare.gov
Medicare Prescription Drug Plans (Part D)
You will need to enroll in Prescription Drug Coverage, as it is required. Medicare Supplement (MediGap) plans do not include your drug coverage. Contrastingly, many Medicare Advantage Plans include have drug coverage included in the plan.
If you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer, union or VA) or get Extra r.
Generally, you’ll pay this penalty for as long as you have Medicare drug coverage. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage. Each plan can vary in cost and specific drugs covered.
NEW INSULIN BENEFIT! The cost of a one-month supply of each Part D-covered insulin is capped at $35 and you don't have to pay a deductible. If you get a 60- or 90-day supply of insulin, your costs can’t be more than $35 for each month’s supply of each covered insulin.
Source: medicage.gov
Ancillary Coverage
Hospital Indemnity Insurance
Hospital indemnity insurance is an insurance plan you can purchase in addition to your health insurance plan. You pay a monthly premium, just as you do for other insurance, and if you end up spending time in the hospital, you receive a fixed benefit amount paid directly to you to help cover expenses.
Vision Insurance
Generally, Medicare does not cover routine eye care. There are a couple of exceptions: if you are suffering cataracts, original Medicare will cover the surgery and a pair of corrected glasses post surgery; if you are diabetic, eye degeneration is a medical side effect and therefore covered; and if you suffer from Macular Degeneration, another medical condition, you are covered under Medicare.
Dental Insurance
Routine dental care is not covered by Medicare, and it is recommended you purchase separate coverage for your teeth and gums. Since 2010 there are more options available to seniors than previously offered.
Typically, there are no waiting periods but there may be graduated coverage for major services.