Medicare

Medicare is a federal health insurance program for people who are 65 or older, and some individuals under 65 with certain disabilities or End-Stage Renal Disease. It was enacted in 1965.There are four parts of Medicare: A, B, C, and D, with each part offering a different level of coverage for healthcare services.

Original Medicare

Medicare Part A (hospital insurance) and Part B (medical insurance) are known as Original Medicare. Together, these parts cover an array of inpatient and outpatient services, like:

  • Inpatient hospital care
  • Hospice, lab tests, surgery and home health care
  • Doctors and other healthcare providers
  • Some preventative services
  • Skilled nursing facility
  • Durable medical equipment

If you or your spouse paid Medicare taxes during your working years, you may get Part A premium-free.  Part B has a premium that varies based on income and is optional.

Medicare Supplements

Medicare Supplement plans, also called Medigap policies, are policies that add to your Original Medicare benefits. Original Medicare doesn’t cover everything, so many people choose a supplement to help pay for the bills that original Medicare does’t pay. These could be deductibles, copays, and coinsurance — out of pocket expenses— when you receive medical services. Medicare Supplements are meant to fill in these “gaps” in coverage.

The plans are A, B, C, D, F, G, K, L, M, and N — each providing different benefits. Plans F and G offer high-deductible versions, meaning you have to meet the deductible amount before the plan pays.

However, Plans C and F are not available like they used to be. Only those eligible for Medicare before 2020 will continue to have the option to enroll in these Medigap plans. This is due to the Medicare Access and CHIP Reauthorization legislation that prohibits supplements from covering the Medicare Part B deductible.

Medicare Advantage

Medicare Advantage, also called Part C, are plans offered by private insurance companies approved by Medicare (CMS). These plans are required to provide the same benefits as Original Medicare, and may have additional benefits such prescription drug coverage (Part D), dental/vision & hearing benefits, fitness programs, and an over-the-counter (OTC) allowance for other health related essentials.

You must be enrolled in both Parts A and B, and then you may enroll in a Medicare Advantage plan.

There are Several types of Medicare Advantage plans available

  • HMO plans typically require you to see only providers that are in-network and usually offer lower copays and out of pocket expenses
  • PPO plans allow you to see providers in and out of network if you choose. You usually will pay less if you use doctors in the plan’s network, but have the freedom to see providers outside of the network as well.
  • PFFS plans allow you to visit any doctor approved by Medicare, hospital and provider that takes the plan’s payment, terms and conditions and agrees to treat you.
  • MSA plans combine a high-deductible plan and a savings account to pay for your medical expenses. The plan will deposit money into the account, and you can use this to pay healthcare costs before meeting the deductible.
  • SNP, special needs plans, have a unique benefits for those with special healthcare needs. The three types of SNPs are C-SNP, D-SNP, and I-SNP. All SNPs must provide Medicare prescription drug coverage.

Veterans with TRICARE and VA benefits may also enroll in a Medicare Advantage plan — which extends their health coverage beyond the VA networks.

 

Medicare Prescription Drug Coverage

  1. Medicare Part D is the prescription drug benefit. Beneficiaries can purchase this coverage in two ways: 1) As a separate, standalone plan with Original Medicare or 2) As an additional benefit with a Medigap plan or some Advantage plans like PFFS, MSA, or a Medicare cost plan.

Part D plans, often called PDPs, need to cover a minimum of two drugs within each of the classes. Each plan has a list of drugs it covers called a formulary. The insurance company decides which drugs in each category will be covered. The drugs are assigned tiers, which determines your maximum copay. We can help find a plan that covers your medications and maximizes your savings.

Reach Out to Our Team

Depending on where you live, there may be dozens of Medicare Advantage, Supplement, and prescription drug plans. How do you know which is right for you? An experienced agent will walk you through your options and help you make an informed decision! And it comes at no additional cost. Call us today for FREE Medicare help. We are local and take pride in serving the communities we live in. Our agents are happy to meet in person, virtually or by telephone.