Medicare is universal healthcare…almost!! It’s only for the universe of people over 65, and a few others. If you are here it’s probably because you just turned 65, are already over 65, or are trying to help someone else. Medicare Insurance, Part C plans, Part D prescription drugs, and Medigap plans are not that complicated if you just focus on a few important concepts. Just like everything else if you can find some one to help and answer questions it will be a lot easier. Good independent agents are hard to find but it is well worth the effort.
CMS – Centers for Medicare & Medicaid Services is a Federal agency and one of the things they are responsible for is overseeing and administering everything Medicare. Medicare’s budget is is about $460 billion dollars and it serves about 46 million people. There are really only 2 ways to go with this…either you add a medicare Supplement plan to your Original Medicare Part A and Part B coverage (add a Part D prescription Drug plan, if you want), OR enroll in a Medicare Advantage plan. We have saved our clients countless hours of valuable time and of course helped them find affordable medicare insurance options.
What is Medicare Advantage, Medicare Part A Coverage, and Medicare Part B Coverage
Medicare is really pretty simple and there are four parts…aptly named Part A, Part B, Part C, and Part D.
- Medicare Part A – coverage for hospital expenses. Also provides coverage for Hospice, home health care, and skilled nursing facilities. There are some things like deductibles per admittance that you will have to pay for out of pocket, but other than that part coverage a lot of medical expenses when you are in the hospital.
- Medicare Part B – does a great job of covering medical expenses incurred outside of a hospital and includes things like doctors visits, diagnostics (X-rays, MRI’s etc.), and some of the preventative routine medical services we all use like check ups and stuff. For the most part Part B pays 80% and you are responsible for the remaining 20%. For a complete breakdown of the Part B coverage please refer to the Medicare guide at the end of this document.
- Medicare Part C – is part of Medicare and the government contracts managed care companies to cover your Part A, B, sometimes D coverage. Most Medicare Advantage plans have zero premium…and some will even reimburse you for your Part B premium!!! The drawback is that you have to use network providers…if you don’t it could cost you more money, you must live in the plans coverage area, and there are restrictions on when you can change your plan. Medicare Part C plans are always guaranteed issue.
Compare Medicare Insurance Plans
Medicare Supplement plan, Medigap plan, are regulated. All the Medicare Supplement plans are standardized so each policy is going to have the same benefits no matter which company you choose to go with. This means that you really can shop based on price. Rates will vary based on where you live but they are also regulated. Medicare advantage plans can only be purchased at certain times of the year…you can can purchase, cancel, change your Medigap plan whenever you want. CMS’s Medicare guide is the best resource for looking up med sup benefits and comparing the different plans. An Independent agent is the fastest and easiest way to get rate information for several companies.
Medicare Advantage and Medicare Part C
Medicare Part C / Medicare Advantage plans are offered by private insurance companies that are contracted by the government to provide subscribers with their Part A, Part B benefits, plus a variety of benefits. The catch is you have to go to network doctors, there is no problem going out of network…but it’s going to cost you. The different Part C plans have a bunch of added benefits like gym memberships, free transportation, meals on wheels, and discount programs. I don’t think you should choose a plan for these features but if that plan you like is also offering you a couple of extra incentives then go for it. Even so most of the plans I have seen are pretty good and if for some reason you don’t like your plan then you can switch in the following Annual Election Period, during a Special Election Period (eligibility requirements). No matter what insurance you have you really should always use network providers. It’s your best option for controlling your medical expenses AND getting the lowest possible rate for medical services. Medicare Advantage plans are not available in all areas…Medicare supplements and Medigap plans are.
Compare Medicare Advantage Plans
Medicare advantage plans are not standardized like the Medsups are so you are going to see a lot of variety in the benefits they offer. As your are reviewing the plans you can ask your self a few simple questions to help compare the coverage being offered.
- Do your doctors and specialist accept that plan? Are they network providers? If not you will probably pay more for their services.
- Do you travel a lot? If so how will that plan cover you when you are away from home or out of the coverage area?
- If you are hospitalized how much is 2-3 days going to cost you? Check to see what the copays or deductibles would apply to your hospitalization?
Medigap / Medicare Supplement Plans
Medigap policies / Medicare Supplement plansare sold by private insurance companies and are designed to cover those costs not covered by Medicare for Medicare approved services. If Medicare pays your supplement plan pays according to benefits for the plan you chose when you enrolled. Since medicare supplement plans are standardized, the plans that are sold are exactly the same…Plan A is exactly the same with every single carrier. Plan B is exactly the same at every carrier. Plans C is exactly… so the only thing that is going to be different is the price and the customer service. Remember these Medicare supplement plans do not cover prescriptions drugs.
Medigap / Medicare Supplement policies are required to adhere to strict legal requirements that are designed to protect the consumer. They were designed to cover the costs that Original Medicare didn’t cover. Which plan is best for you really depends on you.
Medicare Part D Coverage
Medicare Prescription drug plans are available as stand alone products and as part of a Medicare Advantage plan. Part D plans are available during the Initial Enrollment Period when you first become eligible and during the Annual Election Period. If you don’t enroll when you become eligible then you are going to have to pay a late enrollment penalty. The coverage is pretty straight forward and you’ll have co-pays for most of your medications up until you reach the coverage gap or “donut hole”…if you make it through that you’ll have very low coinsurance after… well, until January, when it starts over
Centers for Medicare and Medicaid Services is my favorite source for Medicare information and details relating to the consumer. Everybody going in or in the Medicare system should read “Medicare and You“. It really is a great resource.
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