Understanding Medicare

UNDERSTANDING MEDICARE

Medicare is downright confusing and everyday we hear, even from the most savvy consumers, “I just can’t wrap my head around this!” We get it and that’s why we are the experts who will help simplify the process and assist every step of the way. That starts with understanding the Medicare basics.

What is Medicare

Medicare is a federal health insurance program. It is designed for people who are 65 or older and is also available to those under 65 with qualifying disabilities or people with End-Stage Renal Disease (ESRD) or Amytrophic Lateral Sclerosis (ALS). Medicare includes several “parts” that will cover different things.

What are the different part of Medicare?

Part A: Covers inpatient hospital admission, care in skilled nursing facilities, hospice care and some home health care. While there are deductibles and copayment required, Part A doesn’t cost any monthly premium for most people.

Part B: This is outpatient medical coverage which means it will help pay for medically necessary services performed on an outpatient basis that are needed to diagnose and treatment medical conditions. Examples of these services include but are not limited to services from doctors & other health care providers, outpatient care, home health care, durable medical equipment, lab services and many preventative services. In addition to deductibles, copays and coinsurance, there is a monthly premium required for Part B. Some people may have different Part B premiums based on their income and financial resources.

Part C: Also called, Medicare Advantage, Part C is an alternative to Original Medicare. These plans will often times include prescription drug coverage, along with other benefits not covered by Medicare. These are offered by private insurance companies, so working through an independent broker for these services is usually recommended. You must continue to remain covered by Medicare A&B in order to have Part C.

Part D: Also known as prescription drug coverage, Part D is available as a stand alone option (PDP) or as part of a Medicare Advantage (Part C) plan and helps cover the cost of prescription drugs, including many recommended shots or vaccines. Part D plans are offered only by private insurance companies that are contracted and approved by Medicare. Part D costs such as deductibles are separate from medical deductibles that may apply in Parts A, B and/or C.

What are the different part of Medicare?

Part A:

Covers inpatient hospital admission, care in skilled nursing facilities, hospice care and some home health care. While there are deductibles and copayment required, Part A doesn’t cost any monthly premium for most people.

Part C:

Also called, Medicare Advantage, Part C is an alternative to Original Medicare. These plans will often times include prescription drug coverage, along with other benefits not covered by Medicare. These are offered by private insurance companies, so working through an independent broker for these services is usually recommended. You must continue to remain covered by Medicare A&B in order to have Part C.

Part B:

This is outpatient medical coverage which means it will help pay for medically necessary services performed on an outpatient basis that are needed to diagnose and treatment medical conditions. Examples of these services include but are not limited to services from doctors & other health care providers, outpatient care, home health care, durable medical equipment, lab services and many preventative services. In addition to deductibles, copays and coinsurance, there is a monthly premium required for Part B. Some people may have different Part B premiums based on their income and financial resources.

Part D:

Also known as prescription drug coverage, Part D is available as a stand alone option (PDP) or as part of a Medicare Advantage (Part C) plan and helps cover the cost of prescription drugs, including many recommended shots or vaccines. Part D plans are offered only by private insurance companies that are contracted and approved by Medicare. Part D costs such as deductibles are separate from medical deductibles that may apply in Parts A, B and/or C.

Medicare Supplements

Medicare supplement plans, also referred to as Medigap,are insurance policies that help to pay for the “gap” in coverage from Medicare A & B. These policies are sold by private insurance companies that are licensed to sell Medicare plans and will help cover deductibles, copays and coinsurance that Medicare does not cover. You may even find plans that offer limited coverage overseas. These plans are available to people with Medicare Parts A and B. When you enroll into a Medicare Supplement plan you can choose any stand-alone Part D plan to pay for prescriptions as you would not pair a Part C plan with Medicare Supplement.