What is Medicare?
Medicare is a federal program that ensures citizens who are disabled or 65 and older have affordable health care options. It is also one of the most complex systems of insurance to understand because of the rules, regulations, deadlines, penalties, compliance guidelines, and other policies and procedures set forth by the federal government. Fortunately, our knowledgeable team is well versed in the do’s and do not’s of Medicare. We are here to assist you along your Medicare purchasing journey, ensuring that you find the right coverage for your individual needs.
Part A - Original Medicare
This is your hospital insurance plan. Part A covers nursing care and hospital stays, but does not cover doctors’ fees. Part A also covers some home health services, like skilled nursing care after a hospital stay as well as hospice care. If you have been employed most of your life and paid payroll taxes, the odds are you will not have to pay a monthly premium for Part A. Instead, this will be automatically deducted from your social security check.
Part B - Your Medical Coverage
Medicare Part B is optional. You may choose to opt out of Part B if you continue to carry health insurance through an employer, union, your spouse, etc. Part B pays for a portion of your doctor visits, some home health care, medical equipment, outpatient procedures, rehabilitation therapy, laboratory tests, X-rays, mental health services, ambulance, and blood. You are required to pay a monthly premium to Medicare for Part B coverage.
Part C - Medicare Advantage Plans
Part C plans are offered through private insurance carriers, but are approved by Medicare. In order to enroll in Part C, you must be enrolled in both Part A and Part B. Part C plans pay for the same health services as Original Medicare. The plan may offer additional benefits that are not covered by Original Medicare - such as vision, hearing, and dental care. Many of these plans also provide some level of prescription drug coverage. Medicare Advantage plans are generally organized as health maintenance organizations (HMOs) or preferred provider organizations (PPOs).
Part D - Prescription Drug Coverage
Part D is a stand-alone plan that provides prescription drug coverage. Part D is not mandatory and may be purchased to work alongside with your Original Medicare or Medicare Supplement plan. Generally you will pay a premium for Part D along with co-payments and coinsurance, which varies among plans. It is important to ensure that your plan covers your medications. Every plan has a formulary of covered drugs (normally available online) which varies between plans. Plan D offers catastrophic coverage once your total out of pocket costs have been reached.
Medicare Supplement Plans
Also known as Medigap Plans, these are supplemental insurance plans offered through private carriers that help to cover some of the costs of Original Medicare. Medigap Plans generally help to cover gaps in co-payments, coinsurance, and yearly deductibles that Original Medicare does not provide. These plans can also help pay for some services that are not covered through Medicare, like emergency overseas travel and Part B excess charges. You must be enrolled in Part A and Part B in order to be eligible for a Medigap policy; Medigap is not intended to provide stand-alone coverage.
Medigap policies do not include Part D, cannot be used with Medicare Advantage Plans, and can only cover one person even if you are married (meaning your spouse would need to buy a separate policy). You are expected to pay a monthly premium on your Medigap policy in addition to the Part B premium, and your policy is guaranteed renewable as long as you continue to pay your premium.