Medicare 101
Medicare is a federal health insurance program that primarily serves people aged 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. Established in 1965, Medicare aims to ensure that every eligible American has access to healthcare. Understanding Medicare is pivotal for planning your health future, knowing your rights, benefits, and the range of covered services.
The ABCs (and D) of Medicare
Medicare is divided into four parts: Part A, B, C, and D. Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. Part C, also known as Medicare Advantage plans, is an alternative to original Medicare Parts A & B that often includes additional benefits. Part D adds prescription drug coverage to original Medicare.
Medicare Advantage Plans & Medicare Supplement Insurance
Medicare Advantage Plans (Part C) are an "all in one" alternative to original Medicare. They combine original Medicare Part A & B and generally Part D into one plan. They often also include additional benefits like dental, vision, and hearing. Advantage plans provide predictable out-of-pocket costs with an annual maximum out-of-pocket exposure. In contrast, Medicare Supplement Insurance, otherwise known as a Medigap policy, supplements original Medicare and, depending on the plan chosen, pays for some or almost all costs not included in Medicare Parts A and B. Deciding which option you choose to ease the expenses excluded from original Medicare, either a Medicare Advantage plan or a Medicare Supplement Insurance plan, depends on your personal healthcare needs and budget.
Medicare Enrollment Periods
Navigating Your Medicare Journey
Welcome to Medicare: Your Journey Starts Here
When you turn 65, Medicare becomes a crucial part of your healthcare future. But understanding how it works and picking the right options can be overwhelming. As a local Medicare insurance agency, we are here to clarify the process, help you navigate your choices, and understand your unique needs.
Understanding the Basics of Medicare
On our website, you'll find a wealth of information about the four parts of Medicare and an additional element known as Medicare Supplement Insurance. We encourage you to take your time, explore each role these parts play, and jot down any questions you may have. Once you've gone through the content, reach out to us. We're here to answer your questions and guide you through the Medicare process.
Beware of the 20% Co-Insurance
One key point about understanding Medicare is that it doesn't cover all medical expenses. Original Medicare is an 80/20 plan, meaning it pays for 80% of covered medical costs, and you're responsible for the remaining 20%. With no cap on this 20%, your potential financial exposure can be significant. Explore your two options for managing this risk by reading about the advantages and disadvantages of each option in the Medicare Options section below, helping to make an informed decision.
Expert Guidance for Your Medicare Decisions
Discover Your Medicare Options
The Medicare Options section below provides a brief overview of the two main choices available to Medicare beneficiaries for alleviating some or most of the exposure left by original Medicare. It's not meant to make you an expert, but to help you understand the pros and cons of each option. Making the right decision can be easier with a professional Medicare agent's help.
A Personal Touch to Medicare Guidance
We've seen the look of uncertainty on the faces of many who are turning 65, surrounded by stacks of mail, unsure of their next step. We're here to simplify this process. We work exclusively with Medicare insurance 365 days a year, paid by insurance companies, which means there is no cost to you. Our aim is to ensure you have the best insurance plan tailored to your needs, all while complying with the rules set by the Centers for Medicare & Medicaid Services (CMS).
Medicare Insurance Made Simple
Navigating your health insurance is crucial. While our Medicare Overview page provides you with a solid foundation, our expertise offers additional clarity. We excel at helping people understand their Medicare options and find the best fit. So, why risk going it alone? We're here to assist you at no cost.
Let's get started on your Medicare journey today!
Medicare Options
Protecting Against Unforeseen Costs
Medicare Parts A & B, or Original Medicare, covers 80% of your healthcare costs. However, you, as the beneficiary, are responsible for the remaining 20%. This 20% has no upper limit, exposing you to significant financial risk. Exploring the two additional coverage options is crucial to mitigate this risk.
Managed Healthcare and Beyond
Understanding the two options available for additional coverage is where confusion often arises. These options include managed healthcare plans and others that do not operate under the managed healthcare model. Moreover, you have the option of enrolling in Medicare Part D, which covers prescription drugs. Knowing the benefits and drawbacks of these options is essential to making the right choice.
Option 1
Medicare Supplement Insurance
aka Medigap Plans:
Medigap plans, are approved by the Centers for Medicare & Medicaid Services (CMS) and offered through private insurance companies, they cover some or almost all costs not covered by original Medicare depending on the plan chosen, including co-payments, coinsurance, and deductibles. These plans can also cover services not included in original Medicare, such as overseas healthcare.
Advantages
- Medicare is the primary insurance with no network restrictions.
- If a provider accepts Medicare, the Medigap plan must accept the provider.
- Can make supplement coverage changes anytime during the year.
Disadvantages
- There is an additional monthly premium whether you see a doctor or not.
- The premium generally increases with age.
- Medicare Part D is another separate plan with an additional premium.
Option 2
Medicare Advantage Plans
aka Medicare Part C
Medicare Advantage plans combine original Medicare Parts A & B and usually Part D prescription drug coverage into a single plan. Private insurance companies offer these plans after the Centers for Medicare & Medicaid Services (CMS) approves them. These plans usually include additional benefits not covered by original Medicare, such as dental, vision, and hearing.
Advantages
- They have low or no monthly plan premiums.
- Medicare Part D is generally included in the plan.
- They provide predictable out-of-pocket costs.
- Typically includes extra benefits not provided by original Medicare.
Disadvantages
- Generally requires working within a network.
- Often necessitates a primary care physician.
- Sometimes require a referral to see a specialist.
- No coverage changes outside of Medicare's standard enrollment periods.
Medicare Prescription Drug Plans: Medicare Part D
Medicare Part D plans, offered by private insurance companies and approved by CMS, cover brand-name and generic medications. These plans can either stand alone or be integrated into a Medicare Advantage Plan (MAPD). Each plan has a formulary - a list of the drugs it covers.
Advantages
- Provides coverage for a wide range of prescription drugs.
- Offers financial protection against high costs of medications.
- Many plan varieties creating choice to best fit individual needs and budget.
- Ensures access to necessary medications for managing health conditions.
Disadvantages
- Requires payment of monthly premiums for stand alone plans.
- Often includes an annual deductible before coverage begins.
- May lead to a coverage gap resulting in higher out-of-pocket expenses.
- Complexity in choosing a plan due to numerous formulary options.
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FAQs about Medicare
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
The Initial Enrollment Period for Medicare starts three months before you turn 65 and ends three months after your 65th birthday. If you miss this period, you can sign up during the General Enrollment Period from January 1 to March 31 each year.
A Medigap policy, also known as Medicare Supplement Insurance, is a policy sold by private companies that helps pay some of the health care costs that Original Medicare doesn't cover, like co-payments, co-insurance, and deductibles.
Medigap is supplemental insurance that covers gaps in Original Medicare, whereas a Medicare Advantage Plan (Part C) is an alternative to Original Medicare that often includes additional benefits and might include prescription drug coverage.
It depends on the specific Medicare Advantage Plan. Some plans, known as Medicare Advantage Prescription Drug Plans (MA-PDs), include prescription drug coverage. If your plan doesn't include drug coverage, you may choose to join a Medicare Prescription Drug Plan (Part D).