We offer a variety of solutions for seniors.
What is Medicare?
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) or ALS (also called Lou Gehrig’s disease).
There are different parts of Medicare that help cover specific services:
Medicare Part A: Hospital Insurance
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, lab tests, surgery, and some home health care. You can use any hospital or facility that takes Medicare, anywhere in the U.S. or U.S. territories. There is no monthly premium for Part A, but there is a deductible for each benefit period (from date of admission through 60 consecutive days outside the hospital), and you pay fixed copays after the deductible is met.
Medicare Part B: Medical Insurance
Part B covers certain doctors’ services, outpatient care, medical supplies, and some preventive services. You can use any doctor or health care provider that takes Medicare, anywhere in the U.S or U.S. territories. There is a monthly premium for Part B. There is also an annual deductible, and you pay 20% co-insurance after the deductible is met.
Parts A and B together are called Original Medicare.
Part C: Medicare Advantage
Medicare Advantage is a “bundled” Medicare health plan offered by a private insurance company that contracts with Medicare to provide you with all your Part A and Part B benefits, and usually Part D. Medicare Advantage Plan choices include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare.
Many Medicare Advantage Plans also offer prescription drug coverage as part of the plan. If you decide not to join a Medicare Prescription Drug Plan, or Medicare Advantage Plan or other Medicare health plan that offers Medicare prescription drug coverage when you are first eligible for Medicare, you’ll likely pay a late enrollment penalty unless you have other creditable prescription drug coverage.
Many plans, but not all, have no additional monthly premium for Medicare Advantage (just your Part B premium), but there are co-pays for certain services and co-insurance payments and deductibles for others.
Part D: Medicare Prescription Drug Plan
These plans (sometimes called “PDPs” – short for Prescription Drug Plan) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered. Part D is not technically “required,” but if you don’t enroll when first eligible and decide to enroll later, you may be charged a monthly penalty in addition to your Part D premium.
Medicare Supplement Plan
Covering some of the Health Care Costs that Original Medicare Doesn’t Cover:
A Medicare Supplement insurance policy (also known as Medigap), is sold by private insurance companies, and can help pay some of the health care costs that original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.
If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs, then your Medigap policy pays its share. A Medigap policy, unlike a Medicare Advantage Plan, remains separate from your Original Medicare benefits and just acts as a supplement to them.
Medicare Travel Coverage
Medicare generally doesn’t cover healthcare when you’re traveling outside the U.S., except in a few exceptions. If you have a Medicare Supplement plan, it may offer some limited coverage but please verify with your specific plan. In most cases, any coverage will be limited to “medically necessary” emergency care and will have a lifetime limit of $50,000.
If you have an overseas trip scheduled, you may want to consider purchasing a travel policy that covers any medical care needed during your trip to be sure that any expense incurred won’t fall into the gaps in your Medicare coverage.
*ALL INFORMATION WAS PROVIDED BY MEDICARE.GOV
For more information, please visit medicare.gov or contact us.
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