Medicare’s Alphabet soup and what does it all mean??
When most people think about Medicare, they think in terms of the two components of “original” Medicare: Part A and Part B. Loosely speaking, Part A covers hospital expenses while Part B covers non-hospital medical expenses, such as doctor visits, ambulance rides, physical therapy, outpatient services and medical equipment.
Eligibility is purely a function of age and citizenship status. Any person 65 or older who is a U.S. citizen, or has ben a legal permanent resident for at least five years, can enroll in Medicare. People under the age of 65 can also enroll in Medicare if they have been determined disabled and received Social Security Disability Insurance (SSDI) or Railroad Retirement Board disability payments for at least 24 months.
Medicare Part C or “Medicare Advantage” plans provide Medicare enrollees with access to private insurance plans offering coordinated care and more comprehensive benefits than Original Medicare, while also controlling costs through managed care organizations. Advantage plans run by private insurance companies.
Advantage plans have their pros and cons and may not be the best choice for everybody. On the good side, Advantage plans usually include prescription drug coverage and may offer more comprehensive services than traditional Part A and Part B coverage. Advantage plans also cap the maximum amount you will pay out of pocket each year, ranging on average between $6,000 and $7,000, whereas there is no limit to out of pocket expenses with Part A and Part B alone. Advantage plans also offer the simplicity of carrying a single member card rather than separate cards for Medicare, Medicare Part D and Medicare Supplement (Medigap).
On the downside, Advantage plans are managed care plans that may have limited provider networks, especially in rural communities. They may provide no coverage or charge more for visits to out-of-network providers. Advantage plans may also have complicated copayment or coinsurance schemes for different types of services, which can lead to out-of-pocket costs building up quickly when you have a serious health problem. Most importantly, you need to make sure your doctor will accept this type of plan.
Medicare Part D (Drug Coverage) plans are run by private companies under contract with the federal government. Although every Part D plan is required to offer benefits worth at least a standard minimum value, plans can vary widely in terms of specific drugs covered and out-of-pocket costs for different classes of drugs. We help our clients review their plan and plan benefits yearly to make sure they are on the most cost-effective plan based on their current medications.
Medicare Part C and Part D plans can change from year to year by changing providers, networks, or drug formularies. The Annual Enrollment period from October 15 to December 7 allows plan participants the option of reviewing and selecting a new plan. We notify our clients yearly to review their plan and plan benefits to make sure their providers and medications are still covered. It is imperative that you check your Part D Drug plan each year.
The main purpose of Medicare Supplement plans, also known as Medigap plans, is to cover the out-of-pocket costs connected with Medicare Part A and Part B. Medicare Supplement plans are required to follow a set of standardized federal benefit packages and are also provided by private companies. During your “Open Enrollment” Period to Medicare, you can get a Medicare Supplement without any medical underwriting. Once you have a Medicare Supplement you can change Supplements 365 days a year, however, beyond your “Open Enrollment” Period you must answer the health questions and be able to get through underwriting. Supplements are not subject to the “Annual Enrollment” period. We ask our clients to call any time they get a price increase so we can “re-shop” plans and make sure you are always on the best plan for the lowest cost.
Medicare Supplement plans offer protection against potentially unlimited out-of-pocket costs for serious health problems. With Medicare Supplements you know exactly how much you will spend yearly expenses for Hospital and Medical service. No surprises – no matter what happens!
Medicare Part A is the part of your plan that will cover your medical services.
Medicare Part B covers doctor visits and other outpatient services.
Medicare Part C is purchased from an insurance company and typically covers additional heal services like hearing, dental, vision, as well as other wellness advantages.
Medicare Part D is the part of your plan that covers your costs for prescriptions.
Medicare Supplement Insurance is a type of health insurance policy sold by private insurance companies to compliment Medicare policies. This type of insurance covers the cost of healthcare services that lie outside the scope of Medicare Parts A and B insurance plans. It extends to the gaps not covered by Original Madicare, including copays, coinsurance, and deductibles.