MEDICARE
Medicare is a federal health insurance program for people in the United States who are 65 or older. It is also available for certain people younger than 65 with disabilities or people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). There are many moving parts to Medicare that cover specific services like inpatient hospital stays, doctors’ services and the cost of prescription drugs. Please review below for a high level overview.
Original Medicare
Original / Traditional
Medicare Part A and Part B are also known as Traditional or Original Medicare.
Part A - (Hospital Insurance)
Helps cover:
- Inpatient care in a hospital
- Skilled nursing facility care
- Nursing home care (not custodial or long-term care)
- Hospice care
- Home health care
Part B -(Medical Insurance)
Helps cover medically necessary and preventive services:
- Doctor services
- Outpatient care
- Home Health Services
- Durable medical equipment
- Mental Health services
Medicare Part C - Medicare Advantage Plan
Medicare Advantage Plans are an alternative way of obtaining Medicare Part A and Part B coverage. You must be entitled to Medicare Part A and enrolled in Medicare Part B to be able to enroll in a plan.
The plans are offered by “Medicare-approved” private companies, who must abide by the government CMS Medicare rules.
The plans can include drug coverage (Medicare Part D). The plans arenetwork based by health care providers and some allow for out of network coverage. To be eligible for the plan the Medicare Beneficiary must live within the plan’s service area.
Types of Medicare Advantage Plans:
- Health Maintenance Organization (HMO)
- HMO Point-of-Service (HMO-POS)
- Medical Savings Account (MSA)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plan (SNP) – D-SNP|C-SNP|I-SNP
Medicare Part D - Medicare Drug Coverage
Two ways to obtain Part D coverage:
Part D can come as a stand-alone plan that can be added to Original Medicare, some Medicare Cost Plans, some Private Fee-for-Service plans and Medical Savings Account Plans. You must have both Medicare Part A and/or Medicare Part B to join a separate Medicare drug plan.
Part D coverage can also be as part of a Medicare Advantage Plan
To be eligible for a Part D plan the Medicare Beneficiary must live within the plan’s service area.
Medicare Supplement (MEDIGAP)
Medicare Supplement Plans also known as “Medigap” are plans sold by private companies that helps cover “gaps” Original Medicare, Parts A and B, do not cover.
Those gaps can include: Copayments; Coinsurance; Deductibles
Medigap policies generally don't cover:
- You must have Medicare Part A and Part B
- Plans don’t include Part D coverage, enrollment in a stand-alone plan is needed
- You cannot be sold a Medigap Plan, if you are enrolled in a Medicare Advantage Plan, unless you switch back to Original Medicare.
- Any standardized Medigap policy is guaranteed renewable even if you have health problems, as long as you pay the premium.
Two ways to obtain Part D coverage:
- Dental
- Hearing
- Vision
- Eyeglasses
- Routine Physical Annual Exams
Frequently Asked Question
Medicare is a federal health insurance program in the United States primarily for people aged 65 and older. It also covers certain younger people with disabilities and individuals with End-Stage Renal Disease (ESRD).
Most people become eligible for Medicare when they turn 65. Younger people may also qualify if they have certain disabilities or conditions like ESRD.
If you are already receiving Social Security benefits, you will be automatically enrolled in Medicare Parts A and B when you turn 65. If not, you will need to sign up during your Initial Enrollment Period, which begins three months before your 65th birthday and ends three months after.
Medicare Part A covers inpatient hospital care, skilled nursing facility care (not custodial or long-term care), hospice care, and some home health care. Most people don’t pay a premium for Part A if they paid Medicare taxes while working.
Medicare Planning
Outside of the overview above, there is a great deal more that pertains to Medicare including the different enrollment periods, late enrollment penalties, eligibility, interaction with other health coverages, such as: Medicaid; Employer-or Union-sponsored coverage; Veterans’ Benefits; TRICARE; Long Term Care insurance policies. For a personal Comprehensive Medicare Review tailored to meet your individual needs at no cost to you, contact one of our Medicare Certified Independent 4 Core Advisors.
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