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Medicare
How complicated can the government make it?
As your 65th birthday approaches, you will probably start doing your homework on the medical coverage. What you will learn is it can be difficult to understand what Medicare covers, and just as difficult to understand which gaps are covered by a medicare supplement.
We understand this and we want to help. We have assisted many seniors by educating them about Medicare and offering comprehensive solutions to make sure they have the coverage they need, when they need it, at a price they can afford.
We'd like to help you, too! Please contact us directly.
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Understanding the alphabet soup...
There are various parts to Medicare:
Medicare Part A, Hospital Coverage;
Medicare Part B, Medical (Professional) Coverage;
Medigap (Medicare Supplement Insurance)
Medicare Part C, Private insurance Plans
Medicare Part D, prescription drug coverage.
Generally, people who are over age 65 and getting Social Security automatically qualify for Medicare Parts A and B. So do people who have been getting disability benefits for two years, people who have amyotrophic lateral sclerosis (Lou Gehrig's disease) and receive disability benefits, and people who have permanent kidney failure and receive maintenance dialysis or a kidney transplant.
Part A is paid for by a portion of Social Security tax. It helps pay for inpatient hospital care, skilled nursing care, hospice care and other services.
Part B is paid for by the monthly premiums of people enrolled and by general funds from the U.S. Treasury. It helps pay for doctors' fees, outpatient hospital visits, and other medical services and supplies that are not covered by Part A.
Medigap (Medicare Supplement Insurance)
You can choose to buy private
coverage (or an employer/union may
offer similar coverage) to fill in gaps in Part A and Part B coverage.
Part C (Medicare Advantage) Medicare plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B benefits. Medicare Advantage Plans are HMOs, PPOs, Private Fee-for-Service Plans, or Medicare Medical Savings Account
Plans. If you are enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan, and are not paid for under the Original Medicare Plan. Some Medicare
Advantage Plans offer prescription drug coverage.
Part D (prescription drug coverage) is voluntary and the costs are paid for by the monthly premiums of enrollees and Medicare. Unlike Part B in which you are automatically enrolled and must opt out if you do not want it, with Part D you have to opt in by filling out a form and enrolling in an approved plan.
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Two ways to get Medicare prescription drug coverage
1) Join a Medicare Prescription Drug Plan that adds drug coverage to the Original Medicare Plan, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans.
2) Join a Medicare plan (like an HMO or PPO) that includes prescription drug coverage as part of the plan. You get all of your Medicare coverage through these plans, including
prescription drugs.
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Is a Medigap/Supplement Plan right for me?
Medicare Supplement insurance plan helps cover the "gaps" in coverage that are left unpaid after Original Medicare pays its portion of your health care expenses. For this reason, these plans are often referred to as Medigap plans.
Medicare Supplement policies are standardized into twelve plans - labeled "A" through "L" each with its own set of benefits. Plan A covers the most basic benefits. Plans "B" through "L" provide additional coverage beyond the basics. Plans "K" through "L" are new plans that help limit out-of-pocket costs for doctor's services and hospital care.
Medicare Supplement policies are sold by private insurance companies. While the costs of these policies may vary, individual insurance companies must provide the same standardized benefits as outlined by law. In order to purchase a policy, in general you must be enrolled in Medicare Part A and Part B. In addition to paying the monthly Medicare Part B premium to Medicare, you will have to pay a premium to the insurance company providing your coverage.
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