Medicare is used by millions of Americans. As the federal health care program that provides insurance coverage for those aged 65 and older regardless of income, as well as some others with certain medical conditions, the program is made up of several parts, each of which provides coverage for certain healthcare services. However, some people may not fully understand Medicare and the benefits provided. In this article, we will cover exactly what Medicare is and how it works.
What is Medicare?
Medicare is a federal health care program that is divided into 4 parts. Part A, also known as hospital insurance, covers inpatient hospital stays, care in a nursing facility, some home care health services, and hospice care. For most people, Part A does not require a monthly premium if they or their spouse have Medicare taxes while working.
Part B covers doctor's visits and preventative services as well as outpatient care and medical supplies. There is a monthly premium and possibly a yearly deductible.
Parts A & B together are known as Original Medicare, both of which are managed by the federal government. Beneficiaries can see any doctor that accepts Medicare.
Part C is also known as Medicare Advantage. It includes all benefits and services covered under Part A and Part B, and may also include additional benefits such as vision, dental, and prescription drug coverage. This health plan is offered by private insurance companies, and while beneficiaries must also pay their Part B premium, they may be required to also pay a separate premium to the insurer. One of the main differences between Original Medicare and Medicare Advantage is that Medicare Advantage plans have an annual limit on out-of-pocket costs. These plans are typically HMOs or PPOs, and provide coverage only in specific local areas. In addition, pre-authorization and referrals are usually required.
Finally, Part D is for prescription drug coverage. Run by private insurance companies approved by Medicare, it is offered by private insurance companies and helps with the cost of generic and brand name drugs. A monthly premium is required, so those who wish to enroll should check with their insurance company for information regarding the cost or check this resource out here at boomerbenefits.com - medicare cost info where you can get a definitive answer.
Medigap Plans
Medigap Plans are extra insurance plans that private health insurance company to help cover some of the out-of-pocket costs that are incurred with Original Medicare. Only those who have Original Medicare are able to buy a Medigap Plan. It is important to remember that the policy only covers one person, so spouses must each have their own policy. Those who have a Medigap Policy and receive medical care must understand that Original Medicare first pays its share of the costs. Then, the Medigap Policy pays its share, leaving the beneficiary responsible for any costs that aren't covered. Policies are typically renewed each year, and a beneficiary can only be dropped if they don't pay their monthly premiums, weren't honest on the application, or if their insurance policy goes out of business or goes bankrupt.
How Does Medicare Work?
Understanding how Medicare works is vital for those reaching retirement age or those with certain disabilities that are covered under the plan. The program can be complex and difficult to understand, especially with the various parts and coverage options, so it is important that beneficiaries get their questions answered when it comes to their policy.
All beneficiaries have the option to choose exactly how they receive their coverage. They can either opt for Original Medicare, which includes Part A and Part B, or choose a Medicare Advantage Plan.
For those with Original Medicare, it is essential to understand that while it covers most health care services and supplies, it doesn't cover everything. Services that are covered must be medically necessary, and many preventive services, like shots and screenings are also covered under Medicare.
Medicare Advantage plans work a bit differently. Enrollees are required to use doctors that are approved in the plan's network, and it is also necessary to have both Parts A & B in order to join a Medicare Advantage Plan.
There are certain periods during the year when individuals can enroll in a Medicare Program or change their coverage. The Initial Enrollment Period begins 3 months before a person reaches the age of 65 and ends 3 months later. The Initial Coverage Election period starts 3 months before a person is eligible for Parts A & B, and is when they can enroll in a Medicare Advantage plan with or without prescription drug coverage. In addition, there is an Annual Election Period every year from October 15 to December 7, and is when those who are eligible may change their coverage or enroll. Finally, a Special Election Period is when individuals can enroll in or change a Medicare Advantage Plan, although this must be triggered by a qualifying event.
