What is Medicare?
The Medicare Program helps 43 million Americans get the health care they need. That's a good thing. Just as important, Medicare offers you choices about how you can receive your benefits. You can find a solution that fits your needs, whatever they may be. But choosing Medicare coverage can sometimes seem difficult. You know this choice is important to both your health and your budget, and you want to do a good job. Why is this decision so important? Because healthcare costs are a big part of the budget for many people. It's a fact of life- we've made amazing advances in medicine in the last 50 years, but they come with a big price tag. Medicare offers help with these costs.
When are you eligible?
- You are approaching 65 years old, or are under 65 and qualify on the basis of disability
- You are a US citizen or a legal resident who has lived in the US for at least 5 consecutive years
- If you have end-stage renal disease
Original Medicare
"Original" Medicare includes both Part A and Part B. It is operated by the government and government subcontractors. Medicare pays fees for your care directly to the doctors and hospital you visit.
Part A
Provides help with the cost of inpatient hospital stays and skilled nursing services following a hospital stay, plus some other skilled care.
Medicare Part A insurance helps pay for the "medically necessary" care (care for an illness or medical condition) that involves an inpatient stay in the hospital. Part A also helps pay for a stay in a skilled nursing facility as a follow-up to a hospital stay, hospice care for the terminally ill, and some skilled home health care for the homebound. Part A also helps pay for some blood transfusions.
Part B
Provides help with the cost of doctor visits and other medical services that don't involve inpatient hospital stays.
Medicare Part B insurance helps pay for "medically necessary" care that's not part of an inpatient stay in the hospital. This includes services like doctor's office visits, care in hospitals and clinics when you are not admitted for an inpatient stay, laboratory tests and some diagnostic screenings, and some skilled nursing care at home if you're homebound. Part B is voluntary, but most people sign up when they first become eligible.
Medicare Advantage
Part C
Provides a single plan that combines help with hospital costs, doctor's visits, and other medical services, plus prescription drug coverage if you want it.
Part C is also known as a Medicare Advantage Plan. Advantage plans are operated by private companies approved by Medicare. Medicare pays a fixed fee to the plan for your care, and then the plan handles its own payments to doctors and hospitals. Part C combines hospital costs, doctor's care, and outpatient care in a single plan. Some plans also offer built-in prescription drug coverage at either no additional cost, or an add-on premium. Additional benefits may include vision and hearing services, health screening tests, and nurse help-lines.
Prescription Drug Plans
Part D
Provides help with the cost of prescription drugs.
Part D helps pay for the prescription drugs you use. Part D coverage is not automatic. You decide whether to enroll in a Part D plan. If you delay signing up after you are eligible, though, you may pay a penalty on your premium, unless you qualify for an exception. Prescription drug coverage is an insurance policy you buy from private companies. You can buy a separate policy just for drugs, called a prescription drug plan (PSP). Or you can buy some types of Medicare Advantage plans that include drug coverage. The federal government has created guidelines for the types of drugs that must be covered by drug plans and set minimum standards of benefits. Insurance companies that offer Part D plans must meet these standards. But all plans are not the same. They vary by cost and by their formulary, or list of specific drugs covered.
Medicare Supplements
Provides private insurance coverage that helps fill the gaps in Original Medicare Part A and B
To avoid worries about paying the costs that Part A and B don't cover, many people purchase Medicare supplement policies, or "Medigap" policies. These insurance policies cover some or all of the expenses that Medicare Parts A and B do not cover. There are a set of standard plan available for purchase. Medigap policies are not a government benefit, like Parts A and B. They are insurance policies sold by private companies. Whether you buy a policy is up to you.
Additionally, there are excellent Medicare resources available to you including:
- The Medicare Handbook
- The Guide to Health Insurance for People with Medicare
- The Consumer's Guide to Medicare Supplements
Go to www.medicare.gov for more information
Contact me today to review your options!
Kelley Clarke
661-873-2200 ext:220