Taking a Closer Look at Each Part of Medicare Coverage
Transitioning from traditional health insurance coverage to Medicare is a MAJOR undertaking and can be very confusing. The way that Medicare is structured is a total departure from what we are accustomed to otherwise! Here is some basic information about Medicare and the different “parts” that comprise it’s structure.
Medicare is government sponsored health insurance provided for the following:
- People 65 or older
- People under 65 who are disabled
- People of any age who have End-Stage Renal Disease
- People of any age who have ALS (Amyotrophic Lateral Sclerosis “Lou Gehrig’s Disease”)
Unlike traditional health care, with Medicare there are different “PARTS” that each cover different services. This can be confusing, since the “PARTS” of Medicare can also indicate the type of plan you have.
|Part A: Hospital Insurance Covers:||Part B: Medical Insurance (Medicare Supplement or “Medigap” Plan) Covers:|
|Inpatient Care in Hospitals||Services from Doctors & Other Health Care Providers|
|Skilled Nursing Facility Care||Outpatient Care|
|Hospice Care||Home Health Care|
|Home Health Care||Durable Medical Equipment|
|Some Preventive Services|
For most people Part A is automatically activated prior to their 65th birthday. If this is the case they will receive their Medicare red, white and blue card in the mail approximately 3 months before their 65th birthday. Part A provides for 80% of the services covered by Medicare.
Part B Medicare Supplement Plans are a secondary insurance plan designed to follow behind Part A to cover the 20% of services not covered. These plans must be secured through a private insurance carrier by the individual.
This is very important to take care of and in most cases can be done several months in advance of a person’s 65th birthday so that the Part B Supplement Plan will begin the same day that Part A coverage becomes active.
A Part B Medicare Supplement plan can be changed at any time through the year, given an individual is approved for the new policy. No “open enrollment” period applies.
Medicare Advantage (an alternative to Traditional Medicare)
- All benefits & services covered under Part A and Part B (of traditional Medicare)
- Most often includes prescription drug coverage (Part D)
- Extra benefits and services may be included
A Medicare Advantage plan, unlike Traditional Medicare plans, is run by a private insurance carrier rather than the U.S. Government’s Medicare Administration.
Medicare Advantage Plans, although they cost very little, do have co-pays, deductibles and co-insurance. These plans do have a much higher “out-of-pocket” cost potential!
These plans do operate through a network of providers. Meaning, in order to utilize the plan a person is required to use doctors, healthcare providers or hospitals within the plan’s network. If a provider is not within the plan’s network, than the plan will not cover services performed.
Outside of initial or special enrollment Advantage Plans can only be activated or changed during open enrollment which occurs from October 15 – December 7. Decisions or changes made during open enrollment will become active on January 1st of the following year.
- Some or all of the cost of prescription drugs (depending on the medication)
- Run by a private insurance carrier
- Coverage of prescriptions varies by plan
Plans, in most cases, can only be changed during open enrollment (Oct. 15 – Dec. 7, 2015)
Something very important to keep in mind is that the following are not covered by Medicare Part A & Part B:
- Dental & Vision Care
- Cosmetic/Reconstructive Surgery
- Hearing Aids or services
- Long Term Care
For these additional areas of coverage there are many inexpensive plans with great coverage that you can secure so that those needs are covered for you!
Hopefully this information is helpful and has helped to clear-up some of your questions about Medicare. Please feel free to take advantage of the many resources that we have available. Click on the “Resources” tab above to take a look at some of the helpful links we have provided like the informative Learning Workshops we have available on YouTube!
If you are interested in speaking with one of our knowledgeable Medicare specialists or would like to request a quote please complete the quick form on the right-hand side of your screen!