Medicare is a federal health insurance program created for seniors age 65 and older.
Medicare also covers younger individuals with certain disabilities and end-stage renal disease (ESRD), which is a type of permanent kidney failure that requires a kidney transplant or dialysis.
Medicare is made of different parts that are designed to cover different services that individuals may need. Medicare is divided into four main parts: parts A, B, C, and D.
Those who are eligible for Railroad Retirement benefits or Social Security may be automatically eligible for Medicare along with their spouse.
Medicare is designed to cover several aspects of senior healthcare, but not all expenses. Without special additions, Medicare is not designed to cover long-term in-home care or most nursing home care. Medicare typically operates based on a fee-for-service model.
Part A includes inpatient stays in a hospital, care received in a skilled nursing facility, hospice care, and some home health care.
Most beneficiaries do not pay a premium for Medicare Part A if they have worked at least 10 years (or 40 quarters) and paid Medicare taxes during that time. Individuals who aren’t eligible for premium-free Medicare Part A can still enroll in Part A and pay a premium. Beneficiaries who delay enrollment after they first become eligible for Medicare Part A may be subject to a late enrollment penalty once they sign up.
Part B includes certain services provided by doctors and other providers, medical supplies and devices, outpatient care, and some preventive health services and home health care.
Most people with Part B will pay a monthly premium. If you want coverage to fill in gaps of Original Medicare, you may have the option to purchase Medigap, or Medical Supplement Insurance from a private company.
You will pay both a monthly premium and a yearly deductible for Medicare Part B. The monthly premium amount may vary depending on your specific situation. After the deductible is met, one typically pays 20% of the Medicare-approved amount for the service. You may also owe a copayment for certain outpatient services.
Medicare Supplement plans, commonly referred to as Medigap plan, help cover the gaps in what your Medicare Parts A and B do not cover. Rates vary for these plans, and we will do the work for you to find the Right Plan at the Right Price, saving you time and money!
Medicare Advantage vs. Medicare Supplement
Medicare Supplement or Medigap, is private plan coverage that pays for most of your out-of-pocket costs like co-pays, deductibles and premiums and picks up where Original Medicare stops. However, Medicare Supplement plans don’t cover prescription drugs. That’s where Part D comes in.
Medicare Advantage plans are Medicare-approved private health insurance plans for individuals enrolled in Original Medicare, Part A and Part B. Medicare Advantage usually requires co-pays and deductibles. However, unlike Original Medicare, these payments put annual limits on how much you pay out-of-pocket. Once you have reached that limit, the plan will cover your medical bills for the remainder of the year. This means you will not have to pay anymore after reaching the spending limit.
**Plans vary based on your county
When you join a Medicare Advantage plan, you are still in the Medicare program and must continue paying your Part B premium. Medicare Advantage plans provide all of your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage. They generally offer additional benefits, such as vision, dental, and hearing, and many include prescription drug coverage.
These plans often have networks, which mean you may have to see certain doctors and go to certain hospitals in the plan’s network to get care.
Medicare Advantage plans may potentially save you money because out-of-pocket costs in these plans can be lower than with Original Medicare, Part A and Part B, in some cases.
Part D can help to lower prescription drug costs, as well as help protect prices from rising in the future. This coverage is offered to certain Medicare plans by insurance companies and private companies that have been approved by the Medicare program.
If you don’t sign up when you are first eligible, you might have to pay a late enrollment penalty if you decide to enroll later. The best time to sign up for Medicare prescription drug coverage is usually as soon as you are enrolled in Original Medicare, during your Initial Enrollment Period (IEP).
Contact Us Today
If you believe that Medigap or Medicare Advantage are right for you, contact us today to discuss your insurance options.
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