MEDICARE BASICS

The Basics Of Medicare

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You are at or nearing the age of Retirement (65) and you may still be covered by your own Health Insurance or by your Employer or through the VA. You have heard about Medicare for years but you also know Medicare has Part A, Part B, Part C and Part D.  Family members and friends may have mentioned Medicare Supplement Plans and Medigap Plans, Medicare Advantage Plans and probably Prescription Drug Plans. All of these questions and things to consider probably seem a bot overwhelming at times but we have tried to break things down and make it a little bit easier to decipher and understand.


 The 4 PARTS Of ORIGINAL MEDICARE


  • MEDICARE Part A -  Which takes care of  your inpatient/hospital coverage.
  • MEDICARE Part B -  Covers any and all of your outpatient/medical coverage.
  • MEDICARE Part C -  Uses Independent Insurance Companies to provide for your Medicare Part A & Part B Benefits..
  • MEDICARE Part D -  D allows you to enroll in a company that provides Prescription Drug Services..

 

  

What's Medicare Supplement Insurance (Medigap)?


Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement or a Medigap Insurance policy help pay for additional things such as:


  • Medicare Copayments
  • Physician Coinsurance
  • Plan Deductibles


Note


As of January 1, 2020, Medigap plans sold to new people with Medicare aren't allowed to cover the Part B deductible. Because of this, Plans C and F are not available to people new to Medicare starting on January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans.


Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here's what happens:



  • Then, your Medigap policy pays its share.


Medicare Supplement Plans aka MEDIGAP Insurance


Are the most desired Medicare Plans and they have the most flexibility, you can see any Doctor Nationwide who accepts Medicare patients.  There are well over 800,000 Doctors who accept Medicare that equals out to over 90% of all physicians!  All of these doctors will accept any Medigap Policy that you enroll in, regardless of the Insurance Company you choose to partner with. All of the Medicare Supplement Plans are identified by a Alphabetic Letter such as Plan A, B, C, D, F, G, K, L, M, N, S, T.  


 

Medicare Advantage Plans Cover All Medicare Services


Medicare Advantage Plans must cover all of the services that Original Medicare covers. However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies. In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care.


The plan can choose not to cover the costs of services that aren't medically necessary under Medicare. If you're not sure whether a service is covered, check with your provider before you get the service.


Most Medicare Advantage Plans offer coverage for things that aren't covered by Original Medicare, like vision, hearing, dental, and wellness programs (like gym memberships). Plans can also cover more extra benefits than they have in the past, including services like transportation to doctor visits, over-the-counter drugs, adult day-care services, and other health-related services that promote your health and wellness. Plans can also tailor their benefit packages to offer these new benefits to certain chronically ill enrollees. These packages will provide benefits customized to treat those conditions. Check with the plan to see what benefits are offered and if you qualify. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan. In 2020, the standard Part B premium amount is $144.60 (or higher depending on your income).


If you need a service that the plan says isn't medically necessary, you may have to pay all the costs of the service. But, you have the right to appeal the decision.


You (or a provider acting on your behalf) can request to see if an item or service will be covered by the plan in advance. Sometimes you must do this for the service to be covered. This is called an “organization determination.” If your plan denies coverage, the plan must tell you in writing.


You don’t have to pay more than the plan’s usual cost-sharing for a service or supply if a network provider didn’t get an organization determination and either of these is true:


  • The provider gave you or referred you for services or supplies that you reasonably thought would be covered.
  • The provider referred you to an out-of-network provider for plan-covered services.


 

Medicare Part D Prescription Drug Coverage



Medicare Part D is prescription drug coverage. Medicare Part D is optional, and it’s available only through private insurance companies that contract with Medicare.


 

What Is Medicare Part D? A History


Medicare Part D prescription drug coverage was created by the Medicare Modernization Act (MMA) of 2003 and implemented in 2006. The goal of Medicare Part D is to help make prescription drugs available and affordable for Medicare beneficiaries.


Who Can Get A Medicare Prescription Drug Plan?


Anyone with Medicare coverage—either Medicare Part A (hospital insurance) or Part B (medical insurance) or both parts—may be eligible for a stand-alone Medicare Part D prescription drug coverage. You can’t be turned down because of your health status or income.



Medicare Part D: Types Of Medicare Prescription Drug Plans


You can get your Medicare Part D coverage from either of these types of plans:


  • A Medicare Advantage prescription drug plan, which covers both medical services and prescription drugs. You may find a Medicare Advantage plan particularly attractive if you prefer to receive all your Medicare benefits from one plan, like a health maintenance organization (HMO) or a preferred provider organization (PPO). Not every Medicare Advantage plan includes prescription drug coverage, so make sure the plan has this coverage before you sign up.
  • A stand-alone Medicare Part D prescription drug plan, which provides only prescription drug coverage. This kind of plan can work alongside your Medicare Part A and/or Part B coverage.


If you enroll in a Medicare Advantage plan, note that you continue to pay your monthly Medicare Part B premium. You also pay any premium the plan might charge.

Consulting with your Doctor

SWITCHING OR CHANGING PLANS

You can change Medicare Supplement/Medigap Plans anytime but you need to remember that after your IEP (Initial Enrollment Period) there is no guarantee that you will be accepted by an Insurance Company and you may be subject to Underwriting depending on your current state of health.


You are limited to when you can change your Medicare Advantage Plan.  The Annual Enrollment Period (AEP) Period is in the Fall from October - December.  There are other times you may make a change such as moving out of a coverage area or to another state.

Partnering with your Agent

BUILDING RELATIONSHIPS through Medicare Insurance

We are always available to answer your calls and to give you the best, straightforward answers to all of your healthcare questions. If you would like to engage us to represent you and your interests please know that we get paid by the various Insurance companies and that we would never charge our clients for any services.


The best form of knowing that we helped you is by you referring us to family and friends who need help understanding the fundamentals of Medicare and you have our promise that we will treat them with the same level of care and respect that we have given to you and to each of our nearly 800 Clients.

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