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Medicare Plan?
$0 monthly premium Medicare plans might be available in your area.
New to Medicare?
Medicare is a federal health insurance program that helps you take care of several healthcare expenses. Administered by a division of the US Department of Health and Human Services called Centers for Medicare & Medicaid Services, or CMS, Medicare insurance is typically geared towards catering to people 65 years old and above. However, there are circumstances where adults below 65 might qualify for Medicare benefits, like those with permanent disabilities or eligible medical conditions.
Medicare Services to Help You Find the Right Fit for Your Needs
We are here to help you find the most suitable Medicare plan to match your needs. Of course, Medicare is quite complex to understand, and we want to help you make the most well-informed decision.
Do you need the different parts of Medicare explained?
Let’s take a look at the parts of Medicare so you have an easier time making the right decision when working with our Medicare insurance experts for a plan that matches your requirements.
Medicare consists of four parts. Most people new to Medicare find this quite confusing. Why does Medicare need to have so many parts? What is the difference between the different parts and plans in Medicare?
We have made a breakdown to make it easier for you to understand the key concepts. Medicare itself does not have any plans. It is divided into four parts. Let’s start by explaining the different Medicare Parts.
What is Medicare Part A?
Medicare Part A is the Medicare component that offers you coverage for your hospital costs. The insurance program is designed to make inpatient care at hospitals more affordable for you. Inpatient care refers to the treatment you receive at the hospital as a patient admitted to the facility. It will help you cover the cost of a semi-private room, the meals you have as a patient there, lab services and medical supplies, and any medications the hospital provides you.
What Does Medicare Part A Cover?
Medicare Part A covers more than hospitalization expenses. This part is also designed to cover short-term home healthcare after you are discharged from the hospital and skilled nursing, provided it is necessary. Part A also helps you pay for hospice services, including counseling, social services, DME, and palliative care. Hospice coverage through Medicare also offers short-term respite care to give your primary caregivers a chance to rest.
Medicare Part A may also offer you coverage for specific home health care services, including medical social services, physical therapy, and nursing care. However, it is important to note that you typically get coverage for home health services while you are also getting skilled nursing care. Medicare does not offer coverage for extended stays at nursing homes or other long-term care. If you require help with long-term care, it would be advisable to purchase long-term care insurance.
Medicare Part A comes with a premium free for most people age 65 or older. It is also Premium free if they are married to someone who has been working and paying taxes in the US for at least ten years.
However, there are several expenses in a hospital you might need help with that are covered in Medicare Part B and not Part A. Typically, you should enroll yourself in Medicare Parts A and B together to keep your out-of-pocket expenses to a minimum.
What is Medicare Part B?
Medicare Part B is designed to help you pay for medically necessary outpatient services. Many people typically assume that Medicare Part B is medical coverage. However, this part of Medicare covers expenses for when you are in and out of the hospital. It would be better to consider Medicare Part B as coverage for any care given to you by health care providers.
What Does Medicare Part B Cover?
Medicare Part B offers coverage for several services, including lab testing, doctor office visits, surgeries, chemotherapy and radiation, diagnostic imaging, and much more. Several of the services covered by Medicare Part B are provided as part of inpatient care, but they are classified under Medicare Part B coverage because health care providers offer them.
Medicare Part B also offers you coverage for preventive care, mammograms, flu shots, colonoscopies, and more. Part B coverage also helps you pay for medicine administered to you by physicians in clinics, including antigens, insulin through insulin pumps, infused drugs, and injections for osteoporosis. Beyond this, drugs for your healthcare are typically covered by Medicare Part D.
Medicare Part B is optional. However, we highly recommend enrolling for Medicare Part B if you rely primarily on Medicare coverage for your healthcare costs. The combination of Medicare Parts A and B is what forms Original Medicare. These two are the only Medicare parts you sign up for with Social Security or at the Railroad Retirement Board.
Something very important to note about Medicare Part B: Failing to get Part B when you are first eligible means your monthly premiums might increase by 10% for each year you don’t sign up for Medicare Part B while being eligible for it. You might have to pay this penalty each time you pay your premiums. Signing up for Part B during a Special Enrollment Period might exempt you from late enrollment penalties.
What is Medicare Part C?
Medicare Part C is where things tend to get confusing for many people. Medicare Part C is also called Medicare Advantage. Part C is unlike Medicare Parts A and B in many ways. Parts A and B make up Original Medicare. Medicare Part C, or Medicare Advantage, is another name for private Medicare Insurance. It was created after the Balanced Budget Act of 1997. Please note that Medicare Part C and Medicare Advantage are two terms used interchangeably.
Medicare Advantage plans were created to offer people an alternative to Original Medicare and Medigap. Choosing a private health plan through Medicare Advantage plans gives you access to Medicare Part A and Part B. Some Medicare Advantage plans also offer you Medicare Part D coverage with Parts A and B. The advantage with Medicare Part C is getting the different coverages through a single insurance carrier. Medicare Part C plans typically have a network of providers whom you can seek care from.
What Does Medicare Advantage Cover?
Most people new to Medicare wonder what are the benefits of Medicare Advantage plans as opposed to Original Medicare. What coverage does Part C provide? Let’s understand a few important things about Medicare Advantage to help you identify what makes it different from Original Medicare plans.
Medicare Advantage plans provide you with all the benefits of Medicare Part A and B and coverage for things Original Medicare doesn’t cover. These plans may cover things like fitness programs, vision, hearing aids, dental coverage, OTC drugs, and services that promote your health and wellness. You have deductibles and a 20% coinsurance with Medicare Part B in Original Medicare. You can get help with your medical expenses through Original Medicare at any hospital or doctor visit that participates in the program (most care providers are part of Medicare).
Some Medicare Advantage plans require you to choose care providers from the specific plan’s network. You will need to make copay payments when receiving healthcare services. Each Medicare Advantage plan has its own setup for cost-sharing.
The biggest difference between Original Medicare and Medicare Advantage is the change in benefits. Original Medicare might make slight changes to deductibles for Parts A and B, but its 20% coverage on outpatient services remains the same. Medicare Advantage plans change each year.
Medicare Advantage Plans
Medicare Advantage Part C plans can help you get Medicare Part A and B coverage along with Part D. There are several different types of Medicare Advantage plans. Here is a quick look at the most common Medicare Advantage plans.
- Health Maintenance Organization (HMO) Plans
- Preferred Provider Organization (PPO) Plans
- Medicare Private Fee-for-Service (PFFS) Plans
- Special Needs Plans (SNOs)
- Health Maintenance Organization Point-of-Service Plans (HMO – POS)
You can work with us to understand the details of each type of Medicare Advantage plan and the differences that can help you determine which one might be better suited to your needs.
What is Medicare Part D?
Medicare Part D is another federal insurance program like Medicare Parts A and B. The program is designed to help you minimize your out-of-pocket expenses for prescription drugs. Medicare Part D is not like Medicare Parts A and B. Instead of enrolling for Part D coverage through Social Security or Railroad Retirement Benefits offices, you choose from Part D plans available in your area through private insurance carriers approved by the Federal Government.
