medicare Medicare; Advantage, RX, and Supplements

Medicare Insurance

The Basics

Medicare is a federal government administered health insurance program aimed at providing insurance coverage to the people aged 65 and above, people under 65 but with specific disabilities and people at any age suffering from End-Stage Renal Disease (i.e. Permanent kidney failure that requires a kidney transplant or dialysis).

It's broken down into the following 4 major categories:

Hospital Insurance (Part A)

Medical Insurance (Part B)

Medicare Advantage Plans (Part C)

Prescription Drug Coverage (Part D)

And

Medicare or Medigap Supplements

Part A: Hospital Insurance

Part A is the name given to one category of the Medicare program. For Part A coverage, you typically don’t pay a premium if either you or your partner were paying Medicare taxes while you were working. You will be automatically signed up for Part A in most cases. You may be able to buy Part A if you are not eligible for premium-free Part A as long as you meet specific requirements.

Part A is a type of hospital insurance plan that Medicare provides. Hospital insurance coverage includes critical access hospitals, skilled nursing facilities, and inpatient care in hospitals. Part A doesn’t include custodial or long-term care. You may be eligible for hospice or home health care if you meet certain requirements.

Medicare doesn’t cover everything and it does not cover the total cost for many of the medical supplies or covered services.

Part B: Medical Insurance

Part B coverage includes outpatient care, medically essential doctor’s services and most other services not covered by Part A. They include occupational or physical therapies as well as some home health care services. Certain preventative services are also covered by Part B. While many products and services are covered, it is important to remember that Part B is still not a complete insurance coverage plan. The original Medicare i.e. Part A & Part B covers many health care supplies and services, but it still does not cover many costs (“gaps”).

A premium has to be paid by most people to access Part B. You can check whether you qualify to get help from your state to pay for deductibles and premiums. Premiums will be deducted from your Civil Service Retirement, Railroad Retirement, or Social Security check if you don’t qualify for this. Other payment options for premiums are available such as check draft or quarterly bills.

Part C: Medicare Advantage Plans

Part C is a combination of Part A and Part B options and must cover nothing less than all the services covered under Original Medicare i.e. Part A & Part B. The key difference here is that this type of coverage is provided by private insurance companies approved by Medicare. Part C is usually a lower out-of-pocket risk to Original Medicare, and generally provides additional benefits like dental, hearing, vision, and/or health and wellness programs and can include prescription drug coverage. Plan C plans usually have networks whereby you are required to use hospitals or doctors contracted with the plan. Costs for services and items vary by insurance company and by plan. Several plan types are available under the Medicare Advantage plans.

Part D: Medicare RX Prescription Drug Coverage

Part D refers to prescription drug coverage that private insurance companies offer that’s regulated and approved by Medicare. You need to enroll in Part D when you initially become eligible to avoid being penalized except for particular situations. Part D is designed in part to help enrollees lower their prescription drug costs and guard against future costs. It even provides access to medically essential drugs through a prescription drug plan approved by Medicare.

It is important to remember that a plan’s drug formulator (covered medications), premium (monthly cost), and copay amounts typically vary by insurance company and by plan. Part D plans usually follow the same structure designed by Medicare: Catastrophic Coverage, the Coverage Gap, Initial Coverage, and Annual Deductible.

You can obtain Part D coverage if you buy a “standalone” drug plan or if you buy a Medicare Advantage plan inclusive of Part D coverage in the plan.

Medicare or Medigap Supplements

Medigap (also known as Modernized Supplement Insurance and Medicare Supplement Insurance) is a private health insurance policy designed to supplement Original Medicare i.e. Part A & Part B. It therefore means that it can help pay for some of the “gaps” or health care costs not covered under Original Medicare such as deductibles, coinsurance, and co-payments. Each Medigap policy is required to follow both state and federal laws designed for your protection. Medigap insurance companies are only able to provide a “standardized” plan. All standardized plans are required to offer similar benefits irrespective of the insurance company providing it. Under the new and modernized plans, the insurance company may offer innovative benefits besides the required standardized benefits. Such “innovative” benefits include things such as hearing aid or eye-wear coverage. Ensure that you find out more about the innovative benefits are included in your plans of choice.

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