Medicare Insurance
MEDICARE ADVANTAGE PLANS
Medicare Advantage Plans are health plans that are offered by private companies that contract with Medicare. A Medicare Advantage plan takes over the health care that you receive from original Medicare. If you’re employed or have insurance coverage through a union, joining a Medicare Advantage Plan may cause you to lose your benefits through the employer or union.
Like many Medicare programs, there are benefits and disadvantages that you must weigh prior to choosing your plan.
PROS OF A MEDICARE ADVANTAGE PLAN (MAP):
- MAPs offer at least the same level of coverage as Medicare Part A and Part B plus added benefits.
- MAPs Cost Less – some plans have a premium of $0. Talk to an agent about how this is possible.
- MAPs may have lower shared costs for copayments and coinsurance.
- MAPs offer Coordinated Care. This coordinated care may be convenient to you and get treatment for your health.
CONS OF MEDICARE ADVANTAGE PLANS (MAP):
- Prior Authorization Requirements: MAPs often requires prior authorization for hospital stays, home health care, medical equipment, and other items. You also need prior doctor approval to see specialists.
- Regional Restrictions: If you live in two places throughout the year, you may have difficulty having a MAP. You must reside within a MAPs services area 6 months out of the year.
MEDIGAP INSURANCE POLICY
Medigap Insurance is a Medicare Supplement Insurance Plan that can help you pay the costs associated with healthcare that Medicare insurance won’t pay. Many, but not all health care services and supplies are paid by Medicare.
Items not covered by Medicare Part A or B can include:
- Deductibles
- Copayments
- Coinsurance
- And more. Talk to an agent for a full list of items or ask your specific coverage questions.
If you’re interested in getting a Medigap Insurance Policy, our agency can help you shop private carriers to find you the right policy at the right price.
SO HOW DOES MEDIGAP WORK?
If you have medical costs that are covered by Medicare, your Medicare policy will pay the Medicare-Approved amount (typically, less than the actual amount of your doctor’s bill, then you’re responsible for the rest), then your Medigap Policy will pay its share.
WHAT ARE THE DIFFERENT MEDIGAP PLANS?
There are 10 different Medicare Supplement Insurance Plans that are available in most states through private health insurance. Those plans are: A, B, C, D, F, G, K, L, M and N.
MEDICARE PART A
Medicare Part A is also known as “hospital insurance” in Medicare terms. Normally Medicare Part A covers five main things:
- Inpatient care in a hospital
- You’re admitted to a hospital for inpatient care after you receive an official order from your doctor which says you need inpatient care for treatment of your injury or illness.
- Skilled nursing facility care
- Covers skilled nursing care provided in a Skilled Nursing Facility (SNF) in certain conditions for a short-term basis if you meet certain criteria.
- Inpatient care in a skilled nursing facility (SNF) (not custodial or long-term care)
- Nursing homes are not covered by Medicare if that care is custodial. Medicare may cover a SNF if it is deemed medically necessary for you to have skilled nursing care such as changing your bandages.
- Hospice care
- You can get hospice care if you meet certain conditions: meaning you’re terminally ill and have a life expectancy of 6 months or less, accept palliative care for comfort, not treatment of your illness, you agree to hospice care instead of receiving other Medicare benefits.
- Home health care
- In-home health services such as intermittent skilled nursing care, physical therapy, occupational therapy, speech pathology, medical social services or intermittent home health aide services.
MEDICARE PART B
Medicare Part B, commonly referred to as the Medical Insurance portion of original Medicare, can cover expenses for Medicare services and supplies that are medically necessary to treat your condition. Included items can be things such as preventative services such as immunization for the flu, outpatient care, ambulatory services, and medical equipment. Let’s take a closer look at what these services include:
- Clinical Research
- There are benefits and risks to joining a clinical research study to diagnose and treat an illness. It is your choice whether or not you’d like to join one. Before joining, be sure to ask what portion of your care is covered by Medicare.
- Ambulance Services
If you require ground ambulatory services to a hospital, critical access hospital or skilled nursing facility to receive medically necessary services Medicare Part B would cover this. It may also be possible that an airplane or helicopter may be covered if ground services are not sufficient for your situation.
- Durable Medical Equipment
- If your health requires and you’re prescribed medically necessary durable medical equipment (DME), Medicare Part B covers the cost of certain items. These may include, but are not limited to: Blood sugar monitors, test strips, walking canes, crutches, hospital beds and lifts. Many more items are covered. Visit the Medicare website to learn more.
- Mental Health
- If you require Mental Health treatment, Medicare Part B may pay for treatment you receive out of a hospital as outpatient care. This service can include: depression screening, psychotherapy, family counseling, psychiatric evaluations and more.
- Second Opinions Before Surgery
- A second opinion is when another doctor, other than your primary doctor gives you his or her professional view about your health problem and how to treat that problem. When you’re faced with a big decision like surgery, your Medicare part B will pay for you to have a second opinion about your treatment. However, be sure the doctor giving the second opinion accepts Medicare.
- Outpatient Prescription Drugs
- Medicare Part B covers a limited amount of outpatient prescription drugs. To see a list of drugs that may be covered under Medicare Part B, see the list here.
MEDICARE PART C
Medicare Part C is a Medicare Advantage Plan that will provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage. Medicare Advantage plans are often referred to as Part C or MA Plans and are offered by private companies approved by Medicare.
Medicare Advantage Plans may offer extra coverage for vision, hearing, dental and/or health and wellness programs. Most also include a prescription drug coverage (part D).
When choosing to work with a Medicare Advantage company, it is important to keep a few things in mind.
- Medicare Advantage Plans can charge different out-of-pocket expenses
- Medicare Advantage Plans can set different rules for how you get services such as seeing a specialist, doctors or facilities as well as suppliers of medical supplies.
- These rules can change every year.
MEDICARE PART D
Medicare Part D is also referred to as a Prescription Drug Plan for Medicare eligible recipients. It is an optional government program to help Medicare eligible beneficiaries pay for self-administered drugs.
When choosing to work with a Medicare Part D Prescription Drug Plan it is important to understand these few items:
- New Medigap (Medicare Supplement Plans) cannot be sold with prescription drug coverage, however, if your current plan has it, you can keep it. You can also join a separate Medicare Part D plan and your existing Medigap policy will adjust your premiums.
- Medicare Prescription Drug coverage is optional. If you choose to not get it, you may have to pay more when you do take it as a late enrollment penalty.
- If you have a Medicare Advantage Plan (Part C) you may already have prescription drug coverage.
- Part D may be accompanied by higher premiums if you have a high income.
WHICH SUPPLEMENT PLAN IS RIGHT FOR ME?
Only you can decide what Medicare Supplement Plan is right for you. A licensed agent in our office can help you navigate your choices, but ultimately, only you can choose what’s right.
HOW DO I CHOOSE A MEDIGAP COMPANY?
Your agent will go over each plan and help you find an insurance company that fits your needs and budget. They will then help you with signing up for that plan and paying for it.
To setup an appointment with an agent in our office, please click the link above or fill out the quick contact form to the right. You may also call us anytime during business hours. We’re excited to help you find a plan and look forward to hearing from you.
MEDICARE SUPPLEMENT INSURANCE
Medicare Supplement Insurance, commonly referred to as a Medigap Insurance policy, can help you pay the costs associated with healthcare that Medicare insurance won’t pay. Many, but not all health care services and supplies are paid for by Medicare. These items can include:
- Deductibles
- Copayments
- Coinsurance
If you’re interested in getting a Medicare Supplement policy, our agency can help you shop for private carriers to find you the right policy at the right price.
SO HOW DOES MEDICARE SUPPLEMENT INSURANCE WORK?
If you have medical costs that are covered by Medicare, your Medicare policy will pay the Medicare-Approved amount (typically, less than the actual amount of your doctor’s bill, then you’re responsible for the rest), then your Medicare Supplement Plan will pay its share.
WHEN CAN I BUY MEDICARE SUPPLEMENT INSURANCE?
Typically, the best time to buy a policy is during Medicare Open Enrollment. You first become eligible, 6 months after you turn age 65 and are enrolled in Medicare Part B.
HOW MUCH IS MEDICARE SUPPLEMENT INSURANCE?
The cost of your plan will depend greatly on which plan you choose. There are many supplement plans to choose from so pick a plan that is the right fit for your budget and needs.
WHAT ARE THE DIFFERENT MEDICARE SUPPLEMENT INSURANCE PLANS?
There are 10 different Medicare Supplement Insurance Plans that are available in most states through private health insurance. Those plans are: A, B, C ,D, F, G, K, L, M and N.
WHICH SUPPLEMENT PLAN IS RIGHT FOR ME?
Only you can decide what Medicare Supplement Plan is right for you. A licensed agent in our office can help you navigate your choices, but ultimately, only you can choose what’s right.
DOES IT COST MORE TO GO THROUGH AN AGENT?
No, it does not cost anything to have our agents help you with your Medicare plan choices and you will not pay more for the plan.