Medicare

Originating in the 1960s, Medicare is a government-provided fee-for-service insurance program intended primarily for seniors. The program encompasses several distinct parts, each of which is outlined below.

Medicare Part A covers facility-based care such as hospital visits, emergency room services, hospice, and nursing home care.
Medicare Part B covers traditional outpatient treatments and services, including vaccinations, lab tests, mental health services, outpatient operations, durable medical equipment, and most other medical services not performed in a hospital.
Medicare Part C (Medicare Advantage) covers elements of Parts A, B, and sometimes D.
Medicare Part D covers prescription drugs.
Medigap comes through private insurance companies and aims to fill in the “gaps” left in the traditional Medicare coverage.

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KNOW YOUR CHOICES

While standard Medicare offers coverage for a wide variety of services, you may find that a different plan through a separate insurance carrier better fits your needs. If you are interested in an alternative plan, we can help you find coverage through either a Medicare Supplement plan or a Medicare Advantage plan. Both of these plans offer additional support through third-party insurers, and they are required to provide equal or better coverage when compared to regular Medicare.

MEDICARE OPTIONS

Turning 65 is a major milestone. There is a lot of information available on this health insurance program for people age 65 and older (and people under 65 with certain disabilities and those of all ages incurring End State Renal Disease or ERSD). What is Part A? Am I eligible and if so, do I need Part B? Should I get part D even though right now I am not on any prescription medications? What is the definition of a Medicare Advantage plan? What are Medicare Supplement Plans? Should I have that? There is a lot to know. Below are brief descriptions of the various parts of Medicare although they are not all encompassing. We welcome a conversation with you to explain them in greater detail.

MEDICARE PART A

In brief, Medicare Part A is hospital insurance. It includes critical access hospitals and skilled nursing facilities. It also helps cover hospice care and some home health care. It is generally without premium if you or your spouse has paid into the system while working.

MEDICARE PART B

Part B is designed to cover your doctor visits and outpatient care. It may also cover some services Part A does not cover such as lab work, medical equipment, ambulance services, etc. Part B does require a monthly premium. Medicare Part A and Medicare Part B are known as “Original Medicare”.

MEDICARE PART D

Also know as Prescription Drug Coverage, it is available to everyone with Medicare. It is a Federal program administered through private insurance companies. You are responsible for a monthly premium. While using in-network pharmacies, a percentage of the drug cost is covered by the insurance company while you are responsible the balance. There may be a deductible to be met. There are other factors involved (including coverage gap and catastrophic coverage) so it is important to read your individual plan carefully and ask any questions prior to purchasing.

MEDICARE ADVANTAGE PLANS

Offered through private insurance companies, Medicare Advantage Plans (which may be called Part C or MA Plans) are an alternative to Original Medicare. These plans combine Medicare Parts A & B and are offered by companies approved by Medicare. Often, Medicare Advantage Plans are combined with Prescription Drug Coverage. Most plans also offer things that Original Medicare does not offer such as vision, dental and hearing plans among other benefits (i.e., transportation services or wellness plans, etc.). Since they vary in what they offer, always read the plans benefits summary before purchasing and do note these plans can change year after year.