Medicare Insurance
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About Medicare Insurance
This type of insurance is a U.S. federal government health insurance program that subsidizes healthcare services. The plan covers people over age 65, younger people who meet specific eligibility criteria, and individuals with certain diseases. Medicare is divided into different plans that cover a variety of healthcare situations some of which come at a cost to the insured person.
While this allows the program to offer consumers more choice in terms of cost and coverage, it also introduces complexity for those seeking to sign up.
The program is now administered by the Centers for Medicare and Medicaid Services, CMS, and extends coverage to include people with certain disabilities, as well as those who have end-stage renal disease and amyotrophic lateral sclerosis, ALS, or Lou Gehrig’s disease.
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4 Parts Of Medicare
There are four different parts to Medicare, all of which provide different types of services for the insured:
Medicare Part A Hospital Insurance
Helps pay for bills related to inpatient hospital stays, skilled nursing facility care, inpatient care in a skilled nursing facility, hospice care, and home health care. It covers expenses such as semi-private rooms at skilled nursing facilities, inpatient care, supplies, drugs during a hospital stay, as well as physical and occupational therapy in your home if you are home-bound. Doctor’s services, medication, and grief-and-loss counseling for terminally ill patients are also covered.
Medicare Part C Medicare Advantage
Is offered by private companies approved by Medicare. If you participate in a Medicare Advantage Plan, the plan provides all your Part A and Part B coverages, and it may provide extra coverage for things like vision, hearing, dental, and most also include Medicare Part D, prescription drug, coverage. It is crucial to carefully consider the professional helping you to acquire the best and most suitable Medicare Advantage plan possible.
Medicare Part B Medical Insurance
Is optional and pays a portion of non-hospital provided medical care, such as doctor visits and other outpatient services. It also covers preventive services, ambulance services, mental health costs, and durable medical equipment. There is a monthly fee for this program; the premium depends on your
modified adjusted gross income as reported on
your IRS tax return from two
years ago.
Medicare Part D Prescription Drug Coverage
Is an optional benefit offered to anyone who has Medicare. If you choose not to get Medicare Part D coverage when you're first eligible, you may owe a late enrollment penalty
if you join later, unless you have had other creditable
prescription drug coverage, such as from
an employer or spouse's employer.
MediGap Insurance
This type of Medicare is also called Medicare Supplement Insurance, Medigap is health insurance coverage provided by private companies designed to pay for costs not covered by Original Medicare. Depending on which plan you get, these costs might include copayments, coinsurance, and deductibles, as well as services Original Medicare doesn’t cover, such as travel outside of the U.S. Original Medicare defined as Part A and B will not cover all expenses associated with an illness.
Medigap policies are designed to cover all or a portion of those extra charges depending on the type of coverage, but generally don’t include long-term care, vision, dental care, hearing aids, eyeglasses, or private nursing. Although private insurance companies offer Medigap coverage, the federal government requires companies to offer standardized policies. Your 12 choices are plans A, B, C, D, F, F-High Deductible, G, G-High Deductible, K, L, M, and N. However, for those who become newly eligible for Medicare in 2020 and after, plans C, F, and F-High Deductible are no longer available.
Monthly premiums for a Medigap policy are paid to a private insurance company that is licensed to sell such policies in your state and can be paid in addition to the monthly premium paid to Part B of Medicare.
The policy only covers one person. So, if you and your spouse want coverage, you each need a separate Medigap policy.
“The best time to buy a Medigap policy is during your six-month Medigap open enrollment period. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you are 65 and are enrolled in Medicare Part B, Medical Insurance. After this enrollment period, you may not be able to buy a Medigap policy. If you are able to buy one, it may cost more.”
Shopping for Medigap coverage is straightforward because you merely compare prices and the suitability of the insurance company. Once you have a Medigap policy, it is guaranteed renewable, even if you have health problems. In other words, the insurance company cannot cancel the policy so long as premiums are paid.
Importantly, Medigap coverage does not work with a Medicare Advantage Plan (Part C). Indeed, if you have a Medicare Advantage Plan, it is illegal for someone to sell you Medigap coverage. However, if you have Medicare Advantage and are unhappy with the plan, you can switch to Original Medicare within the first 12 months, at which point you can buy Medigap coverage.
