If you are like many folks, you have struggled to understand your Medicare benefits. Parts, plans, deductibles, co-pays, co-insurance, Medicare supplement, PPO, HMO, POS, MAPD, language that seems to go in circles. You don't have to be a Medicare expert to understand your benefits and choices. The first step is to gain a clear understanding of some Medicare basics.
The Four Parts of Medicare.
Medicare consists of four parts. Each part is designated by a letter. A - D
Medicare Part A covers room and board and some other expenses in an inpatient situation. This can include a hospital, skilled nursing facility and hospice care. Medicare Part A has a deductible and co-insurances that you will be responsible for. Most people do not pay a premium for Part A.
Medicare Part B is the outpatient side of Medicare. This includes doctor visits, surgical services, physical therapy, speech therapy, durable medical equipment, home health care, outpatient testing and some drugs. Part B covers 80% of approved amounts for these expenses after you have met your annual deductible. Part B requires a monthly premium. Enrollment is optional. In most cases there is a late enrollment penalty that will be added to your premium if you delay enrollment in Part B unless you have other creditable coverage. There are limited enrollment periods every year when you are able to enroll in Part B.
Parts A & B are what is known as original Medicare. It was created in the 1965 with the first benefits paid in 1966 to help seniors with medical expenses. It is a government health plan. It covers most of your medical expenses. There are gaps in the coverage and most seniors cover all or some of the gaps with a Medicare Supplement insurance plan. Thus creating a situation where they can control and predict their medical expenses from month to month and year to year.
If you choose to stay with original Medicare you can use any doctor or hospital anywhere in the country as long as they accept Medicare.
Medicare Part C is Medicare Advantage. Since 1997 seniors have had the option to enroll in private Medicare Insurance. The Plan Provider is paid with your Part B premium and an additional amount from Medicare for each enrollee. These plans are required to cover at least what Part A & Part B cover. Some Medicare Advantage Plans include benefits not found in original Medicare like dental coverage, eye glasses and gym memberships. Some of the plans include prescription coverage. There are several types of Medicare Advantage Plans; HMO, PPO, PFFS, and POS. It is very important to remember that the coverage in a Medicare Advantage Plan is the same coverage as Medicare Part A and Part B. It is not the same as Part A and Part B with a supplement. All Advantage Plans will have out-of-pocket expenses in the form of co-pays for office visits, daily co-insurance for hospital stays etc. You are not permitted to add a supplement policy to your Advantage Plan to cover these costs. Regardless of the type of Advantage Plan that you choose, be aware that you will have to choose from providers who accept your specific plan or be ready to pay increased out-of-pocket expenses.
Medicare Part D is Medicare's prescription coverage. These plans are made available by private companies. Medicare mandates and approves the plans that are offered. You will have a monthly premium for the Part D plan that you choose. You may choose to not enroll in a Part D plan but keep in mind that you will pay a late enrollment penalty when you do enroll. The fine will be based on the number of months from when you were eligible for Part D and the month you enrolled. Enrollment opportunities are limited to Medicare Enrollment Periods each year.
By taking a moment to understand what each Part of Medicare covers and knowing where you are exposed within the coverage of each you have provided yourself a solid position from which to plan a solution that works for your unique situation.
Medicare Supplemental Insurance - How to Choose an Advisor? How To Apply For Medicare Supplemental Insurance And Get The Best Rates Help With Your Medicare Supplement Choices What Is Supplemental Security Insurance?
0 comments:
Post a Comment