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Medicare Insurance

What is Medicare?

Medicare is a Health Insurance Program for:

  • People age 65 or older.
  • People under age 65 with certain disabilities.
  • People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Medicare has Four (4) Parts:

  1. Part A (Hospital Insurance). Most people don't have to pay for Part A.
  2. Part B (Medical Insurance). Most people pay a monthly premium for Part B.
  3. Part C (Medicare Advantage Plans)
  4. Part D (Drug Coverage)

Depending on the plan you chose, you may pay a monthly premium for Drug Coverage. 

What is Medicare Part A Coverage?

Part A

Medicare Part A helps cover care in hospitals as an inpatient, critical access hospitals, skilled nursing facilities (not custodial or long-term care), hospice care, and some home health care.

Most people will not have to pay a monthly premium for Part A because they or their spouse paid Medicare taxes while they were working. As long as you or your spouse worked 40 quarters (10 years) and contributed to Medicare during that time, you will qualify for premium-free Part A. If you are not eligible for premium-free Part A, you may be able to buy Part A if you meet one of the following conditions:

  • You are age 65 or older, and you are entitled to (or enrolling in) Part B and meet the citizenship or residency requirements. 
  • You are under age 65, disabled and your premium-free Part A coverage ended

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What is Medicare Part B Coverage?

Part B

Medicare Part B covers medically necessary doctor and outpatient hospital procedures and services as well as preventive services. Most people have to pay a premium for Medicare Part B and it is generally deducted from your Social Security check.

The standard Medicare Part B premium for 2017 is $134.00 per month. However, most people who get Social Security benefits will continue to pay the same Part B premium as they paid in 2016.  The Part B premium is higher for people above certain income levels and can be as much as $428.60 per month.

Although many services are covered under Medicare Part B that are not covered under Medicare Part A, keep in mind that Part B is still not a complete insurance coverage plan. Part B helps cover the medically necessary and preventive services listed below:

  • Doctor

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Medicare Advantage Plans

Medicare Advantage Plans typically combine Medicare Parts A, B & D (prescription medication) into a single plan. These plans are offered through private insurance companies that have been approved by Medicare and follow Medicare guidelines.  Some of these plans include preventive services and a variety of discount programs not offered by traditional Medicare or Medicare Supplements.

Participants in Medicare Advantage Plans still have Medicare and continue to pay their Part B premium, but providers and carriers bill their claims to the insurance company administering their plan instead of Medicare.  Plans must cover what traditional Medicare covers; however members may need to use a network of doctors.  Coverage may be based on Prior Authorization or Pre-Certification specified by the plan.

Medicare Supplement Insurance Policies

Medicare Supplement Insurance Policies are health insurance plans designed to fill the “Gaps” in coverage with Original Medicare, Parts A & B. These policies are sold by private insurance carriers and work with Original Medicare to provide a beneficiary with full hospital and medical coverage. The “Gaps” that these policies cover are some of the health costs; copayments, co-insurances and deductibles, associated with Medicare covered services that are not fully covered by Original Medicare.  Also, some policies may provide coverage for services not covered by original Medicare, like emergency medical care in a foreign country while traveling.

The private insurance companies can only market “Standardized” Medicare Supplement policies regulated by Federal and State laws. These “Standardized” Plans are identified by a Plan letter, A through N. The benefits offered under each Plan letter are the same for each insurance company offering that Plan Letter, but vary in cost (premium). So, a Plan A offered by one insurance company is the same as a Plan A offered by another, but each will have a different premium.  Also, the benefits offered under each Plan letter vary from letter to letter so; a Plan A is not the same as a Plan B or a Plan C and so on. 

D stands for Prescription Drugs!

In 2006 Medicare began providing coverage for prescription drugs to Medicare Eligible beneficiaries with the implementation of Medicare Part D. Unlike Parts A and B, which are directly funded and administered by the federal government (Center for Medicare & Medicaid Services), Medicare Part D plans are offered by private insurance companies. However, these plans are regulated and subsidized by CMS. CMS sets the base coverage limits that each plan must follow but allows the insurance carriers to set up their own plans within these limits. Although plans must meet CMS approval, these private insurance carriers may set their own premiums, copay structures and formularies. Because there are many carriers and a variety of plans available from which to choose from, no one plan is suited for everyone.

There are two

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