Continuing To Understand Differences within Medicare

Medicare is a discussion that often comes with many misinformation being shared and past on.  One issue that is often misunderstood is how much money Medicare will cost and exactly what is included within the insurance plan.  Medicare can be broken down into two main parts coverage types; Medicare Part A and B with supplemental added on or Medicare Advantage. 

Medicare Part A and B is offered to individuals sixty-five and older that meet the requirements associated with the government offered health insurance plan.  It is also available to people you qualify that under sixty-five.  The eligibility requirements associated with Medicare are quite in depth themselves so much that there are internet sites devoted to that subject entirely.

Part A of Medicare is a completely free insurance plan.  Part A offers recipients coverage for hospital visits; in-patient hospital services, skilled nursing homes if required after a hospital stay, hospice and blood transfusions after the first three pints.  However Part B is requires a monthly premium to be paid out of pocket from the individual.  Coverage from Part B offers coverage for miscellaneous medical coverage such as; medical expenses, laboratory services, outpatient service and preventative health exams.

With Medicare Part A and B recipients are able to purchase supplemental insurance that helps fill in the gaps of what is not covered.  Medicare supplemental insurance plans A, B, C, D, F, G, K, L, M and N offer benefits ranging from hospitalization co-pays to deductibles.  All services not covered by Medicare all the recipients’ responsibility unless a Medigap plan has been purchased through an independent insurance company.  Medigap is the term used for the insurance that is purchase to cover the gaps left by Medicare. 

For many this territory is uncharted and confusing.  Terms are used interchangeably which can only add to the confusion.  It is best to get a handle on the terms and there meanings.  For instance a premium is the amount that an individual pays for their coverage.  It will be the amount paid for Medicare Part B plus the additional for the Medigap supplemental insurance policies.  Depending on the coverage that is chosen the premium will vary for each individual.  Deductibles are the amount that is paid out of an individual’s pocket before any covered medical expenses are paid for by Medicare. Co-pays, copayments, are a fixed dollar amount that is paid for medical visits. Finally coinsurance which is the amount that is required to be paid by an individual after Medicare has paid their agreed upon portion.

Medicare Advantage Plans are offered to individuals that are eligible and have Medicare Plan A and B and that live in an area that offers the advantage plan.  When enrolled in Medicare Advantage Plan recipients are still a part of the government supplied Medicare insurance  however are not eligible to purchase extra supplemental insurance such as the Medigap policies talked about earlier.  Medicare Advantage is in the simplest term a program in which Medicare offers contracts to certain area hospitals and doctors for approved amounts.  In turn individuals enrolled in this insurance plan must attend to the facilities of these medical professionals.

Medicare Advantage plan does offer greater coverage for individuals than original Medicare however not available in all areas and not right for everyone.  Individual participants are limited in their choice of doctors and hospitals.  If it is imperative that certain doctors and hospitals are seen than it is up to the individual to make sure they accept Medicare Advantage before signing up for the plan. 

It is important for individuals to seek out the Medicare supplements or advantage plans that are best for their situations.  No one can predict their medical future however, using the past as a basis will help guide individuals to the right choice.  Medicare supplemental insurance is all set in stone by the federal government the cost to individuals however is not.  All supplemental policies are sold through private insurance companies.  Companies such as Senior Health Direct offer services in which clients can review different plan options available in the area and the premiums charged by multiple insurance companies.  This is helpful in the search to find the right coverage at the right price without having to meet with multiple private insurance companies.

Important Information Surrounding Medicare Plans and Coverage

Aging happens to everyone.  It is the one truth that is consistent in life.  Along with aging come certain advantages and disadvantages.  However it is looked upon retirement happens around the age of sixty-five.  Some find retirement as nearing the end while others take on the view that their second lives are starting.  With turning sixty-five, in the United States a “gift” is stowed upon requirement meeting individuals in the name of Medicare.

Medicare is a health insurance program established by the US government to assist in payment of proper health care and expenses related to their health.  Not only does it provide health care assistance to those over sixty-five but also those who find themselves retiring early because of a qualifying disability and health condition.  Medicare insurance covers a portion of care while Medicare Supplemental Insurance can be purchased on an individual basis to cover the remaining portions. 

Medicare Supplemental Insurance is not necessary for all individuals.  Medigap as it is often referred to covers gaps within the Medicare policy.  Some individual already carry a secondary insurance that will fill in the voids of Medicare.  This might include people who have extra coverage through an employer or if retired a former employer.  If you opt instead of Medicare to receive Medicare Advantage supplemental insurance is not an option.  This is confusing.  To help clients understand Medicare and the coverage that exists under the plans it is advisable to look into Medicare supplemental insurance comparison charts. 

Many insurance companies offer to explain the different Medigap policies but it is best to find assistance from a company that looks into each situation and explores the options and costs associated through many different insurance agencies.  The coverage is completely regulated by the government so the plans consist of the same coverage the differences will come in service and cost from different insurance agencies.  A company such as Senior Health Direct which is web based can offer assistance and free information on Medicare and Medigap Supplemental Insurance Plans.  Another source of information that can be easily accessed through Internet is the Medicare government’s site.

The basic break down of Medicare coverage comes down to two parts; Medicare Part A and Medicare Part B.  Part A is often referred to as hospital coverage and Part B is known as medical coverage.  Both of these are provided within the umbrella of Medicare.  The basic coverage states that eighty percent of approved medical costs, doctors and supplies, are covered by Medicare Part A.  Part B provides a specific amount fixed dependent upon the lab service, outpatient treatment and preventatives.  Neither of these base Medicare plans offers prescription coverage. 

Medicare Part D is a piece ofMedicare Supplemental Insurance that can be purchased at an extra expense.  This can be purchase through independent insurance firms.  This is not the only service Medicare does not cover.  It is imperative to look into the different options available within the supplemental programs.  Some of the things that might be needed that are not covered are; long-term care, only medical necessary nursing homes are covered, private duty nurses, dental, health care outside the United States, cosmetic surgery, routine foot care and eye care are all covered under supplemental plans and not traditional Medicare. 

Deciphering Medicare Eligibility

Questions arise all the time about Medicare. Eligibility, cost and coverage are the three topics of conversation that are talked about the most.  Eligibility is a topic all in its own.  Most people are under the assumption that the only requirements to qualify for Medicare benefit is that they have turned sixty-five.  That however is not the case. This article will help layout guidelines on eligibility so that it is easy to determine if you fall under the guidelines to qualify for the Medicare benefits and Medigap supplement insurance.

The first group of people we will look into is the group of adults that are sixty-five and older.  Sixty-five is a qualifying age however there are other requirements that must be met to receive Medicare aid from our government.  It is a must that you are a United States citizen or legal resident.  You must also have proof that you have lived within the United States for at least five years.  It is also important to note that you receive Medicare from working at least ten years in Medicare covered employment. 

If you find you meet all three of these guidelines it is most likely that just prior to your sixty-fifth birthday you will receive a Medicare card and packet in the mail.  This will detail what Medicare is, what it offers to you and how you start using it for your health care needs.  You are automatically given both Medicare part A and Medicare part B.  Part B can be declined as it is optional and does require a monthly premium.

If you are under sixty-five you can also qualify for Medicare benefits under certain circumstances.  One is if you have End Stage Renal Disease.  Kidney disease does allow you to qualify for Medicare benefits if you are under sixty-five.  Another reason qualifications for Medicare are considered under sixty-five is if Social Security Disability Income has been received for twenty-four months. 

Medicare is not the perfect coverage.  It will not cover all of your medical expenses.  This is why it is so important when you finally do qualify for coverage that you look into different Medigap supplemental insurance plans.  Medicare does not cover prescriptions and does require you pay premiums and co-pays.    Additional coverage through the supplemental insurance will help to fill in gaps left by Medicare coverage. 

There are multiple items that Medicare part A and part B do not cover.  Below is a sample list of items that are not covered and that additional coverage should be sought out if they are important for your well being both financial and health.

·         Acupuncture is a type of alternative medicine is not covered.  Acupuncture is a treatment that works through the insertion of thin needles strategically placed throughout the body to help cure ailments.

·         Dental care is an incredibly important part of the aging process and is not part of Medicare.  It is advisable if your dental history has been anything less than stellar that you seek out additional insurance to fill the gap left by Medicare.

·         Chiropractic care is also something that many older people rely on that is not covered.  Often time’s doctors of chiropractics will offer discounted rates to seniors.  This is something to think about however when seeking out gap insurance if your doctor is not one that does.

Obviously the list of covered versus not covered is detailed in great lengths through handbooks, websites and pamphlets.  Supplemental insurance providers are a great source of knowledge as they can review your past history with you and based on the pattern that has developed guide you into the right combination of plans.  This way you are not purchasing additional coverage that is not ever going to be utilized.  

Understanding Medicare and Medigap

So much confusion surrounds Medicare and the different supplemental Medigap supplemental plans.  It is hard to look at the information coming in and decipher what it means to your health care coverage.  In terms understood by many it breaks down to this; Medicare part A and Medicare part B.  From here it is up to the individual to decide if a Medigap supplemental insurance policy is needed.  These plans are paid for by the individual and are for easing the out of pocket amount paid each year in deductibles, copayments and coinsurance plans.

The gap between what is covered and not covered by Medicare is Medigap.  Here is one of the many tricky parts.  Medigap only can be purchased along with an original Medicare plan, part A or part B.  That is correct, reread the last statement.  Medigap supplementalinsurance plans are not available with Medicare part C, part D, private health insurance, Medicaid, TRICARE or Veterans’ Admin benefits. 

Purchasing Medigap supplement insurance is just as tricky as figuring out if you can buy it.  The one thing that stays true no matter where you purchase the insurance from is that because it is regulated by the laws of the state and Federal government the benefits available are the same to everyone.  Although the coverage remains the same no matter the provider there are differences amongst the insurance companies themselves.  The differences will be in price, administrators of the plan and the available Medigap options.

Medigap insurance supplements are each unique and will want to be picked based upon the need of the individual.  For instance, clients who need help with copayment and deductibles for basic benefits will want to choose Medigap plan A for those are the items that it helps cover.  This plan is attractive for it is the least expensive plan available and is accepted by all doctors who accept Medicare.  Drawbacks come with each and every plan available.  The major drawback to plan A is that it covers basic necessities and not items such as long term care, skilled nursing, vision care amongst several other major areas of expense. 

Another option to all of this confusion is Medicare Advantage Plan. This plan is in place of Medicare plan A and Medicare plan B, as well as any Medigap insurance.  Medicare Advantage deals with HMO’s, PPO’s and other options.  The thing to remember is that Medicare Advantage is an option that also allows doctors and hospitals to choose.  They don’t have to take this coverage.  It is a private option not through the government but rather run through private insurance companies. 

In the year before you turn 65 it is wise to sit down and go through all of the different options.  You will want to review your needs in the past five years to see medically where money was spent.  This will help you narrow down what options you will need to further discuss with an insurance agent.  They will can help determine what supplement will maximize your benefits while minimizing the out of pocket expense you concur.