Are You New to Medicare? Do you know what is covered?
Sunday, September 21st, 2014
If you are turning 65, leaving an employer/group plan, or recently starting your Medicare, chances are you have many QUESTIONS. For example, do you know what Part A, B, C, and D cover? Do you need a Medicare Supplement (Medigap), Medicare Advantage (Part C), or do you have other coverage such as TriCare? Original Medicare only covers 80% of hospital and medical costs, so you may want to consider a Medicare Supplement plan or a Medicare Advantage plan to limit your out of pocket expenses.
Part A (Hospital Insurance) helps cover:
- Inpatient care in hospitals
- Inpatient care in a skilled nursing facility (not custodial or long-term care)
- Hospice care
- Home health care
- Inpatient care in a religious nonmedical health care
Part B (Medical Insurance) helps cover:
- Outpatient care
- Home health services
- Durable medical equipment
- Many preventive services (refer to Medicare & You 2015 page 40)
- Shots
- “Welcome to Medicare” preventive visit
Medicare Part A & B do NOT cover:
✘ Most dental care.
✘ Eye examinations related to prescribing glasses.
✘ Dentures.
✘ Cosmetic surgery.
✘ Acupuncture.
✘ Hearing aids and exams for fitting them.
✘ Long-term care.
Medicare Part D is a Medicare Prescription Drug plan offered through private insurance companies under contract with Medicare. When you become eligible, you should consider getting a Medicare Part D plan.
Now that you know the basics of Medicare, you will now need to determine whether you will choose a Medicare Supplement insurance plan or a Medicare Advantage plan (also known as Part C).
A Medicare Supplement (Medigap) is used to fill the gaps and cover the other 20% that Original Medicare doesn’t. These plans have affordable monthly premiums and as long as your provider takes Medicare, they will take your Medicare Supplement. When receiving services, you will show your Medicare red, white, and blue card and also your Medicare Supplement card. Medicare Supplement plans do NOT include Medicare prescription drug coverage, so this will need to be purchased separately.
Medicare Advantage plans (Part C) are all very different. These plans do not supplement Medicare, but rather become the primary. Medicare Advantage plans must offer all the benefits that Medicare does, but may offer additional benefits such as dental, vision, and hearing. They often include Medicare Part D coverage. Many Medicare Advantage plans in our area are offered for a $0 monthly plan premium. You will pay a copay or coinsurance as you use your plan and they also include maximum out of pocket limits to limit your out of pocket expenses. Before enrolling into a Part C plan, you will want to confirm that your physicians and facilities are in the plans network.
Networks and plan benefits may change on an annual basis you should should review your coverage annually during the Medicare Annual enrollment period from October 15th- December 7th. As an independent medicare insurance firm, we are able to represent several Medicare Part C and D insurance carriers, to find the RIGHT plan for you. If you have any questions regarding your current coverage or would like to look at your options, please call us Toll Free at 1-866-691-5571 for your personal appointment.