Medicare
Medicare is a federal health insurance program designed to provide healthcare coverage for individuals with disabilities, End-Stage Renal Disease, or those who are 65 and older.
The program is most commonly thought to be divided into four parts: A, B, C, and D, with each part offering a different amount of coverage for healthcare services.
Original Medicare
Original Medicare, also known as Part A and Part B, is hospital and medical insurance. These two parts together will cover a variety of inpatient and outpatient services, such as:
- Skilled nursing facility care
- Hospice care
- Home health care
- Medical supplies
- Preventive services
- Some outpatient prescriptions
If you or your spouse paid taxes towards Medicare when working, you could receive premium-free Part A. However, you will still have to pay the premium for Part B.
Medicare Supplements
Medicare Supplement Plans, also known as Medigap, serve as extra coverage you can purchase with your Original Medicare plan. Having a Medicare Supplement Plan can provide coverage, or fill the gaps, of the costs that Original Medicare does not cover, such as:
- Deductibles
- Coinsurance
- Copayments
- Excess charges
- Foreign travel emergencies
The plans are labeled as A, B, C, D, F, G, K, L, M, and N, each covering a certain percentage of the benefits listed above. Plans F and G both offer high-deductible options, meaning you must meet the deductible amount for the plan’s coverage to begin.
However, Plans C and F are no longer available to those who were not eligible for Medicare before January 1, 2020. This is because of the Medicare Access and CHIP Reauthorization legislation, prohibiting supplements from covering the Part B deductible.
Medicare Advantage
Medicare Advantage, also known as Part C, includes all the Original Medicare benefits. Some Advantage plans may include additional coverage services such as dental, vision, hearing, fitness programs, wellness and nutritional services, or even prescription drug coverage.
To enroll in Medicare Advantage, you must be enrolled in Original Medicare.
There are several Medicare Advantage Plans to enroll in:
- In an HMO Plan, you must receive your healthcare services in the plan’s network of providers. You may also be required to choose a primary care physician.
- PPO Plans do not require you to stay within their network to receive services. However, because of this flexibility, you will be paying a higher premium than you would with HMO.
- PFFS Plans do not require you to stay within their network. However, if you go outside the network, the provider must first accept your plan’s terms and conditions for you to receive care.
- MSA Plans combine a high-deductible plan and savings account to pay for your medical costs. The plan will deposit money into the savings account, which you can use to pay your healthcare costs before the deductible is met. Once you reach the deductible, your plan’s coverage will begin. However, please note that MSA Plans do not cover Part D prescription drugs.
- SNP Plans, or Special Needs Plans, limit their plan to individuals with specific illnesses and conditions. SNPs do have a network of providers and may require you to choose a primary care physician. They are also required to provide Medicare prescription drug coverage.
Veterans with TRICARE and VA coverage can also enroll in a Medicare Advantage Plan to extend their healthcare coverage outside the VA networks.
Medicare Prescription Drug Coverage
Medicare Part D offers prescription drug coverage, which can be purchased in two separate ways:
- As a standalone plan with Original Medicare
- As an additional benefit with a Medicare Supplement Plan or some Medicare Advantage plans like MSA, PFFS, or a Medicare Cost Plan
Part D plans are required to cover at least two drugs within each of the following classes.
- Antidepressants
- Antipsychotics
- Anticonvulsants
- HIV/AIDS drugs
- Anticancer
- Immunosuppressants
It is up to the insurance company providing the plan to decide which drugs in each category are covered which is why it is important to check the Part D formulary for the Plan you are applying for to ensure your prescriptions are included.
Reach out to
Simple Retirement Benefits
If you are still unsure of which Medicare plan is right for you, we can help. We will discuss all the coverage options with you to determine which plan is best for your needs.
Give us a call today to speak with one of our agents.
