Medicare

Find out Medicare information about Parts A, B, C, or D so you can plan ahead for your health care.

Understand the fundamentals of Medicare.

Medicare is available to most people aged 65 or older who have paid Medicare taxes while working, as well as some younger people with disabilities or end-stage renal disease. Medicare is divided into several sections with differing costs and choices. Rules concerning enrollment eligibility and timing must be considered.

What is Medicare?

Medicare is a government-sponsored health insurance program administered by the Centers for Medicare and Medicaid Services in the United States. Medicare began in 1966 and was originally administered by the Social Security Administration. Over the past half-century, the program has adapted to meet the ever-changing needs of the modern world by adding new program options and allowing for the introduction of supplemental plans.

Medicare has four sections.

Medicare is divided into four sections referred to as Parts A, B, C, and D. Parts A and B are considered Original Medicare.

Medicare Part A.

Most people become eligible to enroll in Medicare Part A when they turn 65. Individuals must enroll during specific enrollment windows. Having health insurance through an employer's plan can impact enrollment timeframes. Part A is provided free for individuals and their spouses who worked and paid Medicare taxes for a minimum of ten years. Those who are not eligible to receive free Part A may be eligible to buy it and pay premiums for coverage. Once eligible for Medicare, individuals will typically be enrolled automatically in Part A if they are receiving Social Security (SS) or Railroad Retirement Board (RRB) benefits. Those who are not receiving SS or RRB benefits, as well as those living in Puerto Rico, are not automatically enrolled.

How does Part A work?

Part A pays a portion of the costs for services associated with hospitalization. For example, these services include inpatient care, skilled nursing facilities, or hospice. Part A does not cover long-term care that is custodial in nature. There are limits to the amounts Medicare Part A will pay based on covered services and length of hospital stay. Medicare does cover inpatient care in a psychiatric hospital. However, coverage is capped at a maximum of 190 days per lifetime. Also, Medicare Part A will only cover care in a semi-private room, unless a private room is medically necessary.

Medicare Part B.

Medicare Part B always requires the individual to pay a premium. Eligibility for Parts A and B tend to coincide. However, Part B eligibility will be impacted by whether or not a person is eligible for premium-free Part A. Enrollment in Part B is voluntary. Depending on a person's eligibility, they may be enrolled in Part B automatically with the option to refuse it, or they may need to enroll on their own. Like Part A, enrollment can only happen during certain windows.

How does Part B work?

Part B covers a portion of the costs associated with medically necessary services to diagnose or treat a condition. It also includes some preventive care costs. For example, Part B typically pays for an ambulance, durable medical equipment, certain health screenings, and some vaccines, including the flu shot and the COVID-19 vaccine. Most preventive services are provided at no cost. However, other services are typically subject to a deductible and 20% coinsurance. There is no limit on out-of-pocket costs.

What's not covered under Original Medicare?

There are services that won't be covered by either Part A or Part B. For example, dental care including dentures, vision exams and glasses, hearing aids and hearing aid fittings, and routine foot care typically are not covered. Additionally, long-term care in a nursing home (custodial care) is not covered. Similarly, Medicare does not cover cosmetic procedures or acupuncture. Services not covered by Medicare must be paid for out of pocket. Alternatively, they may be covered by other supplemental insurance plans. Finally, Original Medicare does not cover services provided outside the United States, except in limited circumstances.

Medicare supplement plans (Medigap).

Medicare supplement plans are also known as Medigap plans. These optional plans are available to individuals who have Parts A and B and wish to supplement that coverage. These policies can help cover the patient's out-of-pocket costs. This includes copayments, coinsurance, and deductibles. Medigap plans may also provide coverage for when an individual needs care while outside the United States. Medigap policies written after 2006 do not include prescription drug coverage. Also, Medigap plans typically do not cover services like dental, vision, and long-term care, eyeglasses, hearing aids, and private-duty nursing.

Contact us to go over your options for Medicare and its alternatives.

Medicare Advantage Plan

Medicare Advantage plans are alternatives to Original Medicare.

Medicare Advantage plans are different.

Sometimes referred to as Medicare Part C or MA plans, these plans are an alternative to Original Medicare Parts A and B. These plans have many things in common with Original Medicare, but they may also offer expanded benefits that aren't available otherwise.

What is a Medicare Advantage plan?

These are plans that usually act as a bundle for Medicare Parts A and B. In many cases, they may also include Part D and prescription drug benefits. Some plans may also include vision, hearing, and dental plans, making them more attractive than Original Medicare, which does not offer these benefits.

What are the benefits of a Medicare Advantage plan?

In addition to the expanded coverage noted above, there are other reasons a person may choose to enroll in an Advantage plan. While Original Medicare requires you to see a Medicare provider, some Advantage plans allow for out-of-network coverage, although this tends to cost more. Unlike Original Medicare, Advantage plans often have limits on out-of-pocket costs, which can take some of the guesswork out of anticipating expenses for those on a fixed income. Here are more examples of benefits:

• Plans may cost less.
• Plans may offer more coverage options.
• Plans may combine health and prescription coverage.

How do Medicare Advantage plans work?

These plans contract with Medicare and also follow the Medicare rules and regulations. They are also reimbursed by the United States government. These plans can charge different premiums, copays, and deductibles than Original Medicare, and these will often differ from plan to plan. The plans are provided through private insurance companies, which allows someone who has Parts A, B, and D to have all their coverage managed by one company.

Additional things to know about Medicare Advantage.

It is possible to buy an Advantage plan that does not include prescription drug coverage. If you enroll in one that does not, such as a Medical Savings Account plan or a fee-for-service plan, you can still enroll in a separate Part D plan. However, if your Advantage plan does offer prescription drug coverage and you enroll in a separate Part D plan, you'll be disenrolled from your Advantage plan and be placed into Original Medicare.

Medicare Advantage and Medicare supplement plans.

Advantage plans do not work with Medigap (Medicare Supplement Insurance) plans. Medigap plans are designed to cover out-of-pocket costs like deductibles, coinsurance, and copayments of Original Medicare. They cannot pay for the out-of-pocket costs of Medicare Advantage plans.

If you'd like to explore your options with Medicare Advantage plans, contact us to learn more.