Medicare is medical insurance for individuals over 65 who are US Citizens or legal residents. Additionally, to be eligible, the individual must have paid Social Security payroll taxes for 10 years or be a spouse of an individual who has paid those taxes, or the individual must be a government worker who has paid Medicare Payroll taxes.
Medicare covers charges which are considered medically necessary to treat an illness, disease, or condition. Coverage is based on Federal and State laws, Medicare rules, and local coverage decisions.
There are four (4) types of Medicare insurance: Part A, Part B, Part C, and Part D.
Medicare Part A is hospital insurance. It would cover inpatient care at a hospital, skilled nursing facility, and hospice. There is no monthly premium associated with Medicare Part A coverage.
Medicare Part B covers the services needed to treat your condition or symptom. It would include medical services such as doctor visits, lab tests, surgery, and certain preventative medical treatments (i.e. flu shots). The 2014 premium cost of Medicare Part B – deducted from your Social Security payment each month – is $104.90.
Because Medicare Part A and B have deductibles, co-pays and limits, to enhance medical coverage with Medicare, many people opt to purchase a Medicare Supplemental plan also known as Medigap coverage. Here’s a link to information on Medicare Supplemental plans
Medicare Part D is prescription drug coverage. Medicare D was enacted into law in 2005. An individual can get coverage by purchasing a Medicare Prescription Drug Plan or through enrollment in a Medicare Advantage Plan. Costs vary by state and type of prescription coverage, and there are a variety of coverage options available. Most major insurance carriers offer Medicare Part D insurance. If you do not sign up for Medicare Part D when you are eligible, you may have to pay a late enrollment penalty.
Medicare Part C is also known as Medicare Advantage Plan. It is a private plan (not through the government) which must include coverage for hospitalization (Part A) and medical services (Part B), but can include additional types of insurance including prescription, vision, and dental coverage. Simply, you would buy a Medicare Advantage Plan through a medical insurance carrier. Medicare will pay a fixed amount toward your coverage directly to the insurance carrier. There can be different monthly premium costs associated with these plans as well as different out of pocket costs and deductibles.
If you are wondering why someone would opt for a Medicare Advantage Plan, here are two scenarios:
You may currently have insurance through a HMO – Health Maintenance Organization – and you want to continue to receive your entire medical care (medical, dental, vision) through the HMO. You may not have any deductibles and your per cost visit might be significantly less that through Medicare.
You may want to have all your Medical Insurance under one carrier for ease of use. Under the Standard Medicare Plan, you would carry Parts A and B through Medicare, have MediGap coverage through a second insurance carrier, and a prescription drug plan through a third carrier.
If you would like additional information on Medical Advantage Plans, here are two links that give a more in depth view of choosing a Medicare Advantage Plan.
For additional information on Medicare, the link to the site is www.medicare.gov
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