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What you need to know about Medicare
Most people don’t know what their insurance covers until they need it. But with Medicare’s Annual Election period opening October 15 and closing December 7, it’s a great time to explore your options, many of which can help keep you well and healthy every day—not just help you when you’re sick!
What is Medicare?
Medicare is the federal health insurance program for adults who are 65 or older, certain people with disabilities, and people with end-stage renal disease (i.e., permanent kidney failure requiring dialysis or a transplant, also known as ESRD).
Once you’re eligible, you can choose to enroll in Original Medicare (the traditional fee-for-service program offered directly through the federal government) or in a Medicare Advantage Plan (a type of private insurance offered by companies that contract with the federal government). Different coverage is provided through each plan.
What does Medicare cover?
According to Medicare.gov, different parts of Medicare cover specific services:
- Medicare Part A: covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
- Medicare Part B: covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
- Medicare Part D: adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, Private-Fee-For-Service Plans, and Medicare Medical Savings Account Plans.
Medicare Part C, also known as Medicare Advantage, includes Part A and Part B (and usually Part D) as well as other helpful benefits like dental and vision coverage, transportation assistance, gym discounts and meal delivery after hospitalization.
How do you determine if it’s right for you?
Both Original Medicare and Medicare Advantage Plans offer Part A and Part B coverage.
In Original Medicare, your coverage is provided directly through Medicare, and you have your choice of doctors, hospitals, and other providers that accept Medicare. About 80 percent of your health care costs are covered, and you usually pay a monthly Part B premium. You can also choose to add a Medicare Supplemental Insurance Policy, or Medigap, to your Original Medicare Plan, which is offered by private companies. This usually requires an additional monthly premium. Many Seniors are surprised that Medicare Advantage often costs the same as traditional Medicare. In some cases, Medicare Advantage plans can save you more over the course of the year by helping you stay healthy, avoiding hospitalization, and getting better coverage for prescription medications.
The downside of Medicare Advantage Plans is that you’re limited to using the plan’s doctors and providers, however those networks can be very comprehensive, and some plans give you more flexibility if you are traveling frequently. In some cases, Medicare Advantage plans have copayments or coinsurance for covered services. Medicare Advantage Plans may offer additional benefits not covered by traditional Medicare, like vision and dental care and transportation assistance.
To add Part D (Medicare Prescription Drug Plans), you usually have to pay another monthly premium. If your Medicare Advantage Plan offers drug coverage, you may have to get it through that plan. Otherwise, you can join a Medicare Prescription Drug Plan.
Want to explore your options further? Get more information by contacting your broker during the Medical Annual Enrollment Period (October 15, 2018 to December 7, 2018). You can also learn more at P3NV.org or by calling 702-333-4700.