Medicare is a health insurance plan for seniors age 65 years or older, those who qualify as disabled or those with permanent kidney failure (ESRD), that is overseen by the Federal government. It ensures that all seniors have basic hospital insurance (Part A) at no cost to them. It also provides the option of medical insurance (Part B). Part A & Part B make up what is called Original Medicare. Part A comes at no cost to the senior. Part B does involve a monthly premium that’s generally automatically taken out of Social Security.
Each Medicare part is designed to cover unique health care needs:
Part A – Hospital Insurance: Covers hospital care (all but first three pints of blood each year), nursing home, home health care, hospice care and skilled nursing facilities. Read about what Part A covers.
Part B – Medical Insurance: Covers 80% of the cost of doctor’s visits, surgeries, lab tests, x-rays, ambulatory services, outpatient care, home health, hospital beds, wheelchairs, walkers, blood supplies, and medical supplies. It may also cover clinical research, mental health services, second opinions before surgery and limited outpatient prescription drugs. Coverage must be determined medically necessary or preventive. Read about what Part B covers.
Part C – Medicare Advantage Plans: Optional private plans that replace Part A & Part B but are required to carry the same benefits, if not more.
Part D – Prescription drug coverage: Optional drug coverage for those with Part A & Part B. For those who’ve enrolled in an Advantage Plan, they must choose a plan with built-in prescription drug coverage; they cannot apply for Part D coverage separately.
The Need for Medigap or Advantage Coverage
The above Medicare structure covers the basics for some seniors, but leaves many with high out-of-pocket costs. Private insurance companies offer Medicare Advantage Plans and supplemental plans to alleviate the financial burdens imposed by relying solely on Part A & Part B for senior health care coverage.
These private plans charge a monthly premium and can offer coverage that protects financial assets in the event medical services needed are not covered by Original Medicare coverage. We work with many seniors and their families to understand Medicare options and provide cost breakdowns and comparisons so that they can make an informed and wise choice about Medicare plans and supplements when open enrollment hits.
About Medicare Health Plans (MHP)
At Medicare Health Plans, we make buying a Medicare Advantage Plan or Medicare Supplement plan as easy as it’s going to get. As insurance professionals, we do all of the work for you. Make sure to mark your calendar and call us around the time your Medicare cards show up – generally about 3 months before your 65th birthday.
It’s during this time considered “open enrollment” that you have big decisions to make. If you don’t opt for an Advantage Plan or a Medigap plan, you might be stuck paying 20% of all of your medical bills for the rest of your life. Luckily, there are plans available to you to help with these costs – some that come at no cost to you.
Our team offers our expertise and experience in the Medicare industry and walks you through this process. When you work with us, we will:
- Explain your benefits
- Illustrate the importance of a Part C plan OR supplemental plan in order to reduce financial risk.
- Request quotes from insurance companies on your behalf.
- Present your options for supplemental coverage (or Part C coverage.)
- Assist in lining up your benefits to become active upon your Medicare enrollment.