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EnsuranceFinder.com connects consumers with variety of medicare plan options. When an American citizen turns 65 years of age, they have the option to enroll in Medicare (they may also qualify before the age of 65 if they are eligible for disability benefits).
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What is Medicare?
Original Medicare, Part A and Part B, is a government health insurance program for those who qualify by age or disability. Part A is hospital insurance, and Part B is medical insurance. There are some out-of-pocket costs associated with Original Medicare, such as copayments, coinsurance, and deductibles.
Medicare Advantage plans
Medicare Advantage plans offer an alternative way to receive your Medicare benefits through a private, Medicare-approved insurance company. They must include all your Medicare Part A and Part B coverage (except hospice care, which is covered under Medicare Part A), but may offer additional benefits not included in Original Medicare.
Medicare Supplement (or Medigap) insurance plans work alongside your Original Medicare coverage. To help with those costs, if you’re enrolled in Original Medicare, you can purchase a Medicare Supplement (Medigap) insurance plan. Medicare Supplement insurance, also known as Medigap or MedSup, is also sold through private insurance companies, but it is not comprehensive medical coverage. Instead, Medigap functions as supplemental coverage to Original Medicare. Current Medigap plans don’t include prescription drug coverage.
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MEDIGAP, WHAT IS IT AND WHO IS IT FOR?
What Is Medigap? Medigap, also known as Medicare Supplement Insurance, is offered by private insurance companies. They help fill the coverage “gaps” left open by Medicare Part A and Part B. There are 10 types of Medigap plans. They are Plans A, B, C, D, F, G, K, L, M and N. Not every insurer offers all 10 plans, and prices can vary, but the amount of coverage is the same across companies.
Do I Need Medigap Insurance? Many can find Medicare Part A and Part B to have too many “gaps” in coverage. Supplementing your coverage with a Medigap plan may help to reduce the amount you pay out-of-pocket when using medical services. Multiple or extended hospitalizations (60 days or more) could potentially costa lot of money out of pocket. So could just one or two outpatient procedures. That is why it may be more cost effective to purchase a Medigap plan, even when factoring in the monthly premium.
Some Medigap plans may also provide you with additional coverage, such as emergency health care when you are travelling internationally, and care at a nursing facility. Be sure to talk with the insurance company offering the plan to fully understand what the plan covers before you sign up.
Who Is Eligible? To be eligible, you must be enrolled in Medicare Part A and Part B.
MEDICARE PART A & B
- What Is It? Medicare Part A and Part B is the health insurance coverage provided by the government. Part A is for inpatient or hospital coverage and Part B is for outpatient or doctor’s office coverage.
- Who Is Eligible? To be eligible, you must be 65 years old, and have paid federal taxes for at least 10 of your working years,or under 65 years old with certain disabilities.
- When Can I Enroll? You can enroll in Medicare Part A and Part B during the Initial Enrollment Period. The Initial Enrollment Period is the 7 months surrounding your 65th birthday (3 months before you turn 65 years old, the month you turn 65 years old, and 3 months after you turn 65 years old).
- If you miss the Initial Enrollment Period, you can sign up during the General Enrollment Period, which is between January 1 and March 31. Unfortunately, you have to wait until July 1 for your coverage to begin. Additionally, you could pay higher premiums when you purchase supplemental coverage from a private insurer.
- If you or your spouse are currently over 65 and have health coverage through your employer, you may be eligible to get Medicare Part A and Part B during the Special Enrollment Period. The Special Enrollment Period will begin once your employer-based coverage expires.
What Is It? Medicare Advantage Plans (also known as Medicare Part C) provide your Medicare Part A and Part B benefits (Parts A & B), along with additional medical coverage, all in one convenient private insurance plan. The additional coverage helps limit, and helps pay for, your out-of-pocket medical expenses.
Unlike Medicare Part A and Part B, many Medicare Advantage plans may also include coverage for prescription drugs (also known as Part D). Medicare Advantage plans may also include dental, vision, and other benefits. Since every plan varies, it is important to understand what your plan covers before signing up.
Most Medicare Advantage Plans tend to be either HMOs or PPOs. HMOs involve using a set of in-network doctors, specialists and hospitals. They typically require you to coordinate your care through a primary care physician, who can refer you to specialists when needed. PPOs tend to have larger networks and do not typically require referrals for specialists. Since Medicare Advantage HMOs and PPOs provide most of your health coverage in a single plan, they can seem similar to the insurance you may have had through an employer.
Why Get It? Medicare Advantage plans can help to reduce the amount you pay out-of-pocket for health care. Medicare Part A and Part B requires you pay for 20% of medical costs when needing outpatient care. It also requires you to pay a set fee per day when hospitalized for 60 days or more, which can vary depending your plan. Further, there is no cap on your out-of-pocket costs. There also is no coverage for prescription drugs, meaning you pay for 100% of costs at the pharmacy.
Medicare Advantage plans can help pay for all of these out-of-pocket costs, with many plans including prescription drug coverage. They also place a “worst-case” maximum limit on your out-of-pocket costs. These limits vary from plan to plan, but can be very affordable. Medicare Advantage maximum out-of-pocket limits can keep your costs both affordable and predictable.
Some people may prefer Medicare Advantage over Medigap because they enjoy the convenience of having one plan. Medigap plans work on top of, or in addition to, Medicare Part A and Part B. Medicare Advantage plans replace Medicare Part A and Part B, and often include additional benefits.
Who Is Eligible? Those who are eligible for Medicare Part A and Part B can enroll in Medicare Advantage. To be eligible for Medicare Part A and Part B, you must be 65 years or older. Those under 65 may eligible if they are disabled.
When Can I Enroll? There are three enrollment periods for Medicare Advantage.The first is the Initial Enrollment Period. Initial Enrollment is the 7 month period surrounding your 65th birthday — 3 months before you turn 65, the month you turn 65, and 3 months after you turn 65.
You can also enroll in a Medicare Advantage Plan during the Medicare Open Enrollment Period. The 2018 Medicare Open Enrollment Period begins on October 15 and ends on December 7. If you already have a plan, but would like a new one, this is also the time where you are permitted to change plans.
The third way to enroll for a Medicare Advantage plan is during the Special Enrollment Period. The Special Enrollment Period is only open to those who recently had a major life change, such as if you recently moved or lost health coverage.
Since Special Enrollment is limited, it is important that you do not miss the Initial or Open Enrollment Periods. Your coverage could be delayed if you wait to enroll in a Special Enrollment period.
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PRESCRIPTION DRUG PLANS
What Is It? Medicare Part A and Part B does not include coverage for prescription drugs at the pharmacy. Fortunately, the government has allowed certain private insurers to offer Medicare Prescription Drug plans (also known as Medicare Part D).
There are two types of Part D plans. The first type is Medicare Advantage Prescription Drug Plans (MAPDPs). This type of coverage is included as part of a Medicare Advantage plan, so you will only be able to access this plan’s coverage if you enroll in a Medicare Advantage plan (also known as Medicare Part C).
The other type is standalone Prescription Drug Plans (SPDPs). This is the type of coverage you get separately along with Medicare Part A and Part B. So, you have two choices for drug coverage: Medicare Part A, Part B, and a standalone prescription drug plan (Medicare Part D), or Medicare Advantage with a Medicare Advantage Prescription Drug Plan.
Why Get It? Paying for prescription drugs out-of-pocket can be very expensive. If you are currently taking medication, or think you may need to, it is highly recommended to get a Medicare Prescription Drug Plan.
Who Is Eligible? You must be eligible for Medicare Part A and Part B to get a Medicare Prescription Drug plan.
When Can I Enroll? Both Medicare Advantage Prescription Drug Plans and Standalone Prescription Drug Plans are best purchased during the Initial Enrollment Period or the Open Enrollment Period.
The Initial Enrollment Period is the 7-month period surrounding your 65th birthday — 3 months before you turn 65, the month you turn 65, and 3 months after you turn 65.
After the Initial Enrollment Period, the next time you can enroll in a prescription drug plan is the Open Enrollment Period, which begins on October 15 and ends on December 7. You may also switch Prescription Drug plans during the Open Enrollment period if you are already enrolled in one and would like to change plans.
Lastly, it may be possible to enroll in a Prescription Drug plan during the Special Enrollment Period. It is important to remember that the Special Enrollment Period is only open to those who recently had a major life change, such as a move or a loss of health coverage.
Since Special Enrollment is limited, it is important that you do not miss the Initial or Open Enrollment Periods.