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Medicare is the health insurance coverage provided by the Federal government for: Senior citizens 65 or older and for younger people with certain defined disabilities and/or end stage kidney diseases.

The Federal Government underwrites the health insurance program, MEDICARE that provides basic emergency and preventative care for all Senior Citizens. The program is designed to be  flexible enough to allow individuals to tailor plans to meet their specific individual and family needs.

What is covered by MEDICARE?

Medicare is divided into 4 distinct parts

PART A) Hospital Insurance (HI)

Medicare Part A, or Hospital Insurance (HI), helps pay for hospital stays, including meals, supplies, testing, and a semi-private room. This part also pays for

  •  home health care such as physical, occupational, and speech therapy that is provided on a part-time basis and deemed medically necessary.
  • a skilled nursing facility as well as certain medical equipment for the aged and disabled such as walkers and wheelchairs

 Part A is generally available without having to pay a monthly premium since payroll taxes are used to cover these costs.

PART B) Medical Insurance (MI)

Also called Supplementary Medical Insurance (SMI). It helps pay for medically necessary physician visits, outpatient hospital visits, home health care costs, and other services for the aged and disabled. For example, Part B covers:

  • Durable medical equipment (canes, walkers, scooters, wheelchairs, etc.)
  • Physician and nursing services
  • X-rays, laboratory and diagnostic tests
  • Certain vaccinations
  • Blood transfusions
  • Renal dialysis
  • Outpatient hospital procedures
  • Some ambulance transportation
  • Immunosuppressive drugs after organ transplants
  • Chemotherapy
  • Certain hormonal treatments
  • Prosthetic devices and eyeglasses.

Medicare part B is funded by premiums. These premiums are determined by individual choices of deductibles, co-pays and co-insurances

Together these 2 parts (A+B) are known as ‘original’ Medicare

PART C) Medicare + Choice (Medicare Advantage)

Medicare Part C, or Medicare + Choice, plans allow users to design a custom plan that can be more closely aligned with their medical needs.

These plans (ADVANTAGE PLANS) are run in cooperation with private insurance companies to provide some of the coverage. Details vary based on the program and eligibility of the insured individual. Some Advantage Plans are linked to Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs) to provide preventive health care or specialist services. Others focus on patients with special needs such as diabetes.

For the widest choice of insurers and ‘best value’ offerings contact a private exchange such as TrueCoverage

PART D)

Original Medicare does not include prescription drug benefits, except in certain situations. You can sign up for prescription drug coverage through a separate Medicare prescription drug plan, or through a Medicare Advantage Prescription.

Medigap

A MEDIGAP plan will provide coverage for services or charges not covered by Medicare in parts A&B.  Emergency treatment abroad would be an example.   Medigap plans can give you protection from unanticipated co-pays and deductibles.

Medigap coverage provided by private companies but you must be registered for ‘Original’ Medicare Parts A and B. There are eleven standard Medigap policies available in most states – plans A through G, K and N. Each plan offers a different set of benefits to fill the gap in your Medicare plan. You may purchase only one Medigap plan per person.

How to get started

Check with your local Social Security office to make sure of your position and consider the alternatives; Original Medicare (A and B) are mandatory but you can choose the plan type that suits your needs.  You can add the Medicare advantage plan (C) and if you anticipate the regular use of prescription drugs you should consider plan D.

If you have been paying for your Social Security benefits throughout your adult life, you will be automatically enrolled in Medicare Part A and B when you turn 65. When you are nearing your 65th birthday make sure you check about this at your local Social Security office and also learn about additional coverage.

Check your recent history of medical service usage.  Reflect this in your Medicare planning?

Contact a private health insurance Marketplace such as TrueCoverage for expert and unbiased advice and free quotation based on your personal circumstances.

How much does it cost?

Part ‘A’ of Medicare is funded by Federal Government from taxes. Part ‘B’ covers specified treatments and services. You would be liable for any costs outside these limits. The Affordable Care Act (ACA) defines eleven (11) supplementary plans (MEDIGAP) which offer the opportunity to insure against potentially life affecting outcomes. The exact amount will depend on the plan you choose and the benefits it offers. Make sure you go through the Summary of Benefits and understand the fine print.

Once you have been accepted on a Medicare plan you cannot be refused continued coverage regardless of your circumstances.

TrueCoverage offers free online tools to compare the widest choice of various Medicare plans and give you quotes.

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