You might think the medicare plans labeled Part A, Part B, Part C, and Part D would be as easy as ABC…   If only!

In this article, we try to reduce nearly 500 pages of legalese into some broad guidance and explain medicare for all. Read this article to understand the principles and to help you make choices.

Renewing or Enrolling for medicare plan for the first time, read on to explore your options.  Make the most of your opportunity windows

  • Renewing Medicare plan? Now until Feb 28th
  • Turning 65? 3 months before and 3 months after your birth month

The AFFORDABLE CARE ACT embraces the Health Insurance needs of the entire US population.

Broadly speaking, the whole population benefits from preventative health programs e.g. immunization and emergency medical treatment.

The AFFORDABLE CARE ACT also ensures that Seniors (i.e. citizens aged 65 and over) and certain groups with defined life-limiting conditions at any age can be assured of the necessary life-sustaining medical and care support they need.

Medicare for all explained (parts A, B, C, and D)

1.) Medicare PART A

Essential hospital services

If you or your spouse have paid Medicare taxes for 10 or more years your Medicare Part A is premium free.  Medicare Part A covers:

  • Emergency care
  • Hospitalization
  • Skilled nursing
  • Hospice care
  • Home health services

The deductible is $1316.  Free hospital stays and skilled nursing facilities are limited to 60 and 20 days respectively and thereafter on a sliding scale.

If you have an incomplete record of Medicare taxes your premium will be between $225-$415 pm.

2.) Medicare PART B

Essential Doctor’s and medical costs
  • Visits to Doctor’s office
  • Laboratory services
  • Medical equipment
  • Mental health services
  • Outpatient and ambulatory (walk-in) services

Medicare Part B is a contributory plan. The standard premium (2020) is approximate $140 pm (but may be higher depending on income). You will pay less if you receive Social Security benefits. The average monthly payment is less than $110.

The deductible, i.e. the bills you pay in full before your plan comes into action, will be less than $200 (each contract period). 

Your insurer will be responsible for 80% of further allowable expenses.

Sounds good: Medicare Plans A+B cover the essentials

But, in the event of a long-term hospital stay or an extended need for medication, prescription drugs or skilled nursing you could face life challenging costs.

The ACA (Obamacare) provides both security and choice.

Security comes from the Federal and State commitment to underwriting the cost of basic medical and health care. Health exchanges ensure that there is a competition between both insurers and provider networks.

The choice comes from the options to build on the ACA foundations to meet individual circumstances.

3.) Medicare PART C (aka Medicare Advantage)

Depending on your additional choices a Medicare Advantage Plan / Medicare Part C combines your Medicare A & Medicare B plans (at a lower premium!) and allows you to add protection according to your specific needs.

Medicare advantage plan may cost nothing but, depending on your choices, can provide the additional security you need for as little as $100 pm.

There are some limitations to medicare advantage plan

  • You will only be able to use ‘in-network’ doctors, hospitals and specifically referred specialists
  • Coverage will be restricted to your local area
  • Costs and coverage may change at renewal

But you do have options to change during the appropriate enrollment periods.

4.) Medicare supplements plan

Without losing the benefits of ACA (Obamacare) you can use medicare supplementary insurance to

  • Reduce or eliminate your out of pocket expenses
  • Give yourself a wider choice of doctors, hospitals, and specialists
  • Be certain of medical coverage when you travel

BONUS!

Once agreed, the coverage is guaranteed and the costs fixed during the lifetime of the policy.

FINALLY

You can add ‘prescription’ drugs (Medicare Part D) to any combination of plans which include Medicare Part A, or automatically through your choice of Medicare Advantage Plan.

If you anticipate the immediate or long term need for prescription drugs you should discuss your circumstances with your doctor. 

The average monthly premium cost is about $35 pm but might be considerably higher depending on your choice of branded or generic drugs.

Contact the exchange of your choice. Even if you start ‘on-line’ select the medicare plan(s) that best reflect your needs and circumstances and discuss them with a qualified advisor.  Most private exchanges (like TrueCoverage) will call you back to give free, unbiased advice.

The role of the exchanges is to ensure that you have informed access to good value health insurance coverage.

The choice of Insurance Company (carrier), choice of medicare plan (any combination of A, B, C &D) is always YOURS.  You can be assured that all plans offered on ‘the exchange’ display a ‘STAR’ rating (5 stars is best).

The STAR RATING offers you a reliable means of comparing the quality and performance of competing plans in key areas of the service being delivered.

In this case

  1. Medical care
  2. Member experience
  3. Plan Administration

Turning 65 in 2020?

You have a window of 3 months before your birthday month and 3 months after, to take the best advantage of Medicare.

  • Talk to your physician
  • Contact your preferred Healthcare Exchange
  • Contact the exchange of your choice. Even if you start ‘on-line’ select the plan(s) that best reflect your needs and circumstances and discuss them with a qualified advisor.  Most private exchanges (like TrueCoverage) will call you back to give free, unbiased advice.
  • The role of the exchanges is to ensure that you have informed access to good value health insurance coverage.

Source: What is Medicare?

Share This