Medicare Summary
Medicare is a government run insurance created by the Centers for Medicare and Medicaid Services (CMS). Of course to be eligible, you must be a citizen and meet certain requirements. These requirements include being 65 or older, if you’re under 65 with disabilities, or if you have End-Stage Renal Disease. If you meet any of these categories, then you’re eligible for Medicare.
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Be aware that there are two different Medicare plans: The Original Medicare Plan and Medicare Advantage Plan. These plans are then further broken down into parts A, B, C, and D. You will be given a summary of each one. We’ll also discuss Medigap, and the different between Medicare and Medicaid.
The Original Medicare Plan covers only part A, but you can add parts B and D if you choose. All applicants are automatically enrolled into the Original Medicare Plan. However, they can ask to go on the Medicare Advantage Plan. This plan is also known as part C. The government owns and runs the Original Medicare Plan. Of course, you should be aware that this plan is offered on a fee-for-service basis. This means that some people will have to pay a deductible, co-pay, or co-insurance.
We talked about part A, which is a Medicare provided hospital insurance plan. Some people won’t end up paying a premium for this plan. Part A covers all the following: inpatient care in skilled nursing facilities, critical access hospitals, hospitals, and hospice and home health care.
Part B, on the other hand, is only for Medicare provided medical supplies and services. Some people will also have to play a premium for this coverage. Part B covers all the following: outpatient care, doctor’s services, physical or occupational therapy, and additional home health care.
The Medicare Advantage Plan combines both parts A and B. As stated before, this plan also known as part C. This plan is provided by private insurance companies instead of the government. You may have to add plan D, if not already included. HMOs, PPOs, private fee-for-service plans, and Medicare special needs plans are all part of the Medicare Advantage Plan. Some advantages include lower costs and extra benefits.
Part D is a plan in itself that offers prescription drug. Again, some people will have to pay a premium for this coverage. Most medically necessary drugs are covered, but plans do vary. It’s up to you to decide which drug plan is right for you.
The biggest misconception about Original Medicare Plan is that it has 100% coverage. You will have to pay deductibles, co-pays, and co-insurance. But Medigap will help pay the costs that Medicare doesn’t cover. It was offered by private health insurance companies to help fill in those gaps. With both of these plans, their shares will be paid to the health care provider.
Medigap only works with the Original Medicare Plan, for parts A and B. Medigap only covers one person per policy, so you and your spouse will have to purchase separate plans. Depending on what state you live in, you will get to choose among 12 different policies. These are known as Medigap plans A through L. We won’t get too in depth, but they do offer a different set of standards and benefits. These are also the case for every insurance company. Become aware though that Medigap plans no longer covers prescription drugs.
Medicaid is on the different side of the health spectrum. It’s a government owned health care plan that offers insurance to those who can’t afford to pay insurance. You will have to meet eligibility and income requirements in order to qualify. Some eligibility requirements include pregnancy, disability, age, blindness, income and resources, and U.S. citizenship. To see if you qualify, just contact your State Medical (Medicaid) Insurance. Also become aware that Medicaid runs differently in each state. With Medicaid, your bills will be sent to your health care provider. Most of time, you may not even get any bills.
As stated before, Medicare doesn’t cover everything. That’s where Medicaid comes in for those who are eligible. If you have both programs, almost all of your costs will be covered.
All of these programs were designed to help people stay and become healthy. For more information or for any questions you may have on these programs, visit the government section of your phonebook. You will find hotlines on the above health insurance programs. You can also visit your state’s web site for more information.