Are you confused by all of the available Medicare plans? You’ve come to the right place for the answers you need.
Americans are lucky enough to have the Medicare program to rely on for healthcare when they get to their golden years. Hospital and medical coverage are so critical for everyone, but that need increases as we age. And after retirement, many seniors might have to forego health insurance, medical care, and treatment if it weren’t for this program.
Medicare is run by the CMS or the Centers for Medicare and Medicaid Services. It’s funded in part by Medicare and Social Security taxes that you pay as part of your income taxes, and partly by the federal government. In addition to those who are age 65 or older, the program insures people on Social Security Disability as well as individuals who suffer from renal failure and who require dialysis or a kidney transplant.
How does the program work, and what does it offer? There are multiple plans depending on your age, your health, and the type of coverage you require. It can be a bit overwhelming if you’re just starting to dig into the information, that’s why we’re here to help. Norgard Insurance Group has all of the information you need on the different plans, and we’re going to break it down for you. There are four parts to the program that include hospital and medical, an advantage plan to cover supplement costs, and prescription drugs. Take a look at how they work together.
Medicare Part A
Medicare Part A is the hospitalization part of the program. It covers inpatient care at a hospital, skilled nursing facility, or hospice. There are some restrictions to coverage.
- Hospital admission must be ordered by an official doctor
- There must be an indication and documentation by your doctor that your illness or injury requires inpatient care
- Your admission must be to a facility that accepts Medicare
The specific types of facilities approved for inpatient care include:
- Acute care hospitals
- Critical access hospitals
- Inpatient rehabilitation facilities or skilled nursing facilities
- Long-term care hospitals
- Care as part of a qualifying clinical research study
- Mental health care facilities and hospitals – mental health inpatient care is limited to 190 total over the course of your Medicare coverage
While admitted to inpatient care, you can rest assured you will be covered for your medical care by the hospital medical staff. There are certain inclusions under Part A, including semi-private rooms, meals during your stay, nursing care, prescription medication or medication necessary for your inpatient treatment, and other necessary hospital supplies and services. Depending on your coverage, you may be responsible for a percentage of the bill after your stay.
If you choose to add other services or amenities during your stay, you will be responsible for the cost and payment. These include, but are not limited to a private room, private-duty nursing, television service, and a telephone in your room.
Medicare Part B
Medicare Part B is the medical insurance portion of the program. This part of the plan covers your medical expenses that are not related to hospital stays. These include services that are medically necessary and preventative services. They break down like this:
- Medically necessary services:
- Durable medical equipment
- Ambulance service
- Clinical research
- Mental health care
- Services necessary to diagnose illness or injury
- Services or supplies necessary to treat a medical condition
- Preventative services:
- Annual wellness visit or physical
- Bone density testing
- Cardiovascular disease screenings
- Doctor’s visits
- Blood work and lab tests
- Well-woman exams, including mammograms and screenings for cervical and vaginal cancer
- Colonoscopies and colorectal cancer screenings
- Depression screening
- Diabetes screening
- Glaucoma testing
- Hepatitis screening
- Lung cancer screening
- Nutrition therapy
- Prostate cancer screening
- Preventative vaccines including flu, hepatitis B, and pneumococcal shots
There are additional preventative services included in your coverage. You can check the Medicare website to see if a test or service is covered. There are annual deductibles and premiums required with the Part B plan.
Medicare Part C
Some individuals require additional coverage for specific conditions, illnesses, or healthcare needs. That’s where Medicare Part C or Medicare Advantage can be beneficial. Part C is a supplemental plan that can often cover some or all costs not covered by Parts A and B. Individuals can incur a 20% cost when they use healthcare services under Parts A and B. Part C will cover some or all of those costs.
The biggest difference between Parts A and B and Medicare Advantage is that the supplemental plans are offered through private insurance companies, such as Norgard Insurance Group. Like all other private insurance providers, Norgard has a contract through CMS to provide this supplement to the Medicare packages. While Part C is optional, it can reduce your out of pocket expenses significantly over time.
Medicare Part D
Like Part C, Part D is optional coverage, but it is available to everyone enrolled in the Medicare Part A and Part B plans. While this part of the plan does include a large number of prescription medications, it does not cover all medications. You can find out if your particular medication is covered on the Medicare website.
It’s important to be careful when deciding whether or not to enroll in Part D. If you don’t enroll when your eligibility begins, you may be required to pay a late enrollment fee for as long as you have the plan. If you have prescription coverage through another source such as an employer, Department of Veterans Affairs, the Indian Health Service, a pension program, or a Medicare supplement plan, you may not need Part D. It’s essential that you consider what your current plan covers and what Medicare Part D covers so you can make an informed decision about carrying one or the other, or both.
Help Choosing the Right Medicare Plan
If your head is spinning from all of this plan information, you’re not alone. It can be daunting to try to manage the information and make the right choices for yourself and your spouse or family member. The team at Norgard Insurance Group is available to answer all of your questions regarding Medicare plans, and more. Contact us for help and guidance when it’s time for you to start thinking about enrollment.