Your Easy-to-Read Guide to the Basics of Medicare Coverage

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Back in the mid-1960s, the medical care costs for a typical American family were spiraling out of control. Over half of seniors aged 65 or older had difficulties paying for their medical expenses. Many seniors found that they simply could not afford medical insurance coverage from their health insurance agencies. This is because most medical insurance coverage for senior Americans costs up to three times as much as it did for younger workers. As a result, many seniors wound up with little to no medical care and coverage, with many opting out of any medical care altogether, to their detriment.

A New Safety Net for America’s Senior Citizens

In 1965, President Lyndon B. Johnson signed Medicare into law, as an extension of Social Security. With this program in place, seniors finally had a ‘safety net’ to help offset the high costs of their care. Since the program has become law, Congress has updated it with several changes and updates. This way, the program can keep up with today’s more complex modern medical care system. For example, Congress recently expanded Medicare health insurance coverage to include younger people who have permanent disabilities and other terminal illnesses.

There are 2 main ways a senior aged 65 or older can obtain Medicare health insurance. The first method uses the government-sponsored Medicare plan to help you pay for hospital costs (Part A), doctor and outpatient care (Part B), and medical drugs and prescriptions (Part D). You can choose to include additional “supplemental” medical insurance coverage from private insurance agencies to help you cover the areas that Medicare does not. Let’s go over each section of this process, part by part:

Medicare Part A: In-Hospital Coverage

Part A covers “inpatient” or “in-hospital” coverage. This means that patients are medically covered in the event they need to go to or stay at a hospital, nursing facility, or hospice center for a length of time. Part A covers the patient’s hospital care, food, and medical tests and procedures while staying at the hospital. With Medicare Part A, patients can stay up to 90 days in a hospital inpatient facility, skilled nursing center, hospice or another medical facility. Medicare fully covers the first 60 days of this time, with an annual deductible. After this 60 days, Medicare requires the patient to pay an additional co-pay, per day to continue their stay. If a patient requires more than 90 days of stay in a hospital, Medicare allows for the use of “lifetime reserve days”. Although technically covered by Medicare, these extended days typically require a much higher co-pay per day.

Part B: Doctor and Outpatient Care

Medicare Part B follows up on Part A for medical coverage. Medicare Part B covers ‘medically necessary services’ to diagnose and treat serious conditions. This includes doctor visits, ambulance services, inpatient or outpatient services, and other services outside of hospital stays. It also helps to cover certain “preventative services”, such as diabetes testing, glaucoma screening, and cancer screening examinations. Medicare Part B typically requires that the insured person pay a monthly premium to take advantage of it, as well as an annual deductible. It also requires the patient to share a percentage of costs. There is no maximum out of pocket expenses for these costs.

Medicare Part D: Prescription Drug Coverage

Part D of Medicare covers prescription drugs and medications. Typically, Medicare Part D is offered as a separate and optional stand-alone plan. Private health insurance agencies usually manage and maintain their own Medicare Part D plans. Because of this, Medicare Part D plans typically come with a premium that the patient has to pay. However, Medicare still regulates these plans. This means that there is oversight over the plans they offer. Also, unlike Medicare Parts A and B, Medicare Part D coverage is not standardized between plans. Because of this, costs and coverages for prescription drug plans under Medicare Part D vary greatly between insurance carriers.

Medicare Supplement Health Insurance: Coverage Above and Beyond Medicare

These additional plans do exactly what they say they do- they supplement or augment the coverage provided by Medicare. They are also known as ‘Medigap plans’ because they help fill in the gaps in Medicare-provided coverage. Many health insurance agencies offer these plans separately to patients as a way to keep medical coverage up where Medicare stops. This typically includes out of pocket costs for Medicare Parts A and B, as well as the annual deductible required. There are many Medicare Supplement plans offered by health insurance agencies. Because of this, plan premiums and coverage offered can vary greatly between them. This is where a good health insurance agent can help sift through the numerous plan options offered, and find the right one for you.

A Better and Simpler Way to Medical Coverage: Medicare Part C

As mentioned above, there are two methods to obtain Medicare. The first method involves obtaining Medicare Parts A, B, and usually D. This method can be complex. It requires the completion of many forms, along with quite a bit of time to set each part up properly. You will need a separate ID card for each part, which can make juggling ID numbers for coverage difficult. To help with this, Medicare and Health Insurance Agencies have come up with Medicare Part C.

Medicare Part C is also known as a ‘Medicare Advantage’ insurance plan. This is a single medical insurance plan, offered by private health insurance agencies. The plan combines coverage for Medicare Parts A and B into a single, more efficient package. Most Medicare Part C plans also include coverage for Medicare Part D as well. In addition, Part C medical insurance plans cover the gaps in Medicare health insurance coverage, just like a Medicare Supplement plan does. Because of this, you do not need a separate Medicare Supplement plan either.

Medicare Part C plans can cover all your health insurance needs in a single, easily manageable plan. There are no additional premiums to pay, and you use just one insurance ID card for all your medical services. Many health insurance agencies offer Medicare part C plans. Each plan has its own coverage options, benefits, advantages, and disadvantages. And these plans can also change from year to year. Because of this, it’s best to speak with an expert health insurance agent, who can help you navigate the numerous plans available.

Health Insurance Agencies Help you get Coverage Through Medicare

A good health insurance agent can be of great assistance to those getting into Medicare. Many health insurance agencies will help a senior go over their Medicare options for free, through workshops, or even a personal review. In addition, most health insurance agencies contract with a wide variety of insurance plans. This allows them a range of plans and options that will benefit you the most, within your budget. Even if you decide not to purchase a health insurance plan, an insurance agent can help you understand the process of obtaining Medicare, and give you valuable information to understand both yours and Medicare’s obligations. With a professional health insurance agent assisting you, you can get the most out of Medicare. This way, seniors can enjoy their golden years without the worries or stress from their medical care expenses.

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