Medicare

Medicare is the federal government healthcare program that subsidizes healthcare services for adults over 65. The plan also covers people younger than 65 who qualify through disability and those with certain diseases, including end-stage renal disease and amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease). To qualify for Medicare, an individual must be either a U.S. citizen or a legal permanent resident that has been in the country for at least five continuous years.

Medicare is separated into different parts that cover a variety of medical situations. While Medicare provides beneficiaries with more choices in terms of coverage and costs, it also presents complexity for the people looking to enroll. Here is an overview of how Medicare parts.

Original Medicare & Plan F

Pros: 

  • Covers remaining 20% of Medicare A & B
  • Any doctor or any hospital that accepts Original Medicare nationwide (No Networks) 
  • No referral needed to see a specialist
  • No deductibles, No coinsurance, No copays
  • You can switch to another Medicare Supplement plan anytime of the year
  • Guaranteed renewable as long as premiums are paid

Cons:

  • Average Monthly premium ranges from $135.00 to $250.00 and up
  • Rate increase averages 10 to 12% each year 
  • Thorough underwriting needed to switch plans at age 66 and over
  • Drug, dental, vision, and hearing plan not included on most plans
  • Plans will no longer be offered to anyone Medicare-eligible starting Jan. 1, 2020

Original Medicare & Plan G

Pros: 

  • Covers remaining 20% of Medicare A & B
  • Any doctor or any hospital that accepts Original Medicare nationwide (No Networks)
  • No referral needed to see a specialist
  • $203.00 annual deductible, No coinsurance, No copays
  • You can switch to another Medicare Supplement plan anytime of the year
  • Guaranteed renewable as long as premiums are paid

Cons: 

  • Average Monthly premium ranges from $90.00 to $110.00 and up
  • Rate increase averages 1 to 3% each year 
  • Thorough underwriting needed to switch plans at age 66 and over
  • Drug, dental, vision, and hearing plan not included on most plans

Medicare Advantage Plans

Pros: 

  • Combines Medicare A, B, and usually D
  • $0.00 to $100.00 monthly premiums depending on the plan you choose
  • Drug plan usually included
  • Dental, vision, and hearing usually included
  • Silver sneaker benefit on most plans
  • No underwriting

Cons: 

  • Must stay in-network for coverage (No coverage outside of network unless emergency room visit)
  • Plan can drop anytime during the year
  • Providers can leave the network anytime during the year
  • Referrals are usually required to see a specialist
  • Copays, coinsurance, and deductibles apply
  • Up to $7,550.00 max out of pocket depending on the plan
  • 1-year minimum contract plan
  • Prior authorizations needed for certain procedures

How Does Medicare Work?

Medicare is a health insurance program created by the United States federal government. While Medicare is a federal government healthcare program, private health insurance companies can and do play a significant role in providing subsidized health plan coverage. 

A Medicare beneficiary can decide to receive their benefits through private health insurance companies, or you can decide to receive Part A and Part B healthcare coverage and enroll in a Medicare Prescription Drug Plan (Part D) with a private health insurance company.

Medicare Parts

To understand the essentials of Medicare, it is crucial to learn the different parts of Medicare coverage, which include:

  • Medicare Part A: This is a part of the Original Medicare plan that covers inpatient care and hospital stays. Medicare Part A is vital in case you have a sudden illness or unexpected injury that requires inpatient care.
  • Medicare Part B: Medicare Part B is the other part that makes up Original Medicare. This part includes long-term preventive care, doctor visits, medical supplies, medical tests, and X-rays. Medicare Part B covers health care visits that help you stay healthy.
  • Medicare Part C (Medicare Advantage): This is an all-in-one Medicare plan that combines Original Medicare and usually Medicare Part D to provide more health care options. Most Medicare Part C plans include coverage for prescription drugs, hearing aids, vision, and dental care.
  • Medicare Part D: This part of Medicare covers prescription drugs. Part D is offered as a standalone prescription drug plan through private insurers, with the monthly fee varying among the private insurance companies.
Part B Premium
Where Can I Find Out More About Medicare?

If you are new to Medicare or know someone who is, and you are looking for someone who can help you make the transition easier, contact Great Nation Insurance.

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