Understand Medicare Solutions
Medicare Part A
Medicare Part A covers your hospital expenses. This includes hospital stays, skilled nursing care, hospice, and home health-care services. You may have to pay various deductibles, coinsurance, and copayments. You earn Part A by paying taxes toward Medicare while working for 10 years (or 40 quarters). If you did not earn Part A, you will pay a premium.
Medicare Part B
Medicare Part B covers services that treat illnesses or conditions such as doctor’s office visits, lab work, x-rays, and outpatient surgeries. It also covers preventive services like cancer screenings and flu shots. Part B also covers medically necessary durable medical equipment such as wheelchairs and walkers to treat a disease or condition. Most people pay a premium for Part B. Even if you are enrolled in a Medicare Advantage plan that provides your Part A and Part B benefits, you will still pay your Part B premium.
Medicare Part D
Original Medicare doesn’t cover prescription drugs. Although Medicare Part D coverage is optional, it can be valuable if you take medications. You will pay a late-enrollment penalty if you don’t sign up for Medicare Part D Coverage when you are first eligible. You can get Medicare Part D prescription drug coverage either through an independent Prescription Drug Plan (PDP), or through a Medicare Advantage Plan that includes prescription drug coverage.
How Medicare Advantage Give You the Edge
Comprehensive Coverage: Medicare Advantage plans often offer more comprehensive coverage than Original Medicare, including benefits for vision, dental, and hearing care that are not covered by Medicare Parts A and B.
Cost Savings: Many Medicare Advantage plans have low or no monthly premiums in addition to the Part B premium, and they provide a cap on out-of-pocket expenses, which can lead to significant cost savings for beneficiaries.
Prescription Drug Coverage: Medicare Part D and many Medicare Advantage plans include prescription drug coverage, helping to reduce the costs of medications. This is a crucial benefit for many seniors who require ongoing medication.
Customization and Choice: With a variety of plans available, beneficiaries can choose the coverage that best fits their health needs and budget. This includes different types of Medicare Advantage plans (like HMOs, PPOs, and Special Needs Plans) and various Medigap policies that supplement Original Medicare.
Simplicity and Convenience: Medicare Advantage plans consolidate coverage into a single plan, making it easier to manage healthcare benefits. This can be more convenient than juggling multiple parts of Original Medicare and separate drug or supplement plans.
Additional Benefits: Some Medicare Advantage plans offer extra benefits, such as fitness programs (like SilverSneakers), over-the-counter drug allowances, and telehealth services, which are not typically covered under Original Medicare.
Network of Providers: Many Medicare Advantage plans offer access to a network of doctors and hospitals. This can simplify the process of finding healthcare providers and ensure care coordination within the network.
Guaranteed Acceptance for Medigap: During the initial enrollment period, insurance companies must accept any applicant for a Medigap policy, regardless of health conditions (except in specific circumstances). This is a critical selling point for those looking for supplemental coverage without fear of denial.
Protecting Against High Out-of-Pocket Costs: Medigap policies help cover some of the costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles, protecting beneficiaries from unexpected high out-of-pocket expenses.
Annual Opportunity to Change Plans: Medicare beneficiaries have an annual opportunity during the Open Enrollment Period to change plans or switch between Medicare Advantage and Original Medicare, allowing them to adapt their coverage to changing health needs and preferences.
Special Needs Plans (SNPs): Medicare Advantage offers SNPs for individuals with specific diseases or characteristics, providing specialized care and coverage tailored to their unique health needs.
Preventive Services at No Extra Cost: Medicare Advantage and Part D plans support preventive care by covering screenings and vaccinations, which can help catch health issues early when they're more manageable.Comprehensive Coverage: Medicare Advantage plans often offer more comprehensive coverage than Original Medicare, including benefits for vision, dental, and hearing care that are not covered by Medicare Parts A and B.
Cost Savings: Many Medicare Advantage plans have low or no monthly premiums in addition to the Part B premium, and they provide a cap on out-of-pocket expenses, which can lead to significant cost savings for beneficiaries.
Prescription Drug Coverage: Medicare Part D and many Medicare Advantage plans include prescription drug coverage, helping to reduce the costs of medications. This is a crucial benefit for many seniors who require ongoing medication.
Customization and Choice: With a variety of plans available, beneficiaries can choose the coverage that best fits their health needs and budget. This includes different types of Medicare Advantage plans (like HMOs, PPOs, and Special Needs Plans) and various Medigap policies that supplement Original Medicare.
Simplicity and Convenience: Medicare Advantage plans consolidate coverage into a single plan, making it easier to manage healthcare benefits. This can be more convenient than juggling multiple parts of Original Medicare and separate drug or supplement plans.
Additional Benefits: Some Medicare Advantage plans offer extra benefits, such as fitness programs (like SilverSneakers), over-the-counter drug allowances, and telehealth services, which are not typically covered under Original Medicare.
Network of Providers: Many Medicare Advantage plans offer access to a network of doctors and hospitals. This can simplify the process of finding healthcare providers and ensure care coordination within the network.
Guaranteed Acceptance for Medigap: During the initial enrollment period, insurance companies must accept any applicant for a Medigap policy, regardless of health conditions (except in specific circumstances). This is a critical selling point for those looking for supplemental coverage without fear of denial.
Protecting Against High Out-of-Pocket Costs: Medigap policies help cover some of the costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles, protecting beneficiaries from unexpected high out-of-pocket expenses.
Annual Opportunity to Change Plans: Medicare beneficiaries have an annual opportunity during the Open Enrollment Period to change plans or switch between Medicare Advantage and Original Medicare, allowing them to adapt their coverage to changing health needs and preferences.
Special Needs Plans (SNPs): Medicare Advantage offers SNPs for individuals with specific diseases or characteristics, providing specialized care and coverage tailored to their unique health needs.
Preventive Services at No Extra Cost: Medicare Advantage and Part D plans support preventive care by covering screenings and vaccinations, which can help catch health issues early when they're more manageable.