Medicare is the second biggest health insurance program in the United States after Medicaid. It pays for the care of millions of patients across the country and influences the business and clinical decisions of millions of providers. Given Medicare’s size and role as a public program, reforms to improve its value have enormous potential to improve the quality of care and health outcomes across the country, as well as generate savings for beneficiaries and taxpayers.
So, we are going to discuss about Medicare health insurance.
Finding the Exact Medicare Plan
Know the Deadline:
There are only certain times you can enrol in Medicare, so make sure you know your penalty-free enrollment window. For most people, it starts three months before your 65th birthday and lasts until three months after your birthday. If you have employment-based health insurance, you may be able to defer enrollment, but check with your benefits manager to see if your employer plan qualifies. If you don’t register when you make your first claim, you may have to pay higher premiums once you register.
If you are already receiving Social Security or disability benefits, you will be automatically enrolled in medical services and hospital care through Medicare.
Existing Insurance Plans:
Before you enrol in Medicare, review any existing insurance plans you plan to continue using. Ask your benefits representative or insurance agent to find out how this plan’s coverage works with Medicare.
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Calculate the Costs:
Most people don’t pay premiums for Medicare Part A (hospital), but you will pay premiums for Part B and other types of Medicare coverage. After you meet the Part B deductible, Medicare pays 80 percent for covered services, and you pay the remaining 20 percent if you don’t have a Medigap policy. Your costs will vary if you choose to go with a Medicare Advantage plan instead of traditional Medicare.
Primary Care Providers:
If it’s important to you to stay with your current healthcare provider, you’ll need to find out if they participate in the plan or plans you’re considering.
If you choose traditional Medicare, you are more likely to be able to stay with your current provider. If you are looking at an HMO Advantage plan, you must choose a primary care physician from their list of approved physicians.
A PPO Advantage Plan gives you a little more freedom and doesn’t require you to use plan-approved doctors. In this case, however, you will pay a higher out-of-pocket cost.
Medicare Health Insurance Options
Part A-Hospital Coverage:
Part A (hospital coverage) covers things like hospital stays, home health care, and some skilled nursing facility care. Medicare Parts A and B are known as Original Medicare.
Most people usually do not pay for Part A if they have paid Medicare taxes for some time while working. However, if you do not qualify for free Part A, it can be purchased for a monthly premium. This amount can vary each year and depends on how long you or your spouse have worked and paid Medicare taxes.
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Part B-Medical Coverage:
Part B (medical coverage) covers things like doctor visits, outpatient services, X-ray and lab tests, and preventive exams.
The short answer is yes, especially if you need the above services. However, if you have health insurance through your current job or have your spouse’s active plan, you can delay your enrollment in Medicare Part B without penalty. Once an employer-covered spouse stops working—whether you or your partner—you have eight months to sign up for Part B. If you want to sign up for a Medicare Advantage plan, you must also be enrolled in Medicare Part B.
Part C-Medicare Advantage:
Medicare Advantage is a private health insurance alternative to the federally-run original Medicare. Think of Advantage as a kind of one-time purchase that combines the different parts of Medicare into one plan. If you choose a Medicare Advantage plan—or MA—you’ll still need to enrol in Parts A and B and pay the premium for Part B. Then, you’ll also need to choose a Medicare Advantage plan and sign up with a private insurer.
The federal government requires these plans to cover everything that Original Medicare covers and some plans pay for services that original Medicare doesn’t cover, including dental and vision care. In recent years, the Centers for Medicare & Medicaid Services, which sets Medicare rules, has allowed Medicare Advantage plans to cover such extras as wheelchair ramps and shower handles for homes, food delivery, and transportation to and from doctor’s offices.
Most Medicare Advantage plans consist of prescription drug coverage. Not all of these plans cover the same extra benefits, so read the plan description carefully. Medicare Advantage plans are generally either health maintenance organisations (HMOs) or preferred provider organisations (PPOs).
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In an HMO, you usually choose a primary care doctor who will manage your care and will usually need to make a referral to see a specialist. PPOs have networks of doctors you can see and facilities you can use, often without a referral. If you go to a provider that is not in the plan’s network, you will likely pay more.
Part D-Prescription Drug Coverage:
The Medicare Prescription Drug Benefit (Part D) is the part of Medicare that provides outpatient drug coverage. Part D is only provided through private insurance companies that have contracts with the federal government – it is never provided directly by the government (unlike Original Medicare).
To get Part D coverage, you must choose and enrol in a Medicare Private Prescription Drug Plan (PDP) or a Medicare Advantage Plan with Drug Coverage (MAPS). Registration is optional (although recommended to avoid future penalties) and is only permitted during approved registration periods. You should usually sign up for Part D when you first become eligible to enrol in Medicare.
You may have creditable drug coverage from your employer or pension insurance. If so, you don’t need to enrol in a PDP until you lose that coverage. Some people who are already enrolled in certain low-income assistance programs may also be automatically enrolled in a Medicare drug plan and get additional financial help to pay for their drugs.
Medicare Advantage plans are another method to get Medicare Part A and Part B coverage. Medicare Advantage plans, sometimes called “Part C” or “MA plans,” are offered by private Medicare-approved companies that must follow rules set by Medicare. These plans set a check on what you’ll have to pay out of pocket each year for covered services. Some plans offer out-of-network non-emergency coverage, but usually at a higher cost. Recall, you must use the card from your Medicare Advantage plan to get Medicare-covered services.
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