What You Need to Know About Medicare Insurance

Medicare is the health insurance program offered by the federal government which is available to people who are aged 65 or older. Learn more today!

This health insurance can be used by those with disabilities. It was introduced as an extended overage option for the elderly and those who are less wealthy. Those without jobs are also in need of health insurance since they are not privy to employer-based insurance, thus Medicare is useful for them.

What Does Medicare Cover?

As you get older, healthcare costs can skyrocket as you are taking necessary precautions to keep yourself healthy. If you're 65 or older, it is best to learn more about Medicare and how you could benefit from having your medical costs. However, it is best to first determine what exactly Medicare insurance can cover for you. Open enrollment for Medicare falls between October 15th and December 7th each year, so it is best to look for Medicare coverage then. Most medical expenses can be covered by "Original Medicare" which normally includes Part A and B. Original Medicare is a fee for service health coverage plan that covers basic medical expenses assuming you have paid your deductible for each. In cases where Medicare Part A and Part B do not cover anything, there is additional Medicare coverage you can look into. This additional Medicare coverage covers items like prescription drugs and Medigap.

The Parts of Medicare Coverage Explained

There are four different healthcare plans within the Medicare program. They are known as Medicare A, B, C, and D. The primary plans are Medicare A and B, and the others are typically add-on plans.

Plan A: This plan covers any hospital costs, including being admitted to the hospital and receiving hospital care. Hospital care can be care in a nursing home, or even home healthcare services, depending on the circumstances. This Medicare plan covers routine things such as lab tests, surgeries, doctors’ visits, and things such as wheelchairs or walkers that are deemed as medically necessary in order to treat a condition the patient has.
Plan B: This option is relatively similar to Plan A in that it covers the majority of health issues one would go to the doctor for such as routine visits, outpatient/inpatient services, lab tests, medical equipment, and preventative services. Preventative services can be defined as any treatment that is used to prevent an illness, such as the flu, by detecting it in an early stage and employing treatment to stop it from starting. Doctors who treat Medicare members cannot charge their patients more than 115% of the approved amount by the program.
Plan C: Medicare C is also known as the Medicare Advantage plan. To use this plan, one must be enrolled in either Medicare A or B first, and then are given this plan which offers benefits in dental plans, vision, hearing, and prescription drug coverage. Usually advantage plans are offered only by private companies who arrange contract agreements with the Medicare program in order to provide them with Part A or B benefits. These advantage plans primarily cover prescription drugs, and the pricing differs by plan provider, so it’s best to compare plans available in the area.
Plan D: This last plan combines prescription drug coverage with one of the original Medicare plans and other included costs. Plan D is offered by insurance companies as well as other private companies that have been approved by Medicare to offer their members these plans. It is possible that Plan D may interfere with the advantage plan, so it is necessary to speak with a Medicare representative before choosing the plan.

Qualifications for Medicare Insurance: Are You Eligible?

In some instances, individuals can be approved automatically for Medicare Part A and B, while others may have to sign up for it. Approval for these plans is based on whether or not the individual gets Social Security benefits. Those who already have disability benefits or are 65 or older are automatically approved for this health insurance and can choose if they want the advantage plan (Plan C) and/or the prescription drug coverage (Plan D). It is best to consult with a Medicare representative to see what specific qualifications are needed. For more information about Medicare eligibility, check out this helpful Medicare resource.

Average Costs of Medicare

Medicare costs fluctuate with the provider you select, the area where you live, and other personal factors. In general, Part A is given to qualified insureds at no cost. If you are those who do not qualify for a free Part A plan, then expect to pay $471 a month for Part A. However, if you paid Medicare taxes for at least 30-39 quarters, then your Part A monthly cost would be $259.

Part B will run you on average around$148, but your deductible and coinsurance cost is $203 in addition to that cost. Plan to pay around 20% of any doctor’s services, therapy or for medical equipment.

Part C premiums can vary widely and is largely determined by the issuing agency. Part C, often referred to as the Advantage Plan, combines Part A and B with vision and dental coverages added in. Part D covers prescription drugs not covered by Part B, and like Part C can vary widely depending on the insurance carrier. Detailed medical costs and exact coverages for most Medicare plans can be found here.

Where to Apply for Medicare

In most instances you automatically get Medicare Part A when you turn 65 years of age. However, Part B must be elected. This means you must sign up for it separately. To do that simply contact and apply one of the following (make sure they are operating in your state…not all do):

Humana

Human is one of the most affordable Medicare plans in the U.S. However, this means you may end up paying a little more in co-pays, and out of pocket costs. Still, it is one of the most popular Medicare Part B plans.

United Health Group

United has 1.3 million doctors and health professionals with nearly 6,500 hospitals who accept their insurance nationwide. They are one of the largest healthcare networks in the U.S.

Aetna

Aetna expanded their life insurance company to also include health care. Aetna is a good mid-priced insurance but is not always available in all states.

Cigna

Cigna’s Part B plans are universally loved because of the wide network of professionals. Many items are covered under Cigna that are not covered under other plans.

Medicare Open Enrollment

You can enroll in Medicare October 15-December 7^th in 2021. However, if you just turned 65 or will turn 65 well before, or well after the open enrollment date, then you can enroll under a special enrollment period. After your first initial enrollment you must wait until the open enrollment time each year to make changes or additions. Keep in mind if you opt not to take Part B initially, then change your mind later, you will incur a penalty for each month thereafter.