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Medicare Coverage

Original Medicare is the federal health insurance program for people who are 65 or older, or those who have certain disabilities or chronic conditions.

Medicare is divided into several parts:

  1. Medicare Part A: This covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
  2. Medicare Part B: This covers doctor services, outpatient care, preventive services, and medical equipment.
  3. Medicare Part C (also known as Medicare Advantage): This is an alternative to traditional Medicare, where beneficiaries can receive their Medicare benefits through a private insurance company that contracts with Medicare.
  4. Medicare Part D: This covers prescription drugs.

To enroll in Medicare, individuals must meet certain eligibility requirements and apply during specific enrollment periods. Some people are automatically enrolled in Medicare, such as those who are already receiving Social Security benefits.
There are costs associated with Medicare, including premiums, deductibles, and coinsurance. However, the program helps to make healthcare more affordable for millions of Americans.

When you are ready to go on Medicare, we are here to help! The process can be confusing and choosing the right plan for you can seem challenging. 2PM Insurance is happy to walk you through the process. We break down the steps and make the process more manageable and easier to understand. We aim to explain all the parts of Medicare and what it will offer you.

Caring and clear advice will help you make sense of how Supplements, Advantage Plans and Prescription Plans will work with your individual medical and financial needs.

Medicare Supplements

Medicare supplements, also known as Medigap plans, are private health insurance policies that help cover some of the costs that Original Medicare doesn’t cover, such as deductibles, coinsurance, and copayments.

Medicare supplements work alongside Original Medicare, so you need to be enrolled in both to benefit from them. There are ten standardized Medigap plans (A, B, C, D, F, G, K, L, M, and N) available in most states. Each plan offers a different level of coverage, but all plans with the same letter must provide the same benefits, no matter which insurance company you buy them from.

It’s important to note that Medigap plans don’t cover prescription drugs. For prescription drug coverage, you need to enroll in a Medicare Part D plan or have a Medicare Advantage plan that includes drug coverage.

Medicare supplements can be a valuable tool for those who need extra coverage for their medical expenses. However, they do come with additional monthly premiums, so it’s important to compare plans and prices to find the one that best fits your needs and budget.

9 things to know about Medicare Supplement policies.

  1. You must have Medicare Part A and Part B.
  2. A Medicare Supplement policy only supplements your Original Medicare benefits.
  3. You pay the private insurance company a monthly premium for your Medicare Supplement policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.
  4. A Medicare Supplement policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
  5. You can buy a Medicare Supplement policy from any insurance company that’s licensed in your state to sell one.
  6. It’s important to compare Medicare Supplement policies since the costs can vary between plans offered by different companies for exactly the same coverage and may go up as you get older.
  7. Any standardized Medicare Supplement policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medicare Supplement policy as long as you pay the premium.
  8. Medicare Supplement policies can no longer be sold with drug coverage, but if you have an older Medigap policy that was sold with drug coverage (before January 1, 2006), you can keep it. You may choose to join a separate Medicare Prescription Drug Plan (Part D).
  9. Medicare Supplement polices generally do not cover, Long-term car, private-duty nursing, vison or dental, hearing or eyeglasses.

Advantage Plans

Medicare Advantage plans, also known as Medicare Part C, are health insurance plans offered by private insurance companies that provide coverage for Medicare-eligible individuals. These plans are an alternative to Original Medicare (Part A and Part B) and offer additional benefits, such as prescription drug coverage, dental, vision, hearing, and wellness programs, that are not typically covered by Original Medicare.

When you enroll in a Medicare Advantage plan, you still receive all the benefits of Original Medicare, but your coverage is provided by the private insurance company you select. The insurance company receives funding from the government to provide your Medicare benefits and must follow the rules set by Medicare.

Medicare Advantage plans may have different rules, costs, and restrictions than Original Medicare. Some plans require you to use a network of doctors and hospitals, while others allow you to go out of network for care but may charge you more. In general, Medicare Advantage plans have lower out-of-pocket costs than Original Medicare, but the trade-off is that you may have less flexibility in choosing your healthcare providers.

To enroll in a Medicare Advantage plan, you must first be enrolled in Medicare Part A and Part B. You can then choose a plan from those available in your area. These plans have an annual open enrollment period, which typically runs from October 15 to December 7 each year. During this time, you may change your advantage plan.

Prescription Plans

Medicare Prescription plans, also known as Medicare Part D, is a program that helps Medicare beneficiaries pay for prescription drugs.

It is offered by private insurance companies approved by Medicare and is available to people who are enrolled in Original Medicare (Part A and Part B) and some Medicare Advantage (Part C) plans.

The plan covers a range of prescription drugs, including those not covered by Original Medicare. Medicare Prescription plans typically have a monthly premium and may also have deductibles, copayments, and coinsurance. The costs and coverage of the plan vary depending on the specific plan and the drugs prescribed.

It is important to review and compare different plans to ensure that the plan chosen covers the necessary medications and provides the best value for the premium paid. Once enrolled in a Part D Prescription plan, you will want to review the plan annually during the Annual Enrollment period between October 15th and December 7th.

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