Is This Guide For Me?
Not quite sure if this guide is right for you? Ultimate Medicare Guide content is for readers who are eligible for Medicare and is confused and overwhelmed. This guide will navigate you through the maze of Medicare to a position that enables you to maximize your Medicare.
Introduction
Medicare and retirement are some of the most challenging choices in life. Retirement seems to have about a zillion moving parts and is one of the most complexes in Medicare. There are a lot of rules with Medicare. If you fail to follow them, you will miss deadlines and pay more. You may wind up not being covered or reimbursed.
It is astounding how many things to consider when signing up for Medicare. For example, Medicare Parts A, B, C, & D, Advantage Plans, Prescription Drug Plans, Supplement Plan, Medigap Plans, Donut Hole, IRMA, LEP, IEP, AEP, and the list goes on. This thorough & easy to understanding guide will lift the confusion & stress of making the best Medicare decisions for yourself & spouse, both now & in the future years.
Original Medicare leaves you exposed to deductibles, co-insurance, and prescription drug costs. You may have used the Medicare.gov website, but it didn’t provide essential pieces of information to empower you and maximize your Medicare benefits. So how can you use Medicare and get the BEST coverage?
First, you are in the driver's seat determining coverage, and you need a road map! This guide will be your starting point on the road map. Secondly, Medicare is not once and done. Options, coverage, plan changes, cost of plans can change annually.
Rob just turned 65, and he just received his Medicare card in the mail. Reviewing his card, he can see Part A and Part B are separated. He doesn't understand why it's split up, let alone what they are. We're going to take a complex topic and explain it in a way that is easy to understand, starting with Part A.
Medicare Part A: Hospital
Part A protects you from outrageous costs after being hospitalized.
Part A covers:
• Inpatient hospital procedures
• Skilled nursing facility following a hospital stay
• Nursing home care
• Hospice care
• Home health care
• Drugs are given during a covered inpatient stay
Medicare Part B: Doctor
As cost continues to rise, Part B saves you money without reducing the quality of care with your doctors.
Part B covers:
• Services from doctors and healthcare providers
• Outpatient surgeries
• Outpatient care
• Home health care
• Some preventive services
• Durable medical equipment
• Drugs are given by infusion or injection in an outpatient setting
• Some vaccines
Now Rob was getting the hang of things until he had surgery. After surgery, his doctor prescribed him some prescription drugs for recovery. He was wondering how he could get help paying for his prescription drugs. In the past, original Medicare exposed you to high costs from prescription drugs until they created Part D.
Medicare Part D: Prescription Drug Plan
Part D helps you avoid the financial pitfalls with the cost of prescription drugs.
Part D covers self-administered drugs
• taken in an outpatient setting
• filled at local pharmacies
• filled through mail order pharmacies
Part D plans are available only through private companies. There are two types of prescription drug plans. Stand-alone plans and package plans under Part C. It's one or the other.
Part C: Medicare Advantage Plan
Part C combines Parts A, B, and sometimes D into one plan. Only private companies offer Part C plans. They cover everything under Parts A and B and may include extra benefits like dental and vision. However, not all Part C plans include Part D prescription drugs benefits.
Part C covers:
• All services under Part A
• All services under Part B
• May include Part D benefits
• May include dental, vision, hearing aids
Part C is one of two ways to complement your Medicare Parts A and B. The second way is with a Supplement plan.
Medicare Supplement Plan
Supplement plans are secondary to Medicare Parts A and B. They are offered by private companies and cover all Parts A and B services. The main function of the supplement plan is to reduce your out-of-pocket costs by paying your cost shares on your claims. In other words, whatever costs are left after Medicare pays its portion on your claims, the supplement plan will cover those costs.
Supplement Plan covers
• Part A covered services
• Part B covered services
• Additional services such as fitness/ gym membership
These plans do not cover outpatient prescription drugs. You have the option of getting a stand-alone prescription drug plan to cover your medicines when using a Medicare Supplement Plan. You CANNOT have a Medicare supplement Plan in conjunction with a Medicare Advantage plan (Part C).
Usage Myth vs. Truth
Covered
The way that the word "covered" is used can be confusing. For example, when beneficiaries say they're covered, it usually means their insurance company will pay for everything without requiring a co-payment or other payment of any kind; however, when speaking with an agent, being covered has nothing to do with copays.
Supplement
When starting Medicare, there are things to consider, such as which supplement plan to choose. This section will help clear the confusing “supplement” word understandably. First, let's start with the definition. According to Oxford Languages, Supplement is something that completes or enhances something else when added to it. Simple meaning and yet applied in the Medicare system seemingly contradicts because of layered regulations. The true Medicare Supplement Plans start with letters. (Also called Medigap)
Deductible
In Medicare, the deductible is simply the amount you pay before the insurance kicks in. Deductible for medical and prescription drugs are separated. When you have private plans, because Medicare plans are highly competitive, most of the time, the medical or hospital and doctor portions do not include a deductible. What’s a deductible? The insured (you) must pay a specified amount of money before an insurance company (Medicare) will pay a claim. The Part A Deductible for 2020 is $1,408. Take a closer look at this deductible trend:
Conclusion
This guide covers all the parts of traditional Medicare and how it works. It provides answers to help you become an informed consumer. It outlines concisely what is covered and identifies the types of plan options that you may choose to complement your Medicare. Eternal Insurance is here to help. Click this link to get in contact with us. We will be happy to provide you with valuable information to save you money and enhance your well-being.
