Medicare ABC's
The Hoot in Medicare
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lets face it... Navigating medicare & insurance products in general can be confusing. Below you will find the breakdown of what medicare is.
lets face it... Navigating medicare & insurance products in general can be confusing. Below you will find the breakdown of what medicare is.
What is medicare?
What is medicare?
Medicare is a health insurance program in the United States primarily designed for individuals aged 65 and older. However, it also covers certain younger individuals with disabilities and those with specific medical conditions.
Individuals Aged 65 and Older:
Most U.S. citizens and legal residents become eligible for Medicare when they turn 65. Enrollment typically begins three months before the individual's 65th birthday.
Individuals Under 65 with Disabilities:
People under the age of 65 may qualify for Medicare if they have been receiving Social Security Disability Insurance (SSDI) for at least 24 months. Medicare coverage begins after a 24-month waiting period following the onset of their qualifying disability.
Individuals with End-Stage Renal Disease (ESRD):
Individuals of any age who have end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant) may be eligible for Medicare.
Individuals with Amyotrophic Lateral Sclerosis (ALS):
Individuals diagnosed with Amyotrophic Lateral Sclerosis, also known as ALS or Lou Gehrig's disease, are eligible for Medicare immediately upon receiving disability benefits.
Understanding Medicare
Understanding Medicare
Navigating the Medicare system can be complex, but breaking it down into its fundamental components—Parts A, B, C, and D—can help you make informed decisions about your healthcare coverage.
1. Medicare Part A: Hospital Insurance
Medicare Part A provides coverage for hospital stays, skilled nursing facility care, hospice care, and some home health care. This section can include information on eligibility, coverage details, and any additional considerations.
2. Medicare Part B: Medical Insurance
Part B covers outpatient care, doctor visits, preventive services, and some home health care. Detail what Part B encompasses, its costs, enrollment information, and examples of covered services.
3. Medicare Part C: Medicare Advantage Plans
Medicare Part C, also known as Medicare Advantage, combines Parts A and B and is offered by private insurance companies. Explain the benefits, coverage options, and potential advantages of choosing a Medicare Advantage plan.
4. Medicare Part D: Prescription Drug Coverage
Part D provides prescription drug coverage through private insurance plans. Discuss the importance of this coverage, how to enroll, and considerations when choosing a plan.
What is supplimental insurance or medigap?
What is supplimental insurance or medigap?
Medigap, also known as Medicare Supplement Insurance, is a type of private health insurance that helps fill in the "gaps" in coverage left by Original Medicare (Medicare Parts A and B). Original Medicare covers many healthcare services and supplies, but it doesn't cover all costs, leaving beneficiaries with out-of-pocket expenses such as copayments, coinsurance, and deductibles.
Supplemental Coverage:
Medigap policies are designed to complement Original Medicare by covering certain costs that Medicare doesn't pay for. This can include copayments, coinsurance, and deductibles.
Standardized Plans:
Medigap plans are standardized by the federal government, meaning each plan type (e.g., Plan A, Plan B, etc.) offers the same basic benefits, regardless of the insurance company selling the plan. However, costs can vary among insurance providers.
Enrollment:
The best time to enroll in a Medigap plan is during the six-month Medigap Open Enrollment Period. This period starts the month you turn 65 and are enrolled in Medicare Part B. During this time, insurance companies cannot deny you coverage or charge you higher premiums based on pre-existing conditions.
Premiums:
Medigap policies typically require the payment of a monthly premium. Premiums can vary based on factors such as the plan type, the insurance company, your location, and your age.
Coverage Outside the U.S.:
Some Medigap plans offer coverage for healthcare services received outside the United States, which is not covered by Original Medicare.
Doesn't Include Prescription Drug Coverage:
Medigap plans do not include prescription drug coverage. If you want prescription drug coverage, you need to enroll in a standalone Medicare Part D prescription drug plan.
Renewable Coverage:
As long as you pay your premiums, the insurance company cannot cancel your Medigap policy.
Medigap plans only work with Original Medicare. If you're enrolled in a Medicare Advantage Plan (Part C), you cannot use a Medigap policy to cover out-of-pocket costs.
Before purchasing a Medigap policy, it's advisable to carefully compare the available plans, understand the coverage options, and consider your healthcare needs and budget.
Find more information on www.medicare.gov website
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