Medicare In Depth: 2022 There are essentially three different Medicare “parts,” each offering a different aspect of coverage. Additionally, there are Medicare Advantaged plans, which take a more all-in-one approach. Let’s take a look at each of the types of plans. Medicare Part A – In Patient Coverage Part A covers hospitalization, including: • In-patient care in a hospital • Skilled nursing facilities • Nursing home care (rehabilitation only) • Hospice care • Home healthcare (for treatment of illness or injury only) Medicare Part B – Out Patient Coverage Part B covers both medically necessary services as well as preventative medicine. This includes things like: • Clinical testing • Ambulance services • Durable medical equipment • In-patient and out-patient mental health treatment, as well as partial hospitalization • A limited number of prescription drugs This also includes regular doctor visits and annual flu shots. There is no copayment for most preventative services, as long as the provider accepts direct payment from Medicare. Medicare Part D – Stand Alone Prescription Drug Plans Part D is private insurance designed specifically to cover prescription drugs. Part D plans may cover different drugs but always include both brand name and generic medications. Each plan must offer at least two drugs for each medical condition on Medicare’s list. This ensures that people with different medical needs can still get the drugs they require. In most cases, even if a drug you need isn’t covered, a similar one in the same class will be. Additionally, your doctor can apply for exceptions for medications not on your plan. Medicare Part C – Medicare Advantage Medicare Advantage plans are offered by private insurance companies contracted with Medicare to provide all of Part A and Part B services. (You must have Part A and B to qualify for an Advantage plan). The idea is to provide a more one-stop-shop healthcare insurance, and many also include prescription drug coverage. Here are four common types of Medicare Advantage plans. • Health Maintenance Organizations (HMOs) • Preferred Provider Organizations (PPOs) • Private Fee-for-Service (PFFS) • Special Needs Plans (SNPs) You can join or change plans at any time during appropriate enrollment periods, and you can switch to Medicare Original (Parts A and B) as well, but only at specific times throughout the year. Because most Medicare Advantage plans, like regular health insurance, have copays, deductibles, premiums, etc. you may want to consider obtaining a complementary insurance like a hospital indemnity plan or a care plan to provide a financial boost for treating serious health conditions. The main difference between Original Medicare and Medicare Advantage is that, with Original Medicare, you’re essentially cost averaging medical expenses by paying roughly the same amount each year. Most people need more medical care as they age. With cost averaging your bills stay about the same even when medical expenses increase. In comparison, Medicare Advantage is more of a pay-as-you-go model because you generally only pay for what medical care you need (most insurance companies offer at least one zero additional premium HMO and/or PPO Advantage options). What’s Not Covered By Original Medicare Coverages can vary from plan to plan, and it’s a good idea to familiarize yourself with what each plan covers so that you can make the most informed decision possible. If you want to check a specific service, test, or piece of equipment, visit https://www.medicare.gov/coverage or call customer service at your insurance company to see if it’s covered. Generally speaking, Parts A and B do not cover the following as part of the plan. • Long-term care (Yes, it’s true! Medicare does NOT cover long term care.) • Dental care • Eye exams for prescription glasses • Dentures • Cosmetic surgery • Acupuncture • Hearing exams and hearing aids • Routine foot care Recently, Medigap plans have begun including discount clubs and other bonus benefits with their plans to help pay for some of these items. For many years, the most common Medicare Advantage plans have offered some benefits for many of these items, but coverage varies from plan to plan. (NOTE: those ads on TV are talking about these extra benefits.) This is one reason why choosing a Medicare plan can be so complicated. There are a lot of types of plans to choose from and pros and cons to each type of Medicare coverage. Next Steps: If you’re like most people you have questions. Get your questions answered accurately and clearly by an experienced, independent Medicare agent by booking an appointment below, or download the Medicare In Depth charts to get a birds-eye view of how it all works. Stay tuned for our next post “How To Pick a Medicare Plan”!
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