Introduction
Medicare coverage is a confusing topic, and it can be difficult to know where to start when you’re trying to figure out which Medicare plan is best for you. In this article, we’ll cover the basics of Medicare plans so that you can make an informed decision about how these insurance policies affect your health care costs and what type of benefits they provide.
Original Medicare (Part A and Part B)
Original Medicare (Part A and Part B) is a program that covers hospitalization, outpatient services, and doctor's visits. If you are eligible for Original Medicare and enrolled in Original Medicare, you will have no premium or monthly payment for either Part A or Part B. You must register in Part B to get coverage for physician services such as office visits, diagnostic tests, x-rays, and other healthcare services provided by a doctor of medicine or osteopathy who is legally authorized to practice in the United States – this helps pay 20% of the cost of these services once you meet your deductible.
The following are examples of things covered by Parts A & B:
You may also want to consider getting prescription drug coverage through Part D if:
You’re on a limited income
There are outrageous co-pays at your pharmacy
Medicare Supplement Insurance Plans
Medicare Supplement insurance plans are sold by private insurance companies and help cover the costs of some of the services that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. You can choose a Medicare supplement plan for yourself or for your spouse if he or she is also eligible for Medicare.
Medicare Supplement policies are not required; however, you may find them helpful in reducing out-of-pocket costs when receiving medical care from covered providers.
Prescription Drug Coverage
You will have prescription drug coverage under the following circumstances:
If you get Original Medicare and enroll in a Medicare Advantage plan through your state's Medicaid program (Medicaid).
If you get Traditional or Enhanced Plan A or B, and you’re also enrolled in a Medicare Part D generic drug plan.
You will NOT have prescription drug coverage under the following circumstances:
If you have Original Medicare only (Parts A and B), and do not enroll in any Part D plans. This type of coverage is called "stand-alone" Part D. You may still be able to purchase stand-alone Part D private insurance policies from some insurers, but they may not cover all drugs at the lowest possible costs that are available through those companies' other plans with different features such as dental care or vision care options included along with prescription drugs offered by their provider networks like Blue Cross Blue Shield of Illinois offers both individual health insurance plans for non-Medicare eligible customers ages 50+ who want more coverage than what traditional medical plans offer but don't qualify for subsidies under Obamacare because they make too much money etc., but are unable to afford employer sponsored healthcare benefits due to rising premiums costs associated with changing rules implemented by Congress which makes them unaffordable for many businesses nationwide due to increased costs associated with providing health benefits packages offered by their employers such as Cigna Universal Life Insurance Company's High Deductible Health Plans etc., so this means that people who really need help paying off medical bills due high deductibles aren't getting any assistance from these types of programs even though there are many ways one could potentially get assistance with paying off medical bills even if one has no income coming in whatsoever since most companies allow employees time off work when sick depending on how sick they seem (ie., if someone has pneumonia then taking time off work might not be necessary because it would likely take several weeks before symptoms improve enough where employee feels rested enough again).
Medigap Policies
Medigap policies are supplemental health insurance that fills in the gaps of what Medicare does not cover. For example, if you have a Medigap policy and get sick, your Medigap plan will pay for things like hospital stays, doctor visits, and prescription drugs.
Depending on your age and health, it is possible to receive the best rates for these plans.
It’s important to understand how each type of supplemental insurance works before deciding which one is right for you. Learn more here: https://www.medicare.gov/
Oral or Cosmetic Surgery
Oral or cosmetic surgery is covered by Medicare if it improves a condition. For example, if you have a jaw deformity that inhibits your ability to chew food or speak, then oral surgery to correct the problem will be covered by Medicare.
If you want your teeth removed simply because they don't look like the teeth in advertisements for whitening toothpaste, then the procedure would not be covered by Medicare (or any insurance). Similarly, if you are unhappy with how far apart your eyes are from each other but this does not affect your health in any way, then cosmetic eye surgery would also not be covered by Medicare.
Hearing Aids and Exams for fitting them
Hearing aids and hearing aid exams are covered by Medicare. Exams to fit hearing aids are also covered. This includes batteries, repairs, and accessories for the hearing aid that you already have. However, if your needs change so that you get a different type of hearing aid (like from open-fit to conventional), this will not be covered by Medicare.
Routine Foot Care
Routine foot care is covered by Medicare Part A, Part B, and Medicare Advantage plans in the following circumstances:
When you are admitted to a hospital as an inpatient for more than 3 days.
When you have a condition that has been diagnosed by a physician.
For up to 60 visits per calendar year (January through December). This means that if you visit your doctor every month from January through December, it counts as one visit toward this total.
Eye Exams related to Prescribing Glasses
Medicare covers eye exams related to prescribing glasses if they are medically necessary. This includes a comprehensive eye exam, as well as the cost of any vision tests performed during that exam.
If you have a vision insurance plan through your employer or union, Medicare won’t pay for an eye exam unless it is medically necessary.
Medicare does not cover routine eye exams for people who have a medical condition that makes it difficult for them to see clearly even with corrective lenses (such as cataracts). Medicare also doesn’t cover routine eyesight examinations if you wear contact lenses and don't need glasses or other visual aids to be able to see well enough in everyday life activities.
Private Duty Nursing
Private duty nursing is not covered by Medicare, but it can be a good idea to have a backup plan in case you need it. One option for private duty nursing is home care; another option is assisted living. The cost of private duty nursing varies depending on the provider and service needed, so contact your insurance company or Medicare representative to find out what your coverage is.
Dentures
If you are missing all your teeth, dentures are a great option for replacing the function of your mouth. Dentures can be made from acrylic, metal, or porcelain and come in different shapes and sizes to fit each patient's unique needs. You may have several dentures that can be removed and cleaned as needed. If these change over time due to changes in your mouth or lifestyle needs, they can be replaced at any time.
If you are looking at medicare options, this is a good overview and we can help with the details.
Medicare is a government-sponsored health insurance program for people over 65. It covers medical services, prescription drug costs, and some other healthcare expenses.
Medicare Part A: Hospital Insurance pays for inpatient hospital care, skilled nursing facility care after a hospital stay, and home health care
Medicare Part B: Medical Insurance covers 80% of the average cost of medical services (such as doctor's visits and tests) that are not covered by your Medigap or other supplemental insurance plans
Medicare Part D: Prescription Drug Plan covers prescription drugs
Conclusion
We can help you make the right choice for your needs and budget. Medicare has changed dramatically in recent years, and we are here to help you navigate the system so that you can get the most out of it.
About Preferred Senior Benefits in Meridian, Idaho
Medicare is a federal program that provides healthcare coverage to individuals 65 years or older. Original Medicare coverage is broken into two parts - Part A and Part B - and is accepted by nearly every doctor and hospital in the country. Medicare Part A covers inpatient or hospital stays, while Part B covers outpatient or medical care. Part A and B cover about 80% of the typical healthcare costs seniors face. This leaves a few significant gaps in coverage. Medicare Supplement (Medigap) and Medicare Advantage plans are policies designed to help extend coverage, lessen costs and ultimately give beneficiaries peace of mind. If you or someone you know would like more information about how to enroll in Original Medicare or one of the Medicare Advantage plans, call now to speak with a licensed agent (208) 818 2523. We cannot wait to help you learn about your options.