For most people choosing health insurance is not a favorite pastime. Selecting the right health insurance plan can be an overwhelming experience. When it comes to Medicare, making the right decision is more important than ever.
If you are looking to make changes to your medicare policy or are enrolling for the first time yourself the open enrollment period is from October through mid-December making now an excellent opportunity to enroll in a Medicare Advantage Plan.
Changing your medicare coverage is by no means difficult however the plethora of different options may overwhelm you. Fear not, by the end of this article you will walk away with a better understanding of the 4 medicare parts (Medicare parts A,B,C,D). Carefully review the information on this page and reach out with any questions you have. Our dedicated Medicare expert is here for you.
What is Medicare and Who is Eligible?
Medicare is a federally-funded health insurance program that is available to Americans age 65 and older. It is also available to certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD) or ALS (also known as Lou Gehrig’s disease or amyotrophic lateral sclerosis).
Initial and Open Enrollment
You can enroll in Medicare Part A or Part B when you first become eligible for Medicare. Then, Original Medicare open enrollment (where you can join, switch, drop or make changes in your plan) is annually from October 15 – December 7. Any new changes will then take effect on January 1.
Parts A and B are basic Medicare
Traditional Medicare consists of 2 parts A, and B. Each Medicare member’s policy includes at minimum Part A(Hospital) and part B(Doctor Visits) Coverage. For now, Parts C and D should be thought of as complementary to standard Medicare policies.
Medicare Part A
In general, Part A covers expenses associated with Hospital visits but covers more as well. These are typically what people consider to be standard insurance. Having coverage of this kind is a must considering a 3-day hospital visit can cost upwards of $30,000
Examples of things covered by Part A of Medicare
- Inpatient care in a hospital
- Skilled nursing facility care
- Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
- Hospice care
- Home health care
Medicare Part B
Another core aspect of medicare coverage is Part B. Part B covers expenses associated with doctor visits and other things such as:
- Clinical research
- Ambulance services
- Durable medical equipment (DME)
- Mental health
- Partial hospitalization
Standard Part B policies are associated with high copays and provide no assistance with prescription drug costs. This inspires many to enroll in Medigap plans meant to help cover out-of-pocket expenses.
Parts C and D are Medicare Advantage
Medicare Advantage Part C
If you prefer an expanded option, you can choose to enroll in a Medicare Advantage plan instead. Also referred to as Part C, Medicare Advantage plans are offered by private insurance companies that contract with Medicare.
These plans can include hospital coverage, medical insurance coverage and prescription drug coverage as well as additional services that Original Medicare doesn’t cover, such as hearing, vision and dental services.
Eligibility and Open Enrollment
To be eligible for a Medicare Advantage plan, you must first have both Medicare Part A and Part B. You can then make the switch to a Medicare Advantage Plan during the program’s open enrollment period, which is between January 1 and March 31. Find more information on Medicare Advantage Open Enrollment.
Medicare Advantage Part D (Prescription Drug Coverage)
If you decide to enroll in Original Medicare, you can also add a Part D prescription drug plan. These plans are offered by private insurance companies and can help to cover the cost of prescription drugs. To be eligible for a Part D plan, you must have both Part A and Part B. Note that most Medicare Advantage plans include prescription drug coverage.
When will Medicare cover my prescription drug costs?
It is very important to know that under Medicare Parts A and B the burden of paying for prescriptions, transportation, and full copays falls on you.
As a traditional medicare member, you are eligible to enroll for additional coverage. Part D prescription drug coverage, Medigap, and Medicare advantage plan all offer seniors additional means to cover their medical expenses.
Part C (Medicare Advantage) and Part D (Perscription Drug) offer supplementary coverage to that offered by Traditional Medicare plans
Part D is any plan meant to cover prescription drugs, of which are not covered under Parts A or B.
Medicare Advantage plans are the ideal way to bundle Parts A, B, and prescription drug coverage.
Doing your research will go a long way but there are some key points to mention here. When comparing Medicare Advantage Plans, Medicare Part C, or Medicare Advantage (MA) it is important to know that Medicare Advantage is a supplemental program for providing additional Medicare benefits and coverage.
Medicare Advantage Plans are typically associated with managed care plans and are administered by private insurance companies in contract with the federal government. While these Health Management organizations (HMOs) and Preferred Provider Organizations(PPOs) have limited provider networks, they are required by law to have increased coverage requirements compared to standard Medicare. We here at Meadowcrest Family Practitioners recommend that our medicare patients enroll in a Medicare Advantage Plan.
Once enrolled your medicare advantage plan will replace your Parts A and B coverage. You can be assured that the new coverage is equal to or superior to your existing medicare policy.
Your window to enroll this year is closing fast
Now is the time to get started. Open enrollment for Medicare Advantage starts October 15 and continues through December 7 each year. There are certain exceptions to this such as when emergency medical care is needed or a person suddenly needs long-term nursing care.
What to Ask Your Insurance Agent
If you’re not sure which type of Medicare plan is right for you, it’s a good idea to speak with a Medicare insurance agent. They can help you compare the different options and find a plan that meets your needs and budget.
When speaking with an agent, be sure to ask about the following:
- The different types of plans available.
- The coverage each plan offers.
- The cost of the premiums, deductibles and copayments.
- The network of doctors and hospitals each plan covers.
- Any extra benefits that are included.
You can also visit the Medicare website to compare plans specific to your individual needs and find more information about the different types of Medicare coverage. There you’ll also find a number of resources and a helpful Medicare handbook.4
Regardless of health Insurance policy, you can be assured that your health care is our number one priority. We have found that our patients are getting better benefits with Medicare Advantage Plans and strongly recommend that you explore your Medicare Advantage options.
At Meadowcrest Family Practitioners our commitment to care goes much beyond our office. If you need additional information regarding Medicare Advantage we have resources to help. Please make an appointment with our in-office rep to learn your options.