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Medicare Advantage, Medicare Prescription Drug Plans, Medicap Coverage
Whether you are seeing your doctor, having tests or being admitted to the hospital, Medicare can help you astronomically reduce your cost burden for these crucial services. Still, what many people do not realize is that the government’s foundational Medicare does not cover 100% of their health care costs. There are still out-of-pocket costs that you must pay.
If you are concerned about how you will be able to afford them, then we are here to help! You should not be forced to choose between getting medical care and paying for it. Medicare insurance plans are the perfect solutions for you, and we have them all right here.
Original Medicare, also called Basic Medicare, is the government’s standard insurance plan. Most people become eligible for it when they turn 65. It contains two components:
- Medicare Part A (Hospital Insurance): Covers inpatient hospital care, emergency services, nursing home care, home health services and hospice.
- Medicare Part B (Medical Insurance): Covers everyday health care. These include things like preventive care, diagnostic and treatment services, health screenings, ambulance services, mental health care, outpatient procedures and clinical research.
Original Medicare does not cover 100% of the cost of your care. Part A & Part B coverage have their own premiums, deductibles and coinsurance rules. Most of the time, the program pays for 80% of your health care costs, while it is up to you to pay the remaining 20%. Additionally, certain expenses will have no coverage at all.
If you are concerned about health care costs that you will have to pay out of pocket, even with Medicare, there are solutions available. Medicare insurance options are designed to supplement Original Medicare program.
Because Original Medicare will not cover all your health care costs, numerous private insurance plans exist to fill the gap. These include:
- Medicare Advantage Plans (Part C Coverage): A Medicare Advantage plan (Part C) is an alternative to original Medicare Parts A and B. It will offer you all the coverage of Part A & Part B. However, it will also provide you other benefits like dental, vision, and prescription drug coverage. Medicare Advantage Plans can also help lower the cost of copays and deductibles. Often these programs cost $0 per month.
- Medicare Prescription Drug Plans (Part D Coverage): Original Medicare does not cover most prescription drugs. Part D coverage offers this benefit. If you do not want Medicare Advantage, a Part D plan is an alternative if you still want prescription drug coverage.
- Medicare Supplement Plans (Medigap Plans): Medicare Supplement insurance is something that you can add on to Original Medicare Parts A and B. If you have Original Medicare, then you can use Medigap to help you pay for costs like coinsurance, deductibles or copayments. This coverage reduces your out-of-pocket burden after Original Medicare coverage pays its share.
Medicare insurance plans are still part of the Medicare program. As a result, a variety of regulations can impact the availability, costs, and eligibility rules of different plans. All Medicare plans must meet coverage standards set by the government, and you must enroll in Original Medicare before you can buy any additional plan.
Not all plans are available in all areas, and plan networks, premiums and covered care can vary depending on the plan you choose. Speak to your agent to learn more about the specifics of your chosen plan options.
Most people enroll in Medicare insurance when they enroll in Original Medicare. This is usually done during the seven-month Initial Enrollment Period (IEP) surrounding your 65th birthday. The IEP:
- Begins the first day of the month three months before the month of your birthday. If your birthday is July 17, then your IEP begins April 1.
- Ends the last day of the month three months after your IEP. If your birthday is July 17, then your IEP ends Oct. 31.
The Medicare Insurance Annual Enrollment Period (AEP) runs each year from Oct. 15 – Dec. 7. During Annual Enrollment, you can:
- Change from Original Medicare to a Medicare Advantage Plan.
- Change from a Medicare Advantage Plan back to Original Medicare.
- Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
- Switch from a Medicare Advantage Plan that does not offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
- Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that does not offer drug coverage.
- Join a Medicare drug plan.
- Switch from one Medicare drug plan to another Medicare drug plan.
- Drop your Medicare drug coverage completely.
You can also make certain changes to your Medicare Advantage benefits during Medicare Advantage Open Enrollment (OEP), which occurs from Jan. 1 – March 31 each year:
- If you are in a Medicare Advantage Plan (with or without drug coverage), you can switch to another Medicare Advantage Plan (with or without drug coverage).
- You can drop your Medicare Advantage Plan and return to Original Medicare. You will also be able to join a Medicare drug plan.
If you enroll in Original Medicare during General Enrollment (Jan. 1 – March 31), then you might be able to enroll in a Part D or an Advantage plan from April 1 – June 30. Restrictions apply.
Medigap Open Enrollment is a six-month period that starts the month that you are both 65 and have Original Medicare Part B. If you do not enroll during this time, you might not qualify for a plan later. You can enroll in a plan if you drop an existing Advantage plan and return to Original Part B.
Please Note: Some people qualify for special enrollment periods and can delay their enrollment in Original Medicare. Your timeline to enroll in Medicare insurance might also change at this time. Speak to one of our agents to find out more.
Shopping for Medicare products does not have to be difficult. We are here to help with the search and answer any questions that often come along with this task. Contact us today to discuss the ways you can make Medicare work for you.
Medicare has neither reviewed nor endorsed this information.