Understanding Medicare Insurance

Qualifying for Medicare can be a great way to maintain your health and wellness while enjoying affordable health insurance. This government-sponsored insurance program provides health insurance to people with disabilities or certain health conditions or who are over age 65. Medicare also works with private insurance companies to offer additional options. However, while Medicare plans may have many benefits, it can also be complicated when deciding which coverage will best meet your needs. If you qualify, it’s essential to understand your options.

What Are the Different Types of Medicare?

Like most health insurance plans available on the market and through employer-sponsored group arrangements, Medicare policies can come in many forms. You should take time to make informed choices and customize your coverage to ensure that it meets your needs.

Health insurance acquired through Medicare can be classified as one of the following:

• Part A is usually free of premiums for most individuals who have paid into the program via Medicare taxes for a sufficient period during their working career. This form of Medicare (in addition to Part B) is often referred to as Original Medicare and may help cover the following:
  • Inpatient hospital care
  • Skilled nursing facility care
  • Home health services
  • Hospice care
• Part B is also part of Original Medicare and generally comes bundled with Part A. Part B may provide financial assistance for the following healthcare costs:
  • Outpatient care
  • Home health care
  • Durable medical equipment (e.g., walkers, wheelchairs, oxygen tanks)
  • Preventive services (e.g., vaccines, screenings)
• Part C, also known as Medicare Advantage Plans, is offered by private insurance companies approved by Medicare and may provide you with access to additional benefits that would otherwise be unavailable, such as the following:
  • Dental treatment
  • Hearing services
  • Vision care
  • Caregiving counseling and training
  • Additional in-home support (e.g., housekeeping)

By electing a Part C plan, you may be subject to different rules, costs and restrictions, and your health coverage will be maintained through your Medicare Advantage Plan rather than Original Medicare. To elect this type of plan, you must already have Parts A and B, and you may be required to pay premiums.

• Part D can help cover prescription drug costs, including recommended shots and vaccines. While the availability of specific drugs may vary, Part D can provide you with vaccination and prescription drug options that may not be available to those who only have Original Medicare. Furthermore, these plans are required to include access to all drugs in the following categories:
  • HIV/AIDS treatment
  • Antidepressants
  • Immunosuppressant medications
  • Anticonvulsive treatments for seizure disorders
  • Antipsychotic medications
  • Cancer drugs not covered by Medicare Part B

Part D plans are available only through private insurance companies that contract with the federal government and are usually included in Medicare Advantage Plans (Part C). However, they may be acquired separately as well.

• Medigap is a supplemental component of Medicare intended to fill coverage gaps in Original Medicare (Parts A and B). These plans are sold by private companies and can help pay for healthcare costs that might not otherwise be covered, including the following:
  • Copayments
  • Coinsurance
  • Deductibles

These policies include monthly premiums and require you to already have Medicare Parts A and B to be eligible. In addition, Medigap plans cover only one person. If you are married, you’ll need two separate policies to cover you and your spouse.

Get the Right Coverage

Having adequate insurance is critical to maintaining your general health and wellness. While Medicare may have many benefits, failing to understand the details and limitations of your coverage could restrict you from accessing the services and care you need, and may even subject you to penalties.

We’re here to help. At Insurance Solutions USA, we have over 20 years of experience helping individuals, families and employers understand and address their coverage needs. Visit our website or call 817-756-1442 to get started today.

This blog is intended for informational and educational use only. It is not exhaustive and should not be construed as legal advice. Please contact your insurance professional for further information.