Michelle Sandoz, Author at Insurance Specialists Group

How Medicare Works

Michelle Sandoz — Sun, 04 Jun 2023 16:53:02 +0000

Generally, you only need to sign up for Part A and Part B once. Each year, you can choose which way you get your health coverage (and add or switch drug coverage).

Medicare is different from private insurance — it doesn’t offer plans for couples or families. You don’t have to make the same choice as your spouse.

2 steps to set up your Medicare coverage:

Sign up for Part A (Hospital Insurance) and Part B (Medical Insurance)
You can sign up at certain times.
Choose which way you want to get your Medicare health coverage
You can choose either Original Medicare or Medicare Advantage (Part C) for your health coverage. If you choose Original Medicare, you’ll also decide if you want drug coverage (Part D) and supplemental coverage, like Medigap.

You’ll have Original Medicare unless you join a Medicare Advantage Plan.

How does Original Medicare work?

Original Medicare covers most, but not all of the costs for approved health care services and supplies. After you meet your deductible, you pay your share of the costs for services and supplies as you get them. There’s no limit on what you’ll pay out-of-pocket in a year unless you have other coverage (like Medigap, Medicaid, or employee or union coverage).

Services covered by Medicare must be medically necessary. Medicare also covers many preventive services, like shots and screenings. If you go to a doctor or other health care provider that accepts the Medicare-approved amount, your share of costs may be less. If you get a service that Medicare doesn’t cover, you pay the full cost.

With Original Medicare, you can:

Go to any doctor or hospital that takes Medicare, anywhere in the U.S.
Join a separate Medicare drug plan (Part D) to get drug coverage.
Buy a Medicare Supplement Insurance (Medigap) policy to help lower your share of costs for services you get.

If you have other insurance, learn how Original Medicare works with your other coverage.

If you’re not lawfully present in the U.S., Medicare won’t pay for your Part A and Part B claims, and you can’t enroll in a Medicare Advantage Plan or a Medicare drug plan.

How does Medicare Advantage work?

Medicare Advantage bundles your Part A, Part B, and usually Part D coverage into one plan. Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.

You join a plan offered by Medicare-approved private companies that follow rules set by Medicare. Each plan can have different rules for how you get services, like needing referrals to see a specialist. Costs for monthly premiums and services you get vary depending on which plan you join.

Plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers. Some plans tailor their benefit packages to offer additional benefits to treat specific conditions.

With Medicare Advantage, you:

Need to use doctors who are in the plan’s network (for non-emergency or non-urgent care).
May pay a premium for the plan in addition to the monthly Part B premium. Plans may have a $0 premium or may help pay all or part of your Part B premiums.
Can’t buy or use separate supplemental coverage (like Medigap).

You must have both Part A and Part B to join a Medicare Advantage Plan.

How does Medicare work with my other insurance?

When you have Medicare and other health insurance (like from your job), one will pay first (called a “primary payer”) and the other second (called a “secondary payer”).

If you have other insurance, who pays first depends on a number of items, like if you’re still working, the type of insurance you have, and if you have a special situation, like End-Stage Renal Disease (ESRD).

The post How Medicare Works appeared first on Insurance Specialists Group.

What are the costs of Medicare?

Michelle Sandoz — Mon, 22 May 2023 14:48:14 +0000

Generally, you pay a monthly premium for Medicare coverage and part of the costs each time you get a covered service. There’s no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage, like a Medicare Supplement Insurance (Medigap) policy, or you join a Medicare Advantage Plan.

Costs for Part A (Hospital Insurance)

What you pay in 2023:

PREMIUM:

$0 for most people (because they paid Medicare taxes long enough while working – generally at least 10 years). This is sometimes called “premium-free Part A.”

If you don’t qualify for a premium-free Part A, you might be able to buy it. In 2023, the premium is either $278 or $506 each month, depending on how long you or your spouse worked and paid Medicare taxes.

You also have to sign up for Part B to buy Part A.
If you don’t buy Part A when you’re first eligible for Medicare (usually when you turn 65), you might pay a penalty.

Deductible

The post What are the costs of Medicare? appeared first on Insurance Specialists Group.

What are the differents parts of Medicare?

Michelle Sandoz — Wed, 22 Feb 2023 13:34:15 +0000

As you probably know by now, Medicare has a few parts. It can be difficult to understand these parts, but we are here to help. Let us break it down for you:

Medicare Part A (Hospital Insurance):
- Medicare Part A covers inpatient hospital care, which includes services like overnight stays, surgeries, and nursing care in a hospital setting.
- It also covers skilled nursing facility care for a limited time after a hospital stay, hospice care for individuals with a terminal illness, and some home health care services.
- Most people are eligible for Part A without paying a monthly premium if they or their spouse paid Medicare taxes while working.
Medicare Part B (Medical Insurance):
- Medicare Part B covers medically necessary services and supplies that are needed to diagnose or treat a medical condition.
- This includes doctor visits, outpatient care, preventive services (like screenings and vaccines), laboratory tests, medical equipment, and certain outpatient surgeries.
- Part B requires a monthly premium, the amount of which can vary based on income.
Medicare Part C (Medicare Advantage):
- Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Parts A and B) and is provided by private insurance companies approved by Medicare.
- Medicare Advantage plans offer the same coverage as Parts A and B, and often include additional benefits such as prescription drug coverage (Part D), vision care, dental care, and hearing aids.
- These plans may have different rules and costs, and you may need to use specific doctors and hospitals within their network.
Medicare Part D (Prescription Drug Coverage):
- Medicare Part D is a standalone prescription drug coverage plan offered by private insurance companies approved by Medicare.
- Part D helps pay for prescription drugs, including both brand-name and generic medications.
- It can be added to Original Medicare or a Medicare Advantage plan that doesn’t already include prescription drug coverage.
- Part D plans have a formulary, which is a list of covered drugs, and different plans may have different costs and coverage for specific medications.
Medicare Supplement Insurance (Medigap):
- Medicare Supplement Insurance, also known as Medigap, is sold by private insurance companies to help fill the “gaps” in coverage left by Original Medicare (Parts A and B).
- Medigap plans can help pay for out-of-pocket costs like copayments, deductibles, and coinsurance.
- These plans work alongside Original Medicare and require a separate premium.
- Medigap plans are standardized and labeled with letters (e.g., Plan F, Plan G), and each plan offers a different set of benefits, so it’s important to compare and choose the plan that suits your needs.

Remember, Medicare eligibility is primarily based on age (65 and older), but certain individuals with disabilities and specific medical conditions may also qualify. Each part of Medicare has its own rules, costs, and coverage, so it’s essential to carefully evaluate your options and choose the right coverage for your healthcare needs.

The post What are the differents parts of Medicare? appeared first on Insurance Specialists Group.