Tag Archives: Medicare Part C

10 Things You Should Know About Medicare Insurance

A Guide to Out of Pocket Medical Costs

Did you know that about 51 million Americans are covered under Medicare today? That number is set to explode, however, as the baby boomers turn 65. By 2020, another 13 million will have signed up. If you’re one of them (or even if you already have Medicare), here’s what you need to know about Medicare insurance.

  1. There are four parts to Medicare Insurance (Parts A-D).
  • Part A covers inpatient hospitalization, hospice care, blood products, and short-term care in a skilled nursing facility, and some home health services.
  • Part B covers all outpatient services, such as doctor visits, ambulatory surgery, durable medical equipment, and home health services.
  • Part C, or Medicare Advantage, is the managed care form of Medicare run by private insurance companies. It covers the same services as Parts A and B, except for hospice care and participation in certain clinical research studies.
  • Part D covers prescription drugs.
  1. “Original” Medicare is one type of Medicare Insurance coverage.

Under original Medicare, you can see any provider who accepts Medicare. You pay premiums, deductibles, and coinsurance or co-payments for most services. If you want drug coverage, you have to purchase a plan separately. There is no limit on your annual out-of-pocket costs.

  1. Medicare Advantage is the other type of Medicare Insurance coverage.

Medicare Advantage is run by private insurance companies and includes all benefits covered under Parts A and B. These plans may have limited provider networks and may require specialist referrals. They may also have premiums, deductibles, and co-payments or coinsurance, although annual out-of-pocket costs are capped. Most plans cover prescription drugs and benefits not covered by Medicare, such as vision, dental, and hearing services.

  1. You have deadlines to meet.

You’re automatically enrolled in Medicare Parts A and B when you turn 65 if you’re getting Social Security and paid Medicare payroll taxes while employed. If you’re not getting Social Security, you have to sign up for Medicare. To avoid paying a penalty, sign up during the seven-month period that begins three months before you turn 65. You can enroll between January 1 and March 31 each year, with coverage beginning July 1.

  1. Your monthly premiums depend on your income.

Most people don’t pay a monthly premium for Part A (sometimes called “premium-free Part A”). If you buy Part A, you’ll pay up to $413 each month. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $413. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $227.

The standard Part B premium amount is $134 (or higher depending on your income). However, most people who get Social Security benefits will pay less than this amount ($109 on average).

The Part C monthly premium varies by plan. Compare costs for specific Part C plans.

The Part D monthly premium varies by plan (higher-income consumers may pay more). Compare costs for specific Part D plans.

  1. Some Medicare Advantage plans are better than others.

Medicare Advantage plans are evaluated based on criteria such as customer satisfaction and quality of care. Plans receive between one and five stars, depending on their scores. Five-star plans have the highest scores, and you can switch into a five-star plan most of the year—not just during open enrollment. Learn how the plans in your area rank here .

  1. You will probably need Medigap insurance.

You can rack up some hefty out-of-pocket costs with the deductibles and co-payments required under original Medicare. For instance, a 10-day hospital stay could cost you more than $12,000. A supplemental insurance policy, called Medigap, helps pay for the unpaid balance of Medicare charges. These secondary insurance policies only reimburses for charges that Medicare (the primary coverage) approved, including deductibles, co-payments and coinsurance. However, you can’t use a Medigap plan to pay for Medicare Advantage plan costs.

  1. You should check to see whether your drugs are covered.

All prescription drug plans and Medicare Advantage plans have drug formularies, which list the medications they cover. The drugs are sorted into tiers based on their cost and effectiveness. The higher the tier, the higher your co-payment. To learn whether your medication is covered—and how much it will cost—contact your prescription drug plan or Medicare Advantage company. Many plans post their formularies online.

  1.  You have protections and rights under Medicare Insurance.

These include the right to be treated with dignity and respect at all times, to be protected from discrimination, and to have your personal and health information kept private. You can also get emergency care when and where you need it, appeal payment or coverage decisions, and file complaints if you’re unhappy with the care you receive.

  1. Medicare Insurance doesn’t cover long-term care.

70% of us will need long-term care at some point. This includes help with daily activities, like bathing and cooking, as well as some medical care. Neither Medicare nor most health insurance plans, including Medigap, cover this type of care. If you’re worried about costs, check into long-term care insurance. Most people who can’t afford long-term care eventually qualify for Medicaid, government health insurance for the poor.

Although we are not experts on Medicare, we are experts on home modification, allowing you to remain in your home with more independence and safety. Please call us at 770-939-0747, or email at info@homefreemods.com to receive a FREE in home assessment. We will respond within 24 hours.