What is Medicare?
In this 5 part series, we will begin to dispel myths about Medicare, uncover why it is important to get the right coverage, and provide a map of understanding when it comes to your options.
What in the world is Medicare anyway?! Or is it Medicaid? Or is it CHIP? Or is Medicare a part of Obamacare? Why do I need it? These are only a few of the common questions that we get on a daily basis regarding Medicare and what it actually is. Though all of these are types of insurance coverages, there is a distinct difference in them all.
Medicare is a Federal Health Insurance Program for people who are 65 years of age and older. This coverage is also available for people who are younger than 65 but have a specific disability, and anyone with End-Stage Renal Disease which is permanent kidney failure requiring Dialysis or a kidney transplant.
Medicare Coverage is based on three factors; Federal and State Laws, Medicare's decision on certain things covered or not covered, and local coverage decisions made by companies that process claims for Medicare. These factors determine what is medically necessary for coverage in specific areas.
There are several different types of Medicare are broken up into 4 Parts:
Medicare Part A
This is commonly referred to as Medicare's Hospital Insurance. This covers hospital stays as an inpatient, time spent in a skilled Nursing Facility, Nursing Home care, certain home health care, and Hospice care. If you are covered under Medicare Advantage or Other Medicare, the rules may be different governing what is allowed or not but they must give you the coverage of Original Medicare (Part A or B).
Medicare Part B
This coverage is known as Medical Insurance. Unlike Part A which covers a stay in the hospital, Part B covers the medical services, doctors, and supplies necessary to provide medical attention. Common things include Ambulance rides, outpatient care, medical supplies, and preventative services. It can also cover part-time home health care and physical therapy if it is ordered by your doctor to treat a condition.
Medicare Part C
This is what we call Medicare Advantage Plans. In order to participate in this plan, you must already be enrolled in Part A and Part B. This additional coverage is offered by Private Health Insurance Companies and. allows you keep all of the benefits of A and B. It is possible to have lower deductibles, or money that you pay out-of-pocket. Some benefits are routine Vision checks, dentures and other dental services, additional medical supplies like Glucometers, blood pressure testing machines, and more. These plans are known to have low premiums, sometimes a $0 premium, but will still require you to pay for your Medicare Part B Premium.
Medicare Part D
This is your Prescription Coverage and is given through Medicare Approved Private Insurance Companies. If you are eligible for Part A and B, and live permanently inside a Medicare Prescription Plan Service Area, then you can sign up for Medicare Part D. You can sign up under your Original Medicare through a Medicare Prescription Plan, or if you have Medicare Advantage, there is a separate Medicare Advantage Prescription Plan. Either of these plans come with a list of covered prescriptions called a Formulary. It is important to check this list every year to be sure that your medicine is covered. An easy way to check this is with the Annual Notice of Change given out by your Prescription Plan every Fall. This coverage is completely optional but if you wait to sign up as soon as your coverage starts, then you may be required to pay a late-enrollment penalty.
There you have it, a simple breakdown of Medicare, what it all means, and why it is necessary. At Royalty Life and Health, we pride ourselves in helping people get the right coverage that they need as well as going the extra mile to help you with figuring it all out. There is a lot of information coming from many different places, especially on the internet. We would like to be the place you can count on to put it all together and help make sense of it all. Call Us today to have all of your questions answered or to get the coverage you need.