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Taking the Mystery Out of Medicare
When is comes to Medicare insurance after age 65 you have Four choices:
1. Employer Group Plan many plans have , co-pay, deductibles and or coinsurance charges.
2. Original Medicare which covers about 80% and you are responsible out-of-pocket for the rest.
3. Medicare Advantage Plans, typically an HMO, a managed care plan, co-pays, must stay within network) or PPO with monthly premiums, co-pays, deductibles and maximum out of pocket expenses for in and out of network benefits. Some plans require prioritization and prior approval.
4. Medicare Supplement with stand-alone Prescription Drug Plan. Note monthly premiums vary and can be used any provider that accepts Medicare without a referral.
What Medicare covers
Medicare Part A hospital insurance covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care.
Medicare Part B (Medical Insurance) covers, including doctor and other health care providers' services and outpatient care. Part B also covers durable medical equipment, home health care, and some preventive services.
What Medicare Does Not Cover
While Medicare covers many aspects of a person’s medical needs after age 65, there are some elements that are not covered by Medicare. Medicare doesn't cover everything. Some of the items and services Medicare doesn't cover include:
- Long-Term Care (also called custodial care )
- Most dental care
- *Eye exams related to prescribing glasses
- Dentures
- Cosmetic surgery
- *Acupuncture (certain limitations)
- Hearing aids and exams for fitting them
- Routine foot care
Note that however, Major Medical Eye Care, such as cataract surgery, diabetic eye check ups, and glaucoma, is covered by Medicare.
Medicare Advantage Plans vs a medigap medicare supplement
Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network.
These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services. Some plans offer non-emergency coverage out of network, but typically at a higher cost. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services.
Once piece of advice, keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.
Below are the most common types of Medicare Advantage Plans.
- Health Maintenance Organization (HMO) Plans
- Preferred Provider Organization (PPO) Plans
- Private Fee-for-Service (PFFS) Plans
- Dual Special Needs Plans (D-SNPs) for both Medicare AND Medicaid eligible beneficiaries.
Medigap/Medicare Supplement plans
Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like: copayments, coinsurance and deductibles.
Medigap policies generally don't cover things like:
- Long-term care (like non-skilled care you get in a nursing home)
- Dental, vision or hearing benefits including hearing aids
- Eyeglasses
- Private-duty nursing
