Today we are diving into the exciting topic of Medicare coverage! It may seem dull but having a better understanding of Medicare is an important part of health management. Being able to understand your coverage gives you knowledge on what services may be offered to you to help manage any conditions you may have. First, we will start with discussing eligibility.
Eligibility:
Those 65 or older
People with conditions such as Amyotrophic Lateral Sclerosis (ALS) and End-Stage Renal Disease (ESRD) regardless of age
In some cases, though not as common, those with certain disabilities can qualify for Medicare coverage early after applying for Social Security Disability Insurance through the Social Security Administration. Medical documentation and evidence must be provided. If approved, Medicare coverage typically starts on the first day of the 25th month of receiving SSDI benefits.
Types:
Part A: This aspect of Medicare covers hospital and skilled nursing stays, hospice care and home-care.
Part B: This aspect of Medicare covers preventative services, outpatient care, doctors visits and some home-care services. Preventative services may include vaccinations or screenings.
Part C: Medicare Advantage plans make up Part C. This is when Medicare partners with private insurance companies to combine Part A and B coverage and may offer other benefits such as dental care.
Part D: This part of Medicare helps to cover the cost of prescriptions and are offered by private insurance companies.
Medicare vs Medicare Advantage Plans
Original Medicare : This comprises Medicare Part A (hospital insurance) and Part B (medical insurance). Beneficiaries have the option to add prescription drug coverage with Part D and a supplemental Medigap policy to help cover out-of-pocket costs. With traditional Medicare, you can see any provider who participates with medicare and do not have to worry about authorization for services like physical, occupational, and speech therapy.
Medicare Advantage : Known as Part C, these plans are offered by private insurance companies approved by Medicare. They often include prescription drug coverage and additional benefits like dental and vision care. With a medicare advantage plan you may have additional authorization restrictions and need to make sure that you are able to see your care team.
Just like with private insurances there are plans that offer being able to see both in and out of network providers. This provides the most flexibility in your care.
Just like with private insurance you will want to understand why your financial responsibility will be for things like copayments, coinsurances, and deductibles.
MediGap?:
This policy is different from a Medicare Advantage Plan, however they are both offer supplemental coverage to cover additional costs and are offered by a private insurance company
Best to enroll in if you chose when you first start Medicare, for advantage plans you are able to switch during enrollment periods
MediGap does not cover prescription drugs.
You should review annually
How Do I Enroll?
Apply either online, by phone or in person
Your initial enrollment period is 3 months before, the month of, and three months after you turn 65
If you are still working you can decide to enroll later when you retire
General enrollment for those beginning Medicare for the first time is from January 1st to March 31st
Notify your current insurance that you are changing to Medicare to avoid penalties
Health insurance can be a complex and confusing topic. Don’t let it be! As part of your healthcare team we are always here to support you if you have any questions or concerns. Call our office at 315-810-2423 or email us at info@brainbodybetter.com with questions.
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