Medicare consists of four parts; Part A, Part B, Part C, and Part D. Part A and Part B are considered to be part of the original plan. It will cover medical services that are deemed medically necessary to treat an existing disease or condition. Part A will cover hospital expenses and Part B will cover your medical expenses. If you or your spouse paid taxes towards Medicare for at least 10 years while working, Part A may be free. Otherwise, you will pay a monthly premium. In order to receive benefits for Part B, you must pay a monthly premium. Listed below is a list of the expenses that are covered under Part A and Part B.
Part A will cover expenses for:
- Inpatient hospital care
- Hospice care
- Nursing facilities
- Home health services
Part B covers expenses for:
- Lab tests
- Doctors visits
- Ambulance services
- Mental health
- Limited outpatient prescription drugs
What About Vision and Dental?
These services are not considered to be medically necessary so they will not be covered under the original plan. However, there are some caveats. Part A will cover dental services that you receive while you’re in a hospital, and also inpatient hospital care if you need to have an emergent or complex dental procedure. Part B will cover yearly eye exams for individuals with diabetes, glaucoma tests for high-risk individuals, and cataract surgery. Routine and preventative dental and vision care are still very important for your overall health. Without it, you may run into more serious problems later on in life that can become very expensive and even decrease your quality of life. You have the option of paying for these services on your own, or you can take advantage of Part C and get an Advantage Plan. If your needing eyeglasses or reading glasses you can also get Free shipping on all readers and glasses at ACLens – Enjoy FREE shipping on all orders of eyeglasses, sunglasses and readers at ACLens.com! (US only)
What are Advantage Plans?
Part C allows private insurers to administer plans that may include assistance with vision and services from a dentist. These plans are called Advantage Plans. If you enroll in this plan, they will provide you with coverage for everything that is covered by Part A and Part B except for hospice care. There may also be additional benefits to this plan, such as vision, hearing, and dental.Advantage plans may also include coverage for prescription drugs. If it does include this, you may not have to sign up for Part D (see below). In order to qualify for an Advantage Plan, you have to be enrolled in Part A and Part B. Joining an Advantage Plan requires you to pay a monthly premium in addition to your Part B premium.
What Are the Benefits of Part D?
Part D is a voluntary add-on for prescription drug assistance. People who have a low income are eligible to receive Part D. This add-on is only available through private companies. If you feel that you need a prescription drug plan you can sign up through private insurers, or you can enroll in an Advantage Plan that provides drug coverage.
What Else Does Part A and Part B Not Cover?
There are a few other services not covered. If you need these services you may have to pay for them at your own expense. Sometimes, even if services are covered you may still have to pay for deductibles, coinsurance, and co-payments at your own expense.If you are not able to afford these expenses you may enroll in a Medigap plan. A Medigap plan can help pay healthcare expenses that are not covered by Part A and B, such as deductibles. Some of the other services not covered include:
- Long-term care
- Cosmetic surgery
- Hearing aids
- Routine foot care
Options for What Medicare and Medicaid DO NOT COVER
For individuals new to Medicare, it’s important to be aware that the program does not cover everything. Below we will cover the most important facts you need to be aware of when seeking to gain supplemental insurance plans otherwise known as Medigap plans. What used to be called the doughnut hole in the Medicare program is now termed Medigap and there are policies that can be purchased that will fill components lacking in the traditional Medicare program. As with much healthcare, Medigap Plans can contain conditions that affect when who and what you can purchase.
Basics of Supplemental Plans
Medigap plans have the same letter designation regardless of the company but can vary in price significantly. Just like when shopping for a car, calling numerous insurers can make a huge difference in the amount paid for the same coverage. For example, when buying Plan F, which is one of the most popular options, a 65-year old man can pay anywhere from $1,000 to $6,500 for the same coverage. Selecting another insurer, however, may not be that easy based on the state in which you live. Individuals that are young and healthy will find more options than those that are older or have preexisting conditions. It becomes especially difficult to find an insurer when over the age of 70. Websites such as NAIC.org and Shiptacenter.org contain direct links to insurance companies in your state that offer Medigap Plan options and others, such as Allsup Medicare Advisor, can provide recommendations based on needs.
Normally when purchasing any medical policy, medical underwriting is required. There are some exceptions, however. If you’re switching from the high priced Plan F to a lower priced Plan F, new underwriting will not be necessary which makes it easier to switch. That can make a huge financial difference depending on the plan selected. For example, if a 65-year old man has secured a low deductible policy it can cost around $2,300. When switching to a high deductible plan, however, it can cost less than $700. Although it sounds great, it’s important to remember that with a high deductible policy the individual will have to pay over $2,100 out-of-pocket before any benefits kick in. This is extremely important since the older a person gets the harder it is to switch plans. Another thing to keep in mind is that Plan F is only one choice. Another option is Plan N that requires individuals to pay $166 for the Medicare Part B deductible annually, a $20 co-pay for each doctor’s visit and $50 for each emergency room visit. Keeping in mind whether the reduction in premiums is worth the extra cost over the long-run will ensure the best policy and insurer has been selected.
Checking your state for any special requirements when considering changing policies can make the move to a new plan effortless. Many states even have buyers’ guides that help individuals navigate the system. Some states only allow changes on the anniversary of the renewal date while others use an individual’s birth date as the basis for decisions. Knowing the rules, what plans insurer’s offer and the monthly premium in advance will ensure the right decision is made the first time.
Other Eligibility Requirements
Of most concern to many people trying to find the right Medigap Plan is the presence of preexisting conditions. That’s because insurance companies are allowed to deny coverage for up to six months after an application has been received. It’s important to note, however, that insurance companies can only require a waiting period if the condition was treated within six months prior to the time the application was made. If not, no waiting period can be applied. Another thing to keep in mind is that if a Medigap Plan was purchased prior to 1990 you cannot be dropped except if you lied on the application or the company goes into bankruptcy. Regardless of the reason, an individual does have the right to purchase another plan. When finding a supplement for Medicare Insurance the most important thing is to know your rights under the Federal Law. You have the right to purchase Medigap coverage and you have protections if you lose or drop your coverage. The best advice is to shop around so you can get coverage that fulfills personal needs yet is affordable.