Medicare is a federal health insurance program designed to “care” for those 65 and older, those with chronic kidney or end-stage renal disease, ALS or Lou Gehrig’s illness, and, in some cases, those receiving Social Security Disability Payments.
Medicare's Four Components
The Original Medicare plan was divided into two parts: A and B.
1. Medicare Part A Provides Hospital Insurance
Inpatient Hospitalization :
This includes any medical care you receive after being admitted to a hospital. Each benefit period, Medicare covers up to 90 days in a regular hospital. You will also receive 60 lifetime reserve days. It also covers up to 190 days in a Medicare-certified psychiatric institution throughout the course of a lifetime.
Care in a Skilled Nursing Facility :
Medicare will pay for your accommodation, board, and certain services in a skilled nursing facility. Medication, tube feedings, and wound care are all included. It provides coverage for up to 100 days every benefit period. To be eligible, you must have spent at least three consecutive days in the hospital within 30 days of being admitted to a skilled nursing facility and required skilled nursing or therapy services.
Home Health Care Services :
Part A coverage will kick in if you have spent at least three consecutive days as a hospital inpatient within 14 days of getting home care, even if it is ordinarily covered by Part B. Up to 100 days of daily care or an infinite amount of intermittent care are covered.
Hospice Service :
Hospice care is covered as long as your clinician verifies that it is medically required.
2. Medicare Part B Provides Outpatient Medical Care.
Service Providers :
Part B covers services deemed medically necessary.
Long-Lasting Medical Equipment :
Equipment that has a medical purpose, is durable, and is suitable for use at home is covered.
Home Health Care :
Part B covers you if you are homebound and require specialized nursing or therapy care.
Emergency Medical Services :
Part B covers you if you are homebound and require specialized nursing or therapy care.
Services for Preventive Maintenance :
Outpatient physical, speech, and occupational therapy treatments are reimbursed if provided by a Medicare-certified therapist.
X-rays and laboratory tests :
All x-rays and lab tests prescribed by the doctor are covered.
Chiropractic Care :
Only when medically essential to correct a spinal subluxation. Some prescription medications: Certain drugs such as immunosuppressants, select anti-cancer, select antiemetic, select dialysis, and other usual drugs supplied by a physician.
3. Medicare Parts C and D
Congress passed legislation in 1997 to relieve the financial strain on Medicare finances and to provide Medicare beneficiaries with a number of additional health-care options. The new alternatives are accessible via Medicare Parts C and D.
Medicare Part C :
Medicare Part C, often known as Medicare Advantage, is a private health insurance plan offered by insurance firms that have contracts with the federal government. You will continue to be enrolled in Original Medicare (Parts A and B), but Medicare Advantage plans may provide benefits that Original Medicare does not, such as:
- Dental coverage
- Vision coverage
- Caregiver Counseling and Training
- Housekeeping
- Prescription Drug Coverage
Medicare Part D :
Prescription medicine coverage is provided via Part D. This covers the majority of outpatient prescription medications. Those who have Parts A and B and live in the plan’s service area can enroll in Part D. Part D is available through private insurance firms as a stand-alone plan or as part of a Medicare Advantage Plan. Each Part D plan contains a list of pharmaceuticals that are covered. If the medication you require is not on the list of covered pharmaceuticals, you may seek an exception, pay out of pocket, or file an appeal.
Each plan must include coverage for all medications in the following categories:
- The treatment of HIV/AIDS
- Antidepressants
- Atypical antipsychotic medicines
- Anticonvulsant medications for seizure disorders
- Immunosuppressants
- Anti-cancer medications (unless they are being covered under Part B)
- Unless they are already covered under Part B, most vaccines are also covered under Part D.
After you are eligible for Medicare, you can apply for Original Medicare, Medicare Parts A and B, at your local social security office or through their website. You must enroll in Medicare Parts C and D.
But what if Medicare still does not meet all of your needs?
4. Medicare Supplement Insurance
Private insurance firms sell Medicare Supplements, often known as Medigap coverage, to help you cover the out-of-pocket costs left by Medicare. When you have a Medigap policy, Medicare will reimburse your medical expenses up to the policy’s limit. Then, up to the limit of your Medicare Supplement plan, it will kick in. The maximum is usually sufficient to pay off the remaining. But, this is dependent on the policy you choose.
There are ten standardized Medicap plans, denoted by the letters A, B, C, D, F, G, K, L, M, or N.
How We Can Help
Medicare can be perplexing. The best thing you can do is work with a registered Medicare Agent, such as the experts at ATIG, to establish your coverage needs and choose the best policy for you. We deal directly with health insurance companies, so our advisors can assist you in comparing and enrolling in coverage at no extra cost. You only pay for the coverage you select. Please contact us right away!
Enrollment Periods for Medicare
Initial Enrollment = 8 Months In Total :
It covers the three months preceding your 65th birthday, your 65th birthday month, and the three months following your 65th birthday. If you celebrate your birthday on the first of the month, your enrollment term will begin one month earlier. For example, if your birthday is October 1, your enrollment period will begin on June 1 and your Medicare coverage would begin one month earlier — on September 1 — as well. You can enroll in Original Medicare (Parts A and B), Medicare Advantage plans, or Medicare Part D during your initial enrollment period.
Enrollment is now open. :
If you have Medicare Parts A and B, you have a six-month open enrollment period for Medigap (Medicare Supplement) policies. This is a one-time election period that begins with your Part B effective date.
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